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Labourot J, Pinette É, Giguère N, Menear M, Cameron C, Marois E, Vachon B. Factors affecting patients' journey with primary healthcare services during mental health-related sick leave. Health Expect 2024; 27:e14036. [PMID: 38561922 PMCID: PMC10985365 DOI: 10.1111/hex.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
CONTEXT Best practice guidelines for the recovery and return to work (RTW) of people with mental disorders recommend access to the services of an interdisciplinary team combining pharmacological, psychological and work rehabilitation interventions. In the Canadian context, primary healthcare services are responsible for providing these services for people with common mental disorders, such as depressive or anxiety disorders. However, not everyone has easy access to these recommended primary healthcare services, and previous studies suggest that multiple personal, practice-related and organizational factors can influence the patient's journey. Moreover, previous studies documented that family physicians often work in silos and lack the knowledge and time needed to effectively manage by themselves patients' occupational health. Thus, the care and service trajectories of these patients are often suboptimal and can have important consequences on the person's recovery and RTW. OBJECTIVE AND POPULATION STUDIED Our study aimed to gain a better understanding of the patient journeys and the factors influencing their access to and experience with primary healthcare services while they were on sick leave due to a common mental disorder. METHODS A descriptive qualitative research design was used to understand and describe these factors. Conventional content analysis was used to analyze the verbatim. RESULTS Five themes describe the main factors that influenced the patient's journey of the 14 participants of this study: (1) the fragmented interventions provided by family physicians; (2) patients' autonomy in managing their own care; (3) the attitude and case management provided by the insurer, (4) the employer's openness and understanding and (5) the match between the person's needs and their access to psychosocial and rehabilitation services. CONCLUSIONS Our findings highlight important gaps in the collaborative practices surrounding the management of mental health-related sick leave, the coordination of primary healthcare services and the access to work rehabilitation services. Occupational therapists and other professionals can support family physicians in managing sick leaves, strengthen interprofessional and intersectoral collaboration and ensure that patients receive needed services in a timelier manner no matter their insurance coverage or financial needs. PATIENTS OF PUBLIC CONTRIBUTION This study aimed at looking into the perspective of people who have lived or are currently experiencing a sick leave related to a mental health disorder to highlight the factors which they feel hindered their recovery and RTW. Additionally, two patient partners were involved in this study and are now engaged in the dissemination of the research results and the pursuit of our team research programme to improve services delivered to this population.
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Affiliation(s)
- Justine Labourot
- École de réadaptation, Faculté de médecineUniversité de MontréalMontréalCanada
- Centre de recherche de l'Institut universitaire en santé mentale de MontréalMontréalCanada
| | - Émilie Pinette
- École de réadaptation, Faculté de médecineUniversité de MontréalMontréalCanada
| | - Nadia Giguère
- Département de médecine de famille et de médecine d'urgenceUniversité de MontréalMontréalCanada
- Centrede recherche de Montréal sur les inégalités sociales, les discriminations et les pratiques alternatives de citoyenneté.MontréalCanada
| | - Matthew Menear
- Département de médecine de famille et de médecine d'urgenceUniversité LavalQuébecCanada
- Vitam—Centre de recherche en santé durableQuébecCanada
| | - Cynthia Cameron
- Département de médecine de famille et de médecine d'urgenceUniversité LavalQuébecCanada
| | - Elyse Marois
- École de réadaptation, Faculté de médecineUniversité de MontréalMontréalCanada
| | - Brigitte Vachon
- École de réadaptation, Faculté de médecineUniversité de MontréalMontréalCanada
- Centre de recherche de l'Institut universitaire en santé mentale de MontréalMontréalCanada
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Gelaw A, Parker S, Johnson A, Nguyen H, Jolly A, Forner V, Deng C, Collie A. Determinants of psychological injury among health and social care workers in community settings: A systematic review. Work 2024; 78:3-27. [PMID: 38578915 DOI: 10.3233/wor-230426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Health and Social Care (HSC) workers face psychological health risks in the workplace. While many studies have described psychological injuries in HSC workers, few have examined the determinants. Previous research has primarily focused on hospitals, lacking systematic reviews of community-based settings. OBJECTIVE To systematically identify and appraise current evidence on the determinants of psychological injuries among HSC workers in community settings. METHODS Searches were conducted in three bibliographic databases, supplemented by citation searches. Included studies focused on community-based HSC workers, reporting statistical associations between psychological injury and personal, health, occupational, or organizational factors. Quantitative studies published in English between January 1, 2000 and August 15, 2023 were included. Quality appraisal was undertaken using the JBI critical appraisal checklist. RESULTS Sixty-six studies were included. Study quality was highly variable, and all studies were cross-sectional. Twenty-three studies linked psychological injury with occupational factors (e.g. low job control, high job demands and low job satisfaction). Thirteen studies observed an association between work environment and psychological injury, and a further eleven between workplace social support and psychological injury. Fewer studies have examined the relationship between psychological injury and personal/individual factors. CONCLUSION Occupational and organisational factors are significantly associated with psychological health among HSA workers, in community settings. These aspects of job design, work environment and workplace relationships are modifiable, suggesting an opportunity for work design interventions to improve workers' psychological health and reduce the prevalence of psychological injury in this sector.
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Affiliation(s)
- Asmare Gelaw
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sharon Parker
- Future of Work Institute, Curtin University, Perth, WA, Australia
| | - Anya Johnson
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Helena Nguyen
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Anu Jolly
- Future of Work Institute, Curtin University, Perth, WA, Australia
| | - Vivien Forner
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Connie Deng
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Geipel M, Pelizäus A, Hamann J. Returning-to-work after mental health-associated sick leave: a qualitative interview study exploring the experiences of general practitioners in Germany. BMC PRIMARY CARE 2023; 24:261. [PMID: 38042796 PMCID: PMC10693165 DOI: 10.1186/s12875-023-02219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND AND AIM Psychiatric disorders are increasing globally. Especially when these disorders affect working people, this places a financial burden on society due to long-term sick leave, the incapacity to work and the inability to earn and pay taxes. General practitioners (GPs) are often the first health professionals to be consulted by those suffering from mental health disorders. This study investigated the experiences of GPs regarding their patients with mental health disorders and identified factors that are important for a successful return to work. METHODS This qualitative study used semi-structured interviews to explore the opinions of GPs (n = 12) working in Munich, Germany, or its metropolitan area. The interviews were audio-recorded, transcribed, and analyzed using the reflexive thematic analysis method. RESULTS GPs think of themselves as important players in the rehabilitation process of patients with mental health disorders. In their daily routine, they face many obstacles to ensure the best treatment and outcome for their patients. They also suffer from poor collaboration with other stakeholders, such as psychiatric hospitals, therapists or employers. They indicate that the mental health disorder of each patient is unique, including the barriers to and possibilities of a successful return to work. Additionally, the workplace appears to play a crucial role in the success rate of re-entry into work. It can exacerbate the course of mental health disorders or support recovery. Fear, shame and stigmatization of the patients are personal factors responsible for prolonged sick leave. CONCLUSION We conclude that GPs believe that they can have a major impact on the rehabilitation of patients with mental health disorders. As such, special focus should be placed on supporting them in this context.
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Affiliation(s)
- Martina Geipel
- Department of Psychiatry and Psychotherapy, TUM School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University of Augsburg, Bezirkskrankenhaus Augsburg, Geschwister-Schönert-Straße 1, 86156, Augsburg, Germany
| | - Anna Pelizäus
- Department of Psychiatry and Psychotherapy, TUM School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Johannes Hamann
- Department of Psychiatry and Psychotherapy, TUM School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
- Bezirkskrankenhaus Mainkofen, Mainkofen A 3, 94469, Deggendorf, Germany.
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4
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Nordling P, Alexanderson K, Hensing G, Lytsy P. Factors associated with general practitioners' contacts with sick-listed patients' employers: A Swedish nationwide questionnaire study. Scand J Public Health 2023; 51:602-610. [PMID: 34689633 PMCID: PMC10854204 DOI: 10.1177/14034948211053141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/06/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022]
Abstract
Background: General practitioners' (GP) contacts with sick-listed patients' employers have been shown to be of importance for return to work. This study aimed to explore GPs' contacts with sick-listed patients' employers and factors associated with such contacts. Methods: In this cross-sectional study, 4228 GPs responded to a nationwide questionnaire about sickness certification (SC) practices. Outcomes of interest were participation in stakeholder meetings, having other contacts with employers, and satisfaction with employer contacts. Logistic regression models were used to investigate associations with factors related to the GP and the GP's workplace. Results: Among GPs, 34.8% participated in stakeholder meetings and 15.1% had other employer contacts; 39.4% had any or both of these contacts. Of GPs who had contacts with patients' employers, 65.8% were satisfied with the contacts. GPs regularly collaborating with rehabilitation coordinators had the strongest adjusted odds ratio (OR) for participating in stakeholder meetings, OR 2.72 (95% confidence interval (CI) 2.24-3.31), and having other contacts with employers, OR 3.85 (95% CI 2.85-5.21). Other factors positively associated with employer contacts were being a specialist, collaborating with other health professionals, finding employer contacts valuable, and having a joint SC routine/policy at the clinic. GPs who did not find SC problematic, had managerial support, or had enough resources for SC tasks were more likely to be satisfied with their employer contacts. Conclusions: Both physician characteristics and organizational factors had importance for GPs' contacts with sick-listed patients' employers. The findings imply that GPs' collaboration with patients' employers may be improved by interventions targeting both individual and organizational factors.
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Affiliation(s)
- Paula Nordling
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Primary Health Care, Region Västra Götaland, Sweden
| | - Kristina Alexanderson
- Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Lytsy
- Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ladegaard Y, Dalgaard VL, Conway PM, Eller NH, Skakon J, Maltesen T, Scheike T, Netterstrøm B. Notified occupational mental disorders: associations with health and income. Occup Med (Lond) 2023; 73:66-72. [PMID: 36738447 DOI: 10.1093/occmed/kqad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies indicate that workers' compensation claim processes may affect patients' health negatively. However, few studies focus on patients with mental health claims, and the claim process varies between countries. AIMS The aims of this study were to examine whether being notified to the Danish Labour Market Insurance with an occupational mental health condition was associated with changes in visits to the general practitioner (GP), use of medicine and annual income. METHODS Study participants were 965 patients with a mental disorder examined at a department of occupational medicine. Of these, 669 patients were notified with an occupational mental disorder, 296 were not. Health-related outcomes, including GP visits and prescriptions of psychotropic drugs, were estimated at baseline during the year of medical examination, while annual income was estimated a year before the examination. The follow-up was the year after the year of examination for all outcomes. Outcomes were collected from the Danish National Bureau of Statistics. Analyses were conducted using Poisson regression and conditional logistic regression. RESULTS All measured outcomes decreased from baseline to follow-up in both groups. These changes were not significantly different depending on notification status at baseline. CONCLUSIONS This study suggests that being notified with an occupational mental disorder does not significantly affect health-related outcomes. A significant decrease in annual income over time was seen in both groups, the notified and the unnotified group, highlighting the importance of providing support to all employees with a mental disorder.
