RESUMEN
BACKGROUND: The study evaluated the cost-effectiveness of hydrotherapy versus land-based therapy in patients with musculoskeletal disorders (MSDs) in Singapore. METHODS: A decision-analytic model was constructed to compare the cost-effectiveness of hydrotherapy to land-based therapy over 3 months from societal perspective. Target population comprised patients with low back pain (LBP), osteoarthritis (OA), rheumatoid arthritis (RA), total hip replacement (THR) and total knee replacement (TKR). Subgroup analyses were carried out to determine the cost-effectiveness of hydrotherapy in individual MSDs. Relative treatment effects were obtained through a systematic review of published data. RESULTS: Compared to land-based therapy, hydrotherapy was associated with an incremental cost-effectiveness ratio (ICER) of SGD 27 471 per quality-adjusted life-year (QALY) gained, which was below the willingness-to-pay threshold of SGD 70 000 per QALY (one gross domestic product per capita in Singapore in 2015). For the respective MSDs, hydrotherapy were dominant (more effective and less costly) in THR and TKR, cost-effective for LBP and RA, and not cost-effective for OA. Treatment adherence and cost of hydrotherapy were key drivers to the ICER values. CONCLUSIONS: Hydrotherapy was a cost-effective rehabilitation compared to land-based therapy for a population with MSDs in Singapore. However, the benefit of hydrotherapy was not observed in patients with OA.
Asunto(s)
Terapia por Ejercicio/economía , Hidroterapia/economía , Enfermedades Musculoesqueléticas/economía , Artritis Reumatoide/economía , Artritis Reumatoide/terapia , Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Análisis Costo-Beneficio , Terapia por Ejercicio/métodos , Humanos , Hidroterapia/métodos , Dolor de la Región Lumbar/economía , Dolor de la Región Lumbar/terapia , Enfermedades Musculoesqueléticas/terapia , Osteoartritis/economía , Osteoartritis/terapia , Años de Vida Ajustados por Calidad de Vida , SingapurRESUMEN
REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to identify and synthesize the best available evidence on the experiences and expectations of being involved in a program that aims to return nurses and midwives, who have acquired a musculoskeletal disorder (MSD) in the workplace, to work.The specific review questions are.
Asunto(s)
Enfermedades Musculoesqueléticas/psicología , Enfermeras y Enfermeros/psicología , Enfermedades Profesionales/psicología , Reinserción al Trabajo/psicología , Adaptación Psicológica , Adulto , Costo de Enfermedad , Femenino , Humanos , Masculino , Partería , Enfermedades Musculoesqueléticas/economía , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Musculoesqueléticas/rehabilitación , Enfermedades Profesionales/epidemiología , Investigación Cualitativa , Factores de Riesgo , Revisiones Sistemáticas como Asunto , Lugar de Trabajo/psicología , Lugar de Trabajo/normasRESUMEN
INTRODUCTION: The chronic nature of musculoskeletal diseases requires an integrated care which involves the Primary Care and the specialities of Rheumatology, Traumatology and Rehabilitation. The aim of this study was to assess the implementation of an integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease using Deming's continuous improvement process and considering referrals and resource consumption. MATERIAL AND METHODS: A simulation model was used in the planning to predict the evolution of musculoskeletal diseases resource consumption and to carry out a Budget Impact Analysis from 2012 to 2020 in the Goierri-Alto Urola region. In the checking stage the status of the process in 2014 was evaluated using statistical analysis to check the degree of achievement of the objectives for each speciality. RESULTS: Simulation models showed that population with musculoskeletal disease in Goierri-Alto Urola will increase a 4.4% by 2020. Because of that, the expenses for a conventional healthcare system will have increased a 5.9%. However, if the intervention reaches its objectives the budget would decrease an 8.5%. The statistical analysis evidenced a decline in referrals to Traumatology service and a reduction of successive consultations in all specialities. DISCUSSION: The implementation of the integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease is still at an early stage. However, the empowerment of Primary Care improved patient referrals and reduced the costs.
Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Enfermedades Musculoesqueléticas/terapia , Atención Primaria de Salud/organización & administración , Rehabilitación/organización & administración , Reumatología/organización & administración , Traumatología/organización & administración , Presupuestos , Enfermedad Crónica , Costos de la Atención en Salud , Humanos , Modelos Teóricos , Enfermedades Musculoesqueléticas/economía , Enfermedades Musculoesqueléticas/epidemiología , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/organización & administración , Derivación y Consulta/organización & administración , España/epidemiologíaRESUMEN
BACKGROUND: Musculoskeletal disorders (MSDs) constitute a major occupational health problem in the working population, substantially impacting the quality of life of employees. They also cause considerable economic cost to the healthcare system, with, notably, the reimbursement of treatments and compensation for lost income. MSDs manifest as localized pain or functional difficulty in one or more anatomical areas, such as the cervical spine, shoulder, elbow, hand, and wrist. Although prevalence varies depending on the region considered and the method of assessment, a prevalence of 30% is found in different epidemiological studies. The disease needs to be prevented, not only for medical and economic reasons, but also for legal reasons, owing to the requirement of assessing occupational risks. The strategy envisaged may thus revolve around active, multimodal prevention that has employees fully involved at the heart of their care. Although physical exercise is widely recommended, few studies with a good level of evidence have enabled us to base a complete, well-constructed intervention on exercise that can be offered as secondary prevention in these disorders. METHODS: A prospective, multicenter, comparative (intervention arm vs. control arm), randomized (immediate vs. later treatment) study using Zelen's design. This study falls under active prevention of MSDs of the upper extremities (UE-MSDs). Participants are workers aged between 18 and 65 years with latent or symptomatic MSDS, with any type of job or workstation, with or without an history of sick leave. The primary aim is to show the superiority at 3 months of a combination of spa therapy, exercise, and self-management workshops for 6 days over usual care in the management of MSDs in terms of employee functional capacity in personal and professional daily life. Secondary aims are to assess the benefit of the intervention in terms of pain, quality of life, and accumulated duration of sick leave. DISCUSSION: This randomized controlled trial is the first that will aim to evaluate multidisciplinary management of UE-MSDs using nonpharmacological treatment combining exercise, self-management, and spa therapy. The originality of this intervention lies, in its short, intensive format, which is compatible with remaining in work; and in its multidisciplinary approach. This trial has the potential to demonstrate, with a good level of evidence, the benefits of a short course of spa therapy combined with a personalized self-management program on the functional capacity, pain, and quality of life of employees in their daily life. TRIAL REGISTRATION: Clinical trial.gov NCT02702466 retrospectively registered. PROTOCOL: Version 4 of 9/10/2015.
Asunto(s)
Balneología/métodos , Terapia por Ejercicio/métodos , Enfermedades Musculoesqueléticas/prevención & control , Enfermedades Profesionales/prevención & control , Medicina de Precisión/métodos , Autocuidado/métodos , Humanos , Enfermedades Musculoesqueléticas/economía , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Profesionales/economía , Enfermedades Profesionales/epidemiología , Salud Laboral/economía , Prevalencia , Estudios Prospectivos , Calidad de Vida , Proyectos de Investigación , Ausencia por Enfermedad/estadística & datos numéricos , Factores de Tiempo , Extremidad SuperiorRESUMEN
BACKGROUND/AIM: Children and adolescents are prolific users of information and communication technologies (ICT) in learning, leisure, and social communication activities. High exposure to ICT is associated with musculoskeletal injuries in adults; however, the management of ICT physical complaints in children is not well-understood. METHODS: An online survey of allied health professionals (occupational therapists, physiotherapists, and chiropractors) was undertaken to determine (i) the number of children and adolescents in Perth, Western Australia who accessed treatment for musculoskeletal complaints related to use of technology; (ii) the typical frequency and duration of service provision; and (iii) the nature of treatment provided. Costs associated with service provision were estimated. RESULTS: Data from 101 identified the most commonly treated musculoskeletal complaints among children and adolescents included: non-specific neck pain; thoracic postural pain disorder; non-specific low back pain; and lumbar postural pain disorder. Approximately 1445 children were treated in the previous 12 months; with one-third of chiropractors each reported treating 31+ children. Most common treatments were soft tissue release, mobilisation, flexibility and conditioning exercises, soft tissue massage and kinesio-taping. Verbal education about healthy use of technology was provided by most clinicians (88%), with some inconsistent recommendations. The estimated cost of treatment was AUD$1,057,715; of which AUD$544,886 was health system funded. CONCLUSIONS: Children and adolescents received allied health treatment for a range of musculoskeletal complaints associated with ICT use. The potential long-term impacts on their health and wellbeing, and the economic burden associated with this health issue warrant the development of systematic risk reduction strategies.
