The European Commission and the European League Against Rheumatism have joined forces in an ambitious 3-year project that is designed to optimize the care of patients with musculoskeletal conditions all across Europe.
The new European Musculoskeletal Conditions Surveillance and Information Network (www.eumusc.net
The eumusc.net project is funded by a grant of nearly 1 million euros from the European Commission along with 300,000 euros from EULAR. After the project ends in 2013, EULAR will take it over, according to Dr. Woolf, professor of rheumatology at the Institute of Health Care Research of Peninsula College of Medicine and Dentistry, Plymouth, England.
“The goal is to improve quality of care [and] to harmonize care so there is more equity across countries and within countries,” the rheumatologist said. “Wherever you're being treated, you should have the same chance of doing well or going into remission.”
“We're not going to come up with new guidelines because we already have excellent guidelines for the management of osteoarthritis and rheumatoid arthritis from EULAR. It's time to get them implemented,” he continued.
The eumusc.net project was granted funding by the European Union Health Program in a competitive bidding process. EU health officials were persuaded to make improved care for musculoskeletal conditions a high priority, in part on the strength of data showing that osteoarthritis is tied with disorders related to alcohol abuse for fourth place on the top-10 list of causes of years lived with disability in high-income countries.
Only unipolar depression, dementias, and adult-onset hearing loss ranked higher. Osteoarthritis was rated higher than cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, and other major chronic diseases. These are the sorts of data that grab the attention of social security and health department officials.
In the United Kingdom, “musculoskeletal conditions are the No. 3 reason for general practitioner consultations. One can put a price on that, and it's very impressive,” Dr. Woolf said.
Although mortality may not be the best indicator of the societal impact of musculoskeletal disorders, Dr. Josef S. Smolen said it's a factor that should not be underestimated.
“If a woman breaks a hip, she has the same life expectancy as a metastasized breast cancer patient, and that's not sufficiently appreciated,” observed Dr. Smolen, professor and chairman of rheumatology at the Medical University of Vienna, 1 of 23 European medical centers and patient organizations serving as partners in eumusc.net.
Dr. Alan J. Silman sounded a note of skepticism regarding eumusc.net, saying that the project sounds like an effort to “harmonize toward the mediocre.”
“We should be encouraging diversity and variability.” Harmonization as a goal “won't work” and “is not something we should ascribe to,” argued Dr. Silman, professor of rheumatic disease epidemiology at the University of Manchester (England).
He observed that virtually all discussion of the eumusc.net project has focused on developing and monitoring standards of care and process measurement. Yet what constitutes good outcomes for patients with many rheumatic diseases hasn't been well established.
“I'm concerned that we're going to get lost in terms of process, numbers of people on drugs, or waiting times for [dual-energy x-ray absorptiometry] scans, or how quickly people go onto [anti–tumor necrosis factor] drugs in the south of Sweden,” he said. “I just wonder if we're deluding ourselves if we think that if we have so many patients on biologics, that's the end of the story.”
In the United Kingdom, “we've got the British Society of Rheumatology Biologics Registry, and we know from that [that] there's a substantial proportion of patients being maintained on biologic agents who've not had a clinical response. We can say, 'Look how wonderful it is that the number of patients on biologics is increasing,' but surely we're failing those patients who aren't having a clinical response, and we're not doing anything further, Dr. Silman said.”
Disclosures: Dr. Woolf, Dr. Smolen, and Dr. Silman had no financial conflicts of interest that were relevant to the report.
'If a woman breaks a hip, she has the same life expectancy as a metastasized breast cancer patient.'
Source DR. SMOLEN