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Affiliation(s)
- Y Ladegaard
- Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
- The Foundation for Mental Health, Valby, Denmark
| | - V L Dalgaard
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - P M Conway
- Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - N H Eller
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - J Skakon
- Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - T Maltesen
- Institute of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - T Scheike
- Institute of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - B Netterstrøm
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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Drolet L, Caron PO, Forget J, Turcotte JR, Guimond C. Family physicians' sick-listing practices in relation to mental disorders: A descriptive study. Work 2022; 75:211-221. [PMID: 36591671 DOI: 10.3233/wor-211301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mental disorders are among the leading causes of disability for which family physicians are often required to complete sickness certificates. Yet, little is known about family physicians' sick-listing practices in Quebec. OBJECTIVE This study aims to describe their practices, difficulties and needs. METHODS Twenty-three family physicians completed a comprehensive questionnaire on sickness certification practices. Descriptive statistics were used. RESULTS Despite being completed on a weekly basis, sickness certifications were deemed problematic by all participants. While they rarely refused to sick-list a patient, 43.5% reported suggesting accommodations as an alternative to sick leave. Waiting-time to access psychotherapy and delays to set-up workplace accommodations are responsible for many unnecessary sick-leave prolongations. Lack of time, long duration absences, situations where the physician held a different opinion than the patient/healthcare provider and assessing an individual's capacity to work are the most common reported problems. More than half of participants indicated medical schools do not greatly prepare them to carry out these tasks. CONCLUSION Sickness certifications are deemed problematic, and more training might be key. Our results can be used by medical schools or bodies responsible for continuous education to improve training.
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Affiliation(s)
| | | | | | | | - Claude Guimond
- Fédération des Médecins Omnipraticiens du Québec, Quebec, QC, Canada
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Nordling P, Jakobsson A, Hensing G. The Capacity Note: a communication facilitator in the sick leave process of patients with common mental disorders - a qualitative study of user perceptions. BMJ Open 2022; 12:e054436. [PMID: 35487752 PMCID: PMC9058774 DOI: 10.1136/bmjopen-2021-054436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To describe the development of a communication facilitator, the Capacity Note, for the sick leave process of patients with common mental disorders (CMDs) in primary care, and to explore users' perceptions of it. DESIGN Qualitive study. SETTING Primary healthcare in Region Västra Götaland, Sweden. PARTICIPANTS AND METHODS The Capacity Note was developed inductively based on data from six qualitative studies of work capacity and CMD and was introduced at primary healthcare centres during 2018-2019. Individual semistructured interviews were performed with 13 informants (8 patients, 2 general practitioners and 3 managers) who had used the Capacity Note at least once. Interviews were audiorecorded and transcribed verbatim and inductive manifest qualitative content analysis was used to analyse the data. RESULTS The Capacity Note comprised questions about work situation, work capacity limitations and possible work adjustments. Based on the interviews, four categories relating to its role as a facilitator for communication about work and health were identified: content and format, understanding, legitimacy and action, openness and timing, and time and efficiency. The participants considered the Capacity Note relevant and easy to use, and as having the potential to improve communication about and understanding of the patient's situation. The increased understanding was perceived as contributing to a sense of legitimacy and agency. Achieving these benefits required, according to the participants, openness, an investment of time and using the Capacity Note at the right time in the sick leave process. CONCLUSION The Capacity Note was found to be relevant and as having, under the right conditions, the potential to improve communication and facilitate the sick leave process.
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Affiliation(s)
- Paula Nordling
- Insurance Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Primary Healthcare, Region Västra Götaland, Gothenburg, Sweden
| | - Annika Jakobsson
- Insurance Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- Insurance Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mæland S, Holmås TH, Øyeflaten I, Husabø E, Werner EL, Monstad K. What is the effect of independent medical evaluation on days on sickness benefits for long-term sick listed employees in Norway? A pragmatic randomised controlled trial, the NIME-trial. BMC Public Health 2022; 22:400. [PMID: 35216560 PMCID: PMC8881877 DOI: 10.1186/s12889-022-12800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Independent medical evaluations are used to evaluate degree and reason for work disability, uncertainty around the functional status, and/or the employee’s rehabilitation potential in several jurisdictions, but not in Norway. The main aim of this trial was to test the return to work effect of independent medical evaluation (IME) (summoning and consultation) compared to treatment as usual (TAU) in Norway, for workers who have been on continuous sick leave for 6 months. Methods This was a pragmatic randomised controlled trial including all employees aged 18–65 years, sick-listed by their general practitioner and on full or partial sick leave for the past 26 weeks in Hordaland County, Norway in 2015/16. Trial candidates were drawn from a central register at the Norwegian Labour and Welfare Administration at 22 weeks of sick leave. Pregnant women, individuals with cancer or dementia diagnoses, those with secret address, employed by NAV or sick listed by the specialist health services were excluded. Separate regression analyses were conducted to investigate the “intention-to-treat” and “treatment on the treated” effects, using the ordinary least squares and instrumental variable methods, respectively. Results After exemption based on predefined exclusion criteria, 5888 individuals were randomised to either IME (n = 2616) or TAU (n = 2599). The final intervention group constitutes 1698 individuals, of which 937 attended the IME consultation. No baseline differences were found between the IME and TAU group regarding gender, age, and previous sick leave. Individuals attending the IME were older than those who cancelled the appointment ((47/45), p = 0.006) and those who did not show up without cancelling ((47/42), p < 0.001). Mainly the IME physician agreed with the regular GP upon level of sick leave. In cases with different assessments, the difference tended to be towards a lower sick leave level. There were no intention to treat or treatment on the treated effect on days of sick leave after randomisation during follow up. Conclusions Overall, the analyses showed no effect of IME on changes in sick leave for sick listed employees. This result was consistent for those who were offered an IME consultation (intention to treat) and those who undertook an IME consultation (treatment on the treated). Trial registration ClinicalTirals.gov trial number NCT02524392 first registration 14.08.2015.
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Affiliation(s)
- Silje Mæland
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway. .,Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Tor Helge Holmås
- NORCE Norwegian Research Centre, Health and Social Sciences, Bergen, Norway
| | - Irene Øyeflaten
- NORCE Norwegian Research Centre, Health and Social Sciences, Bergen, Norway.,Norwegian National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | | | - Erik L Werner
- Department of General Practice, Institute of Health and Society, Faculty of medicine, University of Oslo, Oslo, Norway
| | - Karin Monstad
- NORCE Norwegian Research Centre, Health and Social Sciences, Bergen, Norway
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Mazza D, Chakraborty S, Camões-Costa V, Kenardy J, Brijnath B, Mortimer D, Enticott J, Kidd M, Trevena L, Reid S, Collie A. Implementing work-related Mental health guidelines in general PRacticE (IMPRovE): a protocol for a hybrid III parallel cluster randomised controlled trial. Implement Sci 2021; 16:77. [PMID: 34348743 PMCID: PMC8335858 DOI: 10.1186/s13012-021-01146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Clinical Guideline for the Diagnosis and Management of Work-related Mental Health Conditions in General Practice (the Guideline) was published in 2019. The objective of this trial is to implement the Guideline in general practice. TRIAL DESIGN Implementing work-related Mental health conditions in general PRacticE is a hybrid III, parallel cluster randomised controlled trial undertaken in Australia. Its primary aim is to assess the effectiveness of a complex intervention on the implementation of the Guideline in general practice. Secondary aims are to assess patient health and work outcomes, to evaluate the cost-effectiveness of the trial, and to develop a plan for sustainability. METHODS A total of 86 GP clusters will be randomly allocated either to the intervention arm, where they will receive a complex intervention comprising academic detailing, enrolment in a community of practice and resources, or to the control arm, where they will not receive the intervention. GP guideline concordance will be assessed at baseline and 9 months using virtual simulated patient scenarios. Patients who meet the eligibility criteria (>18years, employed, and receiving care from a participating GP for a suspected or confirmed work-related mental health condition) will be invited to complete surveys about their health and work participation and provide access to their health service use data. Data on health service use and work participation compensation claim data will be combined with measures of guideline concordance and patient outcomes to inform an economic evaluation. A realist evaluation will be conducted to inform the development of a plan for sustainability. RESULTS We anticipate that GPs who receive the intervention will have higher guideline concordance than GPs in the control group. We also anticipate that higher concordance will translate to better health and return-to-work outcomes for patients, as well as cost-savings to society. CONCLUSIONS The trial builds on a body of work defining the role of GPs in compensable injury, exploring their concerns, and developing evidence-based guidelines to address them. Implementation of these guidelines has the potential to deliver improvements in GP care, patient health, and return-to-work outcomes. TRIAL REGISTRATION ACTRN12620001163998 , November 2020.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Australia.
| | | | - Vera Camões-Costa
- Department of General Practice, Monash University, Melbourne, Australia
| | | | - Bianca Brijnath
- National Ageing Research Institute, Parkville, Australia.,School of Allied Health, Curtin University, Perth, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Michael Kidd
- College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Sharon Reid
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Alex Collie
- Insurance Work and Health Group, Monash University, Melbourne, Australia
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10
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Kyron MJ, Rikkers W, O'Brien P, Bartlett J, Lawrence D. Experiences of Police and Emergency Services Employees with Workers' Compensation Claims for Mental Health Issues. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:197-206. [PMID: 32617784 DOI: 10.1007/s10926-020-09909-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose To assess employees' experiences of the workers' compensation claim process for psychological trauma, stress or a mental health condition sustained during the course of work in the police and emergency services sector. Methods 14,868 employees (69.4% male, response rate = 22%) from around Australia participated in Answering the Call: the Beyond Blue National Mental Health and Wellbeing Study of Police and Emergency Services, and were asked questions regarding their workers' compensation experiences for mental health reasons. Results 14% of all employees in police and emergency services organisations had made a workers' compensation claim for mental health reasons. Only 8.2% of employees making a claim had a positive experience (95% CI 6.6-9.8) while 70.3% had a poor experience (95% CI 67.6-73.0). Two-thirds of employees who had made a claim reported that the process was unsupportive and stressful, and over half reported that it had an overall negative impact on their recovery. Employees with poor overall support from their managers and those who perceived negative stigma about mental health in their workplace were more likely to report poor experiences. Conclusions The workers' compensation process is perceived negatively by most police and emergency services employees who have experience with it, and a majority found that it negatively impacted on their recovery. Ways to reform the system to better support employees experiencing significant functional impairments related to mental health issues should be urgently considered.
