Fit for Work Europe: Turning Musculoskeletal Conditions into manageable conditions

8/8/2019 Fit for Work Europe: Turning Musculoskeletal Conditions into manageable conditions

1/20

Turning Musculoskeletal Conditions into

manageable conditions:

What remains to be done to set up effective

systems at a national level?

Professor Anthony D Woolf

Chair, Bone and Joint DecadeProject Leader, eumusc.net

Royal Cornwall Hospital, Truro & Peninsula College of Medicine andDentistry

EUMUSC.NET In partnership with EULAR and 22

centres across Europe supported by the EU

Community Action in the field of Health 2008-2013


2/20

How to we effectively manage

musculoskeletal conditions and reintegratepeople into work and society?


3/20

Conditions affecting the musculoskeletal system

Joint diseases

Osteoarthritis

Rheumatoid arthritis

Gout

Infections

Back pain

Regional musculoskeletal pain

Osteoporosis and low trauma fractures

Bone infections

Trauma and Injuries

Work-related musculoskeletal disorders

ARTHRITIS

OSTEOPOROSIS

BACK PAIN

INJURIES & TRAUMA


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22% of the population currently has, orhas experienced long-term muscle, bone and joint problemssuch as rheumatism and arthritis

Health in the European UnionE

urobarometer Report 2007

22%


5/20

Musculoskeletal conditions affect all ages

Age dependent

diseases & non-

age dependent

diseases

DMC3 study, The Netherlands Picavet, H S J et al. Ann Rheum Dis 2003;62:644-650

Age related

diseases


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Person

Caregivers

Health care system

National economyLower quality of life(pain, restriction of activities) Caregiver time

Health care costs

Work disability

The impact the human and financialconsequences

Social support


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Longstanding troubles with muscles, bones and joints (arthritis,

rheumatism) account for 1 in 4 on longterm treatment in Europe

Health in the European Union Eurobarometer Report 2007

2nd only to hypertension


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Work and Musculoskeletal Conditions

Musculoskeletal conditions

limit work capacity

e.g. osteoarthritis of the hip or

knee prevents many people over

50 yrs working

Work causes musculoskeletal

disorders

e.g. heavy work causes back pain,

repetitive work related to upperlimb problems

WORK

X

X


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Effective treatments and strategies exist

European Bone and Joint Strategies Project (S12.304 598)

Recommendations for prevention and

management based on evidence made

for

The whole population

Those at risk

Those with early disease

Those with established conditions

Evidence taken from guidelinesdeveloped by EULAR and others

Emphasis on early case finding /

diagnosis and treatment for all MSC


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The problem

Musculoskeletal conditions are the single biggest cause of physical disability inthe EU; major cause of healthcare and social support costs; and a major cause oflost productivity

Effective treatments and strategies for their use exist but not beingimplemented effectively or with equity across Europe

Reasons include

lack of awareness and knowledge of the impact (epidemiology, costs etc.)

lack ofroutinely collected indicators at national and European level that arespecifically relevant to monitoring musculoskeletal conditions and thereforelack of knowledge of gaps and inequities in care

lack ofnational health policies and strategies that prioritise rheumatic andother musculoskeletal conditions

standards of care and access to care are not similar across member states


11/20

Factors that influence health policy

Competing

priorities

Evidence

Expert

opinion

Public

opinion

Economic

climate

Lobbying

Opportunities

Contextual

factors

HEALTH

POLICY

NGOs

Commercial

interestsWhat is

achievable

Cost

effectiveness

Needs


12/20

Factors that influence health policy

Competing

priorities

Evidence

Expert

opinion

Public

opinion

Economic

climate

Lobbying

Opportunities

Contextual

factors

HEALTH

POLICY

NGOs

Commercial

interestsWhat is

achievable

Cost

effectiveness

Needs


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IMPACT OF DISEASEIMPACT OF DISEASE

STATE OF THE ARTSTATE OF THE ART

EFFECTS OF INTERVENTIONEFFECTS OF INTERVENTION

UNAVOIDABLEUNAVOIDABLE

BURDENBURDEN

EFFECTS IN CLINICALEFFECTS IN CLINICAL

PRACTICEPRACTICEAVOIDABLEAVOIDABLE

BURDENBURDEN

OF DISEASEOF DISEASE

Closing the Gap between what can and is being

achieved - the avoidable burden

Bone and Joint Monitor ProjectHealth Needs Assessment of Musculoskeletal Conditions


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What is needed?

We have the evidence but how can we drive forward its

implementation?

How Can You ImplementGuidelines?


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eumusc.net

eumusc.net is optimising musculoskeletal health across Europe

by

Setting and monitoring standards for the provision of care of

arthritis

Identifying and helping overcome barriers that may prevent

effectiveness

Providing information on impact of musculoskeletal

conditions

eumusc.net is a health surveillance and information system

that will be embedded within EULAR.


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eumusc.net

Creating a network of institutions, researchers and individuals tofocus on increasing the knowledge base on musculoskeletal

problems and to contribute towards better understanding,

prevention, treatment and care of these conditions

3 year project but will be embedded within EULAR for sustainability

Supported by European Community (EC Community Action in the

Field of Health 2008-2013)

Supported by EULAR

22 partners across Europe


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EUMUSC.NET will provide Agreed indicators of musculoskeletal health and identified sources of data that enable

good quality and comparable information, surveillance and identification of inequalitiesof outcome.

A sustainable health monitoring system

Incidence & prevalence of major musculoskeletal conditionsImpact on individuals

Impact on society

Healthcare resource utilization

Social consequence

Work loss

Provision of care

Human resources

Physical resources

Clinical management

Inclusion in routine national data collection and surveys (eg EHIS)


18/20

EUMUSC.N

ET deliverables

Standards of care for people with major musculoskeletal conditions (initiallyosteoarthritis and rheumatoid arthritis based on existing guidelines) which will be patient

centred and state what a person with these conditions should expect to ensure they

have the best outcome eg access to early diagnosis and appropriate treatment of RA.

Health care quality indicators to enable systems of provision of care to beevaluated to ensure they are providing care that meets the agreed standards.

Evaluation of the current status of meeting these standards by surveys acrossMember States to provide updated information on the care that people receive in clinical

practice and identify inequities.

Barriers and facilitators will be identified to facilitate implementation thesestandards will be identified as well as examples of good practices to act as gold

standards

Dissemination of knowledge and best practice to enable the implementation ofthese standards and the achievement of the indicators


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SET STANDARDS

OBSERVE PRACTICE

COMPARE WITH

STANDARDS

AGREE CHANGES

NEEDED

INTRODUCE

CHANGE

REVIEW

STANDARDS

Improving outcome of patient Care:

Quality cycle


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Actions needed for people to have timely accessto appropriate care

Priority at a European and national level, recognising the importance ofmusculoskeletal health and the needs of those with or at risk of musculoskeletalconditions.

Comprehensive European and national health strategies for health promotion,prevention, treatment and rehabilitation of musculoskeletal conditions.

Priority should be given at the European and national level to the research needsof musculoskeletal conditions, that will lead to more effective prevention andtreatment.

Programmes to prevent musculoskeletal problems and conditions should link with

existing priorities and activities where there are opportunities for mutual benefit.

Data should be collected to monitor determinants for occurrence and impact ofmusculoskeletal conditions in all European states in a standardised manner.

Documents

Fit for Work Europe: Turning Musculoskeletal Conditions into manageable conditions