3 questions to screen for poor work conditions among primary care patients

January 24, 2024

Physicians and researchers – many from the University of Toronto and Unity Health Toronto – developed a simple three-question tool to screen for precarious employment among patients in primary care.

Precarious employment, defined by temporary contracts or job insecurity, is becoming more common and often linked to worse health outcomes and higher workplace stress. “This study demonstrates that a brief screening tool for precarious employment can be used in health care settings. Patients who screen positive could be referred to legal and employment support services, and this information may assist with diagnoses and inform treatment plans,” wrote the authors, who include Upstream Lab researchers Drs. Julia Ho, Emily Bellicoso, and Andrew Pinto.

The screening tool, published in Annals of Family Medicine, includes three questions: 1) Are you currently employed in a casual, short-term or temporary position? 2) Do you feel fearful that you could be fired if you raised employment concerns? 3) Does your pay vary a lot from month to month?

Identifying whether patients face precarious employment is crucial in primary care settings. Clinicians can refer patients to programs that will help them understand their rights at work, actions to take when confronted with health or safety challenges, and pathways to seek new employment. A positive screen also provides more context on how work conditions may affect symptoms, such as exposure to physical hazards and mental health concerns.

To validate the tool, 200 patients at seven Toronto clinics in areas with higher poverty rates than the rest of the city participated in the study. They completed the three-item questionnaire alongside the Poverty and Employment Precarity in Southern Ontario (PEPSO) Employment Precarity Index, an established measure for identifying precarious employment. Patients who answered ‘yes’ to 2-3 screening questions were almost four times more likely to be precariously employed based on their PEPSO scores.

Precarious employment is an important social determinant of health that may be less apparent without a detailed social history, which is sometimes difficult to obtain in busy primary care settings. The study provides a simple tool for screening precarious employment, supporting clinicians to refer patients to services and tailor treatment plans accordingly. Moreover, the data from this study can support policy reforms to reduce precarious employment.

A Brief Tool to Screen Patients for Precarious Employment: A Validation Study is published in Annals of Family Medicine on January 22, 2024. Authors: Julia W. Ho, Emily Bellicoso, Madeleine Bondy, D. Linn Holness, Carles Muntaner, Rosane Nisenbaum, Arlinda Ruco, Nadha Hassen, Andrew Hanna, and Andrew D. Pinto.


Relevant links:

EMployment and PrecariOus Work in Toronto’s Health Sector (EMPOWER) Study

Empower PSW Network

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