IDEA LAB

THE TOOLKIT HELPING PEOPLE BUILD HEALTHIER LIVES: AN INTERVIEW WITH DR. JUAN JOVER

European Steering Group member Professor Juan Jover is the man behind the Early Intervention Clinics in Spain. Aimed at improving care for patients experiencing an episode of work disability, the clinics have proven that better health outcomes for patients can also deliver significant savings for healthcare and social welfare systems. In a bid to encourage other countries to launch their own Early Intervention Clinics, Professor Jover, in collaboration with The Work Foundation is creating an Early Intervention Toolkit that will be launched in the fall. He sat down with us to explain what the toolkit is and what he hopes it will achieve.

 

 

 

 

 

IDEA LAB

THE TOOLKIT HELPING PEOPLE BUILD HEALTHIER LIVES: AN INTERVIEW WITH DR. JUAN JOVER

European Steering Group member Professor Juan Jover is the man behind the Early Intervention Clinics in Spain. Aimed at improving care for patients experiencing an episode of work disability, the clinics have proven that better health outcomes for patients can also deliver significant savings for healthcare and social welfare systems. In a bid to encourage other countries to launch their own Early Intervention Clinics, Professor Jover, in collaboration with The Work Foundation is creating an Early Intervention Toolkit that will be launched in the fall. He sat down with us to explain what the toolkit is and what he hopes it will achieve.

 

 

 

 

 

What is the Early Intervention Toolkit designed to do? How does it work?

Dr. Juan Jover: We’ve known for a long time that in cases of aggressive autoimmune diseases it’s important to identify the patients and treat them effectively very early in the disease course in order to avoid future disability.  In the last 25 or 30 years, health systems have developed specific care pathways for early treatment and the method has been very successful for the more aggressive diseases.

 

We wanted to see if the same approach could help patients suffering from more frequent, less aggressive but still debilitating diseases. In less aggressive diseases, you cannot act early in the disease because you would need to treat forty percent of the population, which is impossible. But when a patient has an episode of disability due to lower back pain or tendonitis you have a chance to treat them. And it turns out that if you treat an episode of disability very early, you change the course of that patient, because the episode of disability is shorter and the patient doesn’t end up with a long-term disability.

 

If you analyse a country, a region or a city, you can confidently predict how many episodes of work disability will occur. The number will be the same from one year to the next. So it’s very easy to plan ahead and to offer to workers early intervention programmes.

 

That’s what the toolkit is about, helping healthcare systems reduce disability rates by treating patients with short term work disability quickly and effectively.

 

Why are musculoskeletal disease rates so stable and predictable?

JJ: Populations don’t change radically from one year to another. If you analyze the data on disability, there are always two main causes in the working age populations: musculoskeletal diseases and mental illnesses. The good news is that these forms of disability can be reversed with the right treatment at the right moment.

 

The concept is very simple. Don’t focus on specific diseases: there are more than 200 diseases that fall under the umbrella of musculoskeletal disorders. You have to focus instead of episodes of disability. Because the idea is to get people back to their lives. If they work, we want to get them back to work. If they’re retired, we want them to have a high quality of life and be able to go out, be able to be with friends and family rather than stuck at home because they are unable to walk.

Juan Jover

That’s what the toolkit is about, helping healthcare systems reduce disability rates by treating patients with short term disability quickly and effectively.

 

Who is the tool kit addressed to?

JJ: Anyone can use it. The general population, policymakers, clinicians. Disabilities impact the healthcare systems, employers and the social security system. So any of the components of these three paths, including patients and their relatives, could be interested in knowing that you can do something different and create new ways of treating patients.

 

It sounds like the tool kit will help raise awareness about how disability can be prevented by early intervention.

JJ: Yes, with very little intervention you can avoid most of the cases. The problem is how to implement it. Health systems today are more focused on preventing death than preventing disability. When you analyse the data regarding the causes of disability, the years lived with disability have increased by thirty percent in the last twenty years. We aren’t doing everything we can to prevent disabilities. It’s not very logical.

 

So people are living longer, but not necessarily with high quality of life?

JJ: Exactly. Life expectancy has increased but quality of life has increased only a little, but much less than expectancy. The EI clinics are a way of integrating primary and specialist care, so patients get the right treatment at the right time. Time is essential. If you do something in the first week of disability, people get well faster. After four or five months it becomes almost impossible to get people back to work. So you have a small window of opportunity to do something.

 

It sounds like these patients need something that bridges the gap between primary care and specialist care.

JJ: Yes, exactly. I like to say it’s not primary or secondary care, it’s one and a half care. Sometimes people think that secondary and tertiary care are very technological. This is not technological, it’s about clinical expertise. It’s the ability to treat the patient from the first minute.

 

What’s your ambition for the toolkit?

JJ: We want people to use it, to see the potential for helping this population. We are able to prevent the development of long-term disability.

If you are at risk of developing a lethal disease, there’s a pathway to treatment. But if you have a disability, no one thinks you need something special. This is very important, because when you have to select from a population of more than half a million people who should been seen in specialist care, people with disabilities should be on the short list, and not at the end of the list.

It’s very difficult to change how healthcare systems are organised, but I think there are more people now thinking about how to promote that and I think the toolkit will help.

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