ACC Treatment Profiles 2001
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ACC5157 Cover a/w.fh8 11/12/00 1:06 PM Page 1 Printed December2000 ISBN0-478-11756-6 579 ACC Treatment Profiles Treatment 2001 Treatment Profiles 2001 Composite ACC5157 Cover a/w.fh8 11/12/00 1:06 PM Page 2 IMPORTANT PLEASE READ BEFORE CONTINUING The information contained in these Treatment Profiles is Copyright to Accident Compensation Corporation (ACC). December 2000. All Rights Reserved. These Profiles are made available by ACC to the recipient on the basis that they will be kept and used only by the recipient, and not lent, sold or otherwise made available to any third party or reproduced in any way, without ACC’s prior written consent. By opening these Profiles the recipient is agreeing to this condition but, if not agreed to, these Profiles are to be promptly returned to ACC. Composite Treatment Profiles 2001 CONTENTS 1 Return to Work 2 Fractures/Dislocations – Plastering Guide 3 Burns 4 Gradual Onset 5 Sprains 6 Lacerations/Abrasions 7 Contusions/Crush Injuries 8 Miscellaneous Introduction KEY POINTS • Treatment Profiles 2001 are consensus-based (not evidence-based) guidelines and are NOT rigid protocols. They are intended as a resource for clinicians to help summarise current practice in management of common injuries • Read codes: recording of injury diagnosis as Read codes is essential. Record the lowest relevant level of Read code For multiple injuries record Read codes for each injury If you cannot find a Read code for the injury, use code Z (unspecified conditions) and provide an accurate written diagnosis • Incapacity Duration Guides contained in the Profiles should be used where possible for any “time off work” certification ACC is responsible for providing access to the most effective treatment, rehabilitation and support services to help claimants lead as normal a life as possible after an injury. These Treatment Profiles are available to assist treatment providers, working with ACC, to achieve this goal. What is a Treatment Profile? A Treatment Profile is a guide to the treatment and rehabilitation services ACC expects claimants to receive for a particular injury. Most of the Profiles were developed by medical organisations as a summary of current good practice, which includes diagnosis, investigation, treatment, referral indications and expected outcomes (including incapacity duration). The Profiles cover a wide range of common injuries but are not rigid prescriptions. They are intended to provide flexibility and choice in clinical judgment according to patients’ individual circumstances. Why use Treatment Profiles? • As an aid for clinical management • To help clinicians manage expectations of patients, providers, employers and case managers. Experience shows this is the key to achieving timely, lasting and cost-effective outcomes • As an insurer, ACC works to balance the interests of premium payers and claimant needs by purchasing effective, affordable health provider services. The Profiles provide a benchmark for ACC to effectively monitor these services How were the Profiles Developed? ACC selected approximately 150 Read codes that cover most primary care injuries. Based on these codes and advice from various health providers, the Treatment Profiles were organised into several categories. Treatment Profiles were written by a wide range of health professionals and subjected to thorough peer review. These Profiles are consensus-based guidelines and are not evidence based. continued overleaf... ACC Treatment Profiles – 2001 Introduction Introduction Using Treatment Profiles Content: Two distinct information sections are contained for each profile. • The major section of the profile contains the consensus-developed clinical information as a summary of current good practice • The section titled Optimal Work Incapacity Duration Guides summarises data covering the likely incapacity durations. These have not been subjected to consensus review. Read Coding Developed in the UK, this is a multi-level system of diagnosis coding that aims to help GPs, primary care providers and funders in managing clinical practice. For example, by using Read codes, a GP can keep track of all patients who suffer low back strains and implement health management strategies accordingly. The New Zealand Health Information Service (NZHIS) is the New Zealand agent for the codes and is providing the system free of charge to providers and agencies. NZHIS encourages GPs to adopt the system for their own benefit as well as to provide accurate reports to NZHIS for planning and funding purposes. Practice management system developers are also modifying their systems to incorporate Read codes. Providers must record Read codes