The role of primary care physicians in return to work after occupational injury or disease: A systematic review of guidelines and literature

Objective: My thesis aims to review the role of primary care physicians (PCPs) in the return to work (RTW) process following an occupational injury or illness. A systematic review was conducted to examine and synthesize evidence from scientific literature and guidelines addressing this topic.;Results: Literature - A total of 1022 papers were identified, and 40 studies met the inclusion criteria. Of those studies, 30 were of sufficient quality to be included in this review. There was strong evidence that, in addition to usual care, collaborative effort among stakeholders, early contact between the physician and workplace is associated with early RTW. There was also strong evidence to support several key concepts in physician's disability management, including time and incentives, advocacy, trust and respect, knowledge and education, awareness of external factors, processes of care. There was moderate evidence that the use of evidence-based care has limited effect on disability improvement and RTW. The level of evidence regarding the effect of early RTW advice on RTW and degree of recovery was mixed. An acronym, CAPPA, is proposed to denote the five major roles for PCPs in RTW management. Guidelines - A total of 11 guidelines were identified from various sources. There are remarkable consistencies among the developed guidelines, and also between guidelines and scientific literature. None of the reviewed guidelines; however, are evidence-based since there was no systematic search and quality appraisal of the literature as part of their formulation.;Conclusions: Evidence-based findings from this review support that PCPs have an important role in facilitating timely RTW for their patients, and they can serve as both facilitators and barriers along the process. Recommendations are made for future guideline development and intervention studies involving physicians.;Methods: Literature -- Four major databases were searched for peer-reviewed studies published in English, between January 1980 and September 2008. Studies were selected to undergo further review if they explored the experiences of primary care physicians, focused on occupational injuries or pain, and included return to work as an outcome. Methodological quality appraisal and data extraction were performed for relevant studies. Guidelines - Guidelines on the role of physicians in return to work were searched and obtained from various medical associations and compensation boards. The searches were limited to English only.