Recover Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
School of Allied Health Sciences, Griffith University, Gold Coast, Australia.
BMC Health Serv Res. 2020 Mar 30;20(1):260. doi: 10.1186/s12913-020-05146-0.
Individuals with whiplash associated disorder (WAD) frequently experience neck pain in addition to other physical, psychological and social symptoms. Consequently, treatment is sought from a variety of health professionals. The limited data available about health services use in this population are conflicting. This study aimed to characterise health service use in individuals with WAD from a motor vehicle crash.
Medical (general practitioner (GP), medical specialist, emergency services (ED), radiology - x-ray, computed tomography, magnetic resonance imaging, ultrasound) and allied health service (physiotherapy, chiropractor, psychologist, osteopath, occupational therapy) use during acute (< 12 weeks) and chronic (12 weeks to 2 years) post-injury periods were analysed in adults claiming compensation for WAD in the no-fault jurisdiction of Victoria, Australia (n = 37,315).
Most WAD claimants had an acute post-injury health service payment (95%, n = 35,348), and approximately one-third (29%, n = 10,871) had a chronic post-injury health service payment. During an acute post-injury period, the most frequently compensated services were for: ED (82% of acute claimants), radiology (56%), and medical specialist (38%). Whereas, physiotherapy (64.4% of chronic claimants), GP (48.1%), and radiology (34.6%) were the most frequently paid services during the chronic period. Females received significantly more payments from physiotherapists (F = 23.4%, M = 18%, z = - 11.3, p < .001, r = 0.13), chiropractors (F = 7.4%, M = 5.6%, z = - 6.3, p < .001, r = 0.13), and psychologists (F = 4.2%, M = 2.8%, z = - 6.7, p < .001, r = 0.18); whereas, males received significantly more medical services payments from medical specialists (F = 41.8%, M = 43.8%, z = - 3.7, p < .001, r = 0.03), ED (F = 74.0%, M = 76.3%, z = - 4.9, p < .001, r = 0.03) and radiology (F = 58.3%, M = 60.1%, z = - 3.4, p < .001, r = 0.02).
Individuals with WAD claimed for a range of health services. Radiology imaging use during the acute post-injury period, and physiotherapy and chiropractor service use during the chronic post-injury period appeared concordant with current WAD management guidelines. Conversely, low physiotherapy and chiropractic use during an acute post-injury period, and high radiology and medical specialists use during the chronic post-injury period appeared discordant with current guidelines. Strategies are needed to help inform medical health professionals of the current guidelines to promote early access to health professionals likely to provide an active approach to treatment, and to address unnecessary referral to radiology and medical specialists in individuals with on-going WAD.
患有挥鞭样损伤相关障碍（WAD）的个体除了其他身体、心理和社会症状外，通常还会出现颈部疼痛。因此，他们会从各种健康专业人员那里寻求治疗。关于该人群的卫生服务利用的有限数据存在矛盾。本研究旨在从机动车事故中描述 WAD 个体的卫生服务利用情况。
在澳大利亚维多利亚州无过错管辖范围内，对声称因 WAD 获得赔偿的成年人（n=37,315），分析了急性（<12 周）和慢性（12 周至 2 年）受伤期内医疗（全科医生（GP）、医学专家、急诊服务（ED）、放射学 - X 光、计算机断层扫描、磁共振成像、超声）和联合健康服务（物理治疗、脊椎指压治疗师、心理学家、整骨医生、职业治疗）的使用情况。
大多数 WAD 索赔者在急性受伤后都有健康服务支付（95%，n=35,348），约三分之一（29%，n=10,871）有慢性受伤后健康服务支付。在急性受伤期间，最常补偿的服务是：ED（82%的急性索赔者）、放射学（56%）和医学专家（38%）。相比之下，在慢性期，最常支付的服务是物理治疗（64.4%的慢性索赔者）、全科医生（48.1%）和放射学（34.6%）。女性从物理治疗师（F=23.4%，M=18%，z=-11.3，p<.001，r=0.13）、脊椎指压治疗师（F=7.4%，M=5.6%，z=-6.3，p<.001，r=0.13）和心理学家（F=4.2%，M=2.8%，z=-6.7，p<.001，r=0.18）获得的支付明显更多；而男性则从医学专家（F=41.8%，M=43.8%，z=-3.7，p<.001，r=0.03）、ED（F=74.0%，M=76.3%，z=-4.9，p<.001，r=0.03）和放射学（F=58.3%，M=60.1%，z=-3.4，p<.001，r=0.02）获得的医疗服务支付明显更多。
患有 WAD 的个体声称使用了一系列的卫生服务。在急性受伤期内进行放射学成像，在慢性受伤期内进行物理治疗和脊椎指压治疗，这似乎与当前的 WAD 管理指南一致。相反，在急性受伤期间物理治疗和脊椎指压治疗的使用率较低，在慢性受伤期间放射学和医学专家的使用率较高，这与当前的指南不一致。需要制定策略，帮助告知医疗保健专业人员当前的指南，以促进他们尽早获得可能提供积极治疗方法的卫生保健专业人员的治疗，并解决在持续存在 WAD 的个体中对放射学和医学专家的不必要转诊。
