Clinical innovation and scope of practice regulation: a case study of the Charlie Teo decision.

The issue of regulation of scope of practice (SOP) has recently been highlighted through the high-profile case of New South Wales-based neurosurgeon, Mr Charles Teo and specifically the finding of 'unsatisfactory professional conduct' by the NSW Health Care Complaints Commission (HCCC) in Teo, Charles (2023) NSWMPSC 2 (12 July 2023). The HCCC decision went to two issues in Teo's practice: (1) his decision to perform a surgery not within the SOP of his profession [at 238]; and (2) his failure to gain patient informed consent for that surgery [at 245]. This paper explores the findings against Teo with respect to SOP and recommends a nuanced approach to the regulation of clinical innovation and SOP evolution.

How can scope of practice be described and conceptualised in medical and health professions? A systematic review for scoping and content analysis.

BACKGROUND: The term scope of practice (SOP) refers to the limits of a health professional's knowledge, skills and experience and reflects all tasks and activities they undertake within the context of their professional role. Inconsistency in definitions of SOP contributes to uncertainty and confusion regarding professional practice boundaries and potentially impacts societal access to safe, effective and efficient healthcare options. The aim of this paper is to understand the conceptual diversity that may exist in terminology used to describe medical, nursing/midwifery and allied health SOP within an Australian practice context exemplar. METHODS: A systematic review for scoping and content analysis of SOP definitions and concepts, involving inductive thematic analysis and synthesis of published and grey literature. RESULTS: The initial search strategy yielded 11,863 hits, of which 379 were suitable for inclusion. Data coding identified various SOP terms and definitions and the emergence of six, conceptual elements underpinning the theoretical construct. These were subsequently proposed as a preliminary conceptual model ('Solar') to explain how the six conceptual elements may be applied across various professions, clinical settings and jurisdictions to better understand and address current and evolving SOP issues. CONCLUSION: The findings of this study highlight limited consistency in SOP definitions and terminology within a single jurisdiction, and the conceptual complexity of the underlying theoretical construct. Further research is required to build on the proposed 'Solar' conceptual model and create a universal SOP definition across jurisdictions, to enhance understanding of the importance of SOP to workforce policy, clinical governance, service models and patient outcomes.

Psychosocial safety behavior: A scoping review of behavior-based approaches to workplace psychosocial safety.

INTRODUCTION: In an era of workplace safety where psychosocial risks are widely recognized as occupational hazards, emerging research has sought to clarify the impact of these risks and the requisite interventions for improving psychosocial safety climate and reducing psychological injury risk. METHOD: The construct of psychosocial safety behavior (PSB) provides a novel framework for emerging research that seeks to apply a behavior-based safety approach to workplace psychosocial risks across several high-risk industries. This scoping review aims to provide a synthesis of existing literature on PSB, including its development as a construct and application in workplace safety interventions to date. RESULTS: Although a limited number of studies of PSB were identified, the findings of this review provide evidence for growing cross-sector applications of behaviorally-focused approaches to improving workplace psychosocial safety. In addition, the identification of a broad spectrum of terminology surrounding the construct of PSB provides evidence of key theoretical and empirical gaps, with implications for future intervention-based research to address emerging areas of focus.

Estimating the impact of work difficulties, work self-efficacy and work psychological safety on MS-related work productivity loss.

BACKGROUND: A comprehensive understanding of factors associated with multiple sclerosis (MS)-related work productivity loss will inform targeted interventions. We have previously shown the strong impact of symptom severity on MS-related work productivity loss. However, the effect of work difficulties, work self-efficacy and work psychological safety is yet to be well evaluated in this context. OBJECTIVES: This study evaluates the association between work difficulties, work self-efficacy and work psychological safety, and MS-related presenteeism, absenteeism and total work productivity loss. METHODS: We analysed data from employed participants of the Australian MS Longitudinal Study (AMSLS) who took part in both the 2015 Medication and Disease Course survey, and 2015 Employment survey (n = 744). Data were analysed using Cragg Hurdle regression models. RESULTS: We found that low workplace self-esteem, interpersonal difficulties at work and work self-efficacy were associated with total work productivity loss. In a multivariable model, a 10-unit decrease in workplace self-esteem, increase in interpersonal difficulties at work and 5-unit increase in work self-efficacy were independently associated with a 3.75% increase, 2.89% increase and 3.36% reduction in total work productivity loss, respectively. When separating total work productivity loss in presenteeism and absenteeism, stronger effects were seen for presenteeism than absenteeism. Surprisingly, work psychological safety was not associated with MS-related work productivity loss. CONCLUSION: Work psychosocial well-being such as self-confidence at work, work self-efficacy and interpersonal difficulties at work are crucial factors governing work productivity in people with MS (PwMS). Multidisciplinary support team assistance of PwMS in symptom self-care, skills around effective communication about MS in the workplace, the psychological impact of work and the modification of work demands may positively influence the employment outcomes.

