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Managing Disability in Employees and Claimants with Health Care Resource Constraints

Sylvia Boddener, Senior Director Business Development, UHN Altum Health, Registered Occupational Therapist and Dr. Shane Journeay, UHN Altum Health Consultant, Physiatrist, Occupational Medicine Specialist.

Doctor helping patient with tablet

From all indications the healthcare system in Ontario is facing considerable pressures post pandemic including access to both primary and specialist care. For working populations, the timely access of health care for both work related injury and illness and/or those with chronic disease and injury can lead to broader reaching impacts on occupational function.

Prior to the pandemic there was a lack of primary health care providers, and now the situation is worse, according to a recent CMAJ article 4.6 million people did not have a primary health care provider prior to Febuary 2020.  Read the full Article here https://www.cmaj.ca/content/194/48/E1655

Reforms and new models of care are being suggested to address this issue including interdisciplinary health teams in community-based clinics as well as virtual care. However, an article published by Dr. Lauren Lapointe-Shaw, a General Medicine Physician at UHN and lead researcher, and her research team, found that those who attend virtual care on a walk in basis, while it being convenient, can actually result in patients seeking subsequent care in expensive hospital emergency departments. LINK article see below

Lapointe-Shaw L, Salahub C, Bird C, Bhatia R, Desveaux L, Glazier R, Hedden L, Ivers N, Martin D, Na Y, Spithoff S, Tadrous M, Kiran T

Characteristics and Health Care Use of Patients Attending Virtual Walk-in Clinics in Ontario, Canada: Cross-sectional Analysis. J Med Internet Res 2023;25:e40267. URL: https://www.jmir.org/2023/1/e40267; DOI: 10.2196/40267

Specialist care is equally, or perhaps, more challenging to access once you are able to see your primary health care provider for a diagnosis and referral. Wait times have increased substantially given back logs caused by COVID reductions in elective surgical consultations and surgeries.

What is the impact of the lack of primary care access on employees, claimants?

At UHN Altum Health, we understand that an employee absence, whether it be occupational or non-occupational is concerning to employees, employers and disability insurers alike. Early access to the right care incorporating disability management and occupational management principles is more important than ever to managing a variety of absences in the workplace.

Impact on employee or claimants

  • May not have primary health care practitioner or be waiting for specialist consult thereby cannot access and are not clear on diagnosis or have received diagnoses but unclear on what they can do or not do to function better
  • Often want to get back to work and life but not sure how without causing more pain/disability while waiting
  • Fearful of re-injury or causing harm and pain; heightened anxiety and other psychosocial concerns, exacerbation of pre-existing mental health conditions as time goes on.
  • Have rapport with local treatment providers who may or may not be aware of and incorporated best practices and evidence into their care plans such as recognizing when to use active versus passive modalities

Impact on insurers and employers/HR/Occ Health professionals

  • Increased claims and duration of short and long-term disability with complex MSK/Mental health conditions and concerns, as conditions were not addressed early or adequately in an integrated approach.
  • Challenges related to providing timely safe and appropriate work modifications and accommodations tailored to the employee and employer situation

What can be done?

Access to integrated multi-disciplinary assessment and treatment options through a third-party payor to facilitate a safe and sustainable return to life and work is key. At UHN Altum Health medical and allied health professionals can quickly assess complex conditions and clarify diagnosis, prognosis and make treatment recommendations using a multi-disciplinary, occupational rehabilitation approach.

Our teams help members identify functional goals, understand and raise awareness of their condition, use education and reassurance as well as other evidence based cognitive behavioural and active, progressive functional treatment activities to teach the member/client how to cope and overcome barriers to recovery and gradually build functional tolerances. Barriers to recovery may include physical, psychosocial, psychological, work related barriers.

By identifying these barriers early and in a fulsome manner, the appropriate evidence based treatment program can be recommended and with member/client consent provided. In many instances, education and reassurance go a long way to alleviating fears and other psychosocial barriers to recovery.

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