Asunto(s)
Servicios de Salud/economía , Servicios de Salud/estadística & datos numéricos , Internet , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/rehabilitación , Adolescente , Niño , Humanos , Manipulación Quiropráctica/economía , Manipulación Quiropráctica/métodos , Enfermedades Musculoesqueléticas/economía , Terapia Ocupacional/economía , Terapia Ocupacional/métodos , Modalidades de Fisioterapia/organización & administración , Red Social , Australia OccidentalAsunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Costos de la Atención en Salud , Enfermedades Musculoesqueléticas/terapia , Administración de la Práctica Médica/organización & administración , Valorización y Adquisición Práctica/organización & administración , Compra Basada en Calidad/organización & administración , Prestación Integrada de Atención de Salud/economía , Planes de Aranceles por Servicios , Investigación sobre Servicios de Salud , Humanos , Modelos Organizacionales , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/economía , Paquetes de Atención al Paciente , Administración de la Práctica Médica/economía , Valorización y Adquisición Práctica/economía , Mejoramiento de la Calidad/organización & administración , Indicadores de Calidad de la Atención de Salud/organización & administración , Compra Basada en Calidad/economíaRESUMEN
INTRODUCTION: Manual therapy is the non-surgical conservative management of musculoskeletal disorders using the practitioner's hands on the patient's body for diagnosing and treating disease. The aim of this study is to systematically review trial-based economic evaluations of manual therapy relative to other interventions used for the management of musculoskeletal diseases. METHODS AND ANALYSIS: Randomised clinical trials (RCTs) on the economic evaluation of manual therapy for musculoskeletal diseases will be included in the review. The following databases will be searched from their inception: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Econlit, Mantis, Index to Chiropractic Literature, Science Citation Index, Social Science Citation Index, Allied and Complementary Medicine Database (AMED), Cochrane Database of Systematic Reviews (CDSR), National Health Service Database of Abstracts of Reviews of Effects (NHS DARE), National Health Service Health Technology Assessment Database (NHS HTA), National Health Service Economic Evaluation Database (NHS EED), CENTRAL, five Korean medical databases (Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Service System (RISS), DBPIA, Korean Traditional Knowledge Portal (KTKP) and KoreaMed) and three Chinese databases (China National Knowledge Infrastructure (CNKI), VIP and Wanfang). The evidence for the cost-effectiveness, cost-utility and cost-benefit of manual therapy for musculoskeletal diseases will be assessed as the primary outcome. Health-related quality of life and adverse effects will be assessed as secondary outcomes. We will critically appraise the included studies using the Cochrane risk of bias tool and the Drummond checklist. Results will be summarised using Slavin's qualitative best-evidence synthesis approach. ETHICS AND DISSEMINATION: The results of the study will be disseminated via a peer-reviewed journal and/or conference presentations. TRIAL REGISTRATION NUMBER: PROSPERO CRD42015026757.
Asunto(s)
Enfermedades Musculoesqueléticas/terapia , Manipulaciones Musculoesqueléticas/economía , Análisis Costo-Beneficio , Evaluación de la Discapacidad , Humanos , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/economía , Manipulaciones Musculoesqueléticas/métodos , Dimensión del Dolor , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como AsuntoRESUMEN
OBJECTIVES: The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions. METHODS: A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases. RESULTS: Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (e.g., osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain. CONCLUSIONS: Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients.
Asunto(s)
Enfermedades Musculoesqueléticas/economía , Enfermedades Musculoesqueléticas/terapia , Modalidades de Fisioterapia/economía , Análisis Costo-Beneficio , Humanos , Dolor de la Región Lumbar/terapia , Dolor de Cuello/terapia , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The Industrial Accident Compensation Insurance Act (IACIA) regulates the workers' compensation insurance system and the standards for the recognition of occupational diseases (ODs). Since its establishment in 1994, the IACIA has been amended several times. Before 2008, the approval of compensation for work-related musculoskeletal diseases (WMSDs) was decided based on the recommendation of consultants of the Korea Workers' Compensation and Welfare Service (COMWEL). The IACIA was amended in 2008, and since then, the approval of compensation for occupational injuries has been decided based on the recommendation of COMWEL consultants, whereas the approval of compensation for ODs was decided based on the judgment of Committee on Occupational Diseases Judgment (CODJ) which was established in 2008. According to the 2013 amendment to the IACIA, degenerative musculoskeletal diseases among workers engaged in musculoskeletal-burdening work should be considered compensable ODs. Despite some commendable changes to the workers' compensation insurance system, other significant issues persist. To resolve these issues, related organizations including the associations of orthopedic surgery, neurosurgery, and occupational and environmental medicine; Ministry of Employment and Labor; and COMWEL need to work cooperatively.
