Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Aila Nica Bandong, Andrew Leaver, Martin Mackey, Rodney Ingram, Samantha Shearman, Christen Chan, Ian D. Cameron, Niamh Moloney, Rebecca Mitchell, Eoin Doyle, Emma Leyten, Trudy Rebbeck

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuously developing and implementing clinical practice guidelines to address the health and economic burden from whiplash associated disorders (WAD). Despite this, it is uncertain the extent to which the guidelines are followed. This study aimed to determine insurer and health professional compliance with recommendations of the 2014 NSW clinical practice guidelines for the management of acute WAD; and explore factors related to adherence. Methods: This was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis. Results: Median time for general practitioner medical consultation was 4 days post-injury and 25 days for physical treatment (e.g. physiotherapy). Rates of x-ray investigations were low (21.5%) and most patients (90%) were given active treatments in line with the guideline recommendations. The frequency of other practices recommended by the guidelines suggested lower guideline adherence in some areas such as; using the Quebec Task Force classification (19.9%); not using specialised imaging for WAD grades I and II (e.g. MRI, 45.8%); not using routine passive treatments (e.g. manual therapy, 94.0%); and assessing risk of non-recovery using relevant prognostic tools (e.g. Neck Disability Index, 12.8%). Over half of the claimants (59.0%) were referred to other professionals at 9-12 weeks post-injury, among which 31.2% were to psychologists and 68.8% to specialists (surgical specialists, 43.6%; WAD specialists, 20.5%). Legal representation and lodgment of full claim were associated with increased number of medical visits and imaging (ρ 0.23 to 0.3; p < 0.01). Conclusion: There is evidence of positive uptake of some guideline recommendations by insurers and health professionals; however, there are practices that are not compliant and might lead to poor health outcomes and greater treatment cost. Organisational, regulatory and professional implementation strategies may be considered to change practice, improve scheme performance and ultimately improve outcomes for people with WAD.

LanguageEnglish
Article number622
Pages1-16
Number of pages16
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
Publication statusPublished - 8 Aug 2018

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Insurance Carriers
South Australia
New South Wales
Professional Practice
Guidelines
Practice Guidelines
Health
Insurance
Wounds and Injuries
Guideline Adherence
Musculoskeletal Manipulations
Quebec
Practice Management
Advisory Committees
Diagnostic Imaging
Health Care Costs
General Practitioners
Health Services
Observational Studies
Neck

Bibliographical note

Copyright the Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Clinical practice guidelines
  • Compliance
  • Guideline adherence
  • Insurance audits
  • Primary care
  • Professional practice
  • Whiplash injury

Cite this

Bandong, Aila Nica ; Leaver, Andrew ; Mackey, Martin ; Ingram, Rodney ; Shearman, Samantha ; Chan, Christen ; Cameron, Ian D. ; Moloney, Niamh ; Mitchell, Rebecca ; Doyle, Eoin ; Leyten, Emma ; Rebbeck, Trudy. / Adoption and use of guidelines for whiplash : an audit of insurer and health professional practice in New South Wales, Australia. In: BMC Health Services Research. 2018 ; Vol. 18, No. 1. pp. 1-16.
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title = "Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia",
abstract = "Background: In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuously developing and implementing clinical practice guidelines to address the health and economic burden from whiplash associated disorders (WAD). Despite this, it is uncertain the extent to which the guidelines are followed. This study aimed to determine insurer and health professional compliance with recommendations of the 2014 NSW clinical practice guidelines for the management of acute WAD; and explore factors related to adherence. Methods: This was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis. Results: Median time for general practitioner medical consultation was 4 days post-injury and 25 days for physical treatment (e.g. physiotherapy). Rates of x-ray investigations were low (21.5{\%}) and most patients (90{\%}) were given active treatments in line with the guideline recommendations. The frequency of other practices recommended by the guidelines suggested lower guideline adherence in some areas such as; using the Quebec Task Force classification (19.9{\%}); not using specialised imaging for WAD grades I and II (e.g. MRI, 45.8{\%}); not using routine passive treatments (e.g. manual therapy, 94.0{\%}); and assessing risk of non-recovery using relevant prognostic tools (e.g. Neck Disability Index, 12.8{\%}). Over half of the claimants (59.0{\%}) were referred to other professionals at 9-12 weeks post-injury, among which 31.2{\%} were to psychologists and 68.8{\%} to specialists (surgical specialists, 43.6{\%}; WAD specialists, 20.5{\%}). Legal representation and lodgment of full claim were associated with increased number of medical visits and imaging (ρ 0.23 to 0.3; p < 0.01). Conclusion: There is evidence of positive uptake of some guideline recommendations by insurers and health professionals; however, there are practices that are not compliant and might lead to poor health outcomes and greater treatment cost. Organisational, regulatory and professional implementation strategies may be considered to change practice, improve scheme performance and ultimately improve outcomes for people with WAD.",
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Bandong, AN, Leaver, A, Mackey, M, Ingram, R, Shearman, S, Chan, C, Cameron, ID, Moloney, N, Mitchell, R, Doyle, E, Leyten, E & Rebbeck, T 2018, 'Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia', BMC Health Services Research, vol. 18, no. 1, 622, pp. 1-16. https://doi.org/10.1186/s12913-018-3439-5

