Abstract
As the leading cause of disability in New Zealand, musculoskeletal (MSK) conditions generate health, social, and economic strains on individual quality of life and health system costs. Research indicates that one in every four adults is affected by MSK conditions, which include arthritis, osteoporosis, lower back pain, spinal disorders and injuries to the spine and limbs.1 MSK conditions are not fatal but come at a significant cost to the physical and holistic wellbeing and quality of life of those affected.
New Zealanders affected by MSK conditions can access a range of health services in primary and secondary healthcare settings. However, the management of chronic MSK conditions is largely episodic, uncoordinated, and often lacks a strong evidence base.2 The management and treatment of MSK conditions is costly; in 2009 it was estimated to comprise at least 25 percent of New Zealand’s total annual health costs.3
As a key health priority for the Ministry of Health (the Ministry), Budget 2015 confirmed a total of $50 million to be invested over the 2015/16 to 2017/18 financial years to improve prevention and treatment for people with orthopaedic and MSK conditions, and to provide more New Zealanders with timely access to planned care. Of this, $44 million was targeted to support extra orthopaedic and general surgeries, and $6 million to improve care for people with MSK conditions by delivering early-intervention, community-based programmes.
The Mobility Action Programme (MAP) was developed by the Ministry as part of this $6 million investment. The MAP was designed to align with best practice approaches to early intervention programmes for MSK conditions and the five themes of the New Zealand Health Strategy.4,5 The MAP aimed to deliver evidence informed, community-based, multidisciplinary interventions for adults with MSK conditions. It intended to support people to access advice, assessment and treatment earlier than had previously been available. The MAP’s priority groups were Māori, Pasifika and individuals living in the highest deprivation quintile. The programme ran from May 2016 to December 2019. During this time, 4,783 individuals participated in the programme.
The key objectives of the MAP were to improve the holistic well-being of adults who experience MSK conditions, reduce demand on secondary healthcare services, and address health inequity. It also aimed to provide evidence on the effectiveness of early intervention programmes targeting MSK conditions in the New Zealand context.
The Ministry established a total of 17 MAP pilot sites (MAPs). The first group of MAPs, involving seven providers, was initiated in May 2016 (Tranche 1 service providers). The second group, involving ten providers, was established in November 2016 (Tranche 2 service providers). All MAPs were designed to provide early intervention models of care, except for one MAP pilot site that targeted individuals in the later stages of their condition.6
The Ministry selected a range of providers to deliver the pilot MAPs. These included Non-Government Organisations (NGOs), private providers (such as physiotherapists, occupational therapists, and psychologists), Māori and Pasifika health providers, District Health Boards (DHBs) and Primary Health Organisation (PHOs). Providers were selected based on a range of criteria (e.g., ability to address inequity, and/or meet the unique socio-cultural and health needs of those with MSK conditions within their service areas).
The Ministry commissioned Allen + Clarke to evaluate the effectiveness and impact of the MAP, and to provide an evidence base that identifies the models and approaches that best achieve the programme’s intended outcomes. The evaluation consists of two cycles.7 This report describes findings from both cycles, with data collected from April 2018 to December 2019.
Evaluation results will be used to inform future investment in MAP-type programmes by the Ministry, DHBs, PHOs and/or other potential funders such as the Ministry of Social Development (MSD), the Accident Compensation Corporation (ACC) and private organisations. The findings will also help inform decisions about which MAPs, and which components of the MAPs will be continued, changed or stopped.