Asunto(s)
Accidentes de Trabajo/economía , Enfermedades Musculoesqueléticas/economía , Enfermedades Profesionales/economía , Traumatismos Ocupacionales/economía , Indemnización para Trabajadores/economía , Humanos , Seguro por Accidentes/economía , Seguro de Salud/economía , Seguro de Salud/normas , República de Corea , Indemnización para Trabajadores/normasRESUMEN
OBJECTIVES: Treatment for musculoskeletal disorders in primary care in Sweden is generally initiated with advice and medication. Second-line therapy is physiotherapy and/or injection and radiography; third-line therapy is referral to an orthopedist. Manual therapy is not routine. It is a challenge to identify patients who benefit from treatment by different specialists. The current referral strategy probably contributes to long waiting lists in orthopedic departments, which is costly and implies prolonged suffering for the patients. The aim of this health economic evaluation was to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low-prioritized, nonsurgical musculoskeletal disorders, after second-line treatment. MATERIALS AND METHODS: Diagnose Related Groups were used to define the costs, and the SF-36 was encoded to evaluate the outcomes in cost per quality adjusted life years gained. RESULTS: Results from a 12 months' follow-up showed significantly larger improvement for the NMT than for orthopedic standard care, significantly lower mean cost per patient; 5427 SEK (*Price level 2009; 1 Euro=106,213 SEK; 1 US Dollar=76,457 SEK) (95% confidence interval, 3693-7161) compared to14298 SEK (95% confidence interval, 8322-20,274), and more gains in outcomes in cost per quality adjusted life years per patient (0.066 compared with 0.026). Thus the result is "dominant." DISCUSSION: It is plausible that improved outcomes and reasonable cost savings for low-prioritized nonsurgical outpatients would be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics.
Asunto(s)
Análisis Costo-Beneficio , Enfermedades Musculoesqueléticas , Manipulaciones Musculoesqueléticas , Ortopedia/economía , Ortopedia/métodos , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/economía , Enfermedades Musculoesqueléticas/rehabilitación , Enfermedades Musculoesqueléticas/cirugía , Manipulaciones Musculoesqueléticas/economía , Manipulaciones Musculoesqueléticas/métodos , Manipulaciones Musculoesqueléticas/estadística & datos numéricos , Pacientes Ambulatorios , Ensayos Clínicos Controlados Aleatorios como Asunto , Sensibilidad y Especificidad , Suecia , Factores de Tiempo , Adulto JovenRESUMEN
The Industrial Accident Compensation Insurance Act (IACIA) regulates the workers' compensation insurance system and the standards for the recognition of occupational diseases (ODs). Since its establishment in 1994, the IACIA has been amended several times. Before 2008, the approval of compensation for work-related musculoskeletal diseases (WMSDs) was decided based on the recommendation of consultants of the Korea Workers' Compensation and Welfare Service (COMWEL). The IACIA was amended in 2008, and since then, the approval of compensation for occupational injuries has been decided based on the recommendation of COMWEL consultants, whereas the approval of compensation for ODs was decided based on the judgment of Committee on Occupational Diseases Judgment (CODJ) which was established in 2008. According to the 2013 amendment to the IACIA, degenerative musculoskeletal diseases among workers engaged in musculoskeletal-burdening work should be considered compensable ODs. Despite some commendable changes to the workers' compensation insurance system, other significant issues persist. To resolve these issues, related organizations including the associations of orthopedic surgery, neurosurgery, and occupational and environmental medicine; Ministry of Employment and Labor; and COMWEL need to work cooperatively.
