Telemedicine, hailed as a pivotal solution amidst the health care landscape upheaval catalyzed by the Coronavirus-19 (COVID-19) pandemic, represents a paradigm shift in medical care delivery. Its essence lies in the utilization of telecommunications technology to facilitate remote diagnosis, consultation, and treatment, thereby ensuring uninterrupted access to health care while mitigating the risks associated with physical interaction.Reference Kurnianto, Fehér and Tololiu 1 Within this transformative landscape, telemedicine has emerged not only as a lifeline for patients seeking medical assistance but also as a conduit for enhancing health care services and bridging accessibility gaps.Reference Kusuma, Pratiwi and Umami 2
The integration of telemedicine into health care systems has not only revolutionized the traditional models of patient care but has also heralded a new era of technological convergence. Concurrent with its adoption, an array of technological advancements has come to the fore, augmenting the capabilities and reach of telemedicine.Reference Eremijenko 3 Among these innovations are blockchain-enabled frameworks designed to orchestrate decentralized responses to pandemics, empowering multi-robot collaborations, and revolutionizing predictive analytics through the fusion of fuzzy inference systems and machine learning algorithms.Reference Jithendra and Sharief Basha 4 –Reference Chen, Xie, Tao and Wang 9 These technological marvels underscore the multifaceted potential of telemedicine, transcending conventional boundaries to encompass a spectrum of health care domains.
In the context of treating non-emergency workplace injuries, telemedicine is recognized as an efficient way that helps workers return to work faster.Reference Wang, Li and Zhu 10 –Reference Jones, Smith-MacDonald and Pike 12 Telemedicine provides easy access for workers to communicate with health care professionals without having to come to the office, making it easier for them to receive appropriate and timely treatment. This study also found that the use of telemedicine can speed up workers’ recovery by ensuring timely communication with health care providers and reducing the risk of missing medical appointments.Reference Shiri, Nikunlaakso and Laitinen 13 –Reference Bagul and Gunjal 15
However, amid the optimism surrounding telemedicine’s transformative potential, challenges persist, particularly concerning its application within Return to Work (RTW) programs. RTW refers to a process within the realm of occupational health and rehabilitation where individuals who have been injured or become ill in the workplace are facilitated in their transition back to their jobs or workplace duties.Reference Kurnianto, Fehér and Tololiu 1 , Reference Kurnianto, Khatatbeh and Prémusz 16 This process typically involves medical assessments, treatment, and rehabilitation aimed at restoring the individual’s ability to perform their job duties safely and effectively.Reference Kurnianto, Fehér and Tololiu 1 RTW programs are essential at encompassing various interventions, such as modified work tasks, workplace accommodations, and ongoing support, to facilitate a smooth and successful return to work for the affected individual.Reference Kurnianto, Khatatbeh and Prémusz 16
Despite the increasing number of occupational accidents, there is a paucity of evidence on the outcomes of patients who receive case management through RTW programs.Reference Kurnianto, Fehér and Tololiu 1 , Reference Kurnianto, Khatatbeh and Prémusz 16 While telemedicine has demonstrated promising outcomes in trauma treatment delivery, its tailored integration into RTW programs remains an underexplored frontier, accentuating the critical need for comprehensive investigations.Reference Kurnianto, Khatatbeh and Prémusz 16 –Reference Chersich, Gray and Fairlie 18 Hence, given the limited evidence on the effectiveness of telemedicine in RTW programs, this research aims to provide comprehensive insights into how telemedicine can enhance case management, reduce medical claims costs, and support the reintegration of disabled workers. By focusing on these aspects, the study seeks to fill the critical gaps in current research and offer practical solutions for optimizing the use of telemedicine to improve the RTW programs.