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Affiliation(s)
- Michael J Kyron
- Graduate School of Education, The University of Western Australia, 35 Stirling Highway, Perth, WA, Australia
| | - Wavne Rikkers
- Graduate School of Education, The University of Western Australia, 35 Stirling Highway, Perth, WA, Australia
| | | | - Jennifer Bartlett
- Graduate School of Education, The University of Western Australia, 35 Stirling Highway, Perth, WA, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, 35 Stirling Highway, Perth, WA, Australia.
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Boileau-Falardeau F, Turcotte JR, Lafleur PA, Corbière M. Dilemmes des médecins traitants lors du retour au travail de personnes aux prises avec un trouble mental courant : illustration par des vignettes cliniques. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1073530ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Les troubles mentaux courants (TMC) sont une des causes majeures d’invalidité au travail dans le monde. Plusieurs études démontrent que plus la durée de l’arrêt de travail est longue, plus minces sont les chances que la personne avec un TMC retourne au travail. Il est donc important que l’arrêt de travail soit d’une durée adéquate pour permettre à l’individu un rétablissement durable tout en diminuant les risques de rechute. Les médecins traitants ont un rôle important à jouer dans le cadre de la reprise professionnelle des personnes avec un TMC.
Objectif Cet article a comme principal objectif de présenter des vignettes cliniques supportées par la littérature relativement à la gestion par les médecins traitants de la reprise professionnelle de leurs patients avec un TMC.
Méthodologie Issues d’expériences cliniques, 3 vignettes cliniques illustrant plusieurs dilemmes que des médecins traitants peuvent rencontrer lors de la reprise professionnelle de leurs patients avec un TMC sont présentées. Les dilemmes sont soutenus par des articles publiés entre 2000 à 2020, provenant des bases de données Medline et PsycInfo.
Résultats et discussion Les 3 vignettes portent sur les dilemmes relatifs aux thèmes suivants : 1) l’évaluation du potentiel thérapeutique des arrêts de travail ; 2) le rôle d’expert octroyé aux médecins traitants et au processus d’évaluation de la capacité à travailler ; 3) les aspects administratifs liés à cette évaluation ; 4) la relation thérapeutique médecin-patient. La littérature nous indique que ce sont des dilemmes récurrents chez les médecins traitants dans le contexte de la gestion de la reprise professionnelle à la suite d’un TMC.
Conclusion La gestion des arrêts maladie chez les travailleurs avec un TMC par les médecins traitants comporte plusieurs dilemmes. Ces dilemmes mettent en lumière, entre autres, l’importance pour les médecins traitants de travailler en collaboration avec les autres acteurs et d’obtenir leur soutien et collaboration. Ces observations nous amènent à conduire une revue plus systématique de l’expérience des médecins traitants et de leurs besoins.
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Affiliation(s)
- Fabienne Boileau-Falardeau
- M.D., FRCPC, candidate à la maitrise en sciences biomédicales, Université de Montréal. Psychiatre, CIUSSS du Nord-de-l’Île-de-Montréal
| | - Jean-Robert Turcotte
- M.D., MPH FRCPC ; Psychiatre et professeur adjoint, Université de Montréal et CIUSSS du Nord-de-l’Île-de-Montréal
| | - Paul-André Lafleur
- M.D. Psychiatre légiste et professeur adjoint, Université de Montréal et CIUSSS du Nord-de-l’Île-de-Montréal
| | - Marc Corbière
- Ph. D. Professeur titulaire au Département d’éducation et pédagogie - Counseling de carrière, Université du Québec à Montréal (UQAM) ; Chercheur au Centre de recherche de l’Institut universitaire en santé mentale de Montréal (CR-IUSMM) ; Titulaire de la Chaire de recherche en santé mentale et travail, Fondation de l’IUSMM
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Chakraborty S, Brijnath B, Dermentzis J, Mazza D. Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions. Health Res Policy Syst 2020; 18:113. [PMID: 32993665 PMCID: PMC7523054 DOI: 10.1186/s12961-020-00628-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. Methods We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. Results A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Conclusions Guideline developers can apply this protocol to develop clinically relevant guideline questions.
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Affiliation(s)
- Samantha Chakraborty
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia.
| | - Bianca Brijnath
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia.,National Ageing Research Institute Ltd, Parkville, Australia
| | - Jacinta Dermentzis
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia
| | - Danielle Mazza
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia
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Corbière M, Mazaniello-Chézol M, Bastien MF, Wathieu E, Bouchard R, Panaccio A, Guay S, Lecomte T. Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:381-419. [PMID: 31673934 DOI: 10.1007/s10926-019-09861-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.
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Affiliation(s)
- Marc Corbière
- Department of Education, Career counselling, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada.
| | - Maud Mazaniello-Chézol
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Marie-France Bastien
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Estelle Wathieu
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Art History, Concordia University, Montreal, QC, Canada
| | | | - Alexandra Panaccio
- John Molson School of Business, Concordia University, Montréal, QC, Canada
| | - Stéphane Guay
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychiatry and Addictology, Université de Montreal, Montreal, QC, Canada
| | - Tania Lecomte
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
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Chakraborty SP, Dermentzis J, Brijnath B, Ivey E, Mazza D. What clinical challenges are associated with diagnosing and managing work-related mental health conditions? A qualitative study in general practice. BMJ Open 2020; 10:e037734. [PMID: 32801204 PMCID: PMC7430442 DOI: 10.1136/bmjopen-2020-037734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE When providing care for patients with work-related mental health conditions (MHCs), the general practitioner's (GP) role includes clinical care, patient advocacy and assessment of a patient's ability to work. GPs can experience difficulty representing these competing roles. As clinical guidelines were being developed to assist GPs in providing this care, our aim was to identify the clinical challenges GPs experience when diagnosing and managing patients with work-related MHCs. DESIGN Qualitative research. SETTING This study was conducted in general practice and workers' compensation settings across Australia. PARTICIPANTS Twenty-five GPs, seven psychiatrists and nine compensation scheme workers. GPs were eligible to participate if they were actively treating (or treated within the previous three years) patient(s) who had submitted a workers' compensation claim for a MHC. Psychiatrists and compensation scheme workers were eligible to participate if they were active in these roles, as they are best placed to identify additional clinical challenges GPs themselves did not raise. METHOD Participants were invited by letter to participate in qualitative semi-structured telephone interviews. Prior to each interview, participants were asked to reflect on two case vignettes, each depicting a patient's illness trajectory over 12 months. Data were thematically analysed using inductive and deductive techniques and then categorised by stages of clinical reasoning. RESULTS Participants reported clinical challenges across four key areas: (1) Diagnosis (identifying appropriate diagnostic tools, determining the severity and work-relatedness of a MHC, and managing the implications of labelling the patient with MHC). (2) Management (determining optimal treatment, recommending work participation). (3) Referral (ambiguity of communication pathways within compensation schemes). (4) Procedure (difficulties navigating compensation systems). CONCLUSION We found that GPs experienced clinical challenges at all stages of care for people with work-related MHCs. We were also able to identify systemic and procedural issues that influence a GP's ability to provide care for patients with work-related MHCs.
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Affiliation(s)
| | - Jacinta Dermentzis
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Bianca Brijnath
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
- National Ageing Research Institute Inc, Parkville, Victoria, Australia
| | - Eli Ivey
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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15
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Collie A, Sheehan L, Lane TJ, Iles R. Psychological Distress in Workers' Compensation Claimants: Prevalence, Predictors and Mental Health Service Use. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:194-202. [PMID: 31646415 DOI: 10.1007/s10926-019-09862-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose To determine the prevalence and predictors of psychological distress among injured and ill workers and their mental health service use. Methods Cross-sectional national survey of adults with work-related musculoskeletal or mental health conditions, accepted workers' compensation claims and at least 1 day off work. Psychological distress was measured using the Kessler-6 scale. Mental health service use was measured using self-report. Results A total of 3755 workers were included in the study (Musculoskeletal disorder = 3160; Mental health condition = 595). Of these, 1034 (27.5%) and 525 (14.0%) recorded moderate and severe psychological distress, respectively. Multivariate ordinal logistic regression revealed that being off work, poor general health, low work ability, financial stress, stressful interactions with healthcare providers and having diagnosed mental health conditions had the strongest associations with presence of psychological distress. Of the subgroup with musculoskeletal disorders and psychological distress (N = 1197), 325 (27.2%) reported accessing mental health services in the past four weeks. Severe psychological distress, being off work, worse general health and requiring support during claim were most strongly associated with greater odds of service use. Conclusions The prevalence of psychological distress among workers' compensation claimants is high. Most workers with musculoskeletal disorders and psychological distress do not access mental health services. Screening, early intervention and referral programs may reduce the prevalence and impact of psychological distress.
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Affiliation(s)
- Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Luke Sheehan
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tyler J Lane
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ross Iles
- School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Hadjistavropoulos HD, Peynenburg V, Mehta S, Adlam K, Nugent M, Gullickson KM, Titov N, Dear B. An Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Clients Referred and Funded by Insurance Companies Compared With Those Who Are Publicly Funded: Longitudinal Observational Study. JMIR Ment Health 2020; 7:e16005. [PMID: 32014840 PMCID: PMC7058169 DOI: 10.2196/16005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/25/2019] [Accepted: 12/15/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Anxiety and depression are leading causes of disability but are often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) improves access to treatment by overcoming barriers to obtaining care. ICBT has been found to be efficacious in research trials and routine care, but there is limited research of ICBT when it is recommended and funded by insurance companies for clients on or recently in receipt of disability benefits or accommodations. OBJECTIVE The aim of this study was to examine ICBT engagement, treatment satisfaction, and effectiveness among individuals involved with 2 insurance companies. The 2 samples were benchmarked against published outcomes from a publicly funded (PF) ICBT clinic. METHODS Individuals who were on or recently in receipt of disability benefits and were either insurance company (IC) employees (n=21) or IC plan members (n=19) were referred to ICBT funded by the respective insurance companies. Outcomes were benchmarked against outcomes of ICBT obtained in a PF ICBT clinic, with clients in the clinic divided into those who reported no involvement with insurance companies (n=414) and those who were on short-term disability (n=44). All clients received the same 8-week, therapist-assisted, transdiagnostic ICBT course targeting anxiety and depression. Engagement was assessed using completion rates, log-ins, and emails exchanged. Treatment satisfaction was assessed posttreatment. Depression, anxiety, and disability measures were administered pretreatment, posttreatment, and at 3 months. RESULTS All samples showed high levels of ICBT engagement and treatment satisfaction. IC employees experienced significant improvement at posttreatment (depression d=0.77; anxiety d=1.13; and disability d=0.91) with outcomes maintained at 3 months. IC plan members, who notably had greater pretreatment disability than the other samples, experienced significant moderate effects at posttreatment (depression d=0.58; anxiety d=0.54; and disability d=0.60), but gains were not maintained at 3 months. Effect sizes at posttreatment in both IC samples were significantly smaller than in the PF sample who reported no insurance benefits (depression d=1.14 and anxiety d=1.30) and the PF sample who reported having short-term disability benefits (depression d=0.95 and anxiety d=1.07). No difference was seen in effect sizes among IC employees and the PF samples on disability. However, IC plan members experienced significantly smaller effects on disability d=0.60) compared with the PF sample with no disability benefits d=0.90) and those on short-term disability benefits d=0.94). CONCLUSIONS Many clients referred and funded by insurance companies were engaged with ICBT and found it acceptable and effective. Results, however, were not maintained among those with very high levels of pretreatment disability. Small sample sizes in the IC groups are a limitation. Directions for research related to ICBT funded by insurance companies have been described.
