Fit For Work Europe: Spain Good Practice

Country good practice case study: Spain Prof Juan Angel Jover San Carlo Hospital, Madrid

Work Disability Related to Musculoskeletal Diseases: A Clinical Approach

Juan A Jover Servicio de Reumatología Hospital Clínico de San Carlos Madrid

Musculoskeletal Diseases (MSD) •

Rheumatic Diseases, Osteoarticular, Locomotor System

•

Classification

•

•

Joints

•

Connective Tissue

•

Spine

•

Soft tissue

•

Bone

•

Generalized pain

Characteristics •

High incidence and prevalence

•

Chronic course

•

High impact in quality of life •

Pain

•

Disability

Disability The ecological gap between the capabilities of the individual and the demands of the environment •Housewife •Active worker •Elderly •Student

The complex ecology of Work Disability (WD) Socio-occupational Process

- Economic Activity - Employers - Unions - Occupational Health

Socio-sanitary Process

Administrative Process

- Individual factors - Collective - Public Health - Health System - Primary Care - Specialized care

- Compensation - Laws - Control - Fraud

TWD Non-recognized Work Disability

What if…? PWD

MSD-TWD Program (98-01)

Inclusion: 12 months

Control TWD initiation due to MSDs (13.000 nonselected patients)

Intervention

• Three health districts in Madrid • Randomized study • Voluntary program • Patients maintained their group • Intention to treat analysis

Follow-up: 12 months Results • Days of TWD • Patients with PWD • Direct Costs • Indirect Costs • Cost/efficacy • Cost/benefit • Early Intervention • Protocolized clinical management • Patient Education • Self-management • Administrative Duties

MSD-TWD Program: Efficacy

100

• 50% reduction of PWD (cases) • Increased patient satisfaction

75

• Positive Economic evaluation

50

Control Intervention • Decreased direct and indirect costs • Benefit/cost at two years: 11 euros

25

• Positive Extension of the Program • > 38.000 processes • >1 million days off-work saved

0

% of patients back to work

• 39 % reduction of TWD duration (days)

0

30

60

90

120 150 180 210 240 270 300 330 360

Days

What to do with patients not doing well?

100 75 25

50

MSD-TWD program

0

% of patients back to work

Early Cognitive Behavioral Intervention Psico MSD-TWD 04

0

30

60

90

120

150

180

Days

210

240

270

300

330

360

Early Psychological intervention 181 patients of the MSD-TWD program, off-work at 3 - 6 weeks Randomization

MSD-TWD Program + CBT Intervention

MSD-TWD Program 1.00

1.00

0.75

0.75

0.50

0.50

0.25

0.25

0.00

0.00 40

60

80

100 120 140 160 180 200 220 240 260

First TWD episode

0

40

80

120

160

200

240

280

TWD relapses

320

360

Recommendations for clinicians • Disability is a major Health problem, include Work Disability as one of your major Clinical Objectives • TWD and PWD are Health indicators, that could help you to improve your Service Organization, regarding: • Access, Process and Health Outcomes Assesment

• An early, clinical approach to TWD is highly efficient • Patients with “serious”, autoimmune conditions • Patients with “banal diseases” and recent-onset TWD

Recommendations for policy makers • Include WD as one of the major Public Health Surveillance Indicators • Reengineer the “complex ecology” of WD, including the administrative, sociolaboral and sociosanitary processes • Promote research in disability • Basic • Occupational • Clinical • Social Sciences • Health System • Implementation

“If you do not know what direction you are going, then any path will take you there." Lewis Carroll’s The Adventures of Alice in Wonderland

Rheumatologists Lydia Abásolo Loreto Carmona César Hernández-García Antonio Bañares Benjamín Fernández-Gutiérrez Gloria Candelas Margarita Blanco Javier Bachiller Marcelino Revenga Paz Collado Cristina Ricci Cristina Lajas Cristina Vadillo Estíbaliz Loza

Health System Research Pablo Lázaro Emilio Vargas

Psychologists Leticia León Miguel A. Pérez Marta Redondo

Administrative Staff María A Pérez de Benito Dolores Olmos