The European principle „rehabilitation–integration–return to the labor market“ and disability assessment

Introduction: The restoration of the working ability with a definite period of employment is enshrined in the definition of the Expert Committee of Rehabilitation at WHO (1958). In Bulgaria, the Territorial Expert Medical Committees (TEMCs) only carry out a medical assessment of disability, and the social assistance based on it is the Social Assistance Agency’s commitment. The purpose of this article is to explore the importance of the expert decision (disability assessment) for the implementation of the principle „rehabilitation-integration-return to the labor market“.Material and Methods: The opinion of 612 patients with disabilities, certified/re-certified by General TEMC (St. Marina Hospital, Varna), was examined. The extract represents 10.2% of those who passed through the Commission in 2017 and was formed in accordance with the inclusion and exclusion criteria.Research Tool: Questionnaire with 15 questions, 13 of which are closed-ended and the other 2 are open-ended. They are organized in the following areas: „organizational and methodological“, „social“, „medical“, „legal“ and „opportunities for change“.Results and Discussion: The analysis of the demographic indicators of the persons included in the given extract allows us to get an idea of the characteristics of this vulnerable group in Varna region’s society. 85.9% of them are persons of working age (16 to 65 years), 64.1% are married, 59.6% are living in a regional city and 40.5% are without employment . Only 4.4% (n = 612) of the persons with a TEMC-determined invalidity/ disability considered rehabilitation sufficient. 81.9% (n = 209) of those who were denied a disability rate during their last re-certification reported that they were not advised to rehabilitation.Conclusion: The study of the principle „rehabilitation-integration-return to the labor market“ under the current Bulgarian legislation reveals a number of problems that do not allow its implementation. In Bulgaria, the activity of TEMC is oriented towards determining the medical assessment of disability without the possibility of introduction to mandatory rehabilitation and control afterwards

The functioning of the Territorial Expert Medical Commission and rehabilitation of disability - the experts` opinion

Introduction: Disability is a medico-social and legal phenomenon, which provokes the researchers to investigate its multidimensional nature. The financial dimensions of the medical system expertise functioning in Bulgaria are also important, but the social significance for the society, the disabled persons and their families should be a political priority.Aim: The aim of the article is to explore and analyze the expert opinion related to the problems of disability rehabilitation and the functioning of the Territorial Expert Medical Commission (TEMC).Materials and Methods:. The opinion of the experts has been selected typologically (intentionally and in a random way) by the following institutions: the National Social Security Institute, the Agency for Social Assistance, the Regional Health Inspectorate, the Territorial Expert Medical Commission, non-governmental organizations for people with disabilities and centers for social rehabilitation on a regional and national scale. The empirical information was received from the in-depth interviews with experts. For the interview, a scenario of 19 open-ended questions (divided into 4 topics) was developed.Results: The Bulgarian practice highlights the disadvantages of the separation of medical and social assessment of disability. An integration into a complex one-step medicо-social disability expertise will be more effective, which would solve the problems of disabled individuals in our country. The opportunities for change in the TEMC system require a working model of the TEMC's methodical and methodological subordination and an assessment of the invalidity/disability that will provide a complex and one-step medical and social expertise allowing timely and adequate social integration. Conclusion: The expected results from the proposed effective model of mixed TEMC and the Agency for Social Assistance functioning will result in more effective rehabilitation of the disabled people, lowering of the degree of disability and more successfully rehabilitated people back to the labor market. This will remove the barriers during the rehabilitation procedures, will lead to the selection of the optimal technical resources and will improve the delivery of social services. The proposed cooperation will eventually enhance the sustainable social inclusion of disabled people

How Can we Replace Disability Pensions with the European Approach of Rehabilitation-integration-return to the Labor Market?

The territorial expert medical commissions (TEMC) and their preventative and occupational functions arethe main instrument providing social integration for people with disabilities in Bulgaria. The TEMC system`s SWOT analyses show that these functions are in fact not performed in way to achieve their goals. The expert decision of TEMC contributes to the socialization of handicapped people only in the aspects of disability pension, technical aids, personal assistance. The current legal framework does not provide for the individual`s capacity for work restoration and employment via the individual rehabilitation programs prescribed in the expert conclusions of TEMCs. The rehabilitation programs are designed with regard to the individual needs of the person with disabilities by the rehabilitator - an occupational therapist.The aim of the article is to present the idea of introducing the European principle „rehabilitation-integration-return to the labor market` instead of paying disability pensions in Bulgaria. Therefore TEMC`s actions should be directedtowards medical prophylaxis, requalification and return to the labor market.The territorial expert medical commissions (TEMC) and their preventative and occupational functions arethe main instrument providing social integration for people with disabilities in Bulgaria. The TEMC system`s SWOTanalyses show that these functions are in fact not performed in way to achieve their goals. The expert decision of TEMC contributes to the socialization of handicapped people only in the aspects of disability pension, technical aids, personal assistance. The current legal framework does not provide for the individual`s capacity for work restoration and employment via the individual rehabilitation programs prescribed in the expert conclusions of TEMCs. The rehabilitation programs are designed with regard to the individual needs of the person with disabilities by the rehabilitator - an occupational therapist.The aim of the article is to present the idea of introducing the European principle „rehabilitation-integration-returnto the labor market` instead of paying disability pensions in Bulgaria. Therefore TEMC`s actions should be directedtowards medical prophylaxis, requalification and return to the labor market