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Affiliation(s)
| | | | - Swati Mehta
- Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada
| | - Kelly Adlam
- Online Therapy Unit, University of Regina, Regina, SK, Canada
| | - Marcie Nugent
- Online Therapy Unit, University of Regina, Regina, SK, Canada
| | | | - Nickolai Titov
- MindSpot, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake Dear
- MindSpot, Department of Psychology, Macquarie University, Sydney, Australia
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Choi K, Maas ET, Koehoorn M, McLeod CB. Time to return to work following workplace violence among direct healthcare and social workers. Occup Environ Med 2020; 77:160-167. [DOI: 10.1136/oemed-2019-106211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/18/2019] [Accepted: 01/01/2020] [Indexed: 11/04/2022]
Abstract
ObjectivesThis study examined time to return-to-work (RTW) among direct healthcare and social workers with violence-related incidents compared with these workers with non-violence-related incidents in British Columbia, Canada.MethodsAccepted workers’ compensation lost-time claims were extracted between 2010 and 2014. Workers with violence-related incidents and with non-violence-related incidents were matched using coarsened exact matching (n=5762). The outcome was days until RTW within 1 year after the first day of time loss, estimated with Cox regression using piecewise models, stratified by injury type, occupation, care setting and shift type.ResultsWorkers with violence-related incidents, compared with workers with non-violence-related incidents, were more likely to RTW within 30 days postinjury, less likely within 61–180 days, and were no different after 181 days. Workers with psychological injuries resulting from a violence-related incident had a lower likelihood to RTW during the year postinjury (HR 0.61, 95% CI 0.43 to 0.86). Workers with violence-related incidents in counselling and social work occupations were less likely to RTW within 90 days postinjury (HR 31–60 days: 0.67, 95% CI 0.48 to 0.95 and HR 61–90 days: 0.46, 95% CI 0.30 to 0.69). Workers with violence-related incidents in long-term care and residential social services were less likely to RTW within 91–180 days postinjury.ConclusionsWorkers with psychological injuries, and those in counselling and social work occupations and in long-term care and residential social services, took longer to RTW following a violence-related incident than workers with non-violence-related incidents. Future research should focus on identifying risk factors to reduce the burden of violence and facilitate RTW.
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Gray SE, Brijnath B, Mazza D, Collie A. Australian General Practitioners' and Compensable Patients: Factors Affecting Claim Management and Return to Work. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:672-678. [PMID: 30715662 DOI: 10.1007/s10926-019-09828-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose General Practitioners (GPs) play an important role in personal injury compensation systems yet system processes have been perceived as burdensome. Objectives were to (1) determine attitudes of Australian GPs on health benefits of return to work (RTW) after injury/illness and (2) identify associations between GP characteristics and agreement with issues surrounding treating compensable patients. Methods Cross-sectional postal survey of 423 Australian GPs to determine agreement with issues associated with compensable patients (including patient advocacy, conflicting opinions between GPs and compensation systems, fitness-for-work certification, and refusal to treat). Results The vast majority of GPs agreed there was a health benefit to early RTW. GPs with 16-20 years' experience had significantly higher odds of agreeing that the certificate of work capacity is the primary method of communication between RTW stakeholders (OR 2.36 [1.13-4.92]) than those with greater experience. 49% of GPs agreed they should be able to refuse to treat compensable patients. Female GPs had significantly lower odds (OR 0.60 [0.40-0.90]) of agreeing with right to refuse than male GPs, as did those from remote or regional practices (OR 0.43 [0.20-0.94]; OR 0.60 [0.39-0.92]) than GPs from urban practices. Conclusions Reducing administrative barriers identified by Australian GPs and improving communication with compensation systems will likely have a positive impact on their refusal to treat compensable patients.
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Affiliation(s)
- Shannon E Gray
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia.
| | - Bianca Brijnath
- Department of General Practice, Monash University, 1/270 Ferntree Gully Rd, Notting Hill, 3168, Australia
- National Ageing Research Institute, 34-48 Poplar Rd, Parkville, 3052, Australia
- School of Occupational Therapy and Social Work, Curtin University, Building 108 Brand Dr, Bentley, 6102, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, 1/270 Ferntree Gully Rd, Notting Hill, 3168, Australia
| | - Alex Collie
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia
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19
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Akbarzadeh Khorshidi H, Marembo M, Aickelin U. Predictors of Return to Work for Occupational Rehabilitation Users in Work-Related Injury Insurance Claims: Insights from Mental Health. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:740-753. [PMID: 30874999 DOI: 10.1007/s10926-019-09835-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose This study evaluates the Occupational Rehabilitation (OR) initiatives regarding return to work (RTW) and sustaining at work following work-related injuries. This study also identifies the predictors and predicts the likelihoods of RTW and sustainability for OR users. Methods The study is conducted on the compensation claim data for people who are injured at work in the state of Victoria, Australia. The claims which commenced OR services between the first of July 2012 and the end of June 2015 are included. The claims which used original employer services (OES) have been separated from claims which used new employer services (NES). We investigated a range of predictors categorised into four groups as claimant, injury, and employment characteristics and claim management. The RTW and sustaining at work are outcomes of interest. To evaluate the predictors, we use Chi-squared test and logistic regression modelling. Also, we prioritized the predictors using Akaike Information Criterion (AIC) measure and Cross-validation error. Four predictive models are developed using significant predictors for OES and NES users to predict RTW and sustainability. We examined the multicollinearity of the developed models using Variance Inflation Factor (VIF). Results About 75% and 60% of OES users achieved RTW and have been sustained at work respectively, whilst just approximately 30% of NES users have been placed at a new employer and 25% of them have been sustained at work. The predictors which have the most association with OES and NES outcomes are the use of psychiatric services and age groups respectively. We found that having mental conditions is as an important indicator to allocate injured workers into OES or NES initiatives. Our study shows that injured workers with mental issues do not always have lower RTW rate. They just need special consideration. Conclusion Understanding the predictors of RTW and sustainability helps to develop interventions to ensure sustained RTW. This study will assist decision makers to improve design and implementation of OR services and tailor services according to clients' needs.
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Affiliation(s)
- Hadi Akbarzadeh Khorshidi
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia.
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Australia.
| | - Miriam Marembo
- University Planning and Statistics, Monash University, Melbourne, Australia
| | - Uwe Aickelin
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
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Sheehan LR, Lane TJ, Gray SE, Collie A. Factors Associated with Employer Support for Injured Workers During a Workers' Compensation Claim. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:718-727. [PMID: 30820825 DOI: 10.1007/s10926-019-09834-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The employer/worker relationship can be an important catalyst for-or obstacle to-successful return to work (RTW). An understanding of factors associated with an injured worker's relationship with their employer, and employer involvement in RTW planning, is warranted. Methods Analysis of n = 8808 cross-sectional survey responses from injured workers in nine Australian workers' compensation (WC) jurisdictions. Workers completed a telephone survey between 6 and 24 months post-WC claim acceptance. Factors associated with the worker's perception of employer support were examined using ordinal regression. Factors associated with employer provision of RTW plans were examined using logistic regression. Results Factors associated with employer support included being aged over 50 years, not having a mental health condition, better self-rated health and less time between injury and claim. Factors associated with having a RTW plan included being female, not having a mental health condition and working for a self-insurer. Factors associated with having a written RTW plan included being female and being under 50 years. There was wide variation in the provision of RTW plans between WC jurisdictions. Conclusions There are strong associations between worker, claim and injury-related factors and the injured worker's experience of employer support. Identification of workers at risk of receiving inadequate support during the RTW process may enable interventions to improve support and RTW outcomes.
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Affiliation(s)
- Luke R Sheehan
- Insurance Work and Health Group, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia.
| | - Tyler J Lane
- Insurance Work and Health Group, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia
| | - Shannon E Gray
- Insurance Work and Health Group, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia
| | - Alex Collie
- Insurance Work and Health Group, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia
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Experiences of Healthcare in Australia's Workers' Compensation Schemes: A Cross-Sectional Study. J Occup Environ Med 2019; 62:80-86. [PMID: 31743307 DOI: 10.1097/jom.0000000000001770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine personal, injury, and scheme factors are associated with experiencing stressful healthcare provider (HCP) interactions, and to determine impact of stressful HCP interactions on return to work (RTW). METHODS Using the 2018 National RTW Survey of 4574 injured workers that submitted a workers' compensation claim, multivariable logistic regression determined factors associated with stressful HCP interactions (recorded as "a bit stressful" to "extremely stressful") and RTW (self-reported yes/no at interview). RESULTS Workers claiming for mental illness, who found healthcare difficult to access, who consulted with multiple HCPs, and who experienced psychological or financial stress, were significantly more likely to experience stressful HCP interactions. Stressful HCP interactions were associated with lower odds of RTW. CONCLUSIONS Findings provide impetus to investigate why HCP interactions are stressful to enable efforts to reduce stress, possibly improving RTW outcomes.
