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Open Access 01-12-2018 | Research article

Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Authors: Aila Nica Bandong, Andrew Leaver, Martin Mackey, Rodney Ingram, Samantha Shearman, Christen Chan, Ian D Cameron, Niamh Moloney, Rebecca Mitchell, Eoin Doyle, Emma Leyten, Trudy Rebbeck

Published in: BMC Health Services Research | Issue 1/2018

Abstract

Background

In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuously developing and implementing clinical practice guidelines to address the health and economic burden from whiplash associated disorders (WAD). Despite this, it is uncertain the extent to which the guidelines are followed. This study aimed to determine insurer and health professional compliance with recommendations of the 2014 NSW clinical practice guidelines for the management of acute WAD; and explore factors related to adherence.

Methods

This was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis.

Results

Median time for general practitioner medical consultation was 4 days post-injury and 25 days for physical treatment (e.g. physiotherapy). Rates of x-ray investigations were low (21.5%) and most patients (90%) were given active treatments in line with the guideline recommendations. The frequency of other practices recommended by the guidelines suggested lower guideline adherence in some areas such as; using the Quebec Task Force classification (19.9%); not using specialised imaging for WAD grades I and II (e.g. MRI, 45.8%); not using routine passive treatments (e.g. manual therapy, 94.0%); and assessing risk of non-recovery using relevant prognostic tools (e.g. Neck Disability Index, 12.8%). Over half of the claimants (59.0%) were referred to other professionals at 9–12 weeks post-injury, among which 31.2% were to psychologists and 68.8% to specialists (surgical specialists, 43.6%; WAD specialists, 20.5%). Legal representation and lodgment of full claim were associated with increased number of medical visits and imaging (ρ 0.23 to 0.3; p < 0.01).

Conclusion

There is evidence of positive uptake of some guideline recommendations by insurers and health professionals; however, there are practices that are not compliant and might lead to poor health outcomes and greater treatment cost. Organisational, regulatory and professional implementation strategies may be considered to change practice, improve scheme performance and ultimately improve outcomes for people with WAD.

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Title: Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia
Authors: Aila Nica Bandong
Andrew Leaver
Martin Mackey
Rodney Ingram
Samantha Shearman
Christen Chan
Ian D Cameron
Niamh Moloney
Rebecca Mitchell
Eoin Doyle
Emma Leyten
Trudy Rebbeck
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-018-3439-5

At a glance: The STEP trials

Springer Medicine

Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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Barriers to progressing through a methadone maintenance treatment programme: perspectives of the clients in the Mid-West of Ireland’s drug and alcohol services