Getting the prescription right for injured workers

icare’s Chief Medical Officer, Dr Chris Colquhoun, discusses how medical tests, treatments and prescriptions, and sometimes not intervening in conventional ways, can support recovery at work.

female doctor smiling with elderly female patient

The twenty-first century focus on data has overturned the accepted workers compensation wisdom of previous decades – that an injured worker should not go back to work unless completely fit to perform all aspects of the job.

We now know that getting back to work is a critical part of the treatment for work-related injury [1]. Not returning to work can lead to poorer health, including greater risks of chronic disease and mental ill-health [2] .

We also know that the longer someone is off work following an injury, the less chance they have of ever returning [3].

Evidence-based paths to recovery 

icare supports an evidence-based path to recovery from work-related injury or illness. Our understanding of best practice is constantly evolving as new medical discoveries and advances are made. 

One of the most common injuries we see in workers compensation is non-specific lower-back pain, something that an x-ray, CT or MRI scan became a standard test for. These tests can be the beginning of the ‘tragic pathway,’ [4] where a simple trip to the GP for back pain leads to invasive surgery and reliance on pain medications.

We now know that ‘abnormalities’ identified in scans for non-specific lower-back pain are often normal body changes, that many cases of lower-back pain will resolve themselves and that maintaining movement, rather than rest, will assist in recovery. 

Overprescribing can be a barrier to recovery

Chronic pain is often at the heart of work disability and one of the big risks for injured workers in these cases is the overprescribing of tests, treatments and medications.

Research shows that opioid use beyond the acute phase of an injury can impair function, be a barrier to recovery and actually increase a worker’s experience of pain rather than diminish it [5].

While over-prescription is ultimately the responsibility of medical practitioners, a recent Australian survey demonstrates that patient expectations is the most common reason given by GPs for overprescribing tests, treatments or drugs [6].

In some cases, these interventions result in reduced function, poorer quality of life and increased drug dependency. There is now significant evidence that psychological and social factors can have as much, sometimes more, impact on return-to-work outcomes as biological factors. This means that the worker’s psychological response to injury (their beliefs about pain or expectations of recovery) or the level of social support provided by the employer, can be more important predictors of the rates of return to work than the type and severity of the injury itself. 

Alternative pathways to recovery

Our approach is to track all risk factors – biological, psychological and social – and intervene as early as possible to help the injured worker’s recovery stay on track. On the treatment front, we’re pursuing promising alternate pathways to recovery and sustained return-to-work outcomes. This includes investment through the icare Foundation in a social prescribing pilot, run by Primary & Community Care Services, which is testing the impact of healthcare providers ‘prescribing’ non-medical interventions (for example men’s sheds, financial management classes) that encourage social participation.

We will evaluate this and other pilots for their success in improving recovery and return-to-work outcomes and their ongoing financial viability. Based on results, we may incorporate them into icare’s case management practises in future.

While it’s not our role to recommend medical treatments to injured workers, what we can do is help our customers actively participate in their recovery, including asking questions about the treatments they are being recommended and ensuring recovery at work is part of the prescription.

References

[1] Dame Carol Black 2008, Working for a healthier tomorrow, Crown copyright, London - a review of the health of Britain's working age population

[2] ibid.

[3] Return to Work Matters 2015, Injury and case management: A practical guide to dealing with return to work after work injury

[4] OHS Alerts, 25 September 2018

[5] National Safety Council (USA), 2014

[6] NPS Medicinewise 2018, Choosing Wisely Australia 2018 Report: Conversations for change