Health & EmploymentEvidence to Practice
Kevin Morris
Director Clinical Services
ACC
Without Work all Life GoesRotten – Albert Camus
•BMJ Editorial October 1992 Richard Smith
•“Unemployment raises the chance that a manwill die in the next decade by about a third, andfor those in middle age – with the biggestcommitments – the chance doubles. The menare most likely to die from suicide, cancer, andaccidents and violence.”
Work & Health
•Health Risk = smoking 10 packets ofcigarettes/day (Ross 1995)
•Suicide in young men 6+ months out of work isincreased 40 fold (Wessely, 2004)
•Suicide rate 6 times higher in long term out ofwork (Bartley et al, 2005)
•Health risk & decreased life expectancy impactmore than many “killer” diseases (Waddell &Aylward, 2005)
•Greater risk than the most dangerous jobs e.g.construction/North Sea (Aylward, 2007)
Work & Health
•Preventing Needless Work Disability by Helping People stay Employed –ACOEM – USA -2006
–Introduced “SAW” language
–Noted the incidence of long absence associated with minor injuries
–Recommended focus on the process
•Working for a Healthier Tomorrow – UK – 2007
–“For most people their work is a key factor in their self worth,family esteem and identity. So if they become sick and are nothelped quickly enough, they can all too easily find themselves ona downward spiral into long term sickness and a life on benefits” –Dame Carol Black
•Realising the Health Benefits of Work – AFOEM – NZ & Australia - 2010
–To date the findings are unambiguous. In general, work is goodfor health and wellbeing.
–As physicians, we see the firsthand the personal tragedies thatlong term work absence, unemployment and work disability wreakon individuals, families and communities.
–Rubbing salt into the wound, extended time off work often sees aworsening rather than an improvement in symptoms andconditions it is supposed to ameliorate
RACP, AFOEM – ConsensusStatement 2011
Prevention
•Primary
–Don’t let bad things happen
•Secondary
–Keeping “little things little”
•Tertiary
–Mitigating the damages
Evidence to Practice
The Issue in 2010/11
•Capacity for work certification does not fitexpected norms
•20,000 clients certified as Fully Unfit for 1 monthor more
•15,000 had exceeded MDA optimum
•10,000 had exceeded MDA maximum
Chance of Returning to Workafter workplace injury:
•70% if off for 20 days
•50% if off for 45 days
•35% if off for 70 days
Johnson D, Fry T. Factors Affecting Return to Work after Injury:A study for the Victorian WorkCover Authority Melbourne.Melbourne Institute of Applied Economic and Social Research;2002
What is Better @ Work?
Better @ Work
•Evidence based
•Paradigm Shift
•Behaviour change through Outcome BasedPayments
•Collaboration
Collaboration
•Employers
•Employees/Unions
•Practitioners
•International Input
ACC Cost of being off work
Total cost of being off work
Better @ Work Process
•GP consultation
•Referral & Certification eACC18
•Local Coordinator
•Handover from coordinator to case manager atnegotiated time if incapacity ongoing
•Local agreements with Emergency and A&Mclinics
•Outcome & Fee for Service payments
Outcomes Wanted
•Fewer Employees certificated as “fully unfit” bypractitioners
•All parties are satisfied with the process
Methodology - Difference inDifference
•The impact of a policy on an outcome can beestimated by computing a double difference, oneover time (before-after) and one across sites(between B@W and not B@W)
•If average sample data is available for B@W andnot B@W for at least two time periods, the DIDmethod produces estimates of impacts that arein principle more plausible than those based ona single difference (either over time or betweengroups).
Statistically Significant Results
•Certification of FFSW vs FUF increased by 4.5%overall
•WC cost for claims that lasted 90 – 180 daysdecreased by 21%
Behaviour Change Findings
•Financial Incentives were not the primarymotivator
•Role of RTWC key for both GPs and Employers
•eACC18 essential mechanism
Satisfaction
•“She really helped me with knowing what to do andsay …. When I wasn’t at my best” - client
•“I’ve enjoyed the process and the approach, it shouldbecome the blueprint for a new way of working” – GP
•Client Survey – 82% satisfied or very satisfied withthe service provided by their B @ W GP
•Employers – very enthusiastic about RTW Coordinatorrole
Summary
•Careful and informed prescribing of modified work ortime off work will improve clinical outcomes forpeople (and have financial benefits for workers andemployers)
•Better @ Work is a new system that supports thedelivery of safer and appropriate care to patients
•Providers, employees, employers and ACC all have akey roles and a mutual interest
“Employment is nature’s physician, and isessential to human happiness”
Claudius Galen
131 – 201AD