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Improving communication between treating practitioners results in an earlier return to work

At a glance:
Improving the quality and flow of information between treating practitioners results in an earlier return to work.
Perspectives:
Employee
Encourage your treating practitioners to talk to the other treaters involved in your care. This may mean the G.P. talking to the physiotherapist, or the physiotherapist talking to the rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 provider. Getting back to work is important for your well-being, and the earlier this occurs the greater the chance of a positive outcome.
Employer
Improving communication between treating practitioners improves return to work outcomes. This study was about communication between practitioners, however, the same issues apply to communication between treating practitioners and the workplace.

Employers can help practitioners to communicate better. Much like you, treating practitioners have many demands on their time. The barriers to better treaters' communication include:

1. Not knowing who to contact at the workplace
2. Not being able to reach the relevant person at the workplace while the patient is present
3. Confusion and lack of clarity regarding confidentiality in discussions about return to work
4. Lack of available time during the practitioner's day
5. A compensation system which relies on treating practitioners doing extra work without being paid
6. A lack of understanding about the importance of communication to return to work outcomes

Employers can work to improve communication by

1. Providing clear documentation about who the treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 should call at the workplace
2. Attending the practitioner's rooms with the patient, if the patient is comfortable with this approach
3. Inviting the practitioner to the workplace
4. Offering to pay practitioners for the time they devote to communication
5. Being available to take a telephone call at the time the patient is attending the practitioner
Treater
Communication between practitioners improves return to work outcomes. This applies to communication between general practitioners and specialists, general practitioners and allied health professionals, and communication generally regarding return to work.

When return to work is a focus and recognised as a key aspect of patient management, better communication is likely to occur.

It is important to understand the likely negative long-term health consequences for people who remain off work. Isolation, depression,
depression
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 strain
strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 on relationships and family, increased morbidity and mortality are all recognised complications of an ongoing absence from work. Good early and ongoing communication is fundamental to return to work management and the well-being of those in return to work programs.
Insurer
Case managers within insurers understand the challenges of communicating with treating practitioners. This simple study showed that improving communication between treaters results in better outcomes. To foster simple, clear communication about return to work issues, compensating practitioners for the time they devote to this work is useful. Being available to talk at an appropriate time (such as when the patient is present) increases the likelihood of effective communication occurring.
Original Article, Authors & Publication Details:
K. Mortelmans, P. Donceel and D. Lahaye (2006).

Disability management through positive intervention
intervention
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 in stakeholders' information asymmetry. A pilot study.
Occupational Medicine; 56(2):129.

1Department of Insurance, Environmental and Occupational Medicine, Katholieke Universiteit Leuven, Kapucijnenvoer 35/5, Leuven 3000, Belgium.
Background, Study Objectives, How It Was Done:
Return to work is more successful when all of the parties involved with rehabilitation are working in a coordinated fashion. On the other hand, when people involved in the return to work process do not have the same information, return to work may be delayed.

Stakeholders (the people involved in the return to work process) include the employee, the employer, the human resources manager, the claims administrator or insurer, rehabilitation providers, treating practitioners, medical specialists, occupational health specialists, and a number of others.

Information exchange is an important component of disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 management. The authors of this study sought to evaluate whether communication between medical practitioners could be improved, and whether earlier return to work would occur as a consequence.

While this study was undertaken in Belgium, the issue of enhancing communication between treating practitioners and other stakeholders is an international problem. The researchers acknowledge that the occupational physician may be best informed about the individual's work, while the treating practitioner may know the most about the person's physical condition and their psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 and social situation.

The aims of this study were:

To test the feasibility of a model to improve communication
To obtain preliminary data on the return to work effects of an improved exchange of information

The intervention included the following steps

1. Patients attending their second work inability assessment consultation (with the social insurance physician) were enrolled in the study.
2. The social insurance physician noted information about the patient's sickness, absence, and work resumption on the specially designed communication form.
3. The communication form was sent to a central administrative area.
4. Some of the patients remained as a control group and went through the usual process. Others, where there was an occupational health service, were assigned to the intervention group.
5. On seeing the patient, the occupational physician read and completed the communication form, including information about the employee's job description. In turn the insurance physician would update the form. The information was passed back and forward between the two practitioners.
Study Findings:
The outcome of the assessment was measured one year after the start of the employee's sickness absence.

70 patients were included in the study, 55 in the control group and 15 in the intervention group.

Improving the information exchange was associated with:

1. Earlier return to work. The chances of resuming work increased for the patients under the intervention group, and
2. Greater likelihood of gradual work resumption
Conclusions:
The authors note that return to work is improved when parties work together to focus on return to work outcomes. Whilst this was a small study it shows that regular communication between the medical practitioners can improve return to work outcomes.

The authors are currently testing this pilot in a larger study.
References:
PubMed Abstract
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