Musculoskeletal Problems and Functional limitation The great Public Health Challenge for the 21st Century Dag Bruusgaard

Transcription

1 Musculoskeletal Problems and Functional limitation The great Public Health Challenge for the 21st Century Dag Bruusgaard Professor, Head of dept. Dept. of General Practice and Community Medicine University of Oslo, Norway

2 Troublesome for the patients, problematic for the health care system, and costly for the society

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4 Musculoskeletal Conditions (MSC) 50% of population report MSC 15-20% of consultations in primary care 30-50% of disability payment 6% of total health care costs (but 90% of indirect costs)

5 Musculoskeletal problems and conditions form a heterogeneous group for a great part with poorly understood causes. The group comprises clear cut diagnoses, biologically and clinically well defined such as rheumatoid arthritis and sciatica; biologically defined, but clinically less well defined diagnoses such as osteoporosis and arthrosis; as well as controversial conditions as nonspecified low back pain, fibromyalgia and myofacial pain syndromes. The common denominators are pain and reduced function resulting from some disturbances in the musculoskeletal system ensuing mainly from inflammation, degenerative processes and trauma.

6 European Community Health Indicators (ECHI) Demography and Socio-economic situation Health status Determinants Health systems (consequences)

7 Musculoskeletal Conditions ECHI hierarcy Health status Perceived and functional health Chronic disease general General musculoskeletal pain

8 Monitoring of Musculoskeletal Conditions Routine data (running) HIS/HES data (repeated) generic HIS/HES data (repeated) spesific

9 Musculoskeletal Conditions Inflammatory arthritis Osteoporosis Osteoarthritis Dorsalgia Other localized pain Chronic widespread musculoskeletal pain Trauma

10 Musculoskeletal Conditions Chronic musculoskeletal pain- A multisymptom syndrome? Chronic fatigue Fibromyalgia Myofacial pain syndrome Amalgamism El-allergy Gulf war syndrome Multichemical hypersensitivity

11 Monitoring of MSC 1. Occurrence of self reported musculoskeletal pain Self report in health interview survey of pain and limited function from different regions, using the question above. 2. Occurrence of rheumatoid arthritis Incidense and prevalence of RA in existing and future regional registers 3. Occurrence of osteoarthritis in hip and knee Prevalence of OA in research projects based on health examination surveys, including x-ray 4. Occurrence of osteoporosis Prevalence of bone density monitored in health examination studies

12 Monitoring of MSC 5. Reduced function Prevalence of persons with reduced function, measured in health interview surveys as recommended by other in the health monitoring project 6. Work disability Permanent or temporal work disability, according to diagnosis from social security statistics

13 Monitoring of MSC 7. Occurrence of hip fracture Incidence of hip fractures from hospital statistics 8. Hip and knee arthroplasty Incidence and indicators for hip and knee replacement from hospital statistics 9. Drugs for treatment and prevention of osteoporosis Defined daily doses of drugs (ATL05B) and actual prescription from whole sale statistics and prescription registers 10. Drugs for treatment of rheumatoid arthritis Defined daily doses of drugs (ATC L 04 A) and actual prescription from whole sale statistics and prescription registers

14 1. During the last week, have you had any pain affecting your muscles, joints, neck or back which has occurred on most days and which has affected your ability to carry out the activities of daily living? If Yes, please tick the region(s) in the grid (column a) 2. Has this pain (or pains) lasted for 3 months or more? If Yes, please tick the region(s) in the grid (column b) Head Neck - Shoulder(s) - Upper back Elbows - Wrist(s) / hand(s) - Low back - Hip(s) / thigh(s) - Knee(s) - Ankles / foot/feet

15 Musculoskeletal Conditions Rheumatologists Orthopedic surgeons Traumatologists Endocrinologists Epidemiologists General Practitioners

16 EULAR B&J Decade

17 Writtendeclarationonrheumatic diseases (41/2005) The European Parliament calls on the Commission and Council to: Ensure that the EU s 7th RFP makes rheumatic diseases one of its explicit priorities; Ensure that the EU s new health strategy makes arthritis (musculoskeletal disorders) one of its priorities

18 Written declaration on rheumatic diseases (41/2005) The European Parliament calls on the Commission and Council to: Ensure that the EU s 7th RFP makes rheumatic diseases one of its explicit priorities; Ensure that the EU s new health strategy makes arthritis (musculoskeletal disorders) one of its priorities

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20 European Community Health Indicators PAIN FATIGUE DEPRESSION ANXIETY

21 European Community Health Health monitoring Indicators Resources mon. Compl/functional mon. Disease monitoring

22 European Community Health Indicators Health status Mortality Morbidity Generic health status Composite health status

23 This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.