Services Provided by Family Physicians for Patients With Occupational Injuries and Illnesses

PURPOSE Many family doctors provide care to patients with occupational injuries and illnesses, but little is known about the type of medical services provided, or how they compare with services provided by other types of physicians. This study used national data to develop a statistical profile of office-based medical care delivered by family physicians to patients with work-related disorders. METHODS Using data from 4 years (1997–2000) of the National Ambulatory Medical Care Survey, we classified visits for patients with work-related conditions according to patient and physician characteristics, services provided, and other visit characteristics. For comparison, we also compiled profiles for visits to other types of physicians for treatment of work-related disorders, and for visits to family physicians for treatment of nonoccupational conditions. RESULTS Analyses were based on 96,183 office visits made to 4,947 physicians. A majority of visits made to family physicians for occupational conditions involved patients seeing their regular primary care doctor. Possibly for this reason, patients at these visits were more likely to have their blood pressure taken, receive diagnostic and screening services, and have prescription drugs prescribed or administered, compared with patients seeing other types of physicians. Only 73.3% of visits to family physicians for work-related disorders were expected to be paid for by workers’ compensation insurance. CONCLUSIONS Our findings suggest that the distinctive types of care provided by family physicians to injured workers may be related to their role as the patients’ regular physician. This finding is relevant to the proposals being considered by many states to expand employers’ and insurers’ ability to choose the treating physician in workers’ compensation cases

Health services research in workers\u27 compensation medical care: policy issues and research opportunities

OBJECTIVE: To describe some of the unique aspects of medical care offered under workers\u27 compensation insurance systems and discuss the major policy considerations relevant to health services researchers undertaking investigations in this area. BACKGROUND AND FINDINGS: State-based workers\u27 compensation (WC) insurance systems requiring employers to pay for medical care and wage replacement for workplace injuries and illnesses were first developed between 1910 and 1920 in the United States. Employers are generally required to purchase state-regulated workers\u27 compensation insurance that includes first-dollar payment for all medical and rehabilitative services and payment of lost wages to workers with work-related illness or injury. Injured workers have variable but usually limited latitude in choosing their health care provider. Employers and workers\u27 compensation insurers have incentives for controlling both the cost of medical care and lost wages. CONCLUSION: The major policy issues in WC medical care--the effect of patient choice of provider and delivery system structure, the ensuring of high-quality care, the effect of integrating benefits, and investigation of the interrelationships between work, health, and productivity--can be informed by current studies in health services research and by targeted future studies of workers\u27 compensation populations. These studies must consider the extent of patient choice of physician, the regulatory environment, the unique role of the workplace as a risk and modifying factor, and the complex interaction between health and disability insurance benefits

Racial and ethnic variations in office-based medical care for work-related injuries and illnesses

OBJECTIVES: This exploratory study uses nationally representative data to evaluate the extent to which ambulatory care for work-related conditions varies by patients\u27 race and ethnicity. METHODS: Using the National Ambulatory Medical Care Survey (NAMCS) for 1997 and 1998, we describe medical care for work-related conditions, stratifying by whether the patient self-identified as African-American, white, Hispanic and/or non-Hispanic. Multivariate regression analyses were conducted to evaluate the impact of patient race and ethnicity on care, controlling for age, gender, geographical region and MSA (urban/rural) status. RESULTS: Compared to white patients, African-American patients were more likely to receive mental health counseling and physical therapy and less likely to see a nurse, after controlling for age, gender, geographical region and MSA status. Hispanic patients were more likely to receive x-rays and need insurer authorization for care and less likely to receive a prescription drug or to see a physician, compared to non-Hispanics. CONCLUSIONS: This is the nation\u27s first study to describe socially based differences in medical care provided for patients with work-related injuries and illnesses. Identifying areas in which these variations in care exist is a critical first step in ensuring that equitable care is afforded to all injured workers

Office-based medical care for work-related conditions: findings from the National Ambulatory Medical Care Survey, 1997-1998

Data from the 1997 and 1998 National Ambulatory Medical Care Surveys were analyzed to describe nationally representative patterns of office-based ambulatory medical care for work-related injuries and illnesses. Key dimensions of care included patient demographics, diagnoses, utilization of services, provider and payer information, and characteristics of the clinical setting in which care was delivered. Multivariate analyses revealed that compared to visits for nonwork related conditions, ambulatory care visits for work-related conditions are more likely to involve x-rays, injury prevention counseling, and physiotherapy. Surgical procedures, mental health counseling, prescription drug medication, and the taking of blood pressure were found to be relatively less common. Additionally, authorization for care was required considerably more often at visits for work-related conditions, and the provider for patients with work-related conditions was less likely to be the patient\u27s regular primary care physician

Screening and Identification of Depression Among Patients with Coronary Heart Disease and Congestive Heart Failure

Depression occurring concurrently with cardiovascular diseases is associated with poor outcomes. Several review articles have examined the link between established indices of depression and prognosis in individuals with known coronary heart disease (CHD). These studies have demonstrated relatively consistent results and suggest an important connection between cardiovascular morbidity and mortality in patients with depressive symptoms or major depression. This article discusses the current best practices for the screening, identification, and treatment of depression in patients with CHD and coronary heart failure, as well as the financial aspects associated with care management