Preliminary Analysis of the Musculoskeletal Services

Preliminary Analysis of the Musculoskeletal Services

Introduction

            The National Health Service is considered to be the largest system of healthcare globally which is also a single-payer. It is used for the healthcare services of each and every constituent countries in the United Kingdom and is funded by the public as well. The constituent countries are; England, Wales, Scottland, and Northern Ireland which has an affiliated health and social welfare. The main aim of this management report is to focus on aiding the Clinical Commissioning Groups (CCG’s) in the decision making for the various forms of musculoskeletal services for the future years (Sarwak, 1997 p.50).

MSK Data Chart

 

Preliminary Analysis of the Musculoskeletal Services

This type of service, often referred to as the musculoskeletal service is one that assesses and treats problems that are associated with bones, soft tissues as well as joints. Such problems affect parts of the body for instance; the spine, hips and legs which are inclusive of feet and ankles as well as the shoulders and hands which are inclusive of the elbows and the wrists. According to Sarwak (1997 p. 53), a lot of musculoskeletal problems affect the patient in a long term manner and therefore there is need for implementation of long term strategies to manage them as well. Such long term management strategies involve education, strategies on how to manage pain and treatment if available.

Consultation and examination is performed on patients on a face to face basis by the CCG’s, such as the physio treatments as well as the others which require minor and major operations (Helmick et al., 1998 p. 790-793).

From the above MSK data table provided, it is clear that whenever there is an increase in the percentage of physio treatment, there is a decrease in the daycases and the inpatients. This is also the case when the vice versa happens. From the table, it can also be depicted that more often than not, the prefferred method of treatment is the physio treatment, clearly shown by the higher percentages with only two readings of below 2%. All the rest are at the rate of above 2%. This is probably because it does not involve any risky kind of operations but just a maximum of one hour face to face modes of treatments. Sarwak (1997, p. 79), asserts that such face to face treatments may include; exercises based on gymnastic classes, home exercises, electrotherapy, splinting, acupuncture, pain management programs and advice, injection therapy, manual therapy, patient advice and information among a variety of others. All of these are necessary because they enhance and encourage the patient to function independently and have autonomy (Helmick et al., 1998 p. 796-799).

Inpatient and daycare treatments are seen to have very low percenteges with none of them going above 5%. In the view of Helmick (1998 p. 795-798), the reason for such statistics could probably be that, for a surgery to take place, a patient must sign documents of consent or if the patient is a minor, the parent or guardian should sign the consent documents. According to Sterling (2015 p. 98-101), most people will hesitate to sign give consentfor fear of the unknown. They prefer physio treatment instead. Availability of healthcare facilities to perform these daycare surgeries could also be a reason why most practitioners do not opt for them. In addition, quite a number of patients still need physio treatments even after the surgeries, not forgrtting that surgeries cost much more than physio more often than not (Sarwak, 1997 p.50-53).

Costs of Musculoskeletal Services

One of the aspects that lead to both patients and practitioners preferring some modes of MSK than the others is the cost of their treatments. They can obviously not cost the same. Some cost more while some cost less (Helmick et al., 1998 p. 788-791). However, when integrated, the musculoskeletal services provide routes to secondary care that are proven to be clearer and faster. Integrating them has also been proven to be effective both clinically and economically (Sterling, 2015 p.201-204). According to the statistics, physio treatment costs two hundred pounds, daycare costs five hundred pounds while inpatient costs one thousand five hundred pounds. This explains why the table shows a constantly decreasing percentage in the two latter treatments, while the physio treatment percentage keeps increasing (Armstrong, 2001 p. 88). They are more expensive than physio treatment hence only few people can afford it even if they could have possibly wanted to go through the surgery. In the year 2008-2009, the total cost of musculoskeletal service disorders by the National Health Services (NHS), was approximately 4.2 billion pounds. This has led to it having a separately identified area in the department of health with its own program budget, due to it being among the highest area of spend in the NHS (Helmick et al., 1998 p. 796-799).

Effects of Age on Treatment

Older people are more likely to suffer musculoskeletal disorders as compared to their younger counterparts. This is because such disorders mostly affect body parts with joints and bones as discussed above, for instance spine, ankles, elbows and wrists among others (Sterling, 2015 p.204).  According to Armstrong (2001, p.110-113), as a person grows older, the loss of bone density accelerates hence making the bones more weak and fragile and prone to disorders and even breakage in the extreme cases of osteoporosis. This is brought about by the major changes that take place in the connective tissues as well as the cartilages as a person grows old (Helmick et al., 1998 p.790). Older people therefore require some kind of special treatment especially when being treated for such kinds of disorders. This clearly explains why the data table in 2a and 2b show that more older people went through the more intense modes of treatment while the younger ones went for those that were less intense. This basically summarizes the fact that age is a very important and crucial determinant in choosing the mode of treatment for MSK services (Sterling, 2015 p. 200).

            If the pattern of treatment of area A were to be moved to area B, area A would save little or no money at all. This is because; area A mostly treats younger people who require a less intense mode of treatment. Shifting the pattern and allowing just any age group to be treated using the more expensive area B patterns would be a total waste of resources on people who most likely do not need that kind of treatment. The cost of the services in area be would therefore be estimated to go higher than normal in an attempt to discourage people from area A adopting that pattern when they do not necessarily need it (Sarwak, 1997 p. 78-80).

