The Relationship between Continuity of Care with a Primary Care Provider and Duration of Work Disability in Workers with Low Back Pain: A Retrospective Cohort Study

Abstract

AbstractObjectiveTo determine the continuity of care (CoC) provided by general practitioners among workers with low back pain; identify personal, workplace and social factors associated with CoC in this population; and investigate if CoC is associated with working time loss.Data sourcesAn administrative database containing accepted workers’ compensation claim and service level data, for workers with back pain from five Australian jurisdictions, injured between July 2010 and June 2015.Study DesignA retrospective cohort study. Outcomes were CoC with a general practitioner, measured with the Usual Provider Continuity index, and working time loss, measured as the number of weeks for which workers’ compensation income support benefits were paid.Extraction methodsEligible workers had at least four general practitioner services, and greater than two weeks working time loss. Usual Provider Continuity index score was categorised as complete, high, moderate, or low CoC. Ordinal logistic regression models examined factors associated with Usual Provider Continuity category. Quantile regression models examined association between duration of working time loss and Usual Provider Continuity category, in four groups with different volumes of general practitioner services.Principal FindingsComplete CoC was observed in 33.8% of workers, high CoC among 37.7%, moderate CoC in 22.1%, and low CoC in 6.4%. Higher Usual Provider Continuity was associated with fewer general practitioner services, older age, living in urban areas, an occupation as a Community and Personal Service Worker or Clerical and Administrative Worker, and the state of Victoria. In workers with more than two months of time loss, those with complete CoC consistently had shorter durations of time loss.ConclusionsHigher CoC with a general practitioner is associated with less working time loss and this relationship is strongest in the sub-acute phase of low back pain.Callout BoxWhat is known on this topicContinuity of care is a key component of best practice primary careLow back pain is a condition that often requires ongoing management and care from a general practitionerThe relationship between continuity of care and work disability duration, recovery and return to work in workers with low back pain is not knownWhat this study addsWorkers with low back pain who see the same general practitioner for all services (i.e., have a greater continuity of care) generally have shorter durations of working time lossHigher continuity of care was observed in workers who had fewer PCP services, were aged over 45, lived in urban areas, and worked as a Community and Personal Service Worker or Clerical and Administrative WorkerWorkers’ compensation systems should consider policies and guidelines that increase continuity of care in injured workers