title: Health-care barriers for workers with HAVS in Ontario, Canada.
abstract: BACKGROUND
  Hand-arm vibration syndrome (HAVS) becomes irreversible unless it is identified early and progression prevented.
  
  
  OBJECTIVE
  To describe the health-care-seeking behaviours of workers with HAVS and barriers to health care.
  
  
  METHODS
  We invited all patients assessed for HAVS between 15 January and 27 March 2013 at a hospital-based occupational health clinic (OHC) in Ontario, Canada, to complete a questionnaire asking why and from whom they sought health care, reasons they waited to seek care and barriers they encountered in accessing care. We analysed the data using descriptive statistics.
  
  
  RESULTS
  Forty-one (82%) patients agreed to participate. Thirty-seven had confirmed HAVS; 30 (84%) were Stockholm workshop vascular stage 2 or greater and 35 (97%) were sensorineural stage 1 or greater. The commonest employment sectors were construction [21 (57%)] and mining [6 (17%)]. The main reasons for seeking treatment were pain [11 (30%)], finger numbness [8 (22%)] and functional limitations [5 (14%)]. The commonest initial point of health care was the family physician [23 (66%)]. The mean wait between symptom onset and seeking treatment was 3.4 years, while the mean time between onset and OHC assessment was 9 years. Reasons for delay in seeking care were ignorance of the seriousness and irreversibility of HAVS and ability to continue to work. Family physicians suspected HAVS in 17% of cases and recommended job modification in 34%.
  
  
  CONCLUSIONS
  Workers with HAVS in Ontario delay seeking health care. Primary care physicians often fail to recognize HAVS. Barriers to health care include ignorance of HAVS and of the importance of prevention.
authors.affiliation: Faculty of Medicine, Undergraduate Medical Education Program, Toronto, Ontario M5S 1A8, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Bodley
authors.affiliation: Faculty of Medicine, Undergraduate Medical Education Program, Toronto, Ontario M5S 1A8, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Nurmohamed
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario M5B 1W8, Canada, Department of Medicine, University of Toronto, Toronto, Ontario M5G 2C4, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada, Department of Occupational and Environmental Health, St. Michael's Hospital, Toronto, Ontario M5B 1W8, Canada.
authors.forename: D L
authors.initials: DL
authors.lastname: Holness
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario M5B 1W8, Canada, Department of Occupational and Environmental Health, St. Michael's Hospital, Toronto, Ontario M5B 1W8, Canada.
authors.forename: R
authors.initials: R
authors.lastname: House
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario M5G 2C4, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada, Department of Occupational and Environmental Health, St. Michael's Hospital, Toronto, Ontario M5B 1W8, Canada. aaron.thompson@utoronto.ca.
authors.forename: A M S
authors.initials: AM
authors.lastname: Thompson
mesh_terms: D060389:Construction Industry; D018450:Disease Progression; D042241:Early Diagnosis; D053421:Hand-Arm Vibration Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008906:Mining; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D016273:Occupational Exposure / Q000009:adverse effects*; D009864:Ontario; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Access to health services; HAVS; hand–arm vibration syndrome; health-seeking behaviours.