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Collie A, Sheehan L, Lane TJ, Gray S, Grant G. Injured worker experiences of insurance claim processes and return to work: a national, cross-sectional study. BMC Public Health 2019; 19:927. [PMID: 31291915 PMCID: PMC6621963 DOI: 10.1186/s12889-019-7251-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background Insurance claims management practices may have a significant impact on the health and experiences of injured workers claiming in workers’ compensation systems. There are few multi-jurisdictional studies of the way workers experience compensation processes, and limited data on the association between claims experience and return to work outcomes. This study sought to identify worker, claim and injury related factors associated with injured worker experiences of workers’ compensation claims management processes, and to examine associations between claims experience and return to work. Methods A national, cross-sectional survey of injured workers involved in ten Australian workers’ compensation schemes. A total of 10,946 workers completed a telephone survey at 6 to 24 months post claim acceptance. Predictors of positive or negative/neutral claims experience were examined using logistic regression. Associations between claims experience, return to work status and duration of time loss were examined using logistic regression. Results Nearly one-quarter (23.0%, n = 2515) of workers reported a negative or neutral claims experience. Injury type, jurisdiction of claim, and time to lodge claim were most strongly associated with claims experience. Having a positive claims experience was strongly associated with having returned to work after accounting for injury, worker, claim and employer factors. Conclusions There is a strong positive association between worker experiences of the insurance claims process and self-reported return to work status. Revision and reform of workers’ compensation claims management practices to enhance worker experience and the fairness of procedures may contribute to improved return to work outcomes.
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Affiliation(s)
- Alex Collie
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Luke Sheehan
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Tyler J Lane
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Shannon Gray
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Genevieve Grant
- Australian Centre for Justice Innovation, Faculty of Law, Monash University, Wellington Road, Clayton, Victoria, 3770, Australia
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Mazza D, Chakraborty SP, Brijnath B, Nowak H, Howell C, Brott T, Atchison M, Gras D, Kenardy J, Buchanan R, Tawia S. Diagnosing and managing work-related mental health conditions in general practice: new Australian clinical practice guidelines. Med J Aust 2019; 211:76-81. [PMID: 31231820 PMCID: PMC6852433 DOI: 10.5694/mja2.50240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction In Australia, mental health conditions (MHCs) arising from workplace factors are a leading cause of long term work incapacity and absenteeism. While most patients are treated in general practice, general practitioners report several challenges associated with diagnosing and managing workplace MHCs. This guideline, approved by the National Health and Medical Research Council and endorsed by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine, is the first internationally to address the clinical complexities associated with diagnosing and managing work‐related MHCs in general practice. Main recommendations Our 11 evidence‐based recommendations and 19 consensus‐based statements aim to assist GPs with: the assessment of symptoms and diagnosis of a work‐related MHC; the early identification of an MHC that develops as a comorbid or secondary condition after an initial workplace injury; determining if an MHC has arisen as a result of work factors; managing a work‐related MHC to improve personal recovery or return to work; determining if a patient can work in some capacity; communicating with the patient's workplace; and managing a work‐related MHC that is not improving as anticipated.
Changes in management as result of the guideline This guideline will enhance care and improve health outcomes by encouraging: the use of appropriate tools to assist the diagnosis and determine the severity of MHCs; consideration of factors that can lead to the development of an MHC after a workplace injury; more comprehensive clinical assessments; the use of existing high quality guidelines to inform the clinical management of MHCs; consideration of a patient's capacity to work; appropriate communication with the workplace; and collaboration with other health professionals.
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Affiliation(s)
| | | | - Bianca Brijnath
- Monash University, Melbourne, VIC.,National Ageing Research Institute, Melbourne, VIC
| | | | - Cate Howell
- Royal Australian College of General Practitioners, Melbourne, VIC
| | - Trevor Brott
- Western Industrial Screening and Accident Clinic, Melbourne, VIC
| | - Michelle Atchison
- Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC
| | - David Gras
- Royal Australasian College of Physicians, Melbourne, VIC
| | - Justin Kenardy
- University of Queensland, Brisbane, QLD.,Australian Psychological Society, Melbourne, VIC
| | - Richard Buchanan
- Office of Industrial Relations, Queensland Government, Brisbane, QLD
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Yeh WY, Chiu WC, Chen RY, Hu PY, Tsai DM. A preliminary evaluation of psychological stress amongst workers in Taiwan: a cross-sectional survey. Int J Ment Health Syst 2019; 13:34. [PMID: 31123489 PMCID: PMC6521344 DOI: 10.1186/s13033-019-0290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Stress and psychological disorders have been assigned increasing significance in the field of occupational health. Based on Japan's psychiatric disability occupational disease recognition regulation, Taiwan's Council of Labor Affairs announced "Evaluation Guidelines for psychiatric diseases induced by work-related stress" in 2009. This evaluation tool was designed to assess the source and intensity of work-related and non-work-related mental stress, and references existing Japanese guidelines. However, empirical data from workers in various sectors in Taiwan are still required to validate the utility of the guidelines. Methods This study recruited 2319 workers from the manufacturing, service, and public administration sectors to participate in a survey between 2010 and 2011. The survey included questions regarding participants' demographic characteristics, job type or attributes, a life event stress intensity evaluation Table (35 work-related and 23 non-work-related items on a scale of 1-10). The Chinese version of the Copenhagen Burnout Inventory (C-CBI) and Chinese Health Questionnaire (CHQ-12) were also included to explore associations between work-related/non-work-related stress and health outcomes. Results Analyses of survey results showed events relating to employment security (e.g., "company bankruptcy" and "being fired or forced to retire" scores; mean stress intensity scores both 6.18) were the cause of the highest intensity work-related stress. Within different demographic/job type categories, women had higher stress intensity scores for most items than men (greatest difference in "sexual harassment in the workplace" score). Furthermore, executive class workers generally experienced more psychological stress than blue-collar workers (greatest difference in "serious injury or disease due to work" score). Results from regression analysis supported the observation that employees' burnout and work-related stress was more significant than non-work-related stress. Moreover, work-related/non-work-related stress intensity levels both had significant negative predictive effects on mental health. Conclusions Regarding policy, this study provides empirical evidence and practical suggestions for establishing a psychological stress intensity database of workers under specific social contexts in a newly industrialized East Asian country. Such a database can be employed to help identify workers with work-related psychological disorders. Additionally, this study also provides a point of reference for enterprises to prioritize agendas when developing employee stress management and support protocols.
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Affiliation(s)
- Wan-Yu Yeh
- 1Center for Evidence-Based Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shipai Rd., Beitou District, Taipei, Taiwan, ROC.,2Department of Health Administration, Tzu Chi University of Science and Technology, 880 Sec.2, Chien-Kuo Rd., Hualien, Taiwan, ROC
| | - Wei-Che Chiu
- 3Department of Psychiatry, Cathay General Hospital, 280 Renai Rd., Sec.4, Taipei, Taiwan, ROC.,School of Medicine, College of Medicine, Fu-Jen Catholic University, 510 Zhongzheng Rd., Xinzhuang Dist., New Taipei, Taiwan, ROC
| | - Ruey-Yu Chen
- 5School of Public Health, Taipei Medical University, 250 Wuxing St., Taipei, Taiwan, ROC
| | - Pei-Yi Hu
- 6Division of Labor Relations, Institute of Labor Occupational Safety and Health, Ministry of Labor, 99, Lane 407, Hengke Rd., Sijhih District, New Taipei, Taiwan, ROC
| | - Dung-Min Tsai
- 6Division of Labor Relations, Institute of Labor Occupational Safety and Health, Ministry of Labor, 99, Lane 407, Hengke Rd., Sijhih District, New Taipei, Taiwan, ROC
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25
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Kidd M. Managing work-related mental health conditions in family medicine. CMAJ 2019; 191:E323-E324. [PMID: 30910879 DOI: 10.1503/cmaj.190284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael Kidd
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ont.; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
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26
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Mazza D, Brijnath B, O'Hare MA, Ruseckaite R, Kosny A, Collie A. Do Health Service Use and Return-to-Work Outcomes Differ with GPs' Injured-Worker Caseload? JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:64-71. [PMID: 29476311 DOI: 10.1007/s10926-018-9765-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose To determine whether healthcare use and return-to-work (RTW) outcomes differ with GPs' injured-worker caseload. Methods Retrospective analyses of the Compensation Research Database, which captures approximately 85% of all injured worker claims in Victoria, Australia was conducted. Four injured-worker caseload groups were examined that represented the 25th, 50th, 75th, and 100th percentiles of claimants seen per GP over the 8-year study period (2003-2010): (i) 1-13 claimants; (ii) 14-26 claimants; (iii) 27-48 claimants; and (iv) 49+ claimants (total claims, n = 124,342; total GPs, n = 9748).The characteristics of claimants in each caseload group, as well as the influence of caseload on three outcomes relevant to RTW (weekly compensation paid, work incapacity days, medical-and-like costs), were examined. Results Distinct profiles for high versus low caseload groups emerged. High caseload GPs treated significantly more men in blue collar occupations and issued significantly more 'alternate duties' certificates. Conversely, low caseload GPs treated significantly more women in white collar occupations, predominantly for mental health injuries, and issued significantly more 'unfit-for-work' certificates. Few significant differences were found between the two intermediate GP caseload groups. High caseload was associated with significantly greater medical-and-like costs, however, no caseload group differences were detected for weekly compensation paid or duration of time-off-work. Conclusions Training GPs who have a low injured-worker caseload in workers' compensation processes, utilising high caseload GPs in initiatives involving peer-to-peer support, or system changes where employers are encouraged to provide preventive or rehabilitative support in the workplace may improve RTW outcomes for injured workers.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia.
| | - Bianca Brijnath
- Department of General Practice, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Mary Alice O'Hare
- Department of General Practice, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Alex Collie
- Insurance Work and Health Group, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Yanar B, Kosny A, Lifshen M. Perceived Role and Expectations of Health Care Providers in Return to Work. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:212-221. [PMID: 29948470 DOI: 10.1007/s10926-018-9781-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose Health care providers (HCPs) play an important role in return to work (RTW) and in the workers' compensation system. However, HCPs may feel unsure about their responsibilities in the RTW process and experience difficulty making recommendations about RTW readiness and limitations. This study examines the ways in which HCPs and case managers (CMs) perceive HCPs role in the RTW process, and how similarities and differences between these views, in turn, inform expectations of HCPs. Methods In-depth interviews were conducted with 69 HCPs and 34 CMs from 4 provinces. Data were double coded and a thematic, inductive analysis was carried out to develop key themes. Findings The main role of HCPs was to diagnose injury and provide patients with appropriate treatment. In addition, the majority of HCPs and CMs viewed providing medical information to workers' compensation board (WCB) and the general encouragement of RTW as important roles played by HCPs. There was less clarity, and at times disagreement, about the scope of HCPs' role in providing medical information to WCB and encouraging RTW, such as the type of information they should provide and the timelines for RTW. Conclusion Interviews suggest that different role expectations may stem from differing perspectives of HCPs and the CMs had regarding RTW. A comprehensive discussion between WCB decision-makers and HCPs is needed, with an end goal of reaching consensus regarding roles and responsibilities in the RTW process. The findings highlight the importance of establishing clearer role expectations.
