Barriers to Psychologists’ Adherence to Evidence-Based Practice Guidelines for Treating Musculoskeletal Injuries Within the State Insurance Regulatory Authority Compensation Schemes

Abstract

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.

Understanding the barriers affecting psychologists’ adherence to evidence-based treatment guidelines from a stakeholder standpoint

“…The insurers justified their actions by citing GPs' behavior as the driver of their own behavior that, as mentioned above, was based on a desire to do "no harm" and was perceived as a potential outcome of applying the biomedical model. These findings are consistent with previous research that shows that insurers typically have insufficient education and skills to effectively address mental health claims and psychologists may have insufficient knowledge and skills to fully comply with recommended protocols and procedures (Brijnath et al, 2014;Haider & Dunstan, 2019;Haider, Dunstan & Bhullar, 2018). In addition, insurers also viewed the management of musculoskeletal injuries, particularly those resulting from motor vehicle injuries, from the standpoint of the "insurance model" (i.e., the presence of secondary gains explains disability) with the knock-on effect of their inaction making it difficult for psychologists to adopt a biopsychosocial intervention framework (Schultz & Gatchel, 2006).…”

“…Coding used a prior template of predetermined codes (i.e., categories) derived from the interview questions and the findings of an earlier study that had qualitatively explored psychologists' compliance with EBP within SIRA insurance frameworks (Haider & Dunstan, 2019). The categories included were (1) barriers to timely referral by GPs of people with a musculoskeletal injury with secondary psychological injury, (2) barriers to insurers' understanding and timely approval for the provision of psychological treatment, and (3) barriers to injured peoples' engagement and participation in psychological interventions.…”

“…Rigor in data collection, analysis, and interpretation was established by using the criteria established by Lincoln & Guba (1985). Credibility was established by (i) conducting multiple focus groups and individual interviews to compare participant perspectives across diverse geographical locations (i.e., within regional, rural, and metropolitan NSW), insurance framework (i.e., CTP and WC) and compensation agents; (ii) truth value was established by using a detailed interview guide; (iii) confidence in the truth of the data was improved by advising participants that consensus was not the goal and by encouraging them to share their view points; and (iv) data triangulation in the analysis and interpretation was established (i.e., through the use of both face-to-face focus groups and individual and telephone interviews across various geographical regions with the three stakeholders) which enabled comparison of results with earlier studies (Haider & Dunstan, 2019;Haider, Dunstan & Bhullar, 2018) and was reflective of multiple realities.…”

“…This study is the first study to investigate the barriers that affect key stakeholders accessing psychological services for musculoskeletal injuries within the NSW compensation schemes. The state of NSW was selected as previous research findings had indicated that psychologists' compliance with EBP guidelines was variable and barriers to compliance were found to be influenced by stakeholders' actions within this state's compensation schemes (Haider & Dunstan, 2019;Haider et al, 2018). It is not known if similar findings would emerge in other jurisdictions since this is a qualitative study and results cannot be generalized.…”

“…However, this study also found that psychologists' use of these biopsychosocial intervention guidelines was suboptimal. Another qualitative study attempted to explore barriers affecting psychologists' adherence by interviewing 20 psychologists working within CTP and WC frameworks and found that the actions of some key stakeholders (i.e., General Practitioners [GPs], insurers, and injured people) created difficulties in the psychologists' application of the guidelines (Haider & Dunstan, 2019;Haider, Dunstan & Bhullar, 2018). The findings showed that implementing a biopsychosocial approach became difficult, with psychologists identifying untimely referrals by GPs, delays in approval for treatment by insurers, and poor engagement by injured people as affecting their practice (Haider & Dunstan, 2019).…”