Première ligne de soins pour les travailleurs atteints de rachialgie occupationnelle : délai de consultation et premier fournisseur de services de santé

Introduction: In 2004, the Ontario workplace safety and insurance board at Work (WSIB) has revised its policy of choices and change of healthcare to allow injured workers to directly seek care from chiropractors, physicians, physiotherapists and registered nurses (extended class). In order to develop the best first line of care possible, it is important to investigate whether the new first healthcare providers have an impact on the delay of return to work. The objectives of this thesis are to investigate the factors related to the time to care and the type of first healthcare provider as well as the association between the latter and the duration of financial compensation of Ontarian workers with back pain.   Methods: We analyzed data from a retrospective cohort of workers with back pain (n=5520) compensated by the WSIB in 2005. Determinants of the first healthcare provider type and of the time to care with the latter were identified using logistic regression and Cox models. The associations between the first healthcare provider, the time to care and the duration of the first episode of compensation were assessed using Cox models. Analysis of a survey of Canadian chiropractors allowed to identify characteristics associated with the number of injured workers they treat annually using a negative binomial regression.  Results: The workers who first consulted a physiotherapist were significantly older, those who chose a chiropractor were less likely to live in community larger than 1,500,000 inhabitants and to have a manual job and those who first consulted a medical doctor had significantly less severe injuries and fewer previous similar injuries. Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100% wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10 to 1.31], p-value <0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100% compensation (adjusted HR=0.84 [0.71 to 0.98], p-value=0.028) during the first 149 days of compensation. Time to care was shorter for workers with access to an early return to work program. More severe nature of injury, employer’s 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, a longer time to care was significantly associated with a delay in the end of the first episode of compensation (HR= 0.98; p <0.001). Canadian chiropractors who reported a higher volume of workers’ compensation patients had practices oriented towards the treatment of injured workers, collaborated with other healthcare providers, and facilitated workers’ access to care.  Conclusion: The type of first healthcare provider sought for occupational back pain is influenced by injury- and work-related factors and by the worker’s community size. Contrary to previous studies, the workers who first sought a physician did not have higher odds of having a severe injury. The type of healthcare provider first visited for back pain and the timing of the first healthcare consultation are determinants of the duration of the first episode of compensation.

Keyphrases: Back pain, Primary care, Healthcare provider, Medical doctor, Chiropractic, Physiotherapy, Occupational health, Compensation duration, Health services accessibility, Occupational injuries