Le suivi post-exposition (SPE) a lieu pendant la vie active et relève des services de prévention et de santé au travail. Le suivi post-professionnel (SPP) a lieu après celle-ci et relève du médecin traitant. Tous deux visent le dépistage précoce des maladies à latence longue. Certains documents en circulation s’écartent cependant des recommandations scientifiques, ce qui conduit à des examens injustifiés aux conséquences physiques, psychiques et économiques. L’objectif est ici de rappeler les nuisances à effet différé justifiant un SPE ou un SPP, les recommandations disponibles et la conduite à tenir en leur absence. Depuis la loi du 2 août 2021, les bonnes pratiques reposent sur trois principes : la traçabilité des expositions, l’anticipation de la surveillance médicale et la coordination entre les acteurs. Lors de la visite de fin d’exposition, le médecin du travail établit un état des lieux précis (durée, intensité, exposition cumulée) qu’il remet au salarié. Les nuisances concernées sont les cancérogènes, les agents responsables de pneumoconioses et les rayonnements ionisants. L’arrêté de 1995 a été abrogé en 2022, si bien qu’il n’existe plus de référentiel réglementaire sur le contenu du suivi. Des recommandations existent néanmoins pour l’amiante, les poussières de bois, les cancérogènes vésicaux, la silice cristalline, le milieu hyperbare et le travail de nuit chez la femme. En dehors de ces situations, tout dépistage doit être évalué au regard des critères de l’Organisation mondiale de la santé adaptés au contexte professionnel, y compris les valeurs prédictives, qui dépendent du niveau d’exposition. L’identification systématique des expositions est un préalable indispensable à toute traçabilité et suivi. En l’absence de recommandations validées, l’abstention est souvent justifiée, sauf avis argumenté d’un centre régional de pathologies professionnelles et environnementales, qui évaluera la balance bénéfice/risque tant individuelle que collective.
Background: Work disability related to health problems is a major occupational and public health issue, often leading to incapacity and dismissal. Since 2021, the North-Eastern Health Insurance Fund has implemented a work-capacity assessment program based on an interprofessional approach, in collaboration with general practitioners, aimed at preventing occupational exclusion. Objective: To assess the impact of this program on patients' care and employment trajectories, from the perspec tive of prescribing general practitioners. Method: A self-administered questionnaire was sent to 71 general practitioners in the Vosges and Moselle depart ments; 26 valid responses were analyzed using mixed methods (descriptive statistics and content analysis with IRaMuTeQ). Results: Physicians reported positive effects on patients' health status (92.3%: clinical improvement and symptom reduction) and employment outcomes (70%: job retention or vocational reorientation). Overall satisfaction was high (96%). Reported barriers mainly concerned delays in access to assessment, geographical constraints, and insufficient interprofessional communication. Conclusion: As a decision-support tool for the orientation and preparation of pre-return-to-work procedures conducted by occupational physicians, the studied system is perceived by respondents as a pertinent lever for pre venting occupational exclusion. Wider implementation requires stronger coordination with occupational health services and local stakeholders to streamline pathways and reduce dismissals due to incapacity.
The hospital public service is governed by specific regulations. Recent changes in 2021 and 2022 have revised the regulations concerning long-term leave and long-term sick leave, as well as therapeutic part-time work, simplifying their implementation and relaxing the eligibility criteria. We have observed that healthcare institutions often apply these regulations in different ways. The French National Association of Occupational Medicine and Ergonomics for Hospital Staff (ANMTEPH) initiated a survey to collect information on these practices. The survey began in February 2024 and ended on April 30th, 2024. It was initially distributed to ANMTEPH members, as well as to the Crihan network, which includes occupational physicians and nurses, and to the French Society of Occupational Health (SFST). A total of 131 responses were received. Our survey reveals significant disparities in how the regulations are interpreted and applied. However, the findings also highlight some positive aspects: the timeframes for medical evaluations and receiving their reports are generally acceptable, pre-return-to-work consultations are arranged before the implementation of therapeutic part-time work in nearly three-quarters of cases, despite the limited resources of Occupational Health and Prevention Services (SPST), occupational physicians are regularly involved in job accommodation processes for these workers. It would be worthwhile to further analyze the gaps identified between regulatory texts and their practical implementation, as these discrepancies may reflect underlying needs for better coordination between Occupational Health Services and hospital management. The issue of job retention is particularly critical in the hospital civil service, given the workforce shortages currently affecting healthcare institutions in France.