Asunto(s)
Humanos , Accidentes de Trabajo/economía , Seguro por Accidentes/economía , Seguro de Salud/economía , Enfermedades Musculoesqueléticas/economía , Enfermedades Profesionales/economía , Traumatismos Ocupacionales/economía , República de Corea , Indemnización para Trabajadores/economíaRESUMEN
OBJECTIVE: The purposes of this study were to examine the direct costs associated with Medicare's 2005-2007 "Demonstration of Expanded Coverage of Chiropractic Services" (Demonstration) and their drivers, to explore practice pattern variation during the Demonstration, and to describe scenarios of cost implications had provider behavior and benefit coverage been different. METHODS: Using Medicare Part B data from April 1, 2005, and March 31, 2007, and 2004 Rural Urban Continuum Codes, we conducted a retrospective analysis of traditionally reimbursed and expanded chiropractic services provided to patients aged 65 to 99 years who had a neuromusculoskeletal condition. We compared chiropractic care costs, supply, and utilization patterns for the 2-year periods before, during, and after the Demonstration for 5 Chicago area counties that participated in the Demonstration to those for 6 other county aggregations-urban or rural counties that participated in the Demonstration; were designated comparison counties during the Demonstration; or were neither participating nor comparison counties during the Demonstration. RESULTS: When compared with other groups, doctors of chiropractic in 1 region (Chicago area counties) billed more aggressively for expanded services and were reimbursed significantly more for traditionally reimbursed chiropractic services provided before, during, and after the Demonstration. Costs would have been substantially lower had doctors of chiropractic in this 1 region had responded similarly to those in other demonstration counties. CONCLUSION: We found widespread geographic variation in practice behavior and patterns. Our findings suggest that Medicare might reduce the risk of accelerated costs associated with the introduction of a new benefit by applying appropriate limits to the frequency of use and overall costs of those benefits, particularly in highly competitive markets.
Asunto(s)
Cobertura del Seguro/economía , Reembolso de Seguro de Salud/economía , Manipulación Quiropráctica/economía , Medicare/economía , Enfermedades Musculoesqueléticas/economía , Mecanismo de Reembolso/economía , Accesibilidad a los Servicios de Salud/economía , Humanos , Cobertura del Seguro/estadística & datos numéricos , Reembolso de Seguro de Salud/estadística & datos numéricos , Manipulación Quiropráctica/estadística & datos numéricos , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Musculoesqueléticas/terapia , Mecanismo de Reembolso/estadística & datos numéricos , Estudios Retrospectivos , Estados UnidosRESUMEN
OBJECTIVES: Complementary and alternative medicine (CAM) providers are becoming more integrated into the United States health care system. Because patients self-select CAM use, risk adjustment is needed to make the groups more comparable when analyzing utilization. This study examined how the choice of risk adjustment method affects assessment of CAM use on overall health care utilization. DESIGN AND SUBJECTS: Insurance claims data for 2000-2003 from Washington State, which mandates coverage of CAM providers, were analyzed. Three (3) risk adjustment methods were compared in patients with musculoskeletal conditions: Adjusted Clinical Groups (ACG), Diagnostic Cost Groups (DCG), and the Charlson Index. Relative Value Units (RVUs) were used as a proxy for expenditures. Two (2) sets of median regression models were created: prospective, which used risk adjustments from the previous year to predict RVU in the subsequent year, and concurrent, which used risk adjustment measures to predict RVU in the same year. RESULTS: The sample included 92,474 claimants. Prospective models showed little difference in the effect of CAM use on RVU among the three risk adjustment methods, and all models had low predictive power (R(2) ≤0.05). In the concurrent models, coefficients were similar in direction and magnitude for all risk adjustment methods, but in some models the predicted effect of CAM use on RVU differed by as much as double between methods. Results of DCG and ACG models were similar and were stronger than Charlson models. CONCLUSIONS: Choice of risk adjustment method may have a modest effect on the outcome of interest.
Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Gastos en Salud , Servicios de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud , Ajuste de Riesgo , Adulto , Terapias Complementarias/economía , Femenino , Servicios de Salud/economía , Humanos , Cobertura del Seguro , Seguro de Salud , Medicina Integrativa , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/economía , Estudios Prospectivos , Ajuste de Riesgo/economía , Ajuste de Riesgo/métodos , WashingtónRESUMEN
BACKGROUND: Within the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain.The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care. METHODS/DESIGN: The design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study. DISCUSSION: For sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System. TRIAL REGISTRATION NUMBER: NTR1047.
