title: Which Characteristics are Associated with the Timing of the First Healthcare Consultation, and Does the Time to Care Influence the Duration of Compensation for Occupational Back Pain?
abstract: Purpose To identify the characteristics associated with the timing of the first healthcare consultation and to measure the impact of that timing on the duration of the first episode of compensation for occupational back pain following the injury. Methods We analyzed data from a cohort of workers with compensated back pain in 2005 in Ontario obtained from the Workplace Safety and Insurance Board. Cox multivariable survival models were performed to identify factors associated with the time to care and to measure its association with the length of the first episode of 100 % compensation. Results Among the 5520 claims analyzed, 93.7 % of workers accessed care within the first week (average = 2.1 days; median = 1 day). Time to care was shorter for males, for workers who had received previous compensation and for those with access to an early return to work program. Age, number of employees in the company and personal earnings were positively associated with the time to care. More severe nature of injury, employers doubt about the work-relatedness of the injury and consulting a physiotherapist as the first healthcare provider were also associated with longer time to care. Considering potential confounders, longer time to care was significantly associated with a delay in the end of the first episode of compensation (hazard ratio = 0.98; P < 0.001). Conclusion Temporal access to a source of care is not problematic for the vast majority of Ontarian workers who receive compensation for occupational back pain; however, for the minority of workers who do not rapidly access care, the timing of the first healthcare consultation is a significant predictor of the duration of the first episode of compensation.
authors.affiliation: Public Health PhD Program, School of Public Health, University of Montreal, Montreal, QC, Canada. marc-andre.blanchette@umontreal.ca.
authors.forename: Marc-André
authors.identifier: 0000-0001-7172-7344
authors.initials: MA
authors.lastname: Blanchette
authors.affiliation: Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.|Public Health Research Institute, University of Montreal, Montreal, QC, Canada.
authors.forename: Michèle
authors.initials: M
authors.lastname: Rivard
authors.affiliation: Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, QC, Canada.|Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec (CHUQ), Québec City, QC, Canada.
authors.forename: Clermont E
authors.initials: CE
authors.lastname: Dionne
authors.affiliation: Institute for Work & Health, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Ivan
authors.initials: I
authors.lastname: Steenstra
authors.affiliation: Institute for Work & Health, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Sheilah
authors.initials: S
authors.lastname: Hogg-Johnson
mesh_terms: D000367:Age Factors; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D053208:Kaplan-Meier Estimate; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D060051:Occupational Injuries / Q000628:therapy*; D009864:Ontario; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D061665:Time-to-Treatment; D014942:Workers' Compensation / Q000706:statistics & numerical data*
keywords: Back pain; Health services accessibility; Occupational injuries