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Affiliation(s)
- Basak Yanar
- Institute for Work & Health, 481 University Ave., Suite 800, Toronto, ON, M5G 2E9, Canada.
| | - Agnieszka Kosny
- Institute for Work & Health, 481 University Ave., Suite 800, Toronto, ON, M5G 2E9, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Marni Lifshen
- Institute for Work & Health, 481 University Ave., Suite 800, Toronto, ON, M5G 2E9, Canada
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Collie A, Newnam S, Keleher H, Petersen A, Kosny A, Vogel AP, Thompson J. Recovery Within Injury Compensation Schemes: A System Mapping Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:52-63. [PMID: 29497925 DOI: 10.1007/s10926-018-9764-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose Many industrialised nations have systems of injury compensation and rehabilitation that are designed to support injury recovery and return to work. Despite their intention, there is now substantial evidence that injured people, employers and healthcare providers can experience those systems as difficult to navigate, and that this can affect injury recovery. This study sought to characterise the relationships and interactions occurring between actors in three Australian injury compensation systems, to identify the range of factors that impact on injury recovery, and the interactions and inter-relationships between these factors. Methods This study uses data collected directly from injured workers and their family members via qualitative interviews, analysed for major themes and interactions between themes, and then mapped to a system level model. Results Multiple factors across multiple system levels were reported by participants as influencing injury recovery. Factors at the level of the injured person's immediate environment, the organisations and personnel involved in rehabilitation and compensation processes were more commonly cited than governmental or societal factors as influencing physical function, psychological function and work participation. Conclusions The study demonstrates that injury recovery is a complex process influenced by the decisions and actions of organisations and individuals operating across multiple levels of the compensation system. Changes occurring 'upstream', for instance at the level of governmental or organisational policy, can impact injury recovery through both direct and diffuse pathways.
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Affiliation(s)
- Alex Collie
- Insurance Work and Health Group, Faculty of Medicine Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Sharon Newnam
- Accident Research Centre, Monash University, Wellington Road, Clayton, VIC, 3168, Australia
| | - Helen Keleher
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Alan Petersen
- School of Social Sciences, Faculty of Arts, Monash University, Wellington Road, Clayton, VIC, 3168, Australia
| | - Agnieszka Kosny
- Institute of Work and Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
| | - Adam P Vogel
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, 550 Swanston Street, Parkville, VIC, 3010, Australia
| | - Jason Thompson
- Melbourne School of Design, Faculty of Architecture Building and Planning, The University of Melbourne, Masson Road, Parkville, VIC, 3010, Australia
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Analysis of healthcare service utilization after transport-related injuries by a mixture of hidden Markov models. PLoS One 2018; 13:e0206274. [PMID: 30408046 PMCID: PMC6224052 DOI: 10.1371/journal.pone.0206274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022] Open
Abstract
Background Transport injuries commonly result in significant disease burden, leading to physical disability, mental health deterioration and reduced quality of life. Analyzing the patterns of healthcare service utilization after transport injuries can provide an insight into the health of the affected parties, allow improved health system resource planning, and provide a baseline against which any future system-level interventions can be evaluated. Therefore, this research aims to use time series of service utilization provided by a compensation agency to identify groups of claimants with similar utilization patterns, describe such patterns, and characterize the groups in terms of demographic, accident type and injury type. Methods To achieve this aim, we have proposed an analytical framework that utilizes latent variables to describe the utilization patterns over time and group the claimants into clusters based on their service utilization time series. To perform the clustering without dismissing the temporal dimension of the time series, we have used a well-established statistical approach known as the mixture of hidden Markov models (MHMM). Ensuing the clustering, we have applied multinomial logistic regression to provide a description of the clusters against demographic, injury and accident covariates. Results We have tested our model with data on psychology service utilization from one of the main compensation agencies for transport accidents in Australia, and found that three clear clusters of service utilization can be evinced from the data. These three clusters correspond to claimants who have tended to use the services 1) only briefly after the accident; 2) for an intermediate period of time and in moderate amounts; and 3) for a sustained period of time, and intensely. The size of these clusters is approximately 67%, 27% and 6% of the number of claimants, respectively. The multinomial logistic regression analysis has showed that claimants who were 30 to 60-year-old at the time of accident, were witnesses, and who suffered a soft tissue injury were more likely to be part of the intermediate cluster than the majority cluster. Conversely, claimants who suffered more severe injuries such as a brain head injury or anon-limb fracture injury and who started their service utilization later were more likely to be part of the sustained cluster. Conclusion This research has showed that clustering of service utilization time series is an effective approach for identifying the main user groups and utilization patterns of a healthcare service. In addition, using logistic regression to describe the clusters in terms of demographic, injury and accident covariates has helped identify the salient attributes of the claimants in each cluster. This finding is very important for the compensation agency and potentially other authorities as it provides a baseline to improve need understanding, resource planning and service provision.
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Schnitzler L, Kosny A, Lifshen M. Healthcare providers' experience with the management of mental health conditions in the context of Workers' Compensation. Work 2018; 59:449-462. [PMID: 29630586 DOI: 10.3233/wor-182695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Little is known about how healthcare providers (HCPs) in Canada manage mental health claims and the return to work (RTW) of injured workersOBJECTIVE:To examine HCPs' experience and challenges on the treatment of mental health conditions (MHCs) in the context of Workers' Compensation (WC) processes and their involvement in RTW. METHODS Ninety-seven interviews with HCPs (general practitioners, n = 59; allied HCPs, n = 19; specialists, n = 19) were conducted in British Columbia, Manitoba, Ontario and Newfoundland. A thematic content analysis was used to analyze interviews. RESULTS HCPs reported that while RTW is extolled at virtually all costs by WC boards, they did not always see it as beneficial. Most HCPs were convinced that successful recovery and RTW depend on being aware of how mental and physical health is intertwined and treating both issues. Organizational barriers within WC processes and adversarial relationships between injured workers (IWs) and WC boards made it difficult for HCPs to adequately treat patients and facilitate RTW. Dealing with IWs' MHCs and their emotional distress due to 'going through WC systems' was challenging. CONCLUSIONS WC boards must identify how policies can be modified to mitigate compensation processes and RTW for WC claimants with MHC.
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Affiliation(s)
- Lena Schnitzler
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.,Institute for Work & Health, Toronto, ON, Canada
| | - Agnieszka Kosny
- Institute for Work & Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Marni Lifshen
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
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Sylvain C, Durand MJ, Maillette P. Insurers' Influences on Attending Physicians of Workers Sick-listed for Common Mental Disorders: What Are the Impacts on Physicians' Practices? JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:531-540. [PMID: 29192369 DOI: 10.1007/s10926-017-9744-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose In many jurisdictions, general practitioners (GPs) play an important role in the sick-leave and return-to-work (RTW) process of individuals with common mental disorders (CMD). Since it is insurers that decide on workers' eligibility for disability benefits, they can influence physicians' ability to act. The nature of these influences remains little documented to date. The aim of this study was therefore to describe these influences and their impacts from the GPs' perspective. Methods Semi-structured interviews were conducted with GPs having a diversified clientele (n = 13). The interviews were audio-recorded, transcribed verbatim and analyzed according to thematic analysis principles. Results The results indicated that the GPs recognized insurers as influencing their practices with patients on sick leave for CMDs. The documented influences were generally seen as constraints, but sometimes as enablers. The impacts of these influences on the GPs' practices depended on the organizational characteristics of their work context (such as limited consultation time) and other characteristics of their practice setting (such as lack of timely access to consultations with specialists). Conclusion The results brought three major issues to light: the quality of the information sent to insurers by GPs, the respect shown (or not) for workers' care preferences, and the relevance of the specialized services offered to support workers' RTW. These issues in turn reveal potential risks for workers, risks that need to be identified and recognized by all parties concerned if we are to come up with possible solutions.
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Affiliation(s)
- Chantal Sylvain
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Hôpital Charles-Le Moyne Research Centre, Université de Sherbrooke, Longueuil Campus, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada.
| | - Marie-José Durand
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Hôpital Charles-Le Moyne Research Centre, Université de Sherbrooke, Longueuil Campus, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada
| | - Pascale Maillette
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Hôpital Charles-Le Moyne Research Centre, Université de Sherbrooke, Longueuil Campus, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada
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Aamland A, Husabo E, Maeland S. Independent medical evaluation for sick-listed patients: a focus group study of GPs´ expectations and experiences. BMC Health Serv Res 2018; 18:666. [PMID: 30157844 PMCID: PMC6114176 DOI: 10.1186/s12913-018-3481-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 08/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Norwegian general practitioners (GPs) are important stakeholders because they manage 80% of people on long-term sick-leave. Independent medical evaluation (IME) for long-term sick-listed patients is being evaluated in a large randomized controlled trial in one county in Norway in an effort to lower the national sick-leave rate (the NIME trial: Effect Evaluation of IME in Norway). The aim of the current study was to explore GPs' expectations of and experiences with IMEs. METHODS We conducted three focus group interviews with a convenience sample of 14 GPs who had had 2-9 (mean 5) of their long-term sick-listed patients summoned to an IME. We asked them to recollect and describe their concrete expectations of and experiences with patients assigned to an IME. Systematic text condensation, a method for thematic cross-case analysis, was applied for analysis. RESULTS To care for and to reassure their assigned sick-listed patients, the participants had spent time and applied different strategies before their patients had attended an IME. The participants welcomed a second opinion from an experienced GP colleague as a way of obtaining constructive advice for further sick-leave measures and/or medical advice. However, they mainly described the IME reports in negative terms, as these were either too categorical or provided unusable advice for further follow-up of their sick-listed patients. The participants did not agree with the proposed routine use of IMEs but instead suggested that GPs should be able to select particularly challenging sick-listed patients for an IME, which should be performed by a peer. CONCLUSION Our participants showed positive attitudes towards second opinions but found the regular IMEs to be unsuitable. The participants did however welcome IMEs if they themselves could select particularly challenging patients for a mandatory second opinion by a peer but emphasized that IME-doctors should not be able to overrule a GP's sick-leave recommendation. These findings, together with other evaluations, will serve as a basis for the Norwegian government's decision on whether or not to implement IMEs for long-term sick-listed patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02524392 . Registered 23 June, 2015.