Work productivity trajectories of Australians living with multiple sclerosis: A group-based modelling approach.

BACKGROUND: Studies have documented reduced work capacity and work productivity loss in multiple sclerosis (MS). Little is known about the longitudinal trajectories of work productivity in MS. OBJECTIVES: To examine trajectories of work productivity in people living with multiple sclerosis (PwMS) and the factors associated with the trajectories. METHODS: Study participants were employed participants of the Australian MS Longitudinal Study (AMSLS) followed from 2015 to 2019 with at least two repeated measures (n=2121). We used group-based trajectory modelling to identify unique work productivity trajectories in PwMS. RESULTS: We identified three distinct trajectories of work productivity: 'moderately reduced' (17.0% of participants) with a mean work productivity level of 47.6% in 2015 (slope -0.97% per year (p= 0.22)), 'mildly reduced' (46.7%) with a mean work productivity of 86.3% in 2015 (slope 0.70% per year (p=0.12)), and 'full' (36.3%) with a mean work productivity of 99.7% in 2015 (slope 0.29% per year (p= 0.30)). Higher education level, higher disability, and higher MS symptom severity are associated with increased probability of being in a worse work productivity trajectory. CONCLUSION: We identified three distinct work productivity trajectories in PwMS which were stable over time and differentiated by their baseline level of work productivity.

Changes in multiple sclerosis symptoms are associated with changes in work productivity of people living with multiple sclerosis.

BACKGROUND: While employment rates have increased in people with multiple sclerosis (PwMS), little is known about the longitudinal trends of work productivity. OBJECTIVE: To describe the longitudinal patterns of work productivity and examine the factors associated with annual change of work productivity of PwMS. METHODS: Study participants were employed participants of the Australian MS Longitudinal Study (AMSLS) followed from 2015 to 2019 with at least two repeated measures (n = 2121). We used linear mixed models to examine if the within-individual variations in MS symptoms are associated with changes in work productivity. RESULTS: The mean annual change in work productivity between 2015 and 2019 was -0.23% (SD = 18.68%). Not the actual severity of symptoms but rather the changes in severity of symptoms that are associated with change in work productivity in the same year. In a multivariable model, every unit increase in mean annual change in 'pain and sensory symptoms', 'feelings of anxiety and depression', and 'fatigue and cognitive symptoms' were independently associated with 2.43%, 1.55% and 1.01% annual reductions in work productivity, respectively. CONCLUSION: Individual changes in work productivity are largely driven by the changes in symptom severity rather than the absolute severity. Stabilising/improving MS symptoms might improve work productivity.

Risk factors for leaving employment due to multiple sclerosis and changes in risk over the past decades: Using competing risk survival analysis.

BACKGROUND: No studies have assessed changes in employment survival in multiple sclerosis (MS) populations over recent decades, including the introduction of disease-modifying therapies (DMTs). OBJECTIVES: To evaluate factors associated with leaving employment due to MS; to assess whether the risk of leaving employment has changed over recent decades in Australia, stratified by MS phenotype. METHODS: We included 1240 participants who were working before MS diagnosis. Information on employment status, reasons for leaving employment and year of leaving were collected. Data were analysed using competing risk survival analysis. RESULTS: Males, progressive MS, lower education level and older age at diagnosis were associated with a higher sub-distribution hazard of leaving employment. Compared to the period before 2010, the sub-distribution hazard during 2010-2016 for relapsing-remitting multiple sclerosis (RRMS) was reduced by 43% (sub-distribution hazard ratio (sHR) 0.67, 95% confidence interval (CI): 0.50 to 0.90), while no significant reduction was seen for primary-progressive multiple sclerosis (PPMS) (sHR 1.25, 95% CI: 0.72 to 2.16) or secondary-progressive multiple sclerosis (SPMS) (sHR 1.37, 95% CI: 0.84 to 2.25). CONCLUSION: Males, people with progressive MS and those of lower education level were at higher risk of leaving employment. The differential changed risk of leaving employment between people with different MS phenotype after 2010 coincides with the increased usage of high-efficacy DMTs for RRMS.

