Healthcare professionals know that it pays to care.
In Australia and Aotearoa New Zealand, many injured workers receive excellent healthcare that is evidence-based, work-focused, and supportive. However, medicalisation of common health problems, over investigation and overtreatment are common and health outcomes for people who experience work injuries are worse than for those who experience similar conditions in non-compensable settings.
As a healthcare professional, you may be responsible for mapping the course to recovery and eventual return to work. You may also be providing treatments or interventions that are crucial to achieving recovery milestones.
No matter what the extent of your role is in the claim journey, you will have opportunities to embed the values of It Pays to Care in your practice.
The Research
Treating practitioners, while not the primary influence on return to work and recovery outcomes for compensable patients, can significantly impact both, particularly within the first six months of a claim.
A study on workers with back pain found that practitioners who address personal psychosocial issues, like attitudes toward pain, and empower patients to self-manage their conditions, reduce sickness absence and long-term disability.
There is clear evidence for the need to address biopsychosocial care in workers’ compensation systems. The biopsychosocial model recognises that an individual’s psychosocial responses influence their neurobiology and can increase pain, distress, and disability. Evidence shows that measuring personal psychosocial responses and then offering tailored education and self-help coaching can help people manage pain and improve their ability to cope, thereby assisting recovery and RTW.
The biopsychosocial model also suggests that educating patients about pain improves participation, serving as an essential component of self-management coaching.
Australian research highlights the importance of providing an estimated RTW date for better outcomes. Other work-focused communication strategies, such as discussing re-injury prevention, are effective only if the injured worker finds the interaction with the treating practitioner low-stress.
The quality of the relationship between the injured worker and the treating practitioner is crucial. Positive experiences with healthcare professionals who respect individual needs, navigate the compensation system, and offer reassurance lead to better outcomes. Conversely, poor communication between the healthcare system and other stakeholders hinders work participation.
Action Areas
To improve work injury management and return to work practices, healthcare professionals can:
- Provide evidence-based, biopsychosocial-informed health care. The Clinical Framework for the Delivery of Health Services outlines the importance of a biopsychosocial model and the need for effective treatment and fostering self-management.
- Develop systematic approaches to address psychosocial influences at the patient level. While people who may benefit from support in tackling psychosocial barriers to work may be identified through claims managers, the workplace or rehabilitation providers, the central point of coordination is often the GP.
- Adopt and promote the Principles on the role of the GP in supporting work participation to guide GPs to foster worker empowerment, communication with other stakeholders, team-based care, the health benefits of good work, and appropriate certification.
- Incentivise evidence-informed, high-value care. There is a need to incentivise value-based health care, that is care that seeks to improve health outcomes that matter to patients while improving efficiency and reducing waste. This may require additional, or improved, training for health professionals and a reconsideration of our models of care delivery.
- Improve work certification practices that support timely RTW to promote recovery. High rates of ‘unfit’ certificates are a barrier to work participation, with some workers who have work capacity certified instead as ‘unfit for work’.
You can find more information on opportunities for healthcare providers in It Pays to Care: Bringing evidence-informed practice to work injury schemes helps workers and their workplaces.
References
These are indicative references only. For complete reference list, please see the It Pays to Care policy paper.
- Australasian Faculty of Occupational and Environmental Medicine. Realising The Health Benefits Of Work: Royal Australasian College of Physicians; 2011.
- Bartys S, Frederiksen P, Bendix T & Burton K. System influences on work disability due to low back pain: An international evidence synthesis. Health Policy. 2017;121(8):903-912.
- Beaumont D. Positive Medicine. Chapter 4. USA: Oxford University Press; 2021.
- Indahl A, Haldorsen EH, Holm S, Reikeras O & Ursin H. Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine. 1998; 23(23): 2625-2630.
- Kilgour E, Kosny A, McKenzie D & Collie A. Healing or harming? Healthcare provider interactions with injured workers and insurers in workers' compensation systems. Journal of Occupational Rehabilitation. 2015; 25(1): 220-239.
- Lane TJ, Lilley R, Black O, Sim MR & Smith PM. Health Care Provider Communication and the Duration of Time Loss Among Injured Workers: A Prospective Cohort Study. Medical Care. 2019; 57(9): 718-722.
- Moseley GL & Butler DS. Fifteen Years of Explaining Pain: The Past, Present, and Future. J Pain. 2015; 16(9): 807-813.