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Affiliation(s)
- Aase Aamland
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
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Dean AM, Matthewson M, Buultjens M, Murphy G. Scoping review of claimants' experiences within Australian workers' compensation systems. AUST HEALTH REV 2018; 43:457-465. [PMID: 30032739 DOI: 10.1071/ah17244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/07/2018] [Indexed: 11/23/2022]
Abstract
Objective The aim of this scoping review was to map the literature on the lived experiences of injured workers in Australia in order to better understand the factors that inhibit the transition back to work and improved health. The ultimate aim of the study was to identify areas for further research into workers' compensation systems and practices that are associated with improved occupational rehabilitation outcomes. Methods PubMed, ProQuest, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for eligible articles published in English in peer-reviewed journals from 2001 to 2017. Narrative data synthesis was used to analyse the data collected from included articles. Results Twelve articles examining injured workers' experiences within Australian workers' compensation systems were identified. Injured workers reported similar experiences across states and territories in Australia. Four common themes and three subthemes were noted, namely: (1) relationships and interactions; (2) injured workers' perceptions (subthemes: mental health effects, social effects and financial effects); (3) the workers' compensation process; and (4) independent medical evaluations. Conclusions There are common difficulties that injured workers experience within Australian workers' compensation systems that are reported to impede rehabilitation and return to work. A less harmful, more cooperative approach to worker rehabilitation and compensation is needed. What is known about the topic? Different workers' compensation systems exist throughout Australia. Little is known about injured workers' perceptions of their experiences within these systems in Australia and whether these experiences are similar or different across systems. What does this paper add? This scoping review synthesises available evidence showing that injured workers report negative experiences of workers' compensation systems, and that this experience is similar across the different systems. This review also identified a clear need for future research on workers' compensation systems in order to promote evidence-based approaches to best support the occupational rehabilitation of injured workers. What are the implications for practitioners? Evidence suggests a more holistic, biopsychosocial approach is required by practitioners when facilitating an injured worker's recovery and return to work. This approach is also vital when considering legislative reforms, such as workers' compensation systems, processes and practices.
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Affiliation(s)
- Anne-Marie Dean
- Division of Psychology, School of Medicine, Faculty of Health, University of Tasmania, Private Bag 30, Hobart, Tas. 7001, Australia. Email
| | - Mandy Matthewson
- Division of Psychology, School of Medicine, Faculty of Health, University of Tasmania, Private Bag 30, Hobart, Tas. 7001, Australia. Email
| | - Melissa Buultjens
- School of Psychology and Public Health, HS2-534, Corner Kingsbury Drive and Plenty Road, La Trobe University, Bundoora, Vic. 3086, Australia.
| | - Gregory Murphy
- School of Psychology and Public Health, HS2-534, Corner Kingsbury Drive and Plenty Road, La Trobe University, Bundoora, Vic. 3086, Australia.
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Aamland A, Maeland S. Sick-listed workers' expectations about and experiences with independent medical evaluation: a qualitative interview study from Norway. Scand J Prim Health Care 2018; 36:134-141. [PMID: 29644920 PMCID: PMC6066295 DOI: 10.1080/02813432.2018.1459168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To reduce the country's sick leave rate, Norwegian politicians have suggested independent medical evaluations (IMEs) for sick-listed workers. IME was tested in a large, randomized controlled trial in one Norwegian county (Evaluation of IME in Norway, or 'the NIME trial'). The current study´s aim was to explore sick-listed workers' expectations about and experiences with participating in an IME. MATERIAL AND METHODS Nine individual semi-structured telephone interviews were conducted. Our convenience sample included six women and three men, aged 35-59 years, who had diverse medical reasons for being on sick leave. Systematic text condensation was used for analysis. RESULTS The participants questioned both the IME purpose and timing, but felt a moral obligation to participate. Inadequate information provided by their general practitioner (GP) to the IME doctor was considered burdensome by several participants. However, most participants appreciated the IME as a positive discussion, even if they did not feel it had any impact on their follow-up or return-to-work process. CONCLUSIONS According to the sick-listed workers the IMEs were administered too late and disturbed already initiated treatment processes and return to work efforts. Still, the consultation with the IME doctor was rated as a positive encounter, contrary to their expectations. Our results diverge from findings in other countries where experiences with IME consultations have been reported as predominantly negative. These findings, along with additional, upcoming evaluations, will serve as a basis for the Norwegian government's decision about whether to implement IMEs on a regular basis. Key points Independent medical evaluations for sick-listed workers has been tested out in a large Norwegian RCT and will be evaluated through qualitative interviews with participating stakeholders and by assessing the effects on RTW and costs/benefits. In this study, we explored sick-listed workers' expectations about and experiences with participating in an IME. • Participants questioned both the IME purpose and timing, but felt a moral obligation to participate. • Inadequate information provided by their general practitioner (GP) to the IME doctor was considered burdensome by several participants • Sick-listed workers appreciated the IME as a positive discussion, even if they did not feel it had any impact on their follow-up or return-to-work process.
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Affiliation(s)
- Aase Aamland
- Research Unit for General Practice, Uni Research Health, Bergen, Norway;
- CONTACT Aase AamlandResearch Unit for General Practice, Kalfarveien 31, N-5018Bergen, Norway
| | - Silje Maeland
- Uni Research Health, Uni Research, Bergen, Norway;
- Department of Occupational Therapy, Physiotherapy and Radiography, Western Norway University of Applied Sciences, Bergen, Norway
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Russell E, Kosny A. Communication and collaboration among return-to-work stakeholders. Disabil Rehabil 2018; 41:2630-2639. [DOI: 10.1080/09638288.2018.1472815] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Bunzli S, Singh N, Mazza D, Collie A, Kosny A, Ruseckaite R, Brijnath B. Fear of (re)injury and return to work following compensable injury: qualitative insights from key stakeholders in Victoria, Australia. BMC Public Health 2017; 17:313. [PMID: 28399837 PMCID: PMC5387374 DOI: 10.1186/s12889-017-4226-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Return to work (RTW) is important for recovery post-injury. Fear of (re)injury is a strong predictor of delayed RTW, and therefore much attention has been given to addressing injured workers' fear beliefs. However, RTW is a socially-negotiated process and it may be important to consider the wider social context of the injured worker, including the beliefs of the key people involved in their RTW journey. METHODS This paper involves data collected as part of a wider study in which semi-structured interviews explored RTW from the perspectives of 93 key stakeholders: injured workers, GPs, employers and insurance case managers in Victoria, Australia. Inductive analysis of interview transcripts identified fear of (re)injury as a salient theme across all stakeholder groups. This presented an opportunity to analyse how the wider social context of the injured worker may influence fear and avoidance behaviour. Two co-authors performed inductive analysis of the theme 'fear of (re)injury'. Codes identified in the data were grouped into five categories. Between and within category analysis revealed three themes describing the contextual factors that may influence fear avoidance and RTW behaviour. RESULTS Theme one described how injured workers engaged in a process of weighing up the risk of (re)injury in the workplace against the perceived benefits of RTW. Theme two described how workplace factors could influence an injured workers' perception of the risk of (re)injury in the workplace, including confidence that the source of the injury had been addressed, the availability and suitability of alternative duties. Theme three described other stakeholders' reluctance to accept injured workers back at work because of the fear that they might reinjure themselves. CONCLUSIONS Our findings illustrate the need for a contextualised perspective of fear avoidance and RTW behaviour that includes the beliefs of other important people surrounding the injured worker (e.g. employers, family members, GPs). Existing models of health behaviour such as The Health Beliefs Model may provide useful frameworks for interventions targeting the affective, cognitive, social, organisational and policy factors that can influence fear avoidance or facilitate RTW following injury.
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Affiliation(s)
- Samantha Bunzli
- The University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia.
| | - Nabita Singh
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | | | - Rasa Ruseckaite
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Bianca Brijnath
- School of Occupational Therapy and Social Work, Curtin University, Perth, Australia
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Goodman-Delahunty J, Schuller R, Martschuk N. Workplace Sexual Harassment in Policing: Perceived Psychological Injuries by Source and Severity. PSYCHOLOGICAL INJURY & LAW 2016. [DOI: 10.1007/s12207-016-9265-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brijnath B, Bunzli S, Xia T, Singh N, Schattner P, Collie A, Sterling M, Mazza D. General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: implications for patient care. BMC FAMILY PRACTICE 2016; 17:82. [PMID: 27440111 PMCID: PMC4955143 DOI: 10.1186/s12875-016-0491-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/13/2016] [Indexed: 11/18/2022]
Abstract
Background In Australia, general practitioners (GPs) see around two-thirds of people injured in road traffic crashes. Road traffic crash injuries are commonly associated with diverse physical and psychological symptoms that may be difficult to diagnose and manage. Clinical guidelines have been developed to assist in delivering quality, consistent care, however the extent to which GPs knowledge and practice in diagnosing and managing road traffic crash injuries concords with the guidelines is unknown. This study aimed to explore Australian GPs knowledge, attitudes and practices regarding the diagnosis and management of road traffic crash injuries, specifically whiplash associated disorders (WAD) and post-traumatic stress disorder (PTSD). Method A cross-sectional survey of 423 GPs across Australia conducted between July and December 2014. We developed a questionnaire to assess their knowledge of WAD and PTSD, confidence in diagnosing and managing WAD and PTSD, frequency of referral to health providers, barriers to referral, and attitudes towards further education and training. Factor analysis, Spearman’s correlation, and multiple ordered logistic regressions were performed. Results Overall, GPs have good level knowledge of WAD and PTSD; only 9.6 % (95 % CI: 7.1 %, 12.8 %) and 23.9 % (95 % CI: 20.8 %, 28.2 %) of them were deemed to have lower level knowledge of WAD and PTSD respectively. Key knowledge gaps included imaging indicators for WAD and indicators for psychological referral for PTSD. GPs who were male, with more years of experience, working in the urban area and with higher knowledge level of WAD were more confident in diagnosing and managing WAD. Only GPs PTSD knowledge level predicted confidence in diagnosing and managing PTSD. GPs most commonly referred to physiotherapists and least commonly to vocational rehabilitation providers. Barriers to referral included out-of-pocket costs incurred by patients and long waiting times. Most GPs felt positive towards further education on road traffic crash injury management. Conclusion This study has enhanced understanding of the knowledge skills and attitudes of GPs towards road traffic crash injury care in Australia, and has identified areas for further education and training. If delivered, this training has the potential to reduce unnecessary imaging for WAD and optimise the early referral of patients at risk of delayed recovery following a road traffic crash.
