Person-centred care after minor transport-related injuries
Therefore, the results on the effect of financial
compensation on health outcomes following muscu-
loskeletal injury remain controversial, indicating that
further research is needed to understand the possible
barriers and complexities involved in compensation
processes and service delivery.
In 2014, Grant et al. (15) have identified common
stressors in the claims process. Some of the common
stressors included high levels of stress associated with
understanding what needed to be done with the claim;
claim delays; number of medical assessments; and the
amount of compensation received. However, from the
aforementioned studies, it is difficult to disentangle the
role of the compensation system from other stressors
affecting poor health outcomes, including the injury
itself and the patient’s pre-existing health state (16).
Based on the above, it is somewhat obvious to
conclude that compensation after a transport-related
injury (TRI) is a complex sociological phenomenon
(7). Injury compensation aims to provide payment
for medical care needed to treat injuries, replace, to
some extent, loss of earnings, and provide support in
reaching independence after injury (17), but, as nu-
merous studies have shown, it seems that sometimes
compensation can do more harm than good.
However, the compensation system operates within
a larger socio-environmental context, and hence may
be affected by other public systems, such as the health
system. The complexity of service delivery navigated
from compensation and health system may conse-
quently result in variations in care and lead to patient
perceptions of receiving poor quality care (personal
communication).
In Australia, different State and Commonwealth or-
ganizations are liable for providing accident compensa-
tion. The level of compensation and access to benefits
is directed by peoples’ residential address (18). In parti-
cular, in the state of Victoria, those injured in land-based
transport accidents are eligible to claim compensation
for treatment, income replacement, rehabilitation and
long-term support services via the Transport Accident
Commission (TAC), regardless of fault.
Due to the growing number of minor injuries and con-
sequent long-term non-recovery in Victoria, the objec-
tives of this study were primarily focused on exploring
current barriers and obstacles to recovery, focusing on
the cohort that sustained predominantly minor injuries.
Therefore, the primary aim of this study was to un-
derstand personal experience of recovery in Victorian
claimants and to identify barriers and complexities
involved in their recovery processes. The secondary
aim was to understand the gaps in compensation ser-
vice delivery and to identify areas and strategies for
quality improvement.
121
METHODS
Setting
This qualitative study was conducted in Victoria, where all
transport compensable injury claims must be lodged through
TAC (19). TAC is a Victorian government organization whose
role is to promote road safety, improve the trauma system
and support those who have been injured on Victorian roads.
The TAC pays for treatment and benefits for people injured in
transport accidents. It is a population-based scheme, funded
from annual car registration payments by Victorian motorists.
This study was approved by the Ethics Committee at Monash
University Human Research (MUHREC 2016 0971-7666).
Study sample
The study sample included clients who were managed by the
TAC Supported Recovery team and were participants in their
Client Outcome Survey (COS). The COS commenced in 2009
and annually tracks health, clinical and vocational outcomes of
clients. Supported Recovery clients mostly claim for minor and
moderate transport-related injuries; have a life of claim excee-
ding 12 months; and account for approximately 19% of claims
and 62% of total claim costs. The current guideline on non-fatal
transport-related injuries defines a Minor injury as follows: “mi-
nor injury means a sprain, strain, whiplash-associated disorder,
contusion, abrasion, laceration or subluxation and any clinically
associated sequelae” (20).
A random selection of 41 Supported Recovery clients who,
when last contacted in November 2016 for the COS, agreed to
be available for future research and had received a TAC-funded
service were invited to participate. To recruit participants living
in both regional and metropolitan areas, oversampling occurred
from people residing in regional Victoria.
Data collection tools
The previously defined conceptual framework was a key part in
the development of the interview guide. It was designed based on
the Biopsychosocial model (BPS) model ensuring that biological,
psychological and social domains of the model were explored in-
depth (21). As per the complexity of different domains explored
in this narrative inquiry, this paper focuses and describes in depth
only one component of the social domain of the model: barriers
related to the compensation system and its service delivery.
The conceptualized framework (Fig. 1) guided the develop-
ment, ensuring that already known risk factors were captured
and allowing for the new themes to be identified. Specifically,
questions in the social domain covered the clients’ environment
including health system, quality of healthcare and relationships
with the healthcare professionals; family and friends; and the
compensation system and its service delivery. Clients’ needs
were also discussed and highlighted in each domain.
A semi-structured interview guide was developed by the
principal researcher and reviewed by a team of research experts
with experience in qualitative research. The interview guide con-
tained a mix of direct and structured questions (Appendix S1 1 ),
which, during interviews, were expanded in order to capture
individual experiences. The interview questions facilitated
consistent responses from all participants, allowed for flexibility
in probing questions and enabled patients to describe their expe-
http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2500
1
J Rehabil Med 51, 2019