Acupuncture and the Australian workers' compensation system : studies on the Chinese medicine profession's perceptions and interactions with the workers' compensation system and their treatment of work-related injuries

University of Technology, Sydney. Faculty of Science.The use of acupuncture by Chinese medicine (CM) practitioners has become an increasingly popular treatment modality of choice in Australia in the last four decades. Acupuncture is increasingly being used as part of an individual's health care strategy, with CM practitioners often integrated within a primary care context; they are being consulted on issues of both acute and chronic illness, as providers of treatment for musculoskeletal injury and as sources of lifestyle and dietary advice. As an extension of an individual's choice of treatment for their health has been their choice of treatment in work contexts where the individual as a 'worker', may have suffered an injury or illness during the course of their employment. Termed 'work-related injuries', this falls within the jurisdiction of the 'workers' compensation system' where the individual still retains the right to their choice of treatment(s). Anecdotal reports from an Australian CM professional association and the New South Wales (NSW) workers' compensation industry indicates that acupuncture is being utilised in the Australian workers' compensation system; that injured workers are seeking acupuncture treatments from CM practitioners; while insurance companies are providing payments to CM practitioners on the workers behalf for acupuncture treatment. Where factual evidence for the use and integration of acupuncture was thought to exist, a preliminary search into the Australian workers' compensation system revealed a noticeable paucity of information on the use of acupuncture by CM practitioners. An extensive literature review was undertaken which identified no collated data or documented information in the available literature on the use of acupuncture by CM practitioners within the workers' compensation system beyond the anecdotal reports. In particular, no studies were located investigating the use of acupuncture as a treatment modality within the Australian workers' compensation system. Consequently, the use of acupuncture by CM practitioners to assist injured workers in the recovery of a work-related injury or illness is unknown. Therefore, the primary aim of this thesis was to provide information and an understanding of the utilisation of acupuncture by CM practitioners within the workers' compensation system through a series of investigative studies. The present research is composed of two distinct but inter-related studies (termed Study 1 and Study 2). The aim of Study 1 was to obtain an overview of the CM profession's engagement with Australia's workers' compensation system and a consequent investigation into their perceptions of this system. Data were gathered on the following three areas: • The proportion of CM practitioners engaging with the workers' compensation system as treatment providers of acupuncture to injured workers • CM practitioners perceptions and views of this system, and • To gather demographic profile of the CM practitioners in order to assist in contextualising the responses received with respect to a respondent's state and/or territory of residence. Study 2 was an investigation into the demographic profile of injured workers who received acupuncture from CM practitioners as part of their workers' compensation claim. This was achieved through a retrospective analysis of workers' compensation claims data held by one Scheme Agent in NSW. The primary aims of Study 2 were: • To gather a profile of the injured workers who utilised acupuncture treatment • Profile the work-related injuries treated with acupuncture (identified as occurring during the acute or chronic phase of the injury, the anatomical location of the injury treated, the mechanism and agency of the injury), and • An analysis of the acupuncture treatment cost Together, the two studies begin to address the lack of information that currently exists in the Australian workers' compensation system on the use of acupuncture by Chinese medicine practitioners in the treatment of work-related injuries. The findings from Study 1 confirmed anecdotal reports that CM practitioners have been treating injured workers in Australia's workers' compensation system, with the first reported workers' compensation 'patient' treated in 1970 by a CM practitioner. Study 1 also found significant associations between a CM practitioner's State of residence, perceptions of the State based workers' compensation Scheme and the difficulties faced when engaging with these Schemes. These relationships were attributed to the varying levels of recognition given to acupuncture (as a treatment modality) and CM practitioners (as therapy providers). The demographic information reported in Study 2 found injured workers from across the State of NSW had utilised acupuncture to assist in the recovery of a work-related injury. There was a preference by injured workers to obtain acupuncture treatments from nonmedical acupuncture practitioners versus registered medical practitioners. The findings showed over half of the injured workers also sought acupuncture treatments during the acute stage of an injury (that is, within three months of sustaining the injury) and presented with injuries predominantly located in the trunk and upper limb areas. Injured workers aged between the years of 30-49 used acupuncture more than any other age group, while men who sustained a work-place injury were found to utilise acupuncture more than women. The cost associated with acupuncture treatments per claim were also shown to be reasonable when compared to physiotherapy and chiropractic costs within the study database. Together, the findings from Study 1 and Study 2 showed an overall increase in the number of CM practitioners treating injured workers, particularly during the years 1994 to 2004. The studies provided concrete evidence that acupuncture has been used as a treatment by injured workers within the Australian workers' compensation. In conclusion, the research presented in this thesis provides the first evidence for the systematic use of acupuncture by Chinese medicine practitioners within the Australian workers' compensation system. The continued use of acupuncture within Australia will most likely see a greater number of injured workers seeking acupuncture treatment to assist in the recovery of their work-related injury or illness. This will have implications for Australia's workers' compensation system when CM practitioners become registered in 2012 as part of the National Registration and Accreditation scheme for health professions. In effect, the findings of the studies are valuable to the professional associations (to identify topics of continuing professional education) and to educators (for developing further necessary subjects on 'professional issues' in relation to workers' compensation). The workers' compensation Schemes themselves can draw upon the findings and better develop systems, policy and procedures governing the utilisation of acupuncture by CM practitioners where at present none exist or where it exists in limited form, with the exception of Victoria. Besides noting a need for information, the development of 'education' can be more specifically directed towards topics that have a practice oriented outcome to assist CM practitioners to better engage with the workers' compensation system. This will benefit the workers' compensation Schemes themselves, ensure suitably qualified practitioners are providing the acupuncture treatments and ultimately, ensure the appropriate and timely treatment of injured workers

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