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Affiliation(s)
- Bianca Brijnath
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia. .,School of Occupational Therapy and Social Work, Curtin University, Perth, WA, 6152, Australia.
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Ting Xia
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Nabita Singh
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Peter Schattner
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.,Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC CRE in Road Traffic Injury Recovery, Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
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Eguchi H, Wada K, Higuchi Y, Smith DR. Co-worker perceptions of return-to-work opportunities for Japanese cancer survivors. Psychooncology 2016; 26:309-315. [PMID: 27072898 DOI: 10.1002/pon.4130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/11/2016] [Accepted: 03/07/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE This study examined workplace factors and perceptions of Return-to-Work (RTW) opportunities for colleagues with cancer-related symptoms and/or treatment side effects in Japan. METHODS We conducted an online, cross-sectional survey of 3710 employed Japanese individuals of working age. Colleagues' perceptions of RTW opportunities for cancer survivors were examined (using a Japanese questionnaire), along with workplace factors such as job demand, job control and workplace social support (using the Brief Job Stress Questionnaire). Associations between workplace factors and RTW opportunities were evaluated using multiple logistic regression analysis, with participants stratified in tertiles (low, middle and high) according to their levels of workplace social support and job control. RESULTS Colleagues' perceptions of inadequate RTW opportunities were associated with low workplace social support (middle tertile: Odds Ratio [OR] 1.22, 95% Confidence Interval [CI]: 1.08-1.36; low tertile: OR 1.43, 95%CI: 1.30-1.57; p for trend <0.01); low levels of job control (middle tertile: OR 1.27, 95%CI: 1.06-1.50; low tertile: OR 1.91, 95%CI: 1.64-2.21; p for trend <0.01); and no prior experience working with a cancer survivor (OR 2.08, 95%CI: 1.83-2.31). CONCLUSIONS This study suggests that workplace factors and prior experience of working with a cancer survivor may affect a colleagues' perception of RTW opportunities in Japanese workplaces. Consideration of workplace social factors (workplace support and job control), as well as increased openness and awareness of the particular needs of cancer survivors, is therefore essential to facilitate successful RTW in Japan, as elsewhere.Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hisashi Eguchi
- Department of Public Health, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Koji Wada
- National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Yoshiyuki Higuchi
- Department of Health and Physical Education, Fukuoka University of Education, 1-1 Akamabunkyo-machi, Munakata, Fukuoka, 811-4192, Japan
| | - Derek R Smith
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, 2258, Australia
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Ruseckaite R, Collie A, Scheepers M, Brijnath B, Kosny A, Mazza D. Factors associated with sickness certification of injured workers by General Practitioners in Victoria, Australia. BMC Public Health 2016; 16:298. [PMID: 27048576 PMCID: PMC4822251 DOI: 10.1186/s12889-016-2957-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/14/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Work-related injuries resulting in long-term sickness certification can have serious consequences for injured workers, their families, society, compensation schemes, employers and healthcare service providers. The aim of this study was to establish what factors potentially are associated with the type of sickness certification that General Practitioners (GPs) provide to injured workers following work-related injury in Victoria, Australia. METHODS This was a retrospective population-based cohort study was conducted for compensation claims lodged by adults from 2003 to 2010. A logistic regression analysis was performed to assess the impact of various factors on the likelihood that an injured worker would receive an alternate/modified duties (ALT, n = 28,174) vs. Unfit for work (UFW, n = 91,726) certificate from their GP. RESULTS A total of 119,900 claims were analysed. The majority of the injured workers were males, mostly age of 45-54 years. Nearly half of the workers (49.9%) with UFW and 36.9% with ALT certificates had musculoskeletal injuries. The multivariate regression analysis revealed that for most occupations older men (55-64 years) were less likely to receive an ALT certificate, (OR = 0.86, (95%CI, 0.81 - 0.91)). Workers suffering musculoskeletal injuries or occupational diseases were nearly twice or three times at higher odds of receiving an ALT certificate when compared to fractures. Being seen by a GP experienced with workers' compensation increased the odds of receiving ALT certificate (OR = 1.16, (95%CI, 1.11 - 1.20)). Occupation and industry types were also important factors determining the type of certificate issued to the injured worker. CONCLUSIONS This study suggests that specific groups of injured workers (i.e. older age, workers with mental health issues, in rural areas) are less likely to receive ALT certificates.
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Affiliation(s)
- Rasa Ruseckaite
- Institute for Safety, Compensation and Recovery Research, Monash University, 222 Excibition St, Melbourne, Victoria, 3000, Australia.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, The Alfred Hospital, Melbourne, Victoria, 3004, Australia.
- School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Alfred Hospital, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Alex Collie
- Institute for Safety, Compensation and Recovery Research, Monash University, 222 Excibition St, Melbourne, Victoria, 3000, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, The Alfred Hospital, Melbourne, Victoria, 3004, Australia
| | - Maatje Scheepers
- Institute for Safety, Compensation and Recovery Research, Monash University, 222 Excibition St, Melbourne, Victoria, 3000, Australia
- Monash Injury Outcomes Unit, Monash Injury Research Institute, Monash University, Building 70, Clayton, Victoria, 3800, Australia
| | - Bianca Brijnath
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia
| | - Agnieszka Kosny
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, The Alfred Hospital, Melbourne, Victoria, 3004, Australia
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario, M5G 2E9, Canada
| | - Danielle Mazza
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia
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Brijnath B, Mazza D, Kosny A, Bunzli S, Singh N, Ruseckaite R, Collie A. Is clinician refusal to treat an emerging problem in injury compensation systems? BMJ Open 2016; 6:e009423. [PMID: 26792215 PMCID: PMC4735202 DOI: 10.1136/bmjopen-2015-009423] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context. DESIGN Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries. SETTING Compensable injury management in general practice in Melbourne, Australia. PARTICIPANTS 25 GPs who were treating, or had treated a patient with compensable injury. RESULTS The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management. CONCLUSIONS In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries.
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Affiliation(s)
- Bianca Brijnath
- Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia
| | | | - Samantha Bunzli
- Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia
| | - Nabita Singh
- Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Victoria, Australia
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Brijnath B, Singh N, Mazza D. Stakeholder perspectives on the new sickness certificate in Victoria: results from a mixed-methods qualitative study. AUST HEALTH REV 2016. [DOI: 10.1071/ah14136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective
The aim of this study was to present the views of four stakeholder groups, namely general practitioners (GP), employers (EMP), injured workers (IW) and compensation agents (CA), about the content and usability of the draft of the new Victorian sickness certificate.
Methods
A cross-sectional mixed-methods qualitative study was conducted in GP clinics and community settings in Melbourne, Australia. Interviews were conducted with GPs, EMPs and IWs and one focus group discussion was completed with CAs (n = 29). Data were collected between October and December 2013. Thematic analysis was performed.
Results
All stakeholders viewed the new draft certificate as an improvement on the old one. GPs saw the certificate as a form of communication, whereas EMPs and CAs saw it as a therapeutic device. GPs continued to certify based on incapacity and provided little information about what IWs could do on return to work. All groups said that assessments for mental health needed more clarity and specificity. GPs, EMPs and CAs also said that the new certificates must be electronically available and integrated into existing medical software to streamline uptake.
Conclusions
To ensure appropriate use of the new certificate, stakeholders must share a common understanding about its purpose and the certificate must be incorporated into existing medical software. Content on mental health assessment, an area of continued difficulty, needs additional refinement. The new certificate replaced the old certificate in March 2015; after it has been established in clinical practice, an impact evaluation should be completed to determine whether GPs are certifying capacity and earlier return to work.
What is known about the topic?
When it comes to sickness certification, GPs tend to focus on what injured patients cannot do, rather than what they can do. The new sickness certificate aims to change GP behaviour by focusing the certificate more on capacity (i.e. what the injured patient can do).
What does this paper add?
Four stakeholder groups agreed that the content and usability of the new certificate has improved. However, they agreed that the assessment of mental health capacity needs further specificity. Dissonances also remain between the stakeholders on the purpose of the certificate.
What are the implications for practitioners?
Appropriate use of the new certificate requires a common understanding about the purpose of the certificate, training on its appropriate use, incorporation into existing medical software and clarity on mental health assessment.
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Mazza D, Brijnath B, Singh N, Kosny A, Ruseckaite R, Collie A. General practitioners and sickness certification for injury in Australia. BMC FAMILY PRACTICE 2015; 16:100. [PMID: 26275607 PMCID: PMC4537596 DOI: 10.1186/s12875-015-0307-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/10/2015] [Indexed: 12/02/2022]
Abstract
Background Strong evidence supports an early return to work after injury as a way to improve recovery. In Australia, General Practitioners (GPs) see about 96 % of injured workers, making them the main gatekeepers to workers’ entitlements. Most people with compensable injuries in Australia are certified as “unfit to work” by their GP, with a minority of patients certified for modified work duties. The reasons for this apparent dissonance between evidence and practice remain unexplored. Little is known about the factors that influence GP sickness certification behaviour in Australia. The aim of this study is to describe the factors influencing Australian GPs certification practice through qualitative interviews with four key stakeholders. Methods From September to December 2012, 93 semi-structured interviews were undertaken in Melbourne, Australia. Participants included GPs, injured workers, employers and compensation agents. Data were thematically analysed. Results Five themes describing factors influencing GP certification were identified: 1. Divergent stakeholder views about the GP’s role in facilitating return to work; 2. Communication between the four stakeholder groups; 3. Conflict between the stakeholder groups; 4. Allegations of GPs and injured workers misusing the compensation system and 5. The layout and content of the sickness certificate itself. Conclusion By exploring GP certification practice from the perspectives of four key stakeholders, this study suggests that certification is an administrative and clinical task underpinned by a host of social and systemic factors. The findings highlight opportunities such as practice guideline development and improvements to the sickness certificate itself that may be targeted to improve GP sickness certification behaviour and return to work outcomes in an Australian context. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0307-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC, 3168, Melbourne, Australia.
| | - Bianca Brijnath
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC, 3168, Melbourne, Australia.
| | - Nabita Singh
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC, 3168, Melbourne, Australia.
| | - Agnieszka Kosny
- Institute for Work and Health, University of Toronto, Toronto, Canada.
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia. .,Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Australia.
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Kilgour E, Kosny A, Akkermans A, Collie A. Procedural Justice and the Use of Independent Medical Evaluations in Workers’ Compensation. PSYCHOLOGICAL INJURY & LAW 2015. [DOI: 10.1007/s12207-015-9222-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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