Hudon Anne, Hunt Matthew, Ehrmann Feldman Debbie
Faculty of Medicine, School of Rehabilitation, University of Montreal, Pavillon du Parc, office 402-27, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada.
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada.
BMC Health Serv Res. 2018 Sep 3;18(1):682. doi: 10.1186/s12913-018-3491-1.
In recent years, significant efforts have been made to improve the provision of care for compensated injured workers internationally. However, despite increasing efforts at implementing best practices in this field, some studies show that policies overseeing the organisation of care for injured workers can have perverse influences on healthcare providers' practices and can prevent workers from receiving the best care possible. The influence of these policies on physiotherapists' practices has yet to be investigated. Our objectives were thus to explore the influence of 1) workers' compensation boards' and 2) physiotherapy clinics' policies on the care physiotherapists provide to workers with musculoskeletal injuries in three large Canadian provinces.
The Interpretive Description framework, a qualitative methodological approach, guided this inquiry. Forty participants (30 physiotherapists and 10 leaders and administrators from physiotherapy professional groups and workers' compensation boards) were recruited in British Columbia, Ontario and Quebec to participate in an in-depth interview. Inductive analysis was conducted using constant comparative techniques.
Narratives from participants show that policies of workers' compensation boards and individual physiotherapy clinics have significant impacts on physiotherapists' clinical practices. Policies found at both levels often place physiotherapists in uncomfortable positions where they cannot always do what they believe to be best for their patients. Because of these policies, treatments provided to compensated injured workers markedly differ from those provided to other patients receiving physiotherapy care at the same clinic. Workers' compensation board policies such as reimbursement rates, end points for treatment and communication mechanisms, and clinic policies such as physiotherapists' remuneration schemes and restrictions on the choice of professionals had negative influences on care. Policies that were viewed as positive were board policies that recognize, promote and support physiotherapists' duties and clinics that provide organisational support for administrative tasks.
In Canada, workers' compensation play a significant role in financing physiotherapy care for people injured at work. Despite the best intentions in promoting evidence-based guidelines and procedures regarding rehabilitation care for injured workers, complex policy factors currently limit the application of these recommendations in practice. Research that targets these policies could contribute to significant changes in clinical settings.
近年来，国际上为改善对有赔偿的受伤工人的护理做出了重大努力。然而，尽管在该领域实施最佳实践的努力不断增加，但一些研究表明，监督受伤工人护理组织的政策可能会对医疗服务提供者的做法产生不良影响，并可能阻碍工人获得尽可能好的护理。这些政策对物理治疗师做法的影响尚未得到研究。因此，我们的目标是探讨：1）工人赔偿委员会的政策；2）物理治疗诊所的政策，对加拿大三个大省中为肌肉骨骼受伤工人提供护理的物理治疗师的影响。
采用定性研究方法——诠释性描述框架指导本次调查。在不列颠哥伦比亚省、安大略省和魁北克省招募了40名参与者（30名物理治疗师以及10名来自物理治疗专业团体和工人赔偿委员会的领导及管理人员）参与深度访谈。采用持续比较技术进行归纳分析。
参与者的叙述表明，工人赔偿委员会和个体物理治疗诊所的政策对物理治疗师的临床实践有重大影响。两个层面的政策常常使物理治疗师处于两难境地——他们并不总是能做自己认为对患者最有利的事情。由于这些政策，为有赔偿的受伤工人提供的治疗与在同一诊所接受物理治疗护理的其他患者明显不同。工人赔偿委员会的政策，如报销率、治疗终点和沟通机制，以及诊所政策，如物理治疗师的薪酬方案和对专业人员选择的限制，对护理产生了负面影响。被视为积极的政策是那些认可、促进和支持物理治疗师职责的委员会政策，以及为行政任务提供组织支持的诊所政策。
在加拿大，工人赔偿在为工作中受伤的人支付物理治疗费用方面发挥着重要作用。尽管在促进针对受伤工人康复护理的循证指南和程序方面有良好意愿，但目前复杂的政策因素限制了这些建议在实践中的应用。针对这些政策的研究可能会给临床环境带来重大改变。
