Psychologists’ Application of Clinical Guidelines and Recommended Protocols and Procedures within State Insurance Regulatory Authority Insurance Frameworks: Outcomes for Injured Patients with Musculoskeletal Injuries

Abstract

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.

Improving psychologists' adherence to evidence‐based practice guidelines for treating musculoskeletal injuries: A feasibility study

“…The current study adopted a partnership approach with field experts and psychologists to generate recommendations in order to increase adherence with EBP treatment guidelines within the SIRA compensation schemes (Haider et al, ; Tasca, ). Active involvement of psychologists in proposing and examining the feasibility of the recommendations was aimed at improving EBP and increasing engagement to facilitate adoption of the guidelines in ordinary clinical settings (Baker et al, ; Francke, Smit, de Veer, & Mistiaen, ).…”

“…This study also found that poor injured person outcomes were observed when psychologist's adherence to the treatment principles was low (Haider et al, ). Overall, the study found that psychologists' adherence with the treatment principles contained in the Clinical Framework for the Delivery of Health Services was suboptimal (Haider et al, ). The finding is consistent with research in the mental health field which has found that clinicians lack of trust in EBP stems from their belief that clinical guidelines support the interests of administrators and not patients (Corrigan, McCracken, & Blaser, ; Milne, Gorenski, Westerman, Leek, & Keegan, ).…”

“…The coding used a prior template and pre‐determined categories from an earlier study that had found psychologists' adherence with the five EBP principles contained in the Clinical Framework for the Delivery of Health Services was suboptimal (Haider et al, ). The categories included questions aimed at generating recommendations to increase psychologists' adherence with the five EBP principles.…”

“…The findings of a recent study showed that when psychologists' adherence with the treatment principles contained in the Clinical Framework for the Delivery of Health Services was high, improved injured person outcomes and reduced claim costs was observed for musculoskeletal injuries (Haider, Dunstan, & Bhullar, ). This study also found that poor injured person outcomes were observed when psychologist's adherence to the treatment principles was low (Haider et al, ). Overall, the study found that psychologists' adherence with the treatment principles contained in the Clinical Framework for the Delivery of Health Services was suboptimal (Haider et al, ).…”

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

“…The role of psychologists within this intervention framework is significant, as the central focus is on the injured person experiencing the pain and includes appraisal of cognitive and behavioral factors leading to the maintenance and exacerbation of pain (Turk, 2014). In addition, a recently completed qualitative study of case-level files found that when psychologists' adherence with the Clinical Framework was high in the treatment of musculoskeletal injuries (with a secondary psychological injury), lower claims costs and greater positive functional outcomes for injured people were observed (Haider, Dunstan, & Bhullar, 2018). However, this study also found that psychologists' use of these biopsychosocial intervention guidelines was suboptimal.…”