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 - Compensation
- Collective - Laws
- Public Health - Control
- Health System - Fraud
- Primary Care
- Specialized care TWD
Non-recognized
Work Disability
What if…?
PWD
 MSD-TWD Program (98-01)

Inclusion: 12 months Follow-up: 12 months

Control Results
• Days of TWD
TWD initiation • Patients with PWD
due to MSDs • Direct Costs
(13.000 non- • Indirect Costs
selected • Cost/efficacy
Intervention • Cost/benefit
patients)

• Three health districts in Madrid • Early Intervention

• Randomized study • Protocolized clinical management
• Voluntary program • Patient Education
• Patients maintained their group • Self-management
• Intention to treat analysis • Administrative Duties
 MSD-TWD Program: Efficacy

• 39 % reduction of TWD duration (days)

• 50% reduction of PWD (cases)
100
% of patients back to work

• Increased patient satisfaction

• Positive Economic evaluation
75

Control
• Decreased Intervention
direct and indirect costs
50

• Benefit/cost at two years: 11 euros

• Positive Extension of the Program
25

• > 38.000 processes

• >1 million days off-work saved
0

0 30 60 90 120 150 180 210 240 270 300 330 360

Days
 What to do with patients not doing well?

Early Cognitive Behavioral Intervention

Psico MSD-TWD 04
100
% of patients back to work
75

MSD-TWD program
50
25
0

0 30 60 90 120 150 180 210 240 270 300 330 360

Days
 Early Psychological intervention

181 patients of the MSD-TWD program, off-work at 3 - 6 weeks

Randomization

MSD-TWD MSD-TWD Program

+
Program CBT Intervention
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 0 40 80 120 160 200 240 280 320 360

First TWD episode TWD relapses

 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 Health System

Lydia Abásolo Research
Loreto Carmona
Pablo Lázaro
César Hernández-García
Emilio Vargas
Antonio Bañares
Benjamín Fernández-Gutiérrez
Gloria Candelas Psychologists
Margarita Blanco
Javier Bachiller Leticia León
Marcelino Revenga Miguel A. Pérez
Paz Collado Marta Redondo
Cristina Ricci
Cristina Lajas
Cristina Vadillo Administrative Staff
Estíbaliz Loza María A Pérez de Benito
Dolores Olmos