for all ACC claims. For GPs without Read code software, ACC can provide a quick Read code reference list sorted by type and location of injury. Points to note: • Read codes are a hierarchical coding system – each level provides more specific diagnosis. Please record the lowest relevant level of Read code. • Where there are multiple injuries, please record the Read code for each injury • If you cannot source a Read code, use code Z (unspecified condition) and provide an accurate written diagnosis. An ACC Case Manager may contact you to clarify and confirm the diagnosis. If you have any questions about using Read codes please contact NZHIS or your local ACC branch. Incapacity Durations Each Treatment Profile indicates the possible “time off work” required. This is based on a return to work duration: when most people without significant treatment complications or co-morbid medical conditions are likely to be able to return to work. Most Treatment Profiles provide five occupational classes based on the amount and frequency of exertion or force required in their work duties. For example: •“Sedentary” work requires sitting most of the time but can include walking or standing for brief periods •“Very Heavy” work involves exerting 45kg occasionally, and/or 23kg frequently and/or 9kg constantly continued overleaf... Introduction ACC Treatment Profiles – 2001 Introduction Please use the following guide to determine the appropriate occupational class based on your patient’s usual work duties: • Sedentary, eg office worker/receptionist • Light, eg shop assistant/parking warden • Medium, eg shelf packer/light factory worker • Heavy, eg mechanic/plasterer • Very Heavy, eg labourer/drain layer ACC Case Managers will develop your patient’s rehabilitation plan based on this guide. The information you provide will help them liaise with the employer and patient about return to work goals and alternative work duties, if appropriate. Please also use the duration guides for any “time off work” certification for injuries covered by the Profiles. Obviously, some patients may take less or more time to recover so please modify the durations as required. To help with rehabilitation planning, an ACC Case Manager may contact you to discuss these special circumstances. Any listed injury is not necessarily covered by ACC in every instance: eg an injury with a gradual onset over several weeks, but caused by a non-work activity. Cover under the ACC scheme is determined by legislation. ACC Treatment Profiles – 2001 Introduction Introduction Thank You ACC would like to acknowledge the following groups in particular, for their considerable contribution to the original 1999 Treatment Profiles: • First Health, Auckland • Integrated Primary Care Services Ltd, in conjunction with the National Institute of Health and Safety Ltd • Pinnacle IPA, Hamilton • Wellington IPA • Papanui Medical Centre Valuable contributions also came from the New Zealand Society of Physiotherapists, the Royal Australasian College of Radiologists, Smith and Nephew Limited, the New Zealand Medical Association and the National Poisons Centre. The following organisations and people have contributed extensively to this 2001 edition: • Royal New Zealand College of GPs Jim Vause, Rob Williams, Carole Atmore, Mick Ozimek, Janet Irvine, Saji Weerasinghe • Accident and Medical Practitioners Association Alistair Sullivan, Rob Kofed • Australasian College of Emergency Medicine Michael Roberts, Scott Pearson • Faculty of Rehabilitation Medicine Tudor Caradoc-Davies • New Zealand Orthopaedic Association Alan Panting • Faculty of Occupational Health Medicine Des Gorman • National Poisons Centre John Fountain • Doctors for Sexual Abuse Counselling Regular updating of these Treatment Profiles will be undertaken. ACC’s health services subsidiary company (ACC Healthwise) will be responsible for the Treatment Profiles. Introduction ACC Treatment Profiles – 2001 work return to return Section 1 Return to Work 1 CONTENTS Optimal Work Incapacity Duration Guides – Fractures/Dislocations Gradual Onset Sprains Miscellaneous Return to Work Optimal Work Incapacity Durations WORK DEFINITIONS Five job classifications based on the amount of physical effort required, are used [*] Reprinted with permission from the Medical in this book. The classifications are taken from the Strength Factor classifications Disability Advisor: Workplace Guidelines for described in the United States Department of Labour’s Dictionary of Occupational Disability Duration, Third Edition (1997), Titles. Presley Reed, MD (Reed Group, Ltd. Boulder, Colorado, USA. (303) 247 1860. All rights Sedentary Work reserved, http://www.rgl.net Exerting up to 4.5kg of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most