Methods
Study Design
This study employs a retrospective cohort observational design to investigate the dynamic alterations in outcomes promptly following the implementation of telemedicine in the RTW program during COVID-19 pandemic in Indonesia. The study group comprised individuals employed in Indonesia who have occupational injury insurance and had registered as customers in the BPJS Ketenagakerjaan program. These individuals experienced disability as a result of occupational injuries and had actively engaged in the RTW program. The intervention measure under investigation involved the implementation of a telemedicine policy within the RTW program. We settled on April 2020 as the cutoff because that’s when the policy mandating the use of telemedicine in health care during the COVID-19 pandemic went into force. Furthermore, it should be noted that the commencement of the RTW program took place on July 1, 2015, although without the utilization of telemedicine at that time. Henceforth, the period preceding the implementation of the policy, spanning from July 1, 2015 to March 31, 2020, shall be deemed as the reference period. Conversely, the period succeeding the policy’s implementation, encompassing April 1, 2020 to December 31, 2022, shall be regarded as the intervention period wherein telemedicine is employed.
Implementation of RTW Program
The primary objective of the RTW program, as implemented by BPJS Ketenagakerjaan, is to facilitate the reintegration of workers who have encountered occupational accidents or illnesses back into the workforce throughout comprehensive rehabilitation, included medical, vocational, and psychosocial rehabilitation.Reference Kurnianto, Khatatbeh and Prémusz 16 The present program offers comprehensive support to individuals who may potentially experience disability, commencing from the moment of admission to the emergency room and extending until the participant achieves a state of readiness to resume occupational activities. The provision of aid encompasses a comprehensive array of medical interventions, encompassing health care provisions, restorative therapies, vocational skill development, and gainful employment facilitation. The RTW program is exclusively accessible to individuals who have experienced an unfortunate disability condition due to an incident or have contracted an occupational disease and received a subsequent recommendation from a medical advisor.
However, there are certain criteria that must be met before an employee may participate in the BPJS Ketenagakerjaan RTW program.Reference Aprianto, Hakim and Sahara 19 The individuals under consideration have a prior history of encountering a disability due to a workplace incident or occupational disease. Furthermore, it is essential that the prospective participant receives a formal endorsement from a qualified medical advisor in order to be eligible to participate in the program. In order to engage in transitional work, it is imperative that the worker undergoes a comprehensive evaluation by a qualified health care professional to obtain clearance. Ultimately, it is important that the individual in question possesses the inherent capacity to resume their customary occupational duties.
Data Source
The data used in this study were obtained from the BPJS Ketenagakerjaan, the Indonesian Social Security Agency on Employment. The dataset comprised information related to individuals who had participated in RTW programs and experienced disabilities due to occupational accidents.
The dataset included a wide range of variables such as demographic attributes, business dimensions, industry categorizations, disability classifications, and levels of contribution. The contribution levels of participants varied based on the level of occupational risk, as per rules set by BPJS Ketenagakerjaan, ranging from 0.24% to 1.74% of salaries reported.
Before conducting the analysis, several preprocessing steps were undertaken to ensure the quality and reliability of the data. These steps may have included data cleaning to remove any inconsistencies or errors, data transformation to make the data suitable for analysis, handling missing values, and standardizing variables for comparability. Additionally, data validation processes may have been implemented to verify the accuracy and completeness of the dataset. According to the management report of BPJS Ketenagakerjaan in 2022, the total count of individuals actively engaging in the occupational injury insurance program stands at 35,864,017. This population is categorized into distinct membership segments, including formal sector workers, informal sector workers, and individuals employed in the construction services sector.Reference Ketenagakerjaan 20 Within the scope of this study, we have collected pertinent data pertaining to the occupational accident insurance program. Specifically, we have meticulously documented the number of claim cases as well as the corresponding cost payments that have transpired in connection with the implementation of the RTW program.
