The Role of Resilience in Workers Compensation Peta Odgers ACHRF 2013
ACC Recent Experience With Primary Margaret Macky ACHRF 2013
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Transcript of ACC Recent Experience With Primary Margaret Macky ACHRF 2013
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ACC’s recent experience with primarycare and “stay at work”
Margaret Macky MBChB FAFOEM
Acting Co-Director Clinical Services Directorate
Accident Compensation Corporation , NZ
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Why General Practice ?
•75% incapacity certificates
• Task treated as end of consult administrative step
• Opportunity:• to lift clinical approach to determining fitness for work• encourage a stay at work approach
•Help GPs to see their role differently
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Pilot in three sites
• GPs able to refer to a primary care based “Better at work”coordinator
• Direct referral embedded in a purpose built off work electroniccertificate
• Enable patients to stay at work with safe modified duties
• Feedback on certification and data on RTW via primaryhealthcare organisations
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Results a window on behaviouralchange
Better @Work 2008-2010 demonstrated
• Certifying behaviour of GPs changed with knowledge, trustin a RTW coordinator and an enabling form
• Safe RTW could be much earlier in course of injury withthe right support
• GPs don’t feel they have enough control over workplace tocertify FFSW without someone protecting patient
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Certification project
•Start with GPs
•Make it easy to certify responsibly : The form must enable good
clinical practice
•Ensure GPs have the knowledge and feedback on progress: liftcertification to clinical level.
•Make sure good rehabilitation services are available
• ACC commitment to respond to GPs as partners
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An enhanced eACC18 form
• Remove any default incentive to fully unfit
• Encourage “Fitness for work” thinking
• Easy to use
• Rapid transit to ACC
• Enable referral for return to work assistance
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[8]
Completing the eACC18
Some key changes have been
made to the eACC18 form to
reflect the shift from thinking
about ‘sick notes’ to thinking
about ‘fit notes.
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[9]
Completing the eACC18
The old work capacity section has
been renamed Fitness for Work
and the boxes reordered so Fully
Unfit for Work is after Fit for Some
Work 1 and 2.
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[10]
Completing the eACC18
Support needed to stay at work /
return to work – if you tick this box,
ACC will take action within two
working days.
Clinical review of patient’s fitness
for work needed – tick this if you
want to request this service.
0508 ACC RTW – if you’d like to
speak to ACC about return to work.
If RTW help is required at the first
visit, you can either use theeACC18 as well as the ACC45
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Vocational rehabilitation
“stay at work” service available atthe GPs’ signal
•Trusted OT/PT/OHN assessing workplace
•Ensuring safe translation of certificate into the workplace
•Quick response
•Ensure employer adherence
• Watch for flags
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[12]
Cert i fy ing Fi tness fo r Work
Stay at Work Level 1 Service for patients with simplerehab needs to return to pre-injury employment or
temporarily modified job with their current employer
Stay at Work Level 4 – Tailored Service for patients
with complex rehab needs with multiple risk
factors/barriers to achieve an early return to work.
