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Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0001-6049-5402
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
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1997 (English)In: Scandinavian Journal of Social Medicine, ISSN 0300-8037, Vol. 25, no 4, 229-237 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement.

Design: Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness.

Setting: Out-patient clinic at the department of social medicine in tertiary care hospital.

Subjects: 239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found.

Main outcome measures: Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs.

Results: The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.6 MSEK (£600,000). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (£2,500,000). The net present value of the programme at the 1991 price level was 27.5 MSEK (£2,365,000).

Conclusions: Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.

Place, publisher, year, edition, pages
1997. Vol. 25, no 4, 229-237 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-81538DOI: 10.1177/140349489702500402OAI: oai:DiVA.org:liu-81538DiVA: diva2:553276
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2013-09-05Bibliographically approved
In thesis
1. Integrating perspectives in social medicine
Open this publication in new window or tab >>Integrating perspectives in social medicine
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In this thesis sickness absence was studied from a socio-medical perspective using both epidemiological and clinical data and methods of analysing. The specific aim of the epidemiological studies was to analyse sickness absence patterns and its changes in the total population of Östergötland. Furthermore, variations with gender, age and occupation were analysed. Gender trends in sickness absence concerning musculoskeletal diagnoses, its changes from 1985 to 1987 and association of numerical gender segregation in occupational categories with sickness absence due to musculoskeletal diagnoses was also investigated.

The specific aim of the clinical studies was to estimate the frequency and character of psycho-social problems in a population with repeated short-term sickness absence. A clinical socio-medical supportive program for this patient-group was assessed. Finally, the vocational activity, program costs and possible benefits to society of a clinical, socio-medical case management program was evaluated.

The results showed that women had much higher sickness absence than men generally and in particular in male-dominated occupational categories. The cumulative incidence percentage of siclmess absence in all diagnoses increased for both genders from 1985 to 1987. There were large variations between different occupational categories; blue-collar occupations were high-risk for sickness absence while white-collar occupations were low risk.

Women had higher cumulative incidence than men in musculoskeletal diagnoses and also longer duration of sick leave days per sick leave insured person and per sick-listed person. The cumulative incidence for the diagnostic sub-group "neck/shoulder diagnoses" showed the highest percentage increase from 1985-87. The cumulative incidence in all musculoskeletal diagnostic groups was highest for both genders in extremely male-dominated occupational categories (>90% men).

The study of repeated short-tenn sick leave showed that the underlying reasons were less medical and more of a socio-medical origin for 2/3 of the patients in comparison with an age- and sex-matched sample of patients at the general practitioner's surgery in the same area. A majority of patients, who had taken part in a socio-medical supportive program reported a better quality of life, although they did not specifically ascribe this to the socio-medical intervention.

When investigating the long-term economic effect of a clinical case management program for patients with chronic minor disease, the benefit-cost ratio of the program was 4.9. Fifty per cent of the patients had been absent from working life for more than two years on admission to the program. The rehabilitation rate of patients back to work was 20.5% after one year and 11 .7% after five years.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 61 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 754
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-26341 (URN)10865 (Local ID)91-7373-199-4 (ISBN)10865 (Archive number)10865 (OAI)
Public defence
2002-11-20, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-18Bibliographically approved

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Timpka, ToomasLeijon, MargaretaKarlsson, GöranBjurulf, Per

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