The inclusion requirements for the study refer to claims data that meet the necessary conditions of being associated to the occupational accident insurance program under the cover of social security employment assurance. Furthermore, it is necessary that the collected data are specifically related to people who have participated in RTW program and experienced a disability due to occupational accidents. The dataset encompasses a comprehensive array of variables, encompassing demographic attributes, business dimensions, industry categorizations, disability classifications, and levels of contribution. According to rules set from a range of 0.24% to 1.74% of salaries reported to BPJS Ketenagakerjaan, the contribution level of participants fluctuates depending on the level of occupational risk. 21
Statistical Analysis
In this study, we evaluated the effectiveness of telemedicine in supporting the RTW process for workers with disabilities due to occupational injuries. Data on occupational injury cases and claim payments were obtained from Indonesia’s Social Security Employment Agency (BPJS Ketenagakerjaan) for the period July 2015 to December 2022. The Interrupted Time Series Analysis (ITSA) method has been employed to conduct an examination of occupational injury claims data that extend a period of seven years.
Interrupted Time Series Analysis (ITSA) is a statistical technique used to evaluate the impact of an intervention by analyzing data before and after the intervention. Several investigations have employed ITSA to explore the dynamic changes in outcomes immediately after the implementation of the intervention.Reference Mohammed, Dwomoh, Nonvignon and Amugsi 22 –Reference Su, Cheng and Cai 24 We may evaluate the efficacy of telemedicine in easing the return-to-work process for workers who have become handicapped due to work accidents by comparing the number of cases and claim payments before and after its deployment. The utilization of the ITSA model enables us to effectively capture the dynamic alterations in outcomes promptly following the implementation of the intervention. This approach yields significant insights into the enduring impacts of telemedicine on worker disability, specifically in relation to the occurrence of injury cases and the corresponding claim payments over an extended period. All statistical analyses were conducted using R software (version 3.4.4). For the analysis results to have statistical significance, we used a two-tailed P value threshold of less than 0.05.
Results
Participant Demographics and Characteristics
In this study, we aimed to evaluate the effectiveness of a telemedicine program in supporting workers with disabilities due to work injuries in the RTW process. As part of this study, we collected data on the characteristics and demographics of participants involved in the program before and after the COVID-19 pandemic. The following tables summarize the results of our data analysis. Data in Table 1 illustrate the characteristics based on the number of cases before and during COVID-19 using telemedicine.
Table 1. Characteristic based on number of cases
The observed rates of participant contribution show variation based on the level of occupational risk, comprising from 0.24% to 1.74% of the individual’s wages as reported to BPJS Ketenagakerjaan. The reported fluctuations in the data are indicative of the intricate interplay between various occupational risks and their corresponding impacts. These findings offer a comprehensive understanding of the intricate connection between individual contributions and the degree of risk associated with the scope of one’s professional engagement. In terms of the age of the participants, it can be observed that most participants were in the 25-54 age group, with a significant number of participants before and after the pandemic. In addition, participants below 25 years old and above 54 years old were also involved in this study, although the number was relatively smaller. These data suggest that the telemedicine program can be used by different age groups of workers with disabilities.
Table 2 delineates a comparison of nominal values pertaining to the all-encompassing rehabilitation benefit, drawing a distinction between the time period before the emergence of the COVID-19 outbreak and the period during the pandemic. The tables provide an in-depth analysis of the characteristics and associations with the number of cases and comprehensive rehabilitation benefit values based on different factors. From a categorical standpoint, it is clear that “Functional Disabilities” has the largest overall number of instances, with 1 253 individuals classified as disabled in this way. This observation suggests that a significant percentage of individuals in the workforce encounter varying degrees of functional limitations after sustaining occupational injuries. In a parallel vein, when contemplating the comprehensive scope of contribution, it is noteworthy that the category labeled as “Moderate” exhibits the most substantial tally, amounting to 2,374,116,178 IDR in terms of comprehensive rehabilitation benefit values. This observation implies that a considerable proportion of the therapeutic advantages in the field of comprehensive rehabilitation can be ascribed to instances that fall under the category of “Moderate” on the contribution scale.
Table 2. Characteristic based on nominal of rehabilitation benefit
While further investigating the connection between the different kinds of industries and the variables, it was found that the “Processing Industry” group had the largest number of cases both before and after the COVID-19 pandemic, with counts of 421 and 301, respectively. These data suggest that the processing industry exhibits a comparatively elevated prevalence of occupational injuries leading to disabilities. In the context of comprehensive rehabilitation benefit values, it is noteworthy that the “Processing Industry” demonstrates a prominent position in both the pre and during-COVID-19 periods. This observation implies a considerable magnitude of medical expenditures linked to occupational injuries within this sector.
