Return-to-work programs are changing every day, and employers are working hard to get their injured workers back to an appropriate level of functional restoration, engagement 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?

There are several medical and pharmaceutical considerations employers need to have when it comes to returning workers back to the job.

Silvia Sacalis, BS, PharmD, VP of Clinical Services, Healthesystems, sat down with Risk & Insurance® to discuss what some of those considerations are and how employers, physicians, pharmacists and even employees can team up to create a successful return-to-work.

What would you say are some of the top medical and pharmaceutical considerations for return-to-work?

There are a number of different considerations that are really impactful to return-to-work, because they can not only have health consequences but also safety consequences related to job duties and responsibilities.

Silvia Sacalis, vice president of clinical services, Healthesystems

Drug interactions and side effects, comorbidities, gender and age are a few considerations. Each has its unique overall effect on the individual.

A few other considerations are how medications are absorbed, distributed, metabolized, and eliminated.

The reason this is important is because there are just a few key enzymes in the body that are primarily responsible for the metabolism and elimination of drugs. With multiple drugs going through the same pathway, there’s a lot of potential interactions, and they’re going to affect individuals differently.

You mentioned drug interactions as another potential complication. Why is this a medical/pharma consideration in return-to-work?

Drug interactions can have adverse effects on the patient and keep them out of work longer. When we look at the patient holistically, we must be mindful of outside medications they may already be taking for comorbidities unrelated to the claim.

For example, one very common medication in workers’ compensation is the nonsteroidal anti-inflammatory category of drugs. Medications like Advil, for example, or ibuprofen.

This particular drug group can have a significant number of interactions with medications that are being used to treat chronic conditions outside of a claim. Examples include diabetes medication, as well as blood thinner medications. So, having a comorbidity such as a heart condition or diabetes can significantly affect the type of treatment options that are available to an injured worker.

Are there any other factors that need to be addressed when reviewing workers’ comp medication prescriptions?

 Age is one crucial element that should be considered. We all have a calendar age determined by the date we are born. And then there’s what we call in health care the physiological age. That refers to the “age you function at,” and is determined by a patient’s overall health status, including tobacco use, activity or nutrition and comorbidities.

Having a physiological age that’s lower than the calendar age can sometimes accelerate return-to-work. Conversely, having a physiological age that’s significantly higher than the calendar age, will adversely affect and may slow down the time it will take for that patient to return to work.

Gender is another factor. Females tend to metabolize drugs very differently from males. It’s important to note, especially at the start of a claim. It’s better to start at much lower dosage, especially with opioids, in the female population.

Why is knowing about these considerations important to return-to-work?

Having these considerations as part of the return-to-work process enables employers to collaborate with the various stakeholders in the workers’ comp claim. The more multidisciplinary collaboration that occurs, the more successful the return-to-work will be.

Employers can engage the pharmacy team, whether that’s through a PBM or through retail pharmacists. They can engage with physical therapists, the occupational medicine doctors, behavioral health. Employers may also have their own clinicians on staff and have a better understanding of their workers’ complete medical history and how that can impact a claim.

How have employers been approaching these considerations so far? In what ways could employers enhance their efforts?

Health care is dynamic. There’s always more that can be done, in my opinion. We’re never going to get to a 100% understanding of everything. The employers who are successful at this are collaborating and communicating with the physicians caring for their injured workers and getting that holistic perspective.

More work needs to be focused in that area because holistic care is important when treating an injured worker.

Worker support is also an area that can continue to be improved. When a physician releases a worker back to light duties and modifies the worker’s responsibilities, employers should work toward having an open mind and finding ways to accommodate. Depending on the severity and the nature of the injury, that worker may never be able to come back to work in the same capacity. Return-to-work should be less focused on the short-term gain of returning an employee to his or her exact pre-injury job, but instead more focused on fostering a sustainable culture that addresses employees’ needs and focuses on jobs they can accomplish and ways they can be more productive in the short and long term.

You’ve mentioned that having a holistic understanding of the injured worker is key in this process. Why is that also an important consideration in return-to-work?

Each individual hears things differently. We process things differently. We have a different level of health literacy, and injured workers did not ask for their injuries. Most of them are not intentionally trying to get hurt on the job and most of them are trying hard to return to work.

They’re dealing with a complicated period in their life. They may lose their family over it or they might lose their livelihood over it. That’s a lot of potentially challenging things to deal with all at one time.

An empathetic, holistic approach is crucial to helping our injured workers get back to work, because an injured worker who has a support system in place may be more likely to return to work faster.

How can employers begin to get a holistic understanding of their workers?

One thing they can do is try to get a medical record with the overall background of the injured worker first.

In talking with the physician community, employers must stress to the doctors the importance of being focused on the holistic perspective of their employee. In that vein, employers should suggest the workers’ comp doctor is in contact with the worker’s family practitioner as well.

The employer may not have a direct role in that communication, but they can play an active role in facilitating and emphasizing the important nature of collaboration between doctors. That really is the most important aspect that often gets overlooked. &