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Healthcare Provider participation is important in achieving early return to work

At a glance:
  • The advice of health care providers is important in encouraging early return to work.
  • Contact between a health care professional and their patient's workplace can assist return to work.
  • Workplaces respond positively to the advice of health care professionals regarding modifications of work space and duties.
  • Patients respond well to positive recommendations to return to work from their health care professional.
Perspectives:
Employee
Contact between your workplace and your treating doctor will help your recovery and return to work.

When your health care provider is in contact with your workplace a realistic assessment of any modifications required to accommodate your injury is more likely.

In addition, the workplace is more likely to respond to a health professional's advice and modify your workplace to help you get back to work.

Encouraging your doctor and your employer to talk to each other regarding your return to work is likely to make the process easier and assist you in preventing re-injury.
Employer
Contact with an injured worker's health care provider makes it more likely that they will return to work soon after injury. When health care providers have an understanding of their patient's workplace and normal work activities they can make better recommendations regarding when they can return to work, what duties are suitable and any workplace modifications that are necessary.

Contact with the health care provider can also give them a better understanding of the limitations the workplace may have regarding modifications and job change.

Unfortunately, health care practitioners are in short supply and high demand. Communication with providers should be straightforward and make the best use of scarce time.
Treater
This study shows that it is important that health care providers encourage patients to return to work as early as possible. Contact with employers will better inform your recommendation regarding the patient's ability to perform their work duties, plus the employer is twice as likely to listen to your professional opinion regarding workplace modifications to accommodate the patient's injury.

This study found evidence that contact between the health care provider and the patient's workplace makes it twice as likely that they will return to work early.

Additionally, patients (employees) respond well to positive recommendations to return to work from their health care professional. Simply giving patients a return to work date and guidance as to how to prevent recurrence, or re-injury makes an early return to work more than twice as likely to occur.
Insurer
Encouraging early contact between health care providers and workplaces has been shown to improve return work rates. Health care providers get a more informed understanding of the flexibility of the workplace through contact and can make clearer recommendations.

Being given a clear and positive date for return to work by a health practitioner doubles the likelihood that an injured worker will return to work early. Providing the patient with advice on how to prevent re-injury also facilitates early return to work.

Employers appear to be twice as likely to take notice of recommendations made by health care providers than those made by others.

Health care providers are often overloaded, so communication with the patient and their workplace needs to be simple, effective and, most importantly, not time consuming.
Original Article, Authors & Publication Details:
A. Kosny1,2, R-L. Franche1,2, J. Pole1,2, N. Krause1,2,3, P. Côté1,2and C. Mustard1,2 (2006).

Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal
musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 injury
. Journal of Occupational Rehabilitation; 16( 1): 27-39

1 Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

2 Institute for Work & Health, Toronto, Ontario, Canada.

3 Department of Medicine, University of California, San Francisco.
Background, Study Objectives, How It Was Done:
The Canadian Medical Association and Ontario Medical Association view the process of return to work after injury as a joint responsibility between employer, employee and health care provider. In Ontario, the province in which this study was conducted, physicians and chiropractors play an important role in the return to work process. They are responsible for directly communicating with the Workplace Safety and Insurance Board about the progress and readiness of the injured worker to return to work.

This study examined the association between three actions by health care providers and early return to work after a compensated work-related musculoskeletal injury:
  1. A positive return to work recommendation
  2. Proactive communication with the injured worker
  3. Contact with their patient's workplace
From a possible study population of 6,530 Ontario workers, 417 were contacted. Of these, 205 completed the interviews, but a further 18 were excluded because of their type of injury, so 187 individuals were included in the study.

Participants all had been compensated for missing time at work from back, neck, or upper limb
upper limb
arm
 musculoskeletal injuries. In the sample, most were full time workers, with 13% being classified as “white-collar' workers and 87% as “blue-collar' workers. The most common injury was to the back (58% of the claims).

The study compared an early attempt at returning to work with the following three statements:
  • “your health care provider told you the date you could return to work'
  • “your health care provider advised you on how to prevent re-injury or recurrence"
  • “your health care provider made contact with your workplace'
Study Findings:
For the majority of workers (74.9%) a medical doctor was their main health care provider.

If a health care provider gave their patient a date after which they could return to work, they were more than three times as likely to return to work soon after injury. Forty-eight (48%) percent of patients reported their health care provider giving them a return to work date.

If a patient was given guidance on how to prevent recurrence and re-injury they were more than twice as likely to return to work early.62% of patients said that their health care provider told them how to prevent re-injury.

If the health care provider contacted their patient's workplace it was about twice as likely that an injured worker would return to work early. 38% of patients reported that their health care provider made contact with their workplace.

Contact with the workplace involves considerable time and energy at a time when health care providers have increasing demands on their time. This study suggests future research should explore the benefits of training and institutional change to facilitate the increased involvement of health care providers in helping injured workers return to work successfully.
Conclusions:
The study results suggest health care providers should play an active role early on in the process of returning to work after injury, including proactive communication with the patient and direct contact with their workplace.

The Interaction between the Health Care Provider and the Workplace:

When recommendations for ergonomic
ergonomic
Designing activities and the workplace in a way to minimize discomfort. i.e. Adapting work tasks, hours, or workstation to accommodate people. An ergonomic computer workstation allows the person to work in the best position to relieve load on the muscles of the neck and arms.
 (layout of the workplace or workstation) or job changes are made by physicians, employers tend to listen. One study found that although 48% of employers took no action in response to a worker's report of a repetitive strain
strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 injury, a recommendation from a doctor doubled the likelihood of a response.

Direct communication with the workplace gives the health care provider with an understanding of the work conditions that an employee will return to after injury. This enables a better assessment of the level of recovery needed before to return to work and the kind of modifications that may be possible in the workplace.

Health care provider contact with the workplace gives some weight to the worker's injury claim and need for modifications to prevent re-injury.
References:
PubMed Abstract
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