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Variation in General Practice Services Provided to Australian Workers with Low Back Pain: A Cross-Jurisdictional Comparative Study

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Abstract

Purpose: To compare the frequency of General Practitioner (GP) services and the time between first and last GP services (service duration) provided to workers with low back pain (LBP) between four Australian workers’ compensation jurisdictions. Methods: Retrospective cohort study using service level data collated from the Australian states of Western Australia, South Australia, Victoria and Queensland. Negative binomial regression was used to compare GP service volume between jurisdictions in workers with accepted LBP compensation claims. Quantile regression was used to compare GP service duration. Models were adjusted for sociodemographic factors and occupation. Analyses were repeated in four cohorts with progressively more restrictive cohort definitions to account for the influence of jurisdictional policy variation in employer excess, service delivery and maximum time-loss benefit duration. Results: The study sample included 47,185 time-loss claims accepted between July 2010 and June 2015, that were linked with 452,391 GP services. Workers with LBP in Queensland recorded significantly fewer GP services funded and recorded significantly shorter average service duration than in other states. This pattern of jurisdictional variation was evident in all four cohorts, but was attenuated when cohorts excluded short- and long duration claims. In the final, most restricted cohort statistically significant adjusted incidence rate ratios of 1.47–1.60 were observed in Victoria, South Australia and Western Australia, while these states recorded additional service duration of 4.3–20.7 weeks at the median. Conclusion: There is significant variation in provision of GP services to injured workers with LBP between four Australian workers’ compensation jurisdictions. Administrative requirements for time-based provision of work capacity certificates by medical practitioners may be contributing to service variation.

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Acknowledgements

This paper uses data supplied by WorkSafe Victoria, WorkCover Queensland, ReturnToWork South Australia, and WorkCover Western Australia. The views expressed are the responsibility of the authors and are not necessarily the views of WorkSafe Victoria, WorkCover Queensland, ReturnToWork South Australia, or WorkCover Western Australia.

Funding

Funding was provided via a grant from Safe Work Australia. The views expressed are those of the authors and may not reflect the views of study funders. Professor Alex Collie is supported by an ARC Future Fellowship (FT190100218). Dr Di Donato is supported by a NHMRC Centre of Research Excellence Postdoctoral Fellowship (APP 1171459).

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Authors and Affiliations

  1. School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Australia

    Alex Collie, Luke Sheehan & Michael Di Donato

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  1. Alex Collie
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  2. Luke Sheehan
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  3. Michael Di Donato
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Contributions

AC conceived the study. LS and MDD contributed to study design. MDD, AC and LS conducted data cleaning and harmonisation. AC and LS developed the analysis strategy. LS conducted statistical analysis. AC drafted the manuscript. LS and MDD critically reviewed the manuscript. All authors approved the manuscript prior to submission.

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Correspondence to Alex Collie.

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Conflict of interest

Authors Alex Collie, Luke Sheehan and Michael Di Donato declare that they have no conflict of interest.

Ethical Approval

This study received ethics approval from the Monash University Human Research Ethics Committee (MUHREC) (Project ID 17267, November 2018).

Consent to Participate

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Participant data were de-identified. Consent for use of data for research purposes is assumed when entering each of the workers’ compensation schemes.

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Collie, A., Sheehan, L. & Di Donato, M. Variation in General Practice Services Provided to Australian Workers with Low Back Pain: A Cross-Jurisdictional Comparative Study. J Occup Rehabil 32, 203–214 (2022). https://doi.org/10.1007/s10926-021-10013-8

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