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The Burden of Musculoskeletal Conditions:

The Burden of Musculoskeletal Conditions:. Challenges and Opportunities in Global Economic Crisis. The Burden of Musculoskeletal Conditions:. Challenges and Opportunities in Global Economic Crisis: Malaysian Context. Dr Zanariah Othman 1.Consultant Orthopaedic Surgeon

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The Burden of Musculoskeletal Conditions:

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  1. The Burden of Musculoskeletal Conditions: Challenges and Opportunities in Global Economic Crisis

  2. The Burden of Musculoskeletal Conditions: Challenges and Opportunities in Global Economic Crisis: Malaysian Context Dr Zanariah Othman 1.Consultant Orthopaedic Surgeon Department of Orthopaedic Faculty Of Medicine & Health Sciences Universiti Putra Malaysia 2. Deputy Director Institute of Gerontology Universiti Putra Malaysia zana@medic.upm.edu.my

  3. (GLOBAL) GENERAL CHALLENGES • The need for health care outstrips resources • Lack of trained medical personnel • Lack of medical facilities • Inability to access existing facilities

  4. ORTHOPAEDIC CHALLENGES • Epidemiologic shift from predominantly infectious & nutrition- related diseases to noncommunicable & degenerative diseases • An increase in trauma-related injury & resultant disability because of population shift from rural to urban areas • Approximately two thirds of the world’s population lack adequate orthopaedic care*

  5. ORTHOPAEDIC CHALLENGES • Approximately two thirds of the world’s population lack adequate orthopaedic care* • More prosperous countries attract physicians from poorer countries further reducing the availability of health care in the areas that need it the most

  6. ORTHOPAEDIC CHALLENGES • Majority of the world’s population, & the part with the highest growth rate, lives neither in the poorest nor in the richest countries but in the great lands of Asia and South America, where the burden of injury is growing & fast approaching 20%. • Countries like Australia, Canada, Germany, the United Kingdom, & the United States of America – have more than three fourths of the world’s physicians!!!

  7. ORTHOPAEDIC CHALLENGES • It is estimated that 80% of the trained orthopaedic surgeons in the world live & practice in the 26 developed nations!!! • In least developed country like Malawi, general physicians & surgeons, nurses, & surgical technicians must provide some musculoskeletal care in these countries.

  8. ORTHOPAEDIC CHALLENGES • Problem to Access Health Care • Infrastructure • Lack of transportation • Lack of means of communication • Patients unaware of availability of medical services • Inadequate physical facilities • Lack of availability equipment • Lack of trained personnel

  9. The Global Burden of Musculoskeletal Disease • Exact severity has not been determined • Nature of MS disease is quite different between developed countries than the rest of the world • In developing countries, the predominant orthopaedic concerns are related to late presentation of traumatic injuries, neglected congenital deformities, & the sequelae of infectious diseases (e.g. haematogenous osteomyelitis, polio, tuberculosis & leprosy)

  10. The Global Burden of Musculoskeletal Disease • Many children are deprived of normal physiologic development because of malnutrition, congenital anomalies, & the secondary effects of infection that may lead to chronic MS problems that result in disability in adulthood. • The sequelae of various types of trauma is a major concern. • Patients with chronic bone & soft tissue infections after open fractures, nonreduced dislocations, malunions, & nonunions may eventually present for treatment but frequently only after a long delay. • This adds complexity to treatment & increases the overall burden on the society for treating these problems.

  11. The Global Burden of Musculoskeletal Disease • Injuries to civilian population from land mines & gunfire place tremendous demands on health-care systems, which are already suffering from the inevitable results of war. • And what about natural catastrophe???

  12. ORTHOPAEDIC CHALLENGES • The United Nations country classification is based on measures of • Economic activity • Education • Health & • Worker productivity

  13. ORTHOPAEDIC CHALLENGES • Trends in Disease Burden • Of special interest to Orthopaedic Surgeons is the prominence of tuberculosis, the sequelae of traffic accidents, & congenital anomalies as a cause of death in developed nations • The proportion of the total disease burden due to MS conditions will increase in the next several decades (table)

  14. ORTHOPAEDIC CHALLENGES • Trends in Disease Burden • Tuberculosis • Since 2000, the number of Malaysians infected with TB has been steadily rising. • The national average of TB infection now stands at 15,000 annually, with a fatality rate of between 1,000 and 1,200 people each year • Ref: http://www.maptb.org.my/mainpage/news2007/NST010707.html

  15. ORTHOPAEDIC CHALLENGES • Trends in Disease Burden • The percentage of diseases of the infectious, maternal, perinatal, or nutritional origin will decrease as the percentage of the disease burden due to noncommunicable diseases & trauma increases.