The Expert Decision - a Necessary Requirement for Social Integration of Disabled People

The realization of the rights of disabled people in Bulgaria is directly related to the activity of Medical Committee. The Expert decision published by Medical Committee is a necessary requirement for the usage of these rights. The insufficiency of a current informa- tion from available source slows down the process of social integration. Also these legal assumptions, which underline these rights are changing dynamically too. The general practice is the point of beginning, from which the procedure for certification starts. This is the place where disabled people come back and look for the answers of their questions, which are created from the Expert decision. The continuing education of general practitioners is an opportunity for improving their competence in this area

Quality of life of individuals with disabilities - concepts and concerns

Introduction: The number of people with disabilities has grown tremendously for the last 15 years in Bulgaria. Standardized quality of life instruments can be helpful in the development of public policies which target the needs of this population. The quality of life (QoL) paradigm is a challenging perspective for considering, planning and implementing changes within the area of disabilities. Moreover, an interview with a disabled person about her/his subjective health is a human care with a positive impact on the overall well-being of the individual. This paper aims at stimulating a debate on these topics by investigating the `QoL` and `disability` territories. Further, a study on QoL of individuals with disabilities is presented. The objectives of this study are: (1) to measure the QoL of a representative sample of 305 individuals with disabilities, who are patients from a general Territory Expert Medical Commission - TEMC* (St. Marina University Hospital, Varna) by using the WHO generic questionnaire (WHOQOL-BREF) - 26 questions; four-domains structure: Physical health, Psychological health, Social relationships,  Environment. (2) To define the influence of the four domains on QoL. (3) To analyze the relationship between QoL and socio-demographic characteristics. (4) To assess the influence of physical pain on QoL.Methods: A cross-sectional study was conducted in 2011 using a representative sample of the register of a general TEMC (n=305, >18 years old). Respondents were selected through the method of multi-stage random selection.Results: As a result of multiple-regression analyses it was found out that all the domains have influence on QoL but the most influential is the `Environment` domain (0.394), followed by `Physical health` domain (0.354), `Psychological health` domain (0.261) and `Social relationships` domain (0.169). The total multiple regression coefficient - R is 0.984 (R2=0.969). The patients who reported higher levels of pain - 95.80 % - have lower QoL. No relations were found between socio-demographic characteristics of the patients and their QoL. Nowadays, the TEMC mission has to cover not only expert assessment and integration of persons with disabilities into society. The TEMC mission should also involve the improvement of QoL of the people with disabilities. A medico-social approach for handicap-assessment is proposed as a prerequisite for sustainable development of the public health policies concerning people with disabilities.

Preparing patients for handicap-stage assessment and the challenges for the general medical practice

General Practitioners (GPs) face a variety of administrative challenges during their daily work. One of them is the growing number of patients who demand assessment for a handicap stage from the Territory Expert Medical Commissions (TEMC). The General Medical Practice (GMP) is the starting point of the Expert Decision (ED) procedure. GMP is also the place where the patients come back with questions about the patients` rights which they obtain receiving ED. The people with disabilities have to traverse a difficult way in order to receive a handicap stage (percentage). The key to success is competent preparation of the patient by the GMP for the TEMC-examination. This also is a guarantee of the normal functioning of the whole System for Medical Expertise of Working capacity (MEW). The continuous medical education of the GPs is an opportunity to enrich and update their knowledge and competences about MEW-procedures. The long-term strategy is to guarantee the patient` rights which are explicitly formulated by the law. As a result, justified patients` complains will be avoided. The overall aim of the presented synopsis is to explore the process of preparing patients for handicap stage assessment by GMP and the challenges which face a GMP related to this process. The methods used are: meta-analysis of legal and medical documents for disability assessment; and participatory research method e.g. follow up of the patients` path and the procedures in TEMC. On the bases of this study recommendations are proposed referred to the effectiveness of the MEW-procedure and the role of GMP in the disability stage assessment process

The design of an agent based model of human activities and communications in cardiac resuscitation

International audienceCardio-pulmonary arrest is a common emergency situation causing over 400,000 deaths per year, more than a 1000 per day, in the USA alone. The goal of this work is to develop an agent based computer simulator that will allow trainers to experiment with different communication protocols, such as those found in air traffic control. This paper describes the first step in designing the simulator development. The design is based on an analysis of communications during real life training simulations using the FIPA standard categories