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8/8/2019 Fit for Work Europe: Turning Musculoskeletal Conditions into manageable conditions
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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
8/8/2019 Fit for Work Europe: Turning Musculoskeletal Conditions into manageable conditions
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How to we effectively manage
musculoskeletal conditions and reintegratepeople into work and society?
8/8/2019 Fit for Work Europe: Turning Musculoskeletal Conditions into manageable conditions
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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%
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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
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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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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)
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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.
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