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

Breast cancer and combined oral contraceptives: Results from a multinational study

A collaborative, hospital-based case-control study was conducted at 12 participating centres in 10 countries. Based on data from personal interviews of 2, 116 women with newly diagnosed breast cancer and 12,077 controls, the relative risk of breast cancer in women who ever used oral contraceptives was estimated to be 1.15 (1.02, 1.29). Estimated values of this relative risk based on data from three developed and seven developing countries were 1.07 (0.91, 1.26) and 1.24 (1.05, 1.47) respectively; these estimates are not significantly different (P = 0.22). Estimates for women under and over age 35 were 1.26 (0.95, 1.66) and 1.12 (0.98, 1.27), respectively, and these estimates are also not significantly different (P= 0.38). Risk was highest in recent and current users and declined with time since last use regardless of duration of use. Risk did not increase with duration of use after stratifying on time since last use. Risk did not increase significantly with increasing duration of use

Intrauterine devices and endometrial cancer

The relationship between intrauterine device (IUD) use and the development of endometrial cancer was assessed in data from seven countries that were collected between 1979 and 1988 for a multinational hospital-based case-control study. Two hundred twenty-six cases of endometrial cancer were compared with 1,529 controls matched for age, hospital, and year of interview. No significant association between use of an IUD and risk of endometrial cancer was observed (OR = 0.74, 95% CI = 0.4-1.33). There were no trends in risk with respect to duration of use, time since first use, or ages at first or last use. No cases had used a copper IUD (OR = 0, 95% CI = 0- 1.71). Although women over age 55 who had used an IUD were at significantly increased risk, this unexpected finding is based on small numbers of users and requires independent confirmation. These results, along with those from other studies, provide reassurance that risk of endometrial cancer is unlikely to be increased by use of an IU

Additional file 1: of Adoption and use of guidelines for whiplash: an audit of insurer and health professional practice in New South Wales, Australia

Appendix 1. Insurer and health professional data collected based on recommendations of the guidelines. Appendix 2. Quebec Task Force classification of grades of WAD. Appendix 3. Flow diagram of claimant files included in the study. (DOCX 37 kb