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Quantitative Insights to Sickness Certification of
Injured Workers by General Practitioners in
Victoria, Australia
Rasa Ruseckaite & Alex CollieInstitute for Safety, Compensation & Recovery Research, Monash University
3rdAustralasian Compensation Health Research Forum
10 October 2013
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Investigators
o Invest igators: Prof D Mazza (Dpt of General
Practice), Dr B Brijnath (Dpt of General Practice),
Dr A Collie (ISCRR), Dr R Ruseckaite (ISCRR), Dr
I Kosny (DEPM), Sir M Aylward (Cardiff University),Dr D Cohen (Cardiff University), T Fitzgerald
(TAC/WorkSafe)
o Adv isors: Ms D Jacobs (WorkSafe), Mr P McKee
(WorkSafe), Ms S Tinsley (WorkSafe)
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Rationale
o GPs occupy an important position and can help
increase understanding of health benefits of work
and facilitate RTW
o There is no data in the academic literature fromthe Australian context on the role of GPs in
enabling injured workers to RTW
o Workers compensation claims data provides a
unique opportunity to explore & understand GPsinteractions with injured workers.
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Facilitating injured persons Return To Work:
Optimizing the general practitioners role in the
Australian injury compensation system
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Objectives
o To determine the behavior of GPs with regard
to medical certification of injured workers
o To develop quantitative insights into the
experiences of injured workers and GPs in the
RTW process
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WorkSafe Victoria dataset
1985 to 2012
All datasets linked by
Claim ID
Services, Payments and
Certificates also linked
by Provider ID
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Quantitative analyses
1. Sickness certification of injured and ill workers
by GPs in Victoriaa descriptive study
2. Has GPs medical certification behavior
changed over time?
3. Does medical certification behavior differ in GPs
with high versus low injured workers case-loads?
4. What are health service use patterns in injuredworkers post-medical certification?
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Sickness certification of injured and ill
workers by GPs in Victoriaadescriptive study
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Aims
o To examine the sickness certification patterns
of GPs by nature of injury and disease
o Unfit for work, alternate duties and fit for
work certificates
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Inclusion/exclusion criteria
o Accepted time-loss claims lodged by working ageadults (15 - 65 years), 2003 - 2010
o Initial medical certificates only
o
Claims were excluded if :o the claim was for healthcare expenses (i.e.,
income replacement benefits were not
paid);
o the initial medical certificate written by ahealth practitioner other than a GP;
o no record of an initial medical certificate.
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Affliction groups
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Sample characteristics
o
9,750 GPs issued initial medical certificates to124,424 workers.
o 71.4% -unfit for work, 22.7% -alternate duties,
3.2% - fit for work certificates.
o Males were significantly more likely to receive
certificates of all types (MHC category is an
exception)
o Workers with traumatic injuries were younger,whereas those with MHCs and other diseases were
slightly older
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Distribution of GP issued initial medical
certificates by workers condition
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Proportion of unfit for work, alternate
duties and fit for work certificates
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Median (IQR) duration of unfit for work &
alternate duties certificates
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Has GPs medical certification behavior
changed over time?
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Aims
o To report annual changes in ratesand duration
of the initial GPs medical certificates over the 8
years period across the most common
conditions
o Unfit for work vs. alternate duties certificates
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Methods
o Unadjusted rates per 1,000 Victorian workingpopulation
o Annual changes in N and % of injured workers -
Poisson count regression, IRRs
o Annual changes in duration - Negative binomial
regression, IRRs
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Models adjusted for age and claim counto Analysis stratified by gender
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Rates per 1,000 Victorian working population
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Incidence rate-ratios by gender
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Summary
o There is substantial variation in the type/duration of medical
certificates.o People with MHC are unlikely to receive alternate duties
certificate.
o A significant decrease in the unadjusted annual certification
rates per 1,000 working population.
o After adjusting for the number of claims, the IRRs increase
over time.
o GPs in Victoria issue an increasing number of sickness
certi f ic ates each year, with the majority of certificates
being unf i t for wo rk.
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Thank you
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This project is funded by WorkSafe Victoria, through theInstitute for Safety, Compensation and Recovery Research.
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Acknowledgements