It is important to acknowledge that the data presented in these tables hold significant potential for yielding valuable insights to policymakers, employers, and health care providers. The observed variations in the prevalence of cases and the values of comprehensive rehabilitation benefits across different categories underscore the significance of implementing focused interventions and bolstering support systems, particularly within industries exhibiting elevated incidence rates. Moreover, these discoveries possess the potential to make a valuable contribution to the realm of informed decision-making pertaining to the allocation of resources and the formulation of policies within occupational health and safety programs.
Comparison of Telemedicine-Assisted Return to Work Program Outcomes with Generic Methods
In this study, we compared the results of a RTW program supported by telemedicine (during the COVID-19 pandemic) with a generic method without telemedicine (before the COVID-19 pandemic). The comparison was based on the results of a regression analysis for two variables, the number of cases and the claim payment amount, using a statistical model. The boxplot depicted in Figure 1 presents valuable insights into the distribution patterns of the data within the respective groups. Within the graphical representation known as the boxplot, it is observed that there exist distinct regions demarcated by colored boxes, which serve to visually represent the statistical measures known as the first quartile (Q1) and the third quartile (Q3). The central axis within the enclosed region is indicative of the median (Q2).
Figure 1. Comparison based on case and nominal payout.
The findings derived from the analysis employing boxplots indicate that the implementation of the telemedicine-supported Return to Work program during the COVID-19 pandemic demonstrates a more favorable distribution of cases and nominal claim payments in contrast to the conventional approach utilized prior to the onset of the pandemic. The presence of elevated quartiles and a reduced interquartile range on the boxplot pertaining to the RTW program incorporating telemedicine suggests a potential correlation. Therefore, it appears that the implementation of telemedicine within RTW initiatives subsequent to the COVID-19 outbreak exhibits a propensity for yielding favorable outcomes in the realm of case management and claims disbursement for individuals afflicted by occupational injuries resulting in disabilities.
Effectiveness of Telemedicine in Facilitating Return to Work Among Workers with Disabilities
This research aims to investigate the effects of integrating telemedicine into RTW programs. The gathered data undergoes a thorough analysis to ascertain that all claim data adhere to the predetermined inclusion criteria. The aforementioned claims data are specifically related to occupational accident insurance, which falls under the purview of the social security employment assurance program. Moreover, the examined data meets the eligibility criteria due to its correlation with the RTW program, thereby addressing instances where claimants have experienced disabilities resulting from work-related accidents. The analysis is constrained by a specific temporal boundary that corresponds to the telemedicine guidelines that regulate the RTW program in the context of the COVID-19 pandemic. This boundary is precisely established at March 2020 or the 26th month, as illustrated in Figure 2 and Figure 3 below. Clearly evident in these data are discernible patterns indicating a decreasing prevalence of recurrent cases being referred to rehabilitation centers, accompanied by a corresponding decline in the financial worth of disbursed payouts.
Figure 2. Model based on cases.
Figure 3. Model based on nominal payout.
In Figure 2, we observe the initial estimation of cases to be 27.368, indicating a progressive increase in case numbers throughout the observed months. In accordance with the findings presented in Figure 3, it is evident that the initial average nominal payout exhibited a noteworthy positive trend as it progressed over time. Through an in-depth examination of both models, the analysis sought to investigate the impact of the variable associated with the intervention, specifically the implementation of telemedicine. Notably, this intervention demonstrated a statistically significant association with decreased instances (P < 0.001) and lowered monetary compensations (P < 0.001).
