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International research has generated strong evidence that healthcare providers (HCPs) play a key role in the return to work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. Aim: Our study sought to understand how HCPs interact with workers compensation boards (WCBs), manage the treatment of workers compensation patients and navigate the RTW process. Method: The study involved in-depth interviews with 97 HCPs in British Columbia, Manitoba, Ontario and Newfoundland and Labrador and interviews with 34 case managers (CMs). An inductive, constant comparative analysis was employed to develop key themes. Findings: Most HCPs did not encounter significant problems with the workers compensation system or the RTW process when they treated patients who had visible, acute, physical injuries, but faced challenges when they encountered patients with multiple injuries, gradual-onset or complex illnesses, chronic pain and mental health conditions. In these circumstances, many experienced the workers compensation system as opaque and confusing. A number of systemic, process and administrative hurdles, disagreements about medical decisions and lack of role clarity impeded the meaningful engagement of HCPs in RTW. In turn, this has resulted in challenges for injured workers (IWs), as well as inefficiencies in the workers compensation system. Conclusion: This study raises questions about the appropriate role of HCPs in the RTW process. We offer suggestions about practices and policies that can clarify the role of HCPs and make workers compensation systems easier to navigate for all stakeholders.

Many individuals (10-30%) experience persistent and/or new symptoms beyond the acute COVID-19 infection, which can present regardless of initial infection severity. Commonly referred to as "Long COVID" among public advocacy groups, this post-COVID condition affects multiple body systems and is thought to reflect persistent inflammation, thrombosis, and an autoimmune reaction. The most consistent complaints of Long COVID are fatigue, shortness of breath, muscle pain and difficulty concentrating. Many with Long COVID experience loss of income, or struggle to fulfill family duties. Given that there have been over 117,000 PCR-test confirmed COVID-19 cases in Manitoba, it is likely that thousands of Manitobans are affected by Long COVID. Emerging international guidance recommends that policy makers address Long COVID through a multidisciplinary approach, including interprofessional rehabilitation services. With this in mind, we conducted an environmental scan to support and make recommendations for Long COVID management in Manitoba. Our objectives were to 1) identify policy for management of Long COVID, 2) learn about the lived experiences and advocacy priorities of people with lived experiences of Long COVID, and 3) gather information on current Long COVID services in Manitoba. We conducted web searches in July-September 2021 for a) provincial/territorial government policies related to Long COVID, b) peer-reviewed evidence syntheses and original studies about Long COVID, and c) Long COVID public advocacy groups. We collected information on current, publicly-funded Long COVID rehabilitation services in Manitoba, by consulting with service providers, managers and researchers with knowledge of the Manitoba health system. Our policy search identified frameworks for managing Long COVID in just two provinces (Alberta and Saskatchewan); both frameworks incorporate integrated, interprofessional care. We were unable to identify Long COVID policy in any other jurisdiction, and four jurisdictions indicated that Long COVID will be managed using existing programs or global budgets. Public advocacy groups consistently raised the lack of recognition, let alone care, for Long COVID. Concerns about accessibility to appropriate health services were consistently expressed by advocacy groups because established services may not be equipped to address the needs of people with Long COVID. Advocacy groups argue for specialized team-based clinics, with rehabilitation as one of the main components of Long COVID management. Our scan of existing Manitoba services indicated that current rehabilitation services are not designed for the needs of people with Long COVID. Major gaps include Long COVID rehabilitation services for children and youth, and accessible community-based interprofessional care for young and middle-aged adults. Long COVID rehabilitation programs are being developed, but are not yet funded.