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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2017

Open Access 01-12-2017 | Research article

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

Authors: Nieke A. Elbers, Robin Chase, Ashley Craig, Lyn Guy, Ian A. Harris, James W. Middleton, Michael K. Nicholas, Trudy Rebbeck, John Walsh, Simon Willcock, Keri Lockwood, Ian D Cameron

Published in: BMC Medical Informatics and Decision Making | Issue 1/2017

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Abstract

Background

Problems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers’ compensation system could provide a partial solution, by reducing uncertainty about effective treatment. The aim of this study was to investigate attitudes of health care professionals (HCP) to the potential implementation of an EBM tool in the workers’ compensation setting.

Methods

The study has a mixed methods design. The quantitative study consisted of an online questionnaire asking about self-reported knowledge, attitudes and behaviour to EBM in general. The qualitative study consisted of interviews about an EBM tool being applied in the workers’ compensation process. Participants were health care practitioners from different clinical specialties. They were recruited through the investigators’ clinical networks and the workers’ compensation government regulator’s website.

Results

Participants completing the questionnaire (n = 231) indicated they were knowledgeable about the evidence-base in their field, but perceived some difficulties when applying EBM. General practitioners reported having the greatest obstacles to applying EBM. Participants who were interviewed (n = 15) perceived that an EBM tool in the workers’ compensation setting could potentially have some advantages, such as reducing inappropriate treatment, or over-servicing, and providing guidance for clinicians. However, participants expressed substantial concerns that the EBM tool would not adequately reflect the impact of psychosocial factors on recovery. They also highlighted a lack of timeliness in decision making and proper assessment, particularly in pain management.

Conclusions

Overall, HCP are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers’ compensation setting. The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences. In general, the treatment approval process in the workers’ compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved.
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Metadata
Title
Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study
Authors
Nieke A. Elbers
Robin Chase
Ashley Craig
Lyn Guy
Ian A. Harris
James W. Middleton
Michael K. Nicholas
Trudy Rebbeck
John Walsh
Simon Willcock
Keri Lockwood
Ian D Cameron
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2017
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-017-0460-2

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