Service elements and timeframes negotiated – will
require an integrated multidisciplinary team (each
case is individually costed)
Stay at Work Level 2 Service for patients with risk
factors/barriers to achieving and early return to work
who require rehab to return to pre-injury
employment or modified job wit their currentemployer – may require an integrated
multidisciplinary team
Stay at Work Level 3 Service – as for Level 2, but
where a patient requires more extensive services
within the same timeframe – likely to require an
integrated multidisciplinary team
Same job
and
employer
or
Modified
job and
same
employer
When an injured worker requires vocational rehab, there are some options:
New joband same
employer
or
Maximum
employmen
t
participatio
n
Maximum
2 weeks
Negotiable
Maximum
6 weeks
Maximum
6 weeks
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Referral to Occupational Health Doctor available on GP’s signal:
Clinical Review of Fitness for Work
• medical practitioner with expertise in assessing fitness for
work ( occupational medicine)
• shorter assessment : intended to be in the early phases ofinjury
• template reports
• emphasis on communication : requirement to call GP andemployer and other parties such as surgeon/physio ifrequired
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Contracting with Primary Healthcare
Organisations to improve GPknowledge and engagement
Goal:
- Increase in Fit For Selected Work
- Use of the electronic certificate
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North Island
Health Hawkes Bay
Waitemata
Procare Networks
Midlands Health Network
Te Tai Tokerau
Alliance Health
Compass Primary Health (including
Wairarapa and Central)
Health Rotorua
Maniaia Health
Te Awakairangi
South Island
Nelson Bays Primary (including KimiHauora Wairau)
Southern
Pegasus Health (includes Christchurch
PHO)
Rural Canterbury
Summary:
14 GPSS contracts are signed, which cover 18 PHOs and they represent coverage
of ~90% of all GPs nationally. These contracts between ACC and PHOs:
– provide CME qualifying and educational training
– support use of the eACC18
In addition ~85% of all GP Practices can now submit ACC18s electronically
General Practice Support Services PHO Contracts
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PHOs taking the lead in influencingknowledge and certifyingbehaviour
• Introducing GP practices to electronic form
• Encouraging uptake
• Educational support : Continuing professional developmentmeetings.
• Pre prepared materials : case studies, e learning, large and smallgroup resources
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[17]
Meet Barry
Barry (56) has been your patient
for 17 years. You know him well –
seeing him fairly regularly forNIDDM and hypertension,
Eight weeks ago, Barry was moving
some sheets of GIB board on site when
the wind caught the sheet he wascarrying and wrenched his right arm up
and backwards. It turned out he
sustained a complete subscapularis
tear. He had surgery as an urgent case
within ten days.
The surgeon saw Barry last week (at 5 weeks
post-op). He advises “take it easy , build up
slowly and don’t overload load or strain the
shoulder for at least 8 further weeks”.
Barry has come to see you to get some painrelief and to get a further work certificate.
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Roll out phased across NZ
Oct 2012
February 2013
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Wobbles
• PHO engagement lagged behind roll out
• Delayed engagement with new services
• Difficult to match data to PHOs leading to mid stream change intargets
• Internal training did not achieve good level of engagement• Delay in response to GPs’ signal RTW need• Resolved with automated task• Poor understanding of potential in clinical review of
fitness for work
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Emerging trends
✔ GPs using the eACC18
But : While GPs are certifying FFSW, overall ratio is static
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How the ACC18 formsand fit for selected work are tracking
nationally
