Fear of (re)injury and return to work following compensable injury: qualitative insights from key stakeholders in Victoria, Australia Bunzli S, Singh N, Mazza D, Collie A, Kosny A, Ruseckaite R, Brijnath B.
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. 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. 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).
General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: implications for patient care. Brijnath B, Bunzli S, Xia T, Singh N, Schattner P, Collie A, Sterling M, Mazza D. BMC Fam Pract. 2016;17:82
Road traffic crashes result in a range of physical and psychological symptoms. This study explored the knowledge, attitudes and practices of Australian general practitioners (GPs) in caring for people following road traffic crashes, specifically whiplash associated disorders (WAD) and post-traumatic stress disorder (PTSD). A survey was conducted with 423 GPs from around Australia.
GPs had a good level of knowledge of WAD and PTSD in general, however they had encountered trouble with understanding imaging indicators for WAD and knowing when to refer patients with PTSD for psychological treatment. Most GPs would like to receive further training about managing road traffic crash injury.
Does medical certification of workers with injuries influence patterns of health service use? Ruseckaite R, Collie A, Prang KH, Brijnath B, Kosny A, Mazza D. Work. 2016 Jun 8;54(3):669-78
The objective of this study was to examine what health services were used the most in the 12 months after a work related injury. The investigators used zero-inflated negative binomial and logistic regressions for major health care services that were accessed in the 12 months following an injury. Physiotherapists were used more by workers who had sustained musculoskeletal disorders, back pain and fractures, while psychological services were used more by workers who had sustained mental health conditions. Workers who were undertaking alternate duties following their injury were likely to visit GPs, pharmacy and physiotherapy services.
Next steps: This study will inform future work about optimising health services for injured workers.
Factors associated with sickness certification of injured workers by General Practitioners in Victoria, Australia. Ruseckaite R, Collie A, Scheepers M, Brijnath B, Kosny A, Mazza D. BMC Public Health. 2016;16:298
The type of sickness certificate that a GP provides to an injured worker can have a long-term impact on the injured worker’s health and wellbeing. The aim of this study was to find out what factors may influence GPs when they are writing certificates for injured workers following a work-related injury. A retrospective population-based cohort study was conducted on compensation claims between 2003 and 2010. The investigators used logistic regression analysis to identify factors that influenced GPs to certify workers as either unfit-for-work versus fit to undertake alternative duties. A total of 119,900 claims were analysed. This study found that specific groups of injured workers (workers with fractures, older age workers, workers with mental health issues, and workers who live in rural areas) were less likely to receive certificates for alternative duties.
Is clinician refusal to treat an emerging problem in injury compensation systems? Brijnath B, Mazza D, Kosny A, Bunzli S, Singh N, Ruseckaite R, Collie A. BMJ Open. 2016;6(1):e009423
This study explored the issue of refusal or reluctance to treat patients with compensable injuries. 25 GPs from Melbourne, Australia participated in face-to-face semi-structured interviews about their knowledge, attitudes and practices facilitating return to work in people with compensable injuries. All of the GPs mentioned reluctance to treat patients with compensable injuries. Most GPs reported refusal to treat amongst their colleagues in primary and specialist care, however many GPs also described their own reluctance to treat people with compensable injuries. Reasons for GP reluctance to treat were the high administrative burden related to a patient with a compensable injury and the level of difficulty associated with a compensable injury case.
Stakeholder perspectives on the new sickness certificate in Victoria: results from a mixed-methods qualitative study. Brijnath B, Singh N, Mazza D. Aust Health Rev. 2016 Feb;40(1):27-32
In 2013 the two statutory injury compensation authorities in Victoria, Australia, WorkSafe Victoria (WSV) and the Transport Accident Commission (TAC), redesigned their sickness certificates to focus on capacity. The aim of this study was to evaluate whether the new draft certificate was usable and whether the revised content and structure were appropriate. Four key stakeholder groups – GPs, injured workers, employers and compensation agents - participated in either individual interviews or a focus group discussion. All stakeholders said that the new certificate was an improvement on the previous certificate however groups differed in their understanding about the purpose of the certificate. All stakeholders wanted more information about mental health assessment to be included in the certificate and most stakeholders wanted the certificate to be available electronically.
General practitioners and sickness certification for injury in Australia. Mazza D, Brijnath B, Singh N, Kosny A, Ruseckaite R, Collie A. BMC Fam Pract. 2015;16:100
Most people with compensable injuries in Australia are certified as ‘unfit to work’ by their GP. 93 GPs, injured workers, employers and compensation scheme agents from Melbourne, Australia participated in face-to-face semi-structured interviews about the factors that influence GP certification. Five themes were identified in this study: (1) divergent views from stakeholder groups about the GPs role in facilitating return to work; (2) communication between the four stakeholder groups; (3) conflict between stakeholder groups; (4) allegations of misuse of the compensation system by GPs and injured workers; and (5) the layout and content of the sickness certificate. This study highlights numerous opportunities for improvement of GP certification practices in Australia.
Mental health claims management and return to work: qualitative insights from Melbourne, Australia. Brijnath B, Mazza D, Singh N, Kosny A, Ruseckaite R, Collie A. J Occup Rehabil. 2014 Dec;24(4):766-76
In Australia work-related mental health claims are the second most common reason for workplace compensation claims, however little is known about how these claims are managed and how return to work following a mental health claim is facilitated. Ninety-three in-depth interviews were undertaken with GPs, compensation agents, employers and injured persons in Melbourne, Australia. This study found that mental health claims were complex to manage because of difficulties with assessing injured workers and diagnosing mental health conditions. Further education and training interventions are needed to help GPs, employers and compensation agents facilitate return to work for people with mental health claims.
Trends in sickness certification of injured workers by general practitioners in Victoria, Australia. Ruseckaite R, Collie A, Bohensky M, Brijnath B, Kosny A, Mazza D. J Occup Rehabil. 2014 Sep;24(3):525-32
This study looked at how GPs complete sickness certificates for injured workers in Victoria, Australia between 2003 and 2010. A retrospective population-based cohort study was conducted and sickness certification rates per 1,000 working population per annum were calculated. Most certificates were classified as unfit for work (74.1%), with alternative duties prescribed in 22.8% of certificates. Only 3.1% of certificates were classified as fit for work. GPs are increasingly classifying workers who have musculoskeletal injuries with alternative duties, however workers with mental health conditions continue to be classified as unfit for work.
Sickness certification of workers compensation claimants by general practitioners in Victoria, 2003-2010. Collie A, Ruseckaite R, Brijnath B, Kosny AA, Mazza D. Med J Aust. 2013 Oct 7;199(7):480-3
A retrospective analysis of the Victoria workers compensation database was conducted for all injured and ill workers between 2003 and 2010. 74.1% recommended that workers were unfit for work and 22.8% recommended alternative duties. Unfit-for-work certificates were issued to 94.1% of workers with mental health conditions, 81.3% of those with fractures, 79.1% of those with other traumatic injuries, 77.6% of those with back pain and strains, 68.0% of those with musculoskeletal conditions and 53.0% of those with other diseases.