Adoption and use of guidelines for whiplash : an audit of insurer and health professional practice in New South Wales, Australia. / Bandong, Aila Nica; Leaver, Andrew; Mackey, Martin; Ingram, Rodney; Shearman, Samantha; Chan, Christen; Cameron, Ian D.; Moloney, Niamh; Mitchell, Rebecca; Doyle, Eoin; Leyten, Emma; Rebbeck, Trudy.

In: BMC Health Services Research, Vol. 18, No. 1, 622, 08.08.2018, p. 1-16.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Leaver, Andrew

AU - Mackey, Martin

AU - Ingram, Rodney

AU - Shearman, Samantha

AU - Chan, Christen

AU - Cameron, Ian D.

AU - Moloney, Niamh

AU - Mitchell, Rebecca

AU - Doyle, Eoin

AU - Leyten, Emma

AU - Rebbeck, Trudy

N1 - Copyright the Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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N2 - Background: In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuously developing and implementing clinical practice guidelines to address the health and economic burden from whiplash associated disorders (WAD). Despite this, it is uncertain the extent to which the guidelines are followed. This study aimed to determine insurer and health professional compliance with recommendations of the 2014 NSW clinical practice guidelines for the management of acute WAD; and explore factors related to adherence. Methods: This was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis. Results: Median time for general practitioner medical consultation was 4 days post-injury and 25 days for physical treatment (e.g. physiotherapy). Rates of x-ray investigations were low (21.5%) and most patients (90%) were given active treatments in line with the guideline recommendations. The frequency of other practices recommended by the guidelines suggested lower guideline adherence in some areas such as; using the Quebec Task Force classification (19.9%); not using specialised imaging for WAD grades I and II (e.g. MRI, 45.8%); not using routine passive treatments (e.g. manual therapy, 94.0%); and assessing risk of non-recovery using relevant prognostic tools (e.g. Neck Disability Index, 12.8%). Over half of the claimants (59.0%) were referred to other professionals at 9-12 weeks post-injury, among which 31.2% were to psychologists and 68.8% to specialists (surgical specialists, 43.6%; WAD specialists, 20.5%). Legal representation and lodgment of full claim were associated with increased number of medical visits and imaging (ρ 0.23 to 0.3; p < 0.01). Conclusion: There is evidence of positive uptake of some guideline recommendations by insurers and health professionals; however, there are practices that are not compliant and might lead to poor health outcomes and greater treatment cost. Organisational, regulatory and professional implementation strategies may be considered to change practice, improve scheme performance and ultimately improve outcomes for people with WAD.

AB - Background: In Australia, the New South Wales (NSW) State Insurance Regulatory Authority has been continuously developing and implementing clinical practice guidelines to address the health and economic burden from whiplash associated disorders (WAD). Despite this, it is uncertain the extent to which the guidelines are followed. This study aimed to determine insurer and health professional compliance with recommendations of the 2014 NSW clinical practice guidelines for the management of acute WAD; and explore factors related to adherence. Methods: This was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis. Results: Median time for general practitioner medical consultation was 4 days post-injury and 25 days for physical treatment (e.g. physiotherapy). Rates of x-ray investigations were low (21.5%) and most patients (90%) were given active treatments in line with the guideline recommendations. The frequency of other practices recommended by the guidelines suggested lower guideline adherence in some areas such as; using the Quebec Task Force classification (19.9%); not using specialised imaging for WAD grades I and II (e.g. MRI, 45.8%); not using routine passive treatments (e.g. manual therapy, 94.0%); and assessing risk of non-recovery using relevant prognostic tools (e.g. Neck Disability Index, 12.8%). Over half of the claimants (59.0%) were referred to other professionals at 9-12 weeks post-injury, among which 31.2% were to psychologists and 68.8% to specialists (surgical specialists, 43.6%; WAD specialists, 20.5%). Legal representation and lodgment of full claim were associated with increased number of medical visits and imaging (ρ 0.23 to 0.3; p < 0.01). Conclusion: There is evidence of positive uptake of some guideline recommendations by insurers and health professionals; however, there are practices that are not compliant and might lead to poor health outcomes and greater treatment cost. Organisational, regulatory and professional implementation strategies may be considered to change practice, improve scheme performance and ultimately improve outcomes for people with WAD.

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KW - Insurance audits

KW - Primary care

KW - Professional practice

KW - Whiplash injury

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