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How to make a national priority into a clinical reality
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Transcript of How to make a national priority into a clinical reality
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How to make a national priority
into a clinical reality
Prof Juan A. Jover,Rheumatology Service
Hospital Clnico San Carlos, Spain
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How to make a national priority
into a clinical reality
Juan A. Jover, Rheumatology Service
Hospital Clnico San Carlos, Madrid. Spain
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The reservoir of knowledge
Research
Dissemination
Applications
A (long) journey from data to results
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The reservoir of knowledge
Musculoskeletal, Rheumatic, Osteoarticular, Diseases, Disorders
Joints
Connective Tissue
Spine
Soft tissue
Bone
Generalized pain
Characteristics High incidence and prevalence
Chronic course
High impact in quality of life: Pain and Disability
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Burden of diseases in Canada, 2000
http://www.phac-aspc.gc.ca/ph-sp/preveco-01-eng.php#fig1Adapted from IHE, 2008; data from the Public Health Agency of Canada
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Sanitary Process
- Individual factors- Collective- Public Health- Health System
- Primary Care- Specialized care
Occupational Process
- Economic Activity- Employers- Unions- Occupational Health
Administrative Process- Compensation- Laws- Control- Fraud
TWD
PWD
What if?
The complexity of Work Disability
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Control
Intervention
Results Days of TWD Patients with PWD Direct Costs Indirect Costs Cost/efficacy Cost/benefit
Inclusion: 12 months Follow-up: 12 months
Three health districts in Madrid Randomized study Voluntary program Patients maintained their group
Intention to treat analysis
MSD-TWD Program (98-01)
TWD initiation dueto MSDs
(13.000 non-selected patients)
Early Intervention Protocolized clinical management Patient Education Self-management
Administrative Duties
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Control Intervention
Days
0
25
50
75
100
0 30 60 90 120 150 180 210 240 270 300 330 360
%of
patientsback
towork
Research:a clinical approach to MSD-WD
39 % reduction of TWD duration (days)
50% reduction of PWD (cases)
Increased patient satisfaction
Positive Economic evaluation
40% Decreased direct costs
50% Decreased indirect costs
1.110 % benefit at two years
Positive Extension of the Program
> 38.000 processes >1 million days off-work saved
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MSD-TWD program
Days
0
25
50
75
100
0 30 60 90 120 150 180 210 240 270 300 330 360
What to do with patients not doing well?
Early Cognitive Behavioural InterventionPsycho MSD-TWD 04
%of
patientsback
towork
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40 60 80 100 120 140 160 180 200 220 240 260
0.75
1.00
0.50
0.25
0.00
First TWD episode
0.00
0.25
0.50
0.75
1.00
0 40 80 120 160 200 240 280 320 360
TWD relapses
Early Psychological intervention
181 patients of the MSD-TWD program, off-work at 3 - 6 weeks
MSD-TWD Program
Randomization
MSD-TWD Program+
CBT Intervention
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System Dynamics Model of TWD
(Valve 1)(Valve2)
(Valve 3)(Valve 4)
(Valve 0)
(Valve5)
(Valve 6)
LWDE(t)SWDE(t)ETWD(t))13(
EFLWD(t)EFSWD(t)EFTWD(t))12(
EGPD(t)dt
EPD(t)d)11(
UERW(t)EFLWD(t)EFSWD(t)dt
ERW(t)d)10(
MWTPD
EWPD(t)100
PUPDUERW(t))9(
MWTPD
EWPD(t)
100
PUPD)-(100EGPD(t))8(
UERW(t)-EGPD(t)-EAPD(t)dt
EWPD(t)d)7(
LWDE(t)100
PEAPDEAPD(t))6(
MDLWD
LWDE(t)EFLWD(t))5(
EAPD(t)-EFLWD(t)-ES2LWD(t)dt
LWDE(t)d)4(
MDSWDEtifSWDE(t)100
PES2L
MDSWDEtif0
ES2LWD(t))3(
MDSWDE
SWDE(t)EFSWD(t))2(
ES2LWD(t)-EFSWD(t)-ESTWD(t)dt
SWDE(t)d)1(
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System Dynamics Model of TWD:An hydraulic analogy
Valve 3
Valve 5
Active Workers
ST-TWDValve 2
LT-TWD
Valve 4
PWD EVAL
Valve 6
PWDConcession
Valve 1
Return toWork
Valve 0
MSD-TWDprogram
(40%)
Psycho-TWDprogram(20%)
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Disability is the major Health problem in Clinical Rheumatology
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
Health Outcomes
An early, clinical approach to TWD is highly efficient
Patients with serious, autoimmune conditions
Patients with banal diseases and recent-onset TWD
Recommendations for clinicians
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Applications
TWD programs in (3)different Autonomous Communities
Inspection Services
Primary care
Rheumatology Services
Procedures
TWD episodes are a fixed phenomenon, in a given population
Access in the first week of TWD
Close follow up until return to work
Specific Clinical Protocols
Funding
NHS
National Institute of Social Security
Public-Private Partnership
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Routine access of new patients (HCSC)
13%
7,5%
9%
% Inflammatory QoL
Poor or Very Poor
1
x 5
x 10
GeneralWL 30-40 days
1.700
1.700
4.000
UrgentLE < 72 h
N
Disability
WL < 7 days
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HealthService
Research
AccessHealthResults
Care Process
ICT-EHR
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Thanks
MSD-TWD Team
Lydia Absolo
Gloria Candelas
Margarita Blanco
Cristina Lajas Petisco
Csar Hernndez-GarcaBenjamn Fernndez-Gutirrez
Leticia Len
Javier BachillerPaz Collado
Marcelino RevengaPatricia Ricci
Pablo LzaroMaria Dolores AguilarEmilio VargasLoreto Carmona
Fundacin ABBOTT Espaa
Antonio BaaresSara Pascual