Department of General Practice, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia.
National Ageing Research Institute, Parkville, VIC, Australia.
J Occup Rehabil. 2019 Mar;29(1):64-71. doi: 10.1007/s10926-018-9765-y.
Purpose To determine whether healthcare use and return-to-work (RTW) outcomes differ with GPs' injured-worker caseload. Methods Retrospective analyses of the Compensation Research Database, which captures approximately 85% of all injured worker claims in Victoria, Australia was conducted. Four injured-worker caseload groups were examined that represented the 25th, 50th, 75th, and 100th percentiles of claimants seen per GP over the 8-year study period (2003-2010): (i) 1-13 claimants; (ii) 14-26 claimants; (iii) 27-48 claimants; and (iv) 49+ claimants (total claims, n = 124,342; total GPs, n = 9748).The characteristics of claimants in each caseload group, as well as the influence of caseload on three outcomes relevant to RTW (weekly compensation paid, work incapacity days, medical-and-like costs), were examined. Results Distinct profiles for high versus low caseload groups emerged. High caseload GPs treated significantly more men in blue collar occupations and issued significantly more 'alternate duties' certificates. Conversely, low caseload GPs treated significantly more women in white collar occupations, predominantly for mental health injuries, and issued significantly more 'unfit-for-work' certificates. Few significant differences were found between the two intermediate GP caseload groups. High caseload was associated with significantly greater medical-and-like costs, however, no caseload group differences were detected for weekly compensation paid or duration of time-off-work. Conclusions Training GPs who have a low injured-worker caseload in workers' compensation processes, utilising high caseload GPs in initiatives involving peer-to-peer support, or system changes where employers are encouraged to provide preventive or rehabilitative support in the workplace may improve RTW outcomes for injured workers.
目的 确定全科医生处理的受伤工人病例数量是否会影响医疗保健的使用和重返工作岗位（RTW）的结果。
方法 对澳大利亚维多利亚州补偿研究数据库进行了回顾性分析，该数据库涵盖了所有受伤工人索赔的约 85%。研究检查了四个受伤工人病例量组，代表了全科医生在 8 年研究期间（2003-2010 年）每处理的索赔人数的第 25、50、75 和 100 百分位数：（i）1-13 名索赔人；（ii）14-26 名索赔人；（iii）27-48 名索赔人；（iv）49+名索赔人（总索赔人数，n=124342；总全科医生人数，n=9748）。检查了每个病例量组中索赔人的特征，以及病例量对与 RTW 相关的三个结果（每周支付的赔偿金、工作能力丧失天数、医疗和类似费用）的影响。
结果 高病例量与低病例量组之间出现了明显的特征差异。高病例量的全科医生治疗的蓝领职业男性明显更多，并且签发的“替代职责”证明明显更多。相反，低病例量的全科医生治疗的白领职业女性明显更多，主要是心理健康受伤，并且签发的“不适合工作”证明明显更多。在两个中间全科医生病例量组之间几乎没有发现显著差异。高病例量与显著更高的医疗和类似费用相关，但是，在每周支付的赔偿金或休假时间方面，没有发现任何病例量组之间的差异。
结论 在工人赔偿程序中培训病例量低的全科医生，在涉及同行支持的倡议中利用病例量高的全科医生，或者在鼓励雇主在工作场所提供预防或康复支持的系统变更中，可能会改善受伤工人的 RTW 结果。