Moreover, the presented data in Table 3 elucidates the relative risk (RR) pertaining to two distinct classifications, namely Occupational Injury Claims and Nominal Payouts, both pre and post the integration of telemedicine. In the context of Occupational Injury Claims, the implementation of telemedicine yielded a RR of 0.59 (95% CI: 0.44 to 0.69). This finding indicates a noteworthy reduction in risk, estimated at approximately 41%. A RR of less than 1 indicates a lower risk of injury claims after the implementation of telemedicine, while a relative risk of greater than 1 indicates a higher risk of injury claims after the implementation of telemedicine. The findings suggest that the implementation of telemedicine was correlated with a reduced relative risk of occurrence of recent cases that increased the number of occupational injury claims. In the realm of nominal payouts, it is noteworthy to mention that the implementation of telemedicine yielded a RR of 0.6 (95% CI: 0.61 to 0.98), signifying a reduction in risk by 40%. The findings suggest a potential association between the integration of telemedicine and a decreased relative risk of elevated nominal payouts.
Table 3. The relative risk (RR) and 95% confidence interval (CI) for alterations in injury claims and nominal payouts in Indonesia before and after the introduction of telemedicine in the RTW program
Taken as a whole, these results are consistent with the idea that telemedicine’s incorporation into the health care system, which is what this intervention seems to indicate, is correlated with lower rates of case incidence and cost.
Thus, it can be concluded that the use of telemedicine in the RTW program is highly effective in managing the number of cases and claim payments for workers with disabilities due to occupational injuries. These results provide a positive indication of the potential of telemedicine in improving the effectiveness of the RTW program and assisting disabled workers in the process of returning to the workforce after an occupational injury.
Discussion
Interpretation of Main Results
The primary objective of this study was to evaluate the effectiveness of a telemedicine intervention in facilitating the reintegration of workers with disabilities caused by occupational injuries into the workforce. The findings of our analysis revealed a noteworthy and statistically significant correlation between the implementation of telemedicine and its positive impact on facilitating the RTW process for the individuals under study. A comparative analysis was conducted to evaluate the effectiveness of telemedicine-assisted approaches versus conventional methods in managing occupational injury-related disabilities within the RTW program. The findings revealed a more favorable distribution of cases and nominal claim payments following the integration of telemedicine. This suggests that telemedicine has the potential to improve case management and facilitate the disbursement of claims in the post-COVID-19 outbreak.
Considering the various disability types observed within the cohort, it is noteworthy that individuals presenting with functional disorders exhibited a predominant presence among those utilizing the telemedicine program for the purpose of facilitating RTW. While a subset of individuals encountered complete or partial disabilities, most functional limitations served to bolster the effectiveness of the program in aiding workers with said disabilities throughout their return-to-work trajectory. Therefore, the results of this study strongly support the essential contribution of telemedicine in enhancing the RTW journey for individuals who have sustained occupational injuries and are experiencing disabilities. The integration of telemedicine into the health care system has been observed to have a beneficial impact on the management of case volumes and claim payments, thereby enhancing the overall effectiveness of the RTW program. The aforementioned insights possess significant implications for various stakeholders, such as practitioners, employers, and governmental bodies, in their pursuit of improving services and providing support to workers who encounter the intricacies of returning to work after sustaining occupational injuries. Furthermore, this study emphasizes the extensive potential of telemedicine initiatives, surpassing the limitations of organizational scale, thus expanding the availability and scope of services for individuals with disabilities across various sectors of the workforce.
Comparison of findings with prior literature
A comprehensive investigation was undertaken to assess the efficacy of remote occupational rehabilitation services amidst the unprecedented COVID-19 pandemic.Reference Gross, Asante and Pawluk 25 This study has elucidated numerous advantageous outcomes, encompassing the seamless provision of rehabilitation services to injured individuals while adhering to the imperative practice of physical distancing. Moreover, it has been observed that the utilization of remote services mitigates the peril of COVID-19 transmission for both the injured workers and the health care personnel involved. Additionally, this innovative approach affords enhanced flexibility and convenience to workers who encounter challenges attending in-person appointments due to limitations in transportation or mobility. Furthermore, there exists a potential reduction in health care expenditures associated with in-person visits and the accompanying travel expenses. Nevertheless, it is imperative to acknowledge that additional investigation is warranted in order to comprehensively comprehend the enduring efficacy of remote occupational rehabilitation services and to ascertain any conceivable constraints or obstacles associated with the dispensation of said services.Reference Gross, Asante and Pawluk 25
According to the data provided, there is a clear correlation between the use of telemedicine within the variable-rate contribution of the occupational injury insurance program and a decrease in the number of cases, especially those involving repeated referrals to rehabilitation centers, as well as a decrease in the overall nominal payouts. This observed pattern is consistent with the results of a prior investigation,Reference Shin, Oh and Yi 26 which demonstrated an association between specific characteristics of insurance systems, such as employer funding mechanisms based on fixed flat rates and broader coverage of compensation schemes, and reduced incidence of occupational accidents. These findings underscore the potential beneficial effects of improved insurance frameworks on occupational health and safety indicators.
