Objective: In 2010, the State Insurance Regulatory Authority (SIRA), which governs the regulatory functions of workers' compensation insurance (WCI) and compulsory third-party insurance (CTP) within NSW, implemented evidence-based clinical guidelines to improve psychologists' practice. The aims of this study were to determine (a) whether this initiative has reduced claims costs and improved injured patient outcomes and (b) whether it has resulted in psychologists using evidence-based practice. Method: The first phase involved quantitatively determining a time-range sample of WCI administrative records of patients with a musculoskeletal injury (n = 26,254) and musculoskeletal injury with a secondary psychological injury (n = 238). The second and third phases involved a qualitative content analysis of case-level files belonging to individuals who had suffered a musculoskeletal injury with a secondary psychological injury under WCI (Phase 2) (n = 12) and CTP (Phase 3) (n = 9). Results: The quantitative component revealed that the total claims costs and return to work timeframes for injured patients suffering from musculoskeletal injury with a secondary psychological injury remained unchanged following the implementation of the clinical guidelines. However, this contrasted with a significant increase of these measures for injured workers with only a musculoskeletal injury. The qualitative content analysis in Phases 2 and 3 of the study showed that psychologists' application of treatment guidelines was suboptimal. Conclusion: The implementation of the 2010 clinical guidelines for psychologists has led to beneficial outcomes for patients injured under the SIRA insurance frameworks; however, greater adherence by psychologists and strategies to improve the adoption of these guidelines are warranted.
Objectives:The use of evidence-based practice (EBP) guidelines by psychologists working within the State Insurance Regulatory Authority (SIRA) compensation schemes for treating musculoskeletal injuries has been found to vary. The aim of this study was to qualitatively explore psychologists’ perceived barriers to adhering with EBP guidelines implemented by the New South Wales (NSW) SIRA.Methods:Registered psychologists (n= 20) working within the NSW SIRA compensation schemes participated in four focus groups conducted face-to-face (F2F) and online. Participants’ responses were audiotaped, transcribed verbatim and entered into NVivo 11 software. Text data were analysed to identify recurrent themes within and across groups (metropolitan, regional and rural).Results:Thematic analysis revealed three key issues: (a) a lack of trust in the validity of the recommended EBP guidelines; (b) lack of knowledge of the psychologist’s role in this context and insufficient skills to fully apply the guidelines, protocols and procedures; and (c) a poor fit between EBP guidelines, client presentations and circumstances, and the SIRA compensation schemes.ConclusionThe findings showed that both individual practitioner variables and contextual barriers influenced adherence to EBP. Practical implications for future research include generating recommendations to overcome the identified barriers using a collaborative approach between policymakers, researchers and practitioners.
Objectives
The New South Wales personal injury compensation schemes have produced evidence‐based practice (EBP) treatment guidelines for the management of functional disability following musculoskeletal injury. Psychologists' adherence with these guidelines is suboptimal, therefore the aim of this study was to elicit recommendations from field experts to overcome barriers to adherence and determine feasibility of their application by psychologists working within these schemes.
Methods
A mixed methods design was used, consisting of a focus group and individual interviews (n = 8) of field experts followed by an online survey of psychologists (n = 150). The qualitative data were imported into QSR NVivo software and analysed using thematic analysis. The survey data were analysed using descriptive statistics in SPSS, and the narrative data were subjected to content analysis.
Results
Five recommendations were made by experts and endorsed by majority of surveyed psychologists; however, some practical issues impacting application were identified. The recommendations included: mandatory training and continuing professional development; use of independent consultants for expert advice; completion of outcome measures prior to the first session and again in the eighth and final sessions; completion of the treatment plan in‐session with the injured person. From the narrative comments of surveyed psychologists two key reasons for not endorsing the recommendations emerged: time and cost burden of compliance; and a perceived low efficacy for enhancing clinical practice.
Conclusion
Overall, the recommendations proposed by field experts to increase adherence with EBP treatment guidelines were endorsed by the wider community of psychologists working under State Insurance Regulatory Authority insurance schemes.
Psychologists’ adherence with evidence-based guidelines based on the biopsychosocial premise in the management of musculoskeletal injuries is influenced by the actions by General Practitioners (GPs), insurers, and injured patients’ actions. For data collection, we interviewed GPs (n = 6), insurers (n = 6), and injured people (n = 15) from the two personal injury compensation schemes in New South Wales. Thematic analysis yielded the following: GPs were reticent to access psychological services that represented a poor fit between their practice and treatment guidelines, insurers lacked trust in the validity of “secondary psychological injury” claims’. Injured peoples’ willingness to engage with treatment was impaired by a poor fit between the treatment guidelines and their experience of insurers’ and psychologists’ practices.
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