Count of ACC18s per week
0
1000
2000
3000
4000
5000
6000
3 / 0 7 / 2 0
1 1
3 / 0 8 / 2 0
1 1
3 / 0 9 / 2 0
1 1
3 / 1 0 / 2 0
1 1
3 / 1 1 / 2 0
1 1
3 / 1 2 / 2 0
1 1
3 / 0 1 / 2 0
1 2
3 / 0 2 / 2 0
1 2
3 / 0 3 / 2 0
1 2
3 / 0 4 / 2 0
1 2
3 / 0 5 / 2 0
1 2
3 / 0 6 / 2 0
1 2
3 / 0 7 / 2 0
1 2
3 / 0 8 / 2 0
1 2
3 / 0 9 / 2 0
1 2
3 / 1 0 / 2 0
1 2
3 / 1 1 / 2 0
1 2
3 / 1 2 / 2 0
1 2
3 / 0 1 / 2 0
1 3
3 / 0 2 / 2 0
1 3
3 / 0 3 / 2 0
1 3
3 / 0 4 / 2 0
1 3
3 / 0 5 / 2 0
1 3
3 / 0 6 / 2 0
1 3
3 / 0 7 / 2 0
1 3
3 / 0 8 / 2 0
1 3
3 / 0 9 / 2 0
1 3
Non electronic
Electronic
ACC18s by week
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
3 / 0 7 / 2 0 1 1
3 / 0 8 / 2 0 1 1
3 / 0 9 / 2 0 1 1
3 / 1 0 / 2 0 1 1
3 / 1 1 / 2 0 1 1
3 / 1 2 / 2 0 1 1
3 / 0 1 / 2 0 1 2
3 / 0 2 / 2 0 1 2
3 / 0 3 / 2 0 1 2
3 / 0 4 / 2 0 1 2
3 / 0 5 / 2 0 1 2
3 / 0 6 / 2 0 1 2
3 / 0 7 / 2 0 1 2
3 / 0 8 / 2 0 1 2
3 / 0 9 / 2 0 1 2
3 / 1 0 / 2 0 1 2
3 / 1 1 / 2 0 1 2
3 / 1 2 / 2 0 1 2
3 / 0 1 / 2 0 1 3
3 / 0 2 / 2 0 1 3
3 / 0 3 / 2 0 1 3
3 / 0 4 / 2 0 1 3
3 / 0 5 / 2 0 1 3
3 / 0 6 / 2 0 1 3
3 / 0 7 / 2 0 1 3
P r o p o r t i o n
e l e c t r o n i c A
C C 1 8 s p e r w
e e k
%
electronic
% FFSW
• the volume of
electronic
ACC18s is
increasing
• the proportion
of ACC18s
overall certified
FFSW is notchanging
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Emerging trends
✔: GPs using the eACC18
But: While GPs are certifying FFSW, overall ratio is static
✔: Certificates tending to be for shorter durations
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Count of ACC18s by days certfied off work (manual or electronic) 52 weeks ending 4 Aug 2013
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
1 4 7 1 0 1 3 1 6 1 9 2 2 2 5 2 8 3 1 3 4 3 7 4 0 4 3 4 6 4 9 5 2 5 5 5 8 6 1 6 4 6 7 7 0 7 3 7 6 7 9 8 2 8 5 8 8 9 1 9 4 9 7 1 0
0
Number of days certified of f w ork on ACC18
C o u n t o f A C C 1 8 s i n y e a r
Electronic
Cert i f icat ionDistribution of days certified
• Most certification
is in 7-day blocks
Count of ACC18s by days certfied off work (manual or electronic) 52 weeks ending 4 Aug 2013
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
1 4 7 1 0 1 3 1 6 1 9 2 2 2 5 2 8 3 1 3 4 3 7 4 0 4 3 4 6 4 9 5 2 5 5 5 8 6 1 6 4 6 7 7 0 7 3 7 6 7 9 8 2 8 5 8 8 9 1 9 4 9 7 1 0 0
Number of days certified off w ork on ACC18
C o u n t o f A C C 1 8 s i n y e a r
Non
electronic
7
14
2128
42
90
7 14
21 28
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20
22
24
26
28
30
32
34
36
38
40
J u l 1 0
J a n 1 1
J u l 1 1
J a n 1 2
J u l 1 2
J a n 1 3
J u l 1 3
J a n 1 4
C e r t i f i e d d a y s o f f
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% E
l e c t r o n i c
52 wk Avg Duration All Certs 52wk Avg Duration Paper
52wk Avg Duration Electronic Electronic % of all certs
Cert i f icat ion
Average Medical Cert i f icate Durat ion Lower
fo r eACC18
eACC18=28
Manual=32
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Emerging trends
✔: GPs using the eACC18
✖ : While more GPs are certifying FFSW, overall ratio is static
✔: Certificates tending to be for shorter durations
✔GPs are signaling the need for RTW assistance
✔: ACC is able to respond ( 82% within a few days)
✖: Very low numbers of referral to Occupational Health referral made
✖: Perception that “Stay at work” is still underutilised
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Emerging trends
✔: roll on effect into emergency departments and orthopaedic clinics
✔: GPs signal ownership of certification as a clinical issue (Omnibussurvey and GP peer group meetings)
✔ Consolidation :
initial lodgement goes electronic ( eACC45)
electronic certificates into specialist/ED
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What went well
• Electronic form
• Project itself
•Vocational rehab providers
keen
• PHOs engaged
..a bit less well
• FFSW results
• Sizing of internal change
• lag between streams of work
• Low referrals : yes more targeted buthave we missed the GP – SAWrelationship lever?
• Employers and patients secondary focus
• Variable PHO capability
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