Thought Leader: Juan Jover: Early intervention

Written by Juan Jover on 31 March 2014 in Thought Leader
Thought Leader

Early intervention is a cost-effective solution to reducing the burden of musculoskeletal disorders, writes Juan Jover.

This Thought Leader article is sponsored by Fit for Work Europe

What costs EU countries upwards of €240bn annually? Musculoskeletal disorders (MSDs) affect 100 million Europeans and member states could see up to 50 per cent of their working-age populations diagnosed with a chronic MSD by 2030. The 2010 report on the global burden of disease states that “[MSDs are] the primary cause of disability in [Europe].” MSDs are not just a health issue, they are a social and economic one, too - one that we simply cannot afford to ignore.

There is hope, however. We founded MSD early intervention trial clinics in Madrid in three different health areas covering a population of more than one million people. The programme included a system that ensured patients were referred to a rheumatologist within a few days of first being unable to work due to an MSD. Compared with standard procedures, our early intervention approach resulted in a 39 per cent reduction in temporary work disability and a 50 per cent reduction in permanent work disability.

Using data from this innovative programme, Fit for Work, a multi-stakeholder coalition working toward a better alignment between the work and health agendas in the EU, published a report in 2013 that demonstrates the impact early intervention has on patient outcomes and health and social systems. Since then, 25 early intervention clinics have opened across Spain, achieving similar results. Some clinics are now completely government-funded - a testament to the cost-effectiveness of early intervention. The pilot programme saw immediate savings, with every euro spent leading to almost €11 in recouped expenditures.

"... Our early intervention approach resulted in a 39 per cent reduction in temporary work disability"

With early intervention clinics we are saving the social security system money because patients are taking fewer days off work; we are saving the healthcare system money because patients recover faster and consume less healthcare overall; and we are ensuring increased patient satisfaction because they receive additional support and faster relief from their symptoms. With early intervention, everybody wins. The success of the early intervention clinics in Spain is inspiring and replicable.

If our Spanish model were reproduced in 12 member states, one million working-age people on disability leave due to MSDs could return to work. Similar initiatives are being rolled out in other EU countries, but for it to be a pan-European success all member states must see it as a primary concern. As professor Maurizio Cutolo, president of EULAR, the umbrella body in Europe for patients, clinicians and health professionals in the area of MSDs points out, “The adoption of social and health policies to improve prevention and management is crucial for reducing the burden of these conditions.

Initiatives such as the early intervention clinic and EULAR’s project co-funded by DG Sanco are concrete and promising examples.” The early intervention model could even be adapted to other chronic diseases. To achieve this, leaders must coordinate their efforts to make early intervention a sustainable healthcare priority.

I will be making the case for early intervention as a cost-effective solution to reducing the burden of MSDs at the upcoming EU summit on chronic diseases. This summit presents an opportunity to shift perceptions. Health expenditures are not a drain on public resources, they are an investment. A healthy population means increased productivity, lower healthcare and social expenditures and fewer lost tax revenues.

Strong cooperation on health issues is essential if we are to ensure people with MSDs receive the treatment they need to continue contributing to Europe’s economic and social wellbeing.


About the author

Dr Juan Jover is head of rheumatology at hospital clínico San Carlos, Madrid

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