A health system program to reduce work disability related to musculoskeletal disorders
A health system program to reduce work disability related to musculoskeletal disorders
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DOI：
10.7326/0003-4819-143-6-200509200-00005
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发表时间：
2005-09-20
影响因子：
39.2
通讯作者：
Jover, JA
中科院分区：
文献类型：
--
作者：
Abásolo, L;Blanco, M;Jover, JA
背景资料：肌肉骨骼疾病（MSDs）是一个常见的原因，工作残疾，占生产力损失在工业化社会相当于1.3%的美国国民生产总值（GNP.Objective）：为了评估是否提供给患者的人口为基础的临床计划，最近插入工作残疾造成的MSDs是成本效益。研究对象：西班牙马德里的三个卫生区，研究对象：1998年和1999年与MSD相关的暂时性工作障碍患者。干预措施：对照组接受标准的初级保健管理，必要时转介到专科护理。干预组接受了一个特定的程序，由风湿病学家管理，在定期访问期间提供护理，包括3个主要元素：教育，基于协议的临床管理，和administrative duties.Measurements：疗效变量为1）暂时性工作残疾的天数和2）永久性工作残疾的患者人数。所有分析都是在意向治疗的基础上进行的。结果：13 077例患者被纳入研究，对照组7805例，干预组5272例，产生了16 297次与MSD相关的临时工作障碍。干预组的这些发作时间短于对照组（男性，26天与41天; P < 0.001），两组患者的发作次数相似。干预组接受长期残疾补偿的患者（n = 38 [0.7%]）少于对照组（n = 99 [1.3%]）（P < 0.005）。干预组的直接和间接费用低于对照组。为了节省1天的临时工作残疾，必须在该计划中投资6美元。每投资1美元，收益为11美元。该计划的净效益超过$50000.Limitations：该研究是unblinded.Conclusions：该计划的实施，提供给一般人群，提高了短期和长期的工作残疾的结果，是具有成本效益的。
Background: Musculoskeletal disorders (MSDs) are a frequent cause of work disability, accounting for productivity losses in industrialized societies equivalent to 1.3% of the U.S. gross national product.Objective: To evaluate whether a population-based clinical program offered to patients with recent-inset work disability caused by MSDs is cost-effective.Design: Randomized controlled intervention study. The inclusion and follow-up periods each lasted 12 months.Setting: Three health districts in Madrid, Spain.Patients: All patients with MSD-related temporary work disability in 1998 and 1999.Intervention: The control group received standard primary care management, wit referral to specialized care if needed. The intervention group received a specific program, administered by rheumatologists, in which care was delivered during regular visits and included 3 main elements: education, protocol-based clinical management, and administrative duties.Measurements: Efficacy variables were 1) days of temporary work disability and 2) number of patients with permanent work disability. All analyses were done on an intention-to-treat basis.Results: 13 077 patients were included in the study, 7805 in the control group and 5272 in the intervention group, generating 16 297 episodes of MSD-related temporary work disability. These episodes were shorter in the intervention group than in the control group (man, 26 days compared with 41 days; P < 0.001), and the groups had similar numbers of episodes per patient. Fewer patients received long-term disability compensation in the intervention group (n = 38 [0.7%]) than in the control group (n = 99 [1.3%]) (P < 0.005). Direct and indirect costs were lower in the intervention group than in the control group. To save 1 day of temporary work disability, $6.00 had to be invested in the program. Each dollar invested generated a benefit of $11.00. The program's net benefit was in excess of $5 million.Limitations: The study was unblinded.Conclusions: Implementation of the program, offered to the general population, improves short- and long-term work disability outcomes and is cost-effective.