According to a report by the International Labour Organization, the number of occupational accidents in Indonesia is high, with an estimated 95 000 accidents per year. 27 The Indonesian National Agency for Social Security on Employment provides insurance coverage for work-related injuries.Reference Kurnianto, Khatatbeh and Prémusz 16 A study on RTW programs for work-injured employees in Indonesia found that the success rate of such programs is influenced by various factors, including the severity of the injury and the type of job.Reference Aprianto, Hakim and Sahara 19 The Indonesian government has taken steps to improve social security for informal workers, including subsidizing social security contributions and employment injury insurance. 28 , Reference On Madya and Nurwahyuni 29
Telemedicine offers various benefits in RTW programs for injured workers. In our study, it was found that telemedicine can improve the effectiveness of an injured worker’s recovery process by reducing the risk of missing medical appointments and ensuring timely communication with health care providers. In addition, the use of telemedicine can also reduce health costs for workers by eliminating the need to travel to urgent care facilities or hospitals, thus helping workers save money on medical services, fuel, and transportation costs. Another advantage found is the increased involvement and utilization of workers in their health care, which in turn can improve the overall health of workers and benefit employers.
Furthermore, the examination of participant demographics has provided valuable observations. The demographic distribution of participants predominantly consisted of individuals aged 25 to 54 years. Notably, significant engagement was observed both prior to and following the occurrence of the pandemic. Significantly, individuals predominantly affected by functional impairments demonstrated the most pronounced level of involvement with the telemedicine program, indicating its heightened efficacy in assisting employees with these disabilities during the RTW procedure. It aligns with multiple research investigations examining the advantages of telemedicine in the context of disability management.Reference Laaksonen and Gould 30 –Reference Khanal, Burgon and Leonard 32 Moreover, the incorporation of participants spanning a wide range of business magnitudes, including enterprises of significant, moderate, minor, and minute proportions, highlights the versatility of the telemedicine initiative within heterogeneous business environments.
However, in accordance with a comprehensive investigation on the subject of telemedicine,Reference Swanson Kazley, McLeod, Wager, Menachemi and Singh 33 –Reference Haleem, Javaid, Singh and Suman 35 it has been observed that individuals afflicted with functional impairments exhibited a greater degree of engagement and active participation in the telemedicine program, as opposed to their counterparts who suffer from anatomical impairments. The study did not elucidate the precise etiology underlying this observation; however, it postulates that telemedicine may confer notable advantages for individuals afflicted with functional impairments. The study additionally delineated various impediments to the utilization of telemedicine, encompassing deficient reimbursement mechanisms, absence of linguistic congruity, limited technological accessibility, challenges pertaining to physician licensure or credentialing, insufficiency of trained support personnel, and concerns regarding patient privacy and security assurances. It is imperative for health care professionals and decision-makers to collaboratively tackle these obstacles in order to enhance the utilization of telemedicine and enhance the accessibility of health care services.
