Here’s What a Successful Return-to-Work Program Actually Needs
Return-to-work programs are growing and changing every day, and employers are working hard to get their injured workers back to life and productivity.
Sometimes that means investing in wellness centers to bolster worker health. Sometimes that means adopting different temporary positions to transition workers back into the workforce.
But, how often does a successful return-to-work program focus on the medications being administered to their injured workers?
At the National Workers’ Compensation and Disability Conference® & Expo, presenters Silvia Sacalis, VP of clinical services, Healthesystems, and Adam Seidner, chief medical officer, The Hartford, spoke on the various ways prescription drugs can prolong a claim.
In case you missed “Medical and Pharmacy Insights for a Successful Return to Work,” here are some of the case studies Sacalis and Seidner shared:
Case Study 1 — A Prolonged Presence of Narcotics
A 48-year-old male was injured on the job and hurt his back.
He was taken to the ER, where he was given Percocet and Advil for the pain.
Outside of injury, this patient was being treated for several comorbidities, including diabetes, cardiac disease and allergies.
Three days into his injury, the worker was recommended to an occupational medicine doctor who ordered physical therapy three times a week and continued the Percocet prescription. At this time, the worker was released to modified duty, but the employer did not accommodate the worker’s restrictions.
At seven days into the injury, the worker visited the occupational medicine doctor a second time. The doctor attempted to remove the Percocet from the injured worker’s regimen, but the worker refused, believing he still needed it for his pain. The doctor also released the worker to full duty, noting that the worker was still using a prescribed narcotic.
The employer, upon seeing Percocet on the worker’s files, declined work.
Because there was a lack of transitional work and the presence of a narcotic, this worker was unable to return to work when he was cleared for full duty.
“Coordination of care is solely driven by communication and effective transitions of care,” said Sacalis.
Case Study 2 — Deadly Drug Interactions
A 35-year-old female suffered a shoulder injury while at work and was prescribed Vicodin and physical therapy.
However, this injured worker also had two comorbid conditions she was being treated for: depression and PTSD. She was already on a regimen of Adasuve and Prozac before injury.
At two weeks into her claim, the worker refused PT and instead went to her family doctor. This doctor increased the Vicodin dosage.
At two months into her claim, the patient finally begins attending her prescribed PT. Her depression improves, but her pain remains. The doctor again increases the Vicodin dosage.
Soon, the worker was found unresponsive and Narcan was administered.
In this patient’s case, having the presence of both Vicodin and Prozac increased her chances of an opioid-related overdose. A lack of communication between doctors and patient led to this nearly fatal case.
Additionally, added Sacalis and Seidner, gender metabolism had been overlooked. Females require a smaller dose of these types of medications, said Sacalis, because each gender metabolizes at different rates.
Behind the Scenes
Sacalis and Seidner emphasized the need to look at what’s going on behind the scenes with injured workers, because often they have more going on outside of their work injury. Using both pharmacological and non-pharma approaches, injured workers can be examined and guided toward recovery holistically.
The biopsychosocial model is one way to do just this. Sacalis also called this the “human systems” approach:
Bio looks at an injured person’s biological factors, including comorbidities, family health history, sleeping patterns, exercise regimens and overall current health.
The psycho part of biopsychosocial refers to the injured person’s emotional state and how their feelings impact their healing. Do they have fear avoidance, in which they fear returning to the activities that injured them in the first place? Are they catastrophic thinkers, i.e. do they believe the worst is yet to come? This kind of thinking will prolong a claim.
Finally, social refers to the support system an injured worker has and their living arrangements. Is their family supportive? Do they have friends backing them? Do they have dependents? Are they the primary “breadwinner” in the family?
To close out the session, Sacalis added this: “The patient should really be the central part of care, and employee engagement is crucial. Return-to-work shouldn’t be a short-term, miopic decision; job modifications are important if you want to keep good talent.” &