Integrative Care

Initial Integration of Chiropractic Services into a Provincially Funded Inner City Community Health Centre: A Program Description

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc 2015 (Dec); 59 (4): 363–372

Steven R. Passmore, DC, PhDm Audrey Toth, DC, Joel Kanovsky, DC. Gerald Olin, BSc, DC

University of Manitoba,
College of Rehabilitation Sciences;
University of Manitoba,
Faculty of Kinesiology & Recreation Management.

Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center

The Chiro.Org Blog

SOURCE:   Journal of Primary Care & Community Health 2020 (Sep 10) ~ FULL TEXT

Christopher Prater 1, Melissa Tepe 2, Patrick Battaglia 3

Affiliations
1.   Washington University School of Medicine, St. Louis, MO, USA.

2.   Affinia Healthcare, St. Louis, MO, USA.

3.   Logan University, Chesterfield, MO, USA.

Background:   Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies. It is therefore important to develop systems to treat spinal pain within the primary medical home.

Methods:   We designed a prospective observational pilot study at a community health center to measure the effectiveness of two interventions among an underserved population: a multidisciplinary pain team and chiropractic care. Study outcomes were pain and functional disability measured by the Pain Disability Questionnaire (PDQ), and reduction of opioid dose at baseline and 6–12 months. Multivariate linear regression was used to determine associating factors for change in PDQ scores.

Results:   Thirty-five individuals completed baseline and follow-up PDQs from August 2018 to May 2020. Overall, the mean baseline PDQ was 92.4 +/– 6.1 and the mean follow-up PDQ was 81.9 +/– 7.7, resulting in a mean improvement of 10.6 (95% CI 1.2 – –22.3, P = .08). Participants in the chiropractic team (mean change –25.0, P = .01) and those completing the study before COVID-19 (mean change = –22.6, P < .01) were found to have significantly greater improvement at follow-up.

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Chiropractic Integration into Private Sector Medical Facilities:
A Multisite Qualitative Case Study

The Chiro.Org Blog

SOURCE:   J Altern Complement Med. 2018 (Jul 17) [Epub]

Anthony J. Lisi, DC, Stacie A. Salsbury, PhD, RN, Elissa J. Twist, DC, MS, and Christine M. Goertz, DC, PhD

Pain Research,
Informatics, Multi-Comorbidities and Education Center,
VA Connecticut Healthcare System,
West Haven, CT.

OBJECTIVES:   Chiropractic care may have value in improving patient outcomes and decreasing opioid use, but little is known about the impetus for or process of incorporating these services into conventional medical settings. The purpose of this qualitative study was to describe organizational structures, care processes, and perceived value of chiropractic integration within U.S. private sector medical facilities.

DESIGN:   Multisite, comparative organizational case study.

SETTINGS:   Nine U.S. private sector medical facilities with on-site chiropractic care, including five hospitals and four clinics.

PARTICIPANTS:   One hundred and thirty-five key facility stakeholders including doctors of chiropractic (DCs), non-DC clinicians, support staff, administrators, and patients.

METHODS:   Researchers conducted 2-day site visits to all settings. Qualitative data were collected from audio-recorded, semi-structured, role-specified, individual interviews; standardized organizational data tables; and archival document review. A three-member, interdisciplinary team conducted thematic content analysis of verbatim transcripts using an existing conceptual framework and emergent codes.

RESULTS:   These nine medical facilities had unique organizational structures and reasons for initiating chiropractic care in their settings. Across sites, DCs were sought to take an evidence-based approach to patient care, work collaboratively within a multidisciplinary team, engage in interprofessional case management, and adopt organizational mission and values. Chiropractic clinics were implemented within existing human resources, physical plant, information technology, and administrative support systems, and often expanded over time to address patient demand. DCs usually were co-located with medical providers and integrated into the collaborative management of patients with musculoskeletal and co-morbid conditions. Delivery of chiropractic services was perceived to have high value among patients, medical providers, and administration. Patient clinical outcomes, patient satisfaction, provider productivity, and cost offset were identified as markers of clinic success.

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Principles in Integrative Chiropractic

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2003 (May); 26 (4): 254–272

J.Michael Menke, DC

Program in Internal Medicine,
University of Arizona,
Tucson 85719, USA.

As the public acceptance of chiropractic continues to grow in the United States, [1-3] the private practice chiropractor may find opportunities for formal inclusion in the fast growing integration of complementary and alternative medicine (CAM) into health care delivery. The ability of chiropractors to respond confidently to integration into the overall health care system may be the next step in gaining access to more patients and improving the health care quality.

This necessity for chiropractors to become part of the evolving health care system and still maintain a strong chiropractic identity will be essential, since chiropractic’s value lies in cultivating and delivering the very elements that have made it so high in patient satisfaction: emphasis on biomechanics, manual therapy of the spine, good patient rapport, and strong patient-physician bond. [4, 5] However, there are several barriers to integration: consumer, medical, and chiropractic itself.

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Be Good, Communicate, and Collaborate: A Qualitative Analysis of Stakeholder Perspectives on Adding a Chiropractor to the Multidisciplinary Rehabilitation Team

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2018 (Jun 22); 26: 29

Stacie A. Salsbury, Robert D. Vining, Donna Gosselin and Christine M. Goertz

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, USA

Background   While chiropractors are integrating into multidisciplinary settings with increasing frequency, the perceptions of medical providers and patients toward adding chiropractors to existing healthcare teams is not well-understood. This study explored the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting.

Methods   This qualitative analysis was part of a multi-phase, organizational case study designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team. The setting was a 62–bed rehabilitation specialty hospital located in the northeastern United States. Participants included patients, families, community members, and professional staff of the administrative, medical, nursing, and therapy departments. Data collection consisted of audiotaped, individual interviews and profession-specific focus groups guided by a semi-structured interview schedule. Transcripts were imported into a qualitative data analysis program for data analysis. An iterative coding process using thematic content analysis categorized key themes and domains.

Results   Sixty participants were interviewed in June 2015, including 48 staff members, 6 patients, 4 family members, and 2 community members. Our analysis generated a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings composed of 5 domains and 13 themes. The domain, Patient-Centeredness, or the provision of healthcare that is respectful, responsive, and inclusive of the patient’s values, preferences, and needs, was mentioned in all interviews and linked to all other themes. The Professional Qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence. Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting. Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.

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