title: Healing or harming? Healthcare provider interactions with injured workers and insurers in workers' compensation systems.
abstract: BACKGROUND
  Healthcare providers (HCPs) are influential in the injured worker's recovery process and fulfil many roles in the delivery of health services. Interactions between HCPs and insurers can also affect injured workers' engagement in rehabilitation and subsequently their recovery and return to work. Consideration of the injured workers' perceptions and experiences as consumers of medical and compensation services can provide vital information about the quality, efficacy and impact of such systems. The aim of this systematic review was to identify and synthesize published qualitative research that focused on the interactions between injured workers, HCPs and insurers in workers' compensation systems in order to identify processes or interactions which impact injured worker recovery.
  
  
  METHODS
  A search of six electronic databases for literature published between 1985 and 2012 revealed 1,006 articles. Screening for relevance identified 27 studies which were assessed for quality against set criteria. A final 13 articles of medium and high quality were retained for data extraction.
  
  
  RESULTS
  Findings were synthesized using a meta-ethnographic approach. Injured workers reported that HCPs could play both healing and harming roles in their recovery. Supportive patient-centred interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers were highlighted in themes of adversarial relations and organisational pressures. Insurer and compensation system processes exerted an influence on the therapeutic relationship. Recommendations to improve relationships included streamlining administrative demands and increasing education and communication between the parties.
  
  
  CONCLUSIONS
  Injured workers with long term complex injuries experience difficulties with healthcare in the workers' compensation context. Changes in insurer administrative demands and compensation processes could increase HCP participation and job satisfaction. This in turn may improve injured worker recovery. Further research into experiences of distinct healthcare professions with workers' compensation systems is warranted.
authors.affiliation: Institute for Safety Compensation and Recovery Research (ISCRR) and Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Level 11, 499 St Kilda Rd, Melbourne, VIC, 3004, Australia, Elizabeth.Kilgour@monash.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kilgour
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Kosny
authors.forename: Donna
authors.initials: D
authors.lastname: McKenzie
authors.forename: Alex
authors.initials: A
authors.lastname: Collie
mesh_terms: D006282:Health Personnel; D006801:Humans; D060051:Occupational Injuries / Q000523:psychology* / Q000534:rehabilitation / Q000628:therapy; D010817:Physician-Patient Relations; D014942:Workers' Compensation