Asunto(s)
Ensayos Clínicos como Asunto/métodos , Análisis Costo-Beneficio/métodos , Enfermedades Musculoesqueléticas/rehabilitación , Servicios de Salud del Trabajador/métodos , Rehabilitación Vocacional/métodos , Ausencia por Enfermedad/legislación & jurisprudencia , Adolescente , Adulto , Costo de Enfermedad , Evaluación de la Discapacidad , Personas con Discapacidad/rehabilitación , Costos de la Atención en Salud , Necesidades y Demandas de Servicios de Salud/economía , Humanos , Seguro por Discapacidad , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/economía , Programas Nacionales de Salud/normas , Programas Nacionales de Salud/tendencias , Países Bajos , Enfermedades Profesionales/economía , Servicios de Salud del Trabajador/economía , Servicios de Salud del Trabajador/tendencias , Evaluación de Resultado en la Atención de Salud/economía , Desarrollo de Programa/economía , Evaluación de Programas y Proyectos de Salud/economía , Rehabilitación Vocacional/economía , Autoeficacia , Ausencia por Enfermedad/estadística & datos numéricos , Ausencia por Enfermedad/tendencias , Resultado del Tratamiento , Desempleo/estadística & datos numéricos , Desempleo/tendencias , Evaluación de Capacidad de Trabajo , Carga de Trabajo/economía , Adulto JovenRESUMEN
Some osteopathic physicians are not properly reimbursed by insurance companies after providing osteopathic manipulative treatment (OMT) to their patients. Common problems associated with lack of reimbursements include insurers bundling OMT with the standard evaluation and management service and confusing OMT with chiropractic manipulative treatment or physical therapy services. The authors suggest methods of appeal for denied reimbursement claims that will also prevent future payment denials.
Asunto(s)
Honorarios y Precios , Reembolso de Seguro de Salud , Osteopatía/economía , Enfermedades Musculoesqueléticas/terapia , Medicina Osteopática/economía , Médicos Osteopáticos/economía , Control de Formularios y Registros , Humanos , Reembolso de Seguro de Salud/economía , Missouri , Enfermedades Musculoesqueléticas/economía , Médicos Osteopáticos/tendencias , Administración de la Práctica Médica/economía , Estados UnidosRESUMEN
This paper gives a comparative overview of the current clinical care of patients experiencing pain in the musculoskeletal system in Austria and in Germany. The questionnaire used in this study was modified from one used in a survey carried out in Germany in 2002. In our version we asked specifically about pain in the musculoskeletal system. In all 228 health care facilities were reviewed, 56.6% of which offer at least one option for pain therapy. In Austria, the majority of patients with pain in the musculoskeletal system are treated by specialists in the departments of anaesthesiology, internal medicine, and orthopaedics. In 17.4% of the clinics in Austria there are plans to extend the pain therapy they offer, but in over half of the hospitals that responded facilities for pain therapy are considered to be vulnerable. The study highlights a significant higher percentage of in-patient pain therapy services in Austria, while in Germany, in contrast, there are more outpatient options for pain therapy. The quality of pain therapy could by further improved by more intense cooperation between the inpatient and outpatient sectors and by the establishment of interdisciplinary and multimodal solutions.
Asunto(s)
Comparación Transcultural , Enfermedades Musculoesqueléticas/terapia , Clínicas de Dolor/estadística & datos numéricos , Manejo del Dolor , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Austria , Análisis Costo-Beneficio , Atención a la Salud/economía , Atención a la Salud/estadística & datos numéricos , Economía Médica , Alemania , Encuestas Epidemiológicas , Humanos , Medicina/estadística & datos numéricos , Enfermedades Musculoesqueléticas/economía , Enfermedades Musculoesqueléticas/epidemiología , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Dolor/economía , Dolor/epidemiología , Clínicas de Dolor/economía , Clínicas de Dolor/organización & administración , Admisión del Paciente/economía , Admisión del Paciente/estadística & datos numéricos , Grupo de Atención al Paciente/economía , Grupo de Atención al Paciente/estadística & datos numéricos , Especialización , Encuestas y CuestionariosRESUMEN
To assess quality of life (QoL), costs, and cost-effectiveness of acupuncture treatment plus routine care versus routine care alone in osteoarthritis patients, a randomised, controlled trial was conducted in 255 general practices in Germany. Four hundred and eighty-nine patients with chronic pain due to osteoarthritis of the knee or hip were included to evaluated QoL and costs at baseline and after 3 months using health insurance funds data and standardized questionnaires. Patients receiving acupuncture had an improved QoL associated with significantly higher costs over the 3 months treatment period compared to routine care alone (mean cost-difference: 469.50 euros [95%CI 135.80-803.19 euros]). This increase in costs was primarily due to the costs of acupuncture. The overall ICER was 17,845 euros per QALY gained. The degree of cost-effectiveness was influenced by gender, with female patients achieving a better cost-effectiveness ratio than men. In conclusion, acupuncture was a cost-effective treatment strategy in patients with chronic osteoarthritis pain.