  16. ORTHOPAEDIC CHALLENGES • Driving Trends in Disease Burden • The global shift from rural to urban living • The overall aging of the population • The increase in the trauma-related injuries

  17. ORTHOPAEDIC CHALLENGES • Driving Trends in Disease Burden • The global shift from rural to urban living • Life style changes • Increasing numbers of industrial accidents & acts of criminal violence • The number of new tuberculosis cases often paradoxically increases as the populations coalesce in urban centres, which makes transmission easier

  18. ORTHOPAEDIC CHALLENGES • Driving Trends in Disease Burden • The overall aging of the population • 300% in the number of persons over the age of 65 is projected in developing countries by 2035 • Will cause an increase in the number of patients suffering from degenerative diseases such as arthritis & osteoporosis • Leading causes of disability in the USA, affecting approximately 40 million persons in 1995 & a projected 60 millions in 2020! A similar increase is disease prevalence is expected in developing countries.

  19. ORTHOPAEDIC CHALLENGES • Driving Trends in Disease Burden • Osteoporosis • Almost 40% of women over the age of 50 years will suffer at least one episode of osteoporosis related fractures • There was a reported 1.7 million hip fractures in 1990 and it is estimated that the number will rise to 6.3 million in 2050 • In 1997, the incidence of hip fracture in Malaysia among individuals above 50 years of age was 90 per 100,000. There was a marked increase in the incidence among the older age group. The incidence of hip fracture is consistently higher in women

  20. ORTHOPAEDIC CHALLENGES • Driving Trends in Disease Burden • The increase in the trauma-related injuries • Is related to the increase of motor vehicle usage & industrialisation • It is anticipated that MVA will rise from the 9th most common cause of disability to the 3rd as a result of urbanisation • It is expected by 2010 nearly 25% of health care resources of developing countries will be spend on trauma-related care necessitated by MVA, war & violence

  21. ORTHOPAEDIC OPPORTUNITIES • At a time of unprecedented international financial stress, we still have to consider how best to deliver better value health services to the people • It is a time of major challenge, but also a time of opportunity & innovations (Hon Tony Ryall; Minister of Health: Opening speech to NZOA’s Annual Scientific Meeting, Wellington, 19th Oct, 2009)

  22. ORTHOPAEDIC OPPORTUNITES • (IMMEDIATE) POSSIBLE SOLUTIONS • Financial situation  • Clinical leadership & engagement  • Working together 

  23. ORTHOPAEDIC OPPORTUNITES • POSSIBLE SOLUTIONS • Clinical leadership & engagement  • Active engagement of doctors & nurses with the right expertise • Best practice operational approaches in hospitals has positive impact on productivity, infection rates, readmission rates & patient satisfaction & finance • Level of involvement – stronger & more direct means more service & better quality

  24. ORTHOPAEDIC OPPORTUNITES • POSSIBLE SOLUTIONS • Working together  • Better value for money from implant purchasing • Setting a task group – • to look into reduction of expenditure, improve frontline health services & improve value in the public health services • Improving co-operation & harnessing the power of bulk purchasing • Improving purchase of medical devices such as an orthopaedic implants offer a real opportunity to free up money for more care

  25. ORTHOPAEDIC OPPORTUNITES • POSSIBLE SOLUTIONS • Working together  • Clinical network • A stronger emphasis on effective prevention will be needed for MS problems directly linked to aging • New ways of working & providing care to such people • Patients & specialists flow across various hospital boundaries to improve access • Developing new referral pathways

  26. ORTHOPAEDIC OPPORTUNITES • POSSIBLE SOLUTIONS • Working together  • Care Closer to Home • Provision of a wider range of services closer to home e.g. development of co-located multidisciplinary teams • Clinicians may do their assessments & diagnostics and schedule surgery sooner • Work with primary care colleagues to develop better referral pathways

  27. ORTHOPAEDIC OPPORTUNITES • (LONG TERM) POSSIBLE SOLUTIONS • Economic advancement with attendant societal development may provide the initial impetus for generating successful solutions • Implementation of treatment methods that are sustainable & acceptable lead to effective methods of dealing with specific medical & orthopaedic disease

  28. ORTHOPAEDIC OPPORTUNITES • POSSIBLE SOLUTIONS • Improve regional medical care by providing resources that will remain available • Education is the most effective method of providing a sustainable solution • e.g. AAOS has contributed money & educational products to countries throughout the world

  29. ORTHOPAEDIC OPPORTUNITES • POSSIBLE SOLUTIONS • The education must be specific to the country’s culture, resources and religious beliefs • Organised programs should be encouraged to assess the results of their treatment regimens, other variables such as infection, nonunion rates, functional outcome & resource consumption

  30. ORTHOPAEDIC OPPORTUNITES • POSSIBLE SOLUTIONS (CONCLUSION) • Orthopaedic surgeons have the opportunity to work with other stakeholders to produce meaningful research, to define essential interventions & to design & implement strategies to overcome barriers to the delivery of services

  31. thank you for your time

  32. Ref: • Dormans JP et al: Orthopaedics in the developing world: present & future concerns J Am Acad Ortho Surg 2001;9(5):289-6 • Beveridge M et al: The burden of orthopaedic disease in developing countries. JBJS (Am) 2004; 86A(8):1819-22 • Spiegel DA et al: Topics in Global Public Health. Clin Orthop Relat Res 2008; 466:2377-84

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