Implications of the study for occupational health and telemedicine implementation
As the results of the previous study have shown, factors that affect a worker’s ability to return to work after an occupational injury may be taken into account when creating effective policies and treatments, improving outcomes for both employers and insurers.Reference Robichaud, Truchon, St-Arnaud and Nastasia 36 The findings of our study serve to enhance the implications for the domain of occupational health and the implementation of telemedicine. The results indicate that the utilization of telemedicine within the RTW program remains promising as a viable and efficacious option for facilitating the reintegration of individuals with occupational injuries and disabilities back into the workforce. The implementation of telemedicine in occupational rehabilitation services can help facilitate a more flexible RTW process and provide easier access to health services for workers who have difficulty attending face-to-face meetings. These implications show great potential for the implementation of telemedicine in improving workplace inclusion and productivity, especially in pandemic situations such as COVID-19, where physical distance and mobility limitations are major concerns.
Strengths and Limitations of the Study
The ITSA technique, which identifies patterns and trends in occupational rehabilitation service performance over time, makes this study strong. Furthermore, it is worth noting that this study represents a pioneering effort in the realm of public health research, as it delves into the scarcely explored domain of economic evaluation pertaining to the efficacy of telemedicine within the context of return-to-work programs under social security benefits in emerging economies. This research examined developments in the RTW program and telemedicine from 2015 through 2022. Nevertheless, it is essential to acknowledge the presence of certain limitations within this investigation. First, the data used may have limitations in terms of accuracy and completeness, depending on the accuracy and quality of records from the data sources used. In addition, as this study is observational in nature, there is a possibility of confounding factors that cannot be fully controlled for, which may affect the results of the analysis. Therefore, the results of this study need to be interpreted with caution and considered when making decisions in the implementation of telemedicine-based occupational rehabilitation services.
Recommendations for Future Research and Program Development
Based on the findings of this study, it is recommended to conduct further research that delves deeper into the effectiveness and long-term impact of using telemedicine in RTW programs. Future research may consider conducting an experimental study with a robust control design to validate the findings of this study. In addition, more in-depth research is needed to identify other factors that may influence the effectiveness of telemedicine-based occupational rehabilitation services, such as social, economic, and psychological factors. In addition, in program development, more attention is needed toward the development of technological infrastructure and human resources that support the implementation of effective telemedicine services. Collaborative efforts between relevant parties, including the government, health institutions, and companies, also need to be improved to ensure the success and sustainability of the implementation of telemedicine-based occupational rehabilitation services to increase RTW opportunities for workers with disabilities.
Conclusion
In conclusion, the research demonstrates the effectiveness of telemedicine in the RTW program and a notable decrease in the occurrence of recurrent cases of occupational injuries and payment claims. This innovative approach efficiently manages cases and lowers medical expenses, promising to optimize RTW initiatives for individuals with disabilities. The study addresses research inquiries and bridges the knowledge gap, highlighting telemedicine’s potential to facilitate reintegration after occupational injuries. Despite limitations, the findings contribute valuable insights for future telemedicine utilization in RTW programs for individuals with disabilities.
Data availability statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Acknowledgments
The authors would like to express their appreciation to the BPJS Ketenagakerjaan, Indonesian Social Security Agency on Employment, for sharing the data used in this study.
Author contribution
Substantial contributions to the conception or design of the work: Kurnianto. The acquisition, analysis, or interpretation of data for the work: Kurnianto, Amer, and Putri. Drafting the work or revising it critically for important intellectual content: Kurnianto and Amer. Final approval of the version to be published: Nemeskéri, Ágoston. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Kurnianto, Nemeskéri, Ágoston.
Funding statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.
Competing interest
There are no conflicts of interest to declare.
Ethical statement
This study has received ethical approval from the Health Research Ethics Committee, Faculty of Public Health, Universitas Airlangga, with number: 58/EA/KEPK/2021. This study has been deemed to meet ethical criteria based on seven WHO Standards 2011, including social value, scientific validity, fair subject selection, risk reduction, independent review, clear informed consent, and respect for the privacy and confidentiality of participants, in accordance with the 2016 Council for International Organizations of Medical Sciences (CIOMS) Guidelines. Informed consent was obtained from all participants. Fulfillment of the indicators for each standard also indicates the study’s compliance with these ethical requirements.
Open access
