The impact of income support systems on healthcare quality and functional capacity in workers with low back pain: a realist review

Trends in opioid dispensing to injured workers following codeine scheduling changes in Australia: a retrospective cohort study

OBJECTIVES

To describe the prevalence and patterns of opioid analgesic and pain medicine dispenses, and the impact of up-scheduling of low-dose (≤15 mg) codeine-containing products to Australians with accepted workers' compensation time loss claims for musculoskeletal conditions between 2010 and 2019.

DESIGN

Interrupted time series.

SETTING

Workers' compensation scheme in Victoria, Australia.

POPULATION

Australians with accepted workers' compensation time loss claims for musculoskeletal conditions between 2010 and 2019.

MAIN OUTCOME MEASURES

Number and proportion of workers dispensed pain medicines in the first year of claim and the monthly number, percentage of pain medicine dispenses and mean morphine equivalent dispense dose.

RESULTS

Nearly one-third (28.4%, n=22 807) of our sample of 80 324 workers were dispensed any opioid in the first year since the workers' compensation insurer received their claim. There were no significant step or trend changes in the number or percentage of pain medicines dispensed of up-scheduled low-dose codeine. Only 2.9% of workers were ever dispensed up-scheduled low-dose codeine, specifically 2.5% after up-scheduling (1 February 2018). After up-scheduling of low-dose codeine, workers were more likely to be dispensed opioids (excluding codeine) (prevalence ratio (PR) 1.21, 99% CI 1.13, 1.31) or other pain medicines (eg, pregabalin, paracetamol) (PR 1.11, 99% CI 1.03, 1.19) compared with the year prior. There was a significant 28.5% (99% CI 16.3, 41.9) step increase (ie, increase immediately after up-scheduling) in high-dose (>15 mg) codeine with a significant trend decrease (-1.3%, 99% CI -2.5, -0.2).

CONCLUSION

Up-scheduling low-dose codeine to prescription-only medicines did not significantly change the dispensing of low-dose codeine-containing products to workers with accepted workers' compensation time loss claims for musculoskeletal conditions.

Pain Resilience and Coping Behaviors in Individuals in a Collectivist Social Context

BACKGROUND/OBJECTIVES

Pain resilience (PR) may be associated with different coping skills, resulting in differences in pain outcomes. This study aimed to understand the role of PR in dictating the choice of coping methods.

METHODS

This study completed a preliminary validation of the Mandarin Chinese version of the Pain Resilience Scale (PRS-C) with online survey data (n = 46). Further, we conducted interviews with individuals with chronic low back pain (n = 24).

RESULTS

The PRS-C psychometric properties were assessed using a confirmatory factor analysis. The interviews explored pain history, treatment experiences, and coping strategies and were analyzed thematically. The validated PRS-C (10 items) demonstrated satisfactory psychometric properties. The interview results showed that participants who scored lower were more likely to adopt disengagement rather than engagement coping strategies. Qualitative data revealed three themes explaining why and how participants in this collectivist social framework chose their coping methods.

CONCLUSIONS

The findings suggest that while participants tried to understand their pain and treatment experiences, the cognitive appraisal construct in PR influenced some of the coping experiences. However, deeply influenced by Confucianism and Buddhism, participants also expressed factors beyond the scope of individual fortitudes, such as the relationship with a higher power that significantly influenced their coping behaviors.

Exploration of the Usual Care Pathway for Rotator Cuff Related Shoulder Pain in the Western Australian Workers' Compensation System

PURPOSE

Investigate components of care for rotator cuff related shoulder pain in workers' compensation in relation to claim outcomes (claim duration, total medical spend, total claim cost, return to work outcome).

METHODS

Engagement with (had care, time to care) four components of care (prescribed exercise, imaging, injections, surgery) were obtained from auditing 189 closed workers' compensation files. Associations were analysed between components of care and claim outcomes.

RESULTS

80% received prescribed exercise, 81% imaging, 42% injection and 35% surgery. Median time to imaging (11 days) was shorter than the prescribed exercise (27 days), with injection at 38 days and surgery 118.5 days. With univariable regression analysis higher age, the involvement of legal representation and the presence of rotator cuff pathology from diagnostic imaging (partial thickness tear or full thickness tear) were all associated with increased claim duration, total medical spend, total claim cost and less successful return to work outcomes. After adjusting for these three associations, having an injection or surgery were both positively associated with longer claim duration and greater medical spend, and surgery with greater total claim costs. In general, longer time to receiving components of care was associated with increased claim duration and reduced odds of returning to full duties at work.

CONCLUSION

Early management was not consistent with clinical guidelines for managing workers' compensation rotator cuff related shoulder pain. This may negatively affect claims outcomes.

Development and initial application of a harmonised multi-jurisdiction work injury compensation database

Objectives

Workers' compensation schemes provide funding for wage replacement and healthcare for injured and ill workers. In Australia, workers' compensation schemes operate independently in different jurisdictions, making comparisons of health service use challenging. We sought to develop and deploy a new database of health service and income support data, harmonising data from multiple Australian workers' compensation jurisdictions.

Methods

We worked with workers' compensation authorities from six Australian jurisdictions to combine claims, healthcare, medicines and wage replacement data for a sample of compensated workers with claims for musculoskeletal conditions. We designed a structured relational database and developed a bespoke health services coding scheme to harmonise data across jurisdictions.

Results

The Multi-Jurisdiction Workers' Compensation Database contains four data sets: claims, services, medicines and wage replacement. The claims data set contains 158,946 claims for low back pain (49.6%), limb fracture (23.8%) and non-specific limb conditions (26.7%). The services data set contains a total of 4.2 million cleaned and harmonised services including doctors (29.9%), physical therapists (56.3%), psychological therapists (2.8%), diagnostic procedures (5.5%) and examinations and assessments (5.6%). The medicines data set contains 524,380 medicine dispenses, with 208,504 (39.8%) dispenses for opioid analgesics.

Conclusions

The development of this database presents potential opportunities to gain a greater understanding of health service use in the Australian workers' compensation sector, to measure the impact of policy change on health services and to provide a method for further data harmonisation. Future efforts could seek to conduct linkage with other data sources.

Patterns of opioid dispensing and associated wage replacement duration in workers with accepted claims for low back pain: a retrospective cohort study

ABSTRACT

This study aimed to identify patterns of opioid dispensing in Australian workers with low back pain (LBP) and determine the association of dispensing patterns with wage replacement duration. Australian workers' compensation claimants with LBP and at least 1 day of wage replacement were included. We used group-based trajectory modelling to identify opioid dispensing patterns over a two-and-a-half-year period from reported LBP onset and quantile regression to compare wage replacement duration between each dispensing pattern group. Opioids were dispensed to one-third of workers with LBP (N = 3205, 33.3%) at least once during their claim. Three dispensing patterns were identified. Most had a short-term low-volume opioid dispensing pattern (N = 2166, 67.6%), whereas 798 (24.9%) had a long-term moderate-volume pattern and 241 (7.5%) had a long-term high-volume pattern. Workers with dispensed opioids had significantly longer wage replacement duration than those without dispensed opioids (median [weeks]: 63.6 vs 7.1, respectively). In addition, moderate-volume and high-volume long-term dispensing groups had significantly longer wage replacement duration compared with the short-term dispensing group (median [weeks]: 126.9, 126.0, and 30.7, respectively). Without controlling for pain severity, these results offer limited evidence that opioids lead to longer wage replacement duration. Further research controlling for pain severity, psychosocial factors, and recovery expectations is required to confirm whether the relationship between opioid dispensing pattern and wage replacement duration is causal in nature.