Asunto(s)
Acupuntura/economía , Osteoartritis/terapia , Manejo del Dolor , Calidad de Vida , Análisis Costo-Beneficio , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/economía , Enfermedades Musculoesqueléticas/psicología , Enfermedades Musculoesqueléticas/terapia , Osteoartritis/complicaciones , Osteoartritis/economía , Osteoartritis/psicología , Dolor/economía , Dolor/etiología , Dolor/psicologíaRESUMEN
STUDY DESIGN: Population-based before-and-after design with concurrent control group. OBJECTIVE: As continuums of care have been little studied, we evaluated the impact of the Workers' Compensation Board of Alberta (WCB-Alberta) model on sustained return to work, satisfaction with care, and cost. SUMMARY OF BACKGROUND DATA: Musculoskeletal conditions, such as back pain, continue to be leading causes of disability and work loss. From 1996 through 1997, the WCB-Alberta implemented a continuum of care model to guide rehabilitation service delivery for claimants with soft tissue injury. The model was designed as a decision-making tool to promote a consistent, evidence-based approach to care within the jurisdiction. METHODS: The model was implemented province-wide so the entire population of workers insured by the WCB-Alberta was studied. Data were extracted from the WCB-Alberta administrative database from 2 years before implementation (1994-1995) to 5 years after (1996-2000). An intervention group was created from patients filing soft tissue injury claims for the low back, ankle, knee, elbow, and shoulder. The comparison group was formed of workers experiencing fractures or other traumatic non-soft tissue injuries. Satisfaction was measured through surveys. Primary outcome was cumulative days receiving wage replacement benefits. Multivariable Cox regression was used to determine the model's effect. RESULTS: Over the entire study period, 70,116 claimants filed soft tissue injury claims while 101,620 claimants experienced non-soft tissue injuries. Significant improvement was observed in intervention group return-to-work outcomes after model implementation (hazard ratio = 1.54). Median duration of benefits decreased from 13 to 8 days. Little change was seen in the control group's disability duration (median duration, consistently 10 days). The majority of claimants were satisfied with care received. Cost savings over a 2-year full implementation period was $21.5 million (Canadian). CONCLUSION: Implementation of a soft tissue injury continuum of care involving staged application of various types of rehabilitation services appears to have resulted in more rapid and sustained recovery.
Asunto(s)
Continuidad de la Atención al Paciente/economía , Técnicas de Apoyo para la Decisión , Evaluación de la Discapacidad , Costos de la Atención en Salud , Enfermedades Musculoesqueléticas/economía , Enfermedades Musculoesqueléticas/rehabilitación , Indemnización para Trabajadores/economía , Adulto , Alberta , Manejo de Caso/economía , Quiropráctica/economía , Servicios Contratados/economía , Análisis Costo-Beneficio , Empleo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Especialidad de Fisioterapia/economía , Vigilancia de la Población , Evaluación de Programas y Proyectos de Salud , Modelos de Riesgos Proporcionales , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
The introduction of the new prospective payment system for inpatient care entails considerable changes for hospitals in Germany. The Australian Refined Diagnosis Related Groups (AR-DRGs), which form the basis for the German system, give the chance to estimate the consequences and implications for the specialty of orthopaedic surgery in Germany. Our study aims at highlighting the most important musculoskeletal diagnoses and to provide an initial economic forecast for them. The comparison with Australian data gives hints for operative and conservative-rehabilitative orthopaedic departments in respect to potentials and focal points for the development of novel patient management tools. The success of orthopaedic departments will depend in the future much more than now on organisational and management issues.