Comorbidities are prevalent and detrimental for employment outcomes in people of working age with multiple sclerosis.

BACKGROUND: More work is needed to understand the burden of comorbidities in people with multiple sclerosis (MS). OBJECTIVE: To assess prevalence of 30 comorbidities and impacts of comorbidities on employment outcomes in a working-aged MS cohort. METHODS: Participants were from the Australian MS Longitudinal Study (n = 929). Information on specific comorbidity was obtained (whether or not each was present, doctor-diagnosed, limited their activities and being treated). RESULTS: Comorbidities most frequently reported to limit activities were osteoarthritis (51%), migraines (40%), anxiety (33%), depression (29%) and allergies (18%). Mean MS-related work productivity loss in past 4 weeks was 1.3 days for those without comorbidities and 2.5 days for those with any comorbidity. The annual population costs of work productivity loss were highest for people with depression, allergies, anxiety, migraines and osteoarthritis. Higher number of comorbidities was associated with more work productivity loss and a higher likelihood of not working. These associations were substantially reduced after adjustment for MS symptom severity. CONCLUSIONS: Comorbidities substantially impact employment outcomes and these effects were mainly mediated through MS symptom severity. This suggests that optimal and simultaneous management of comorbidities may be a viable strategy to reduce MS symptom severity, which in turn could improve employment outcomes.

Estimating MS-related work productivity loss and factors associated with work productivity loss in a representative Australian sample of people with multiple sclerosis.

BACKGROUND: Little is known about the work productivity loss in multiple sclerosis (MS). OBJECTIVES: To quantify the MS-related work productivity loss and to compare factors associated with labour force participation and work productivity loss. METHODS: Participants were from the Australian MS Longitudinal Study. MS-related work productivity loss included absenteeism (time missed from work) and presenteeism (reduced productivity while working). Data were analysed using log-binomial and Cragg hurdle regression. RESULTS: Among 740 MS employees, 56% experienced any work productivity loss due to MS in the past 4 weeks. The mean total work productivity loss was 2.5 days (14.2% lost productive time), absenteeism 0.6 days (3.4%) and presenteeism 1.9 days (10.8%)), leading to AU$6767 (US$4985, EURO€4578) loss per person annually. Multivariable analyses showed that work productivity was determined most strongly by symptoms, particularly 'fatigue and cognitive symptoms' and 'pain and sensory symptoms', while older age, and lower education level were also predictive of not being in the labour force. CONCLUSION: MS-related presenteeism was three times higher than absenteeism, highlighting the importance of presenteeism being included in employment outcomes. The dominance of symptom severity as predictors of both work participation and productivity loss emphasises the need for improved management of symptoms.

Closing the gap: Longitudinal changes in employment for Australians with multiple sclerosis.

BACKGROUND AND OBJECTIVES: Previous studies have documented far lower employment participation rates for people with multiple sclerosis (PwMS) compared to the general population. In a large national sample of PwMS, we examined employment status, longitudinal changes in employment and the provision of modifications to work role/environment from 2010 to 2013. METHODS: Employment data were collected through the Australian MS Longitudinal Study from 2010 to 2013, with 1260 people responding to all four surveys. Employment rates were compared with the Australian general population. The survey included questions on the provision of modifications to employees' work role and work environment. RESULTS: Employment (full- and part-time) increased from 48.8% in 2010 to 57.8% in 2013, mainly due to increases in male full-time employment. The employment gap between PwMS and the general population fell from 14.3% in 2010 to 3.5% in 2013. Male employment rates, however, remain significantly lower than the general population. The majority of PwMS who required adjustments to either their work role or environment received them. CONCLUSION: The gap in employment between PwMS and the general population has substantially reduced from 2010 to 2013, with organisations responding positively to requests for work role/environment adjustments.