Balancing all the MSK Service Treatments

According to the experimental results in the MSK data chart, if the physio treatment is increased by 7.5%, the level of saving would increase by a much higher value while the level of people needing the more intense and more expensive modes of treatments would hit a down low. In the opinion of Helmick et al., (1998 p. 788), this would be because many people would be exposed to the physio treatment and very few to no people would go untreated for musculoskeletal disorders. This would mean that none of them would subsequently need to go through daycare and inpatient treatments which would lead to very high savings (Armstrong, 2001 p.110-113).

Reducing Both Services by the Same Percentage

Since the experimental result sheet in the MSK data chart shows that an increase in physio treatment subsequently led to a decrease in the two more expensive and more intense modes of treatment services, and an equally cost effective treatment, it is advisable to increase the percentage even more (Helmick et al., 1998 p. 788-799). This is for the main reason of reducing the costs incurred in treatment of MSK disorders, reducing the number of people who remain untreated, as well as reducing the number of people who have to undergo the more intense methods and most importantly making more savings (Armstrong, 2001 p.110-113).

If both the daycare and inpatient services are reduced by the same percentage, it will translate to more and more people opting for the cheaper less intense service which is the physio treatment (Henlick et al., 1998 p. 799).

Major Causes of MSK Disorders

Most people who start experiencing these conditions do so while at their place of work. This is more common to workers who are employed in professions that require more loading and physical activities as compared to their counterparts who are less exposed to physical activities (Armstrong, 2001 p. 112). The biological connection between the exposure and the disorders is undeniably strong especially in occupational settings with high exposure. According to Sterling (2015, p. 209), there are however some interventions that are very specific and can be applied at places of work in order to reduce the risk of contracting such disorders. Such interventions include most importantly paying attention to workers and employees who seem to be at a higher risk of exposure, so that preventive measures can be taken with immediate effect (Sarwak, 1997 p. 52).

Educating the workers on the causal factors and their relationship to biological factors is also an important preventive measure at the place of work (Sterling, 2015 p. 78-80). Workers need to have a better understanding on the course of such disorders. According to Helmick et al., (1998 p. 790), improving measurement of risk factors as well as outcome variables is also crucial in setting up preventive measures at the place of work where workers are exposed to causal factors of MSK.

Impact of MSK on the Quality of Life

Armstrong (2001 p. 112-113) asserts that, MSK conditions and disorders are associated with extreme conditions such as; mental health, respiratory diseases, hearing and visual impairment, cancer, renal diseases and cardiovascular diseases among various other bodily malfunctions. All of these conditions are considered to be the worst life conditions a human being can ever experience and most of the people diagnosed with them are often showing symptoms of chronic pain, depression and suicide to the extreme (Helmick et al., 1998 p. 798). According to Sterling (2015 p. 105), people suffering from MSK conditions are the same people who are likely to become incapacitated after going through severe mental health.

The quality of life can be impaired or totally distorted by these MSK conditions as they are common in primary care. According to Sterling (2015, p. 99), when the approach of integrating all the MSK modes of treatment is used, there is a clear and fast escalation from primary care to secondary care which is efficient and saves on costs at the same time. A service called GP Consortia has been used to develop integration of MSK services by provision of primary care development as well as pushing for secondary care for more efficient results (Henlick et al., 1998 p. 798). GP Consortia is assisted by clinical leadership such as the CCG’s and other organizations. The GP Consortia is prioritized at developing a service that is integrated by getting several different opinions from a particular setting; say a community setting or any other similar setting (Helmick et al., 1998 p. 790-793).

 

Conclusion

A lot of musculoskeletal problems affect the patient in a long term manner and therefore there is need for implementation of long term strategies to manage them as well. Such long term management strategies involve education, strategies on how to manage pain and treatment if available.  Consultation and examination is performed on patients on a face to face basis by the CCG’s, such as the physio treatments as well as the others which require minor and major operations. Providing secondary care for patients is effective in terms of both cost and clinical matters, since this way, the intense and more expensive treatment methods such as daycare and inpatient are reserved for patients who are in desperate need for surgery.

Musculoskeletal diseases and disorders have an increasing effect on the economy for various reasons for instance; the rapid rate at which the American population is aging, the growing of expenditures for the sole treatment of these particular diseases, the alarmingly increase in the prevalence of the said diseases and disorders and the losses that are incurred as a result of these conditions and disorders among others. Over the last decade, the percentage of the population with musculoskeletal disorders steadily grew from an approximate of 28% to 33%, a number which subsequently led to the increase in expenditures of the same conditions and disorders.

 

 

 

 

 

 

References

Sarwak, J.F. 1997 “Essentials of Musculoskeletal Care.” 4^th Edition  P. 50-53

Armstrong, A. D  2001 “Essentials of Musculoskeletal Care. “ 5^th Edition P. 110-113

Sterling, M.  2015 “Grieve’s Mordern Musculoskeletal Physiotherapy.” 4^th Edition P. 200

Lawrence R, Helmick C, Arnett F, et al: 1998 “Estimates of the prevalence of arthritis and selected             musculoskeletal disorders in the United States.” Arthritis Rheum 41:788-799.

National Research Council (US) Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base. Work-Related Musculoskeletal Disorders: Report, Workshop Summary, and Workshop Papers. Washington (DC): National Academies Press (US); 1999. 4, Conclusions. Available from: https://www.ncbi.nlm.nih.gov/books/NBK230853/