Integrative Care

Be Good, Communicate, and Collaborate: A Qualitative Analysis

By Frank M. Painter|June 24, 2018|Integrative Care|

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

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.

There are more articles like this @ our:

Integrated Health Care and Chiropractic Page

(more…)

0

Developing Integrative Primary Healthcare Delivery

By Frank M. Painter|June 21, 2018|Integrative Care|

Developing Integrative Primary Healthcare Delivery: Adding a Chiropractor to the Team

The Chiro.Org Blog

SOURCE: Explore (NY). 2008 (Jan); 4 (1): 18–24

Michael J. Garner, MSc, Michael Birmingham, PhD, Peter Aker, MSc, DC, David Moher, PhD,
Jeff Balon, DC, MD, Dirk Keenan, DC, and Pran Manga, PhD

Carlington Community and Health Services,
Ottawa, Ontario, Canada.

BACKGROUND: The use of complementary and alternative medicine has been increasing in Canada despite the lack of coverage under the universal public health insurance system. Physicians and other healthcare practitioners are now being placed in multidisciplinary teams, yet little research on integration exists.

OBJECTIVE: We sought to investigate the effect of integrating chiropractic on the attitudes of providers on two healthcare teams.

DESIGN: A mixed methods design with both quantitative and qualitative components was used to assess the healthcare teams. Assessment occurred prior to integration, at midstudy, and at the end of the study (18 months).

SETTING: Multidisciplinary healthcare teams at two community health centers in Ottawa, Ontario, participated in the study.

PATIENTS/PARTICIPANTS: All physicians, nurse practitioners, and degree-trained nurses employed at two study sites were approached to take part in the study.

INTERVENTION: A chiropractor was introduced into each of the two healthcare teams.

MAIN OUTCOME MEASURES: A quantitative questionnaire assessed providers’ opinions, experiences with collaboration, and perceptions of chiropractic care. Focus groups were used to encourage providers to communicate their experiences and perceptions of the integration and of chiropractic.

RESULTS: Twelve providers were followed for the full 18 months of integration. The providers expressed increased willingness to trust the chiropractors in shared care (F value = 7.18; P = .004). Questions regarding the legitimacy (F value = 12.33; P < .001) and effectiveness (F value = 11.17; P < .001) of chiropractic became increasingly positive by study end.

There are more articles like this @ our:

Integrated Health Care and Chiropractic Page

(more…)

0

A Survey of American Chiropractic Association Members’ Experiences

By Frank M. Painter|April 24, 2018|Integrative Care|

A Survey of American Chiropractic Association Members’ Experiences, Attitudes, and Perceptions of Practice in Integrated Health Care Settings

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2015 (Dec); 14 (4): 227–239

Leo J. Bronston, DC, Lauren E. Austin-McClellan, DC, MS, Anthony J. Lisi, DC, Kevin C. Donovan, DC, and Walter W. Engle, DC

University of Bridgeport College of Chiropractic,
Bridgeport, CT;
Staff Chiropractor,
VA Connecticut Healthcare System,
West Haven, CT.

OBJECTIVE: The purpose of this study is to examine the self-report of experiences, attitudes, and perceived educational needs of American Chiropractic Association members regarding practice in integrated health care settings.

METHODS: This was a descriptive observational study of the American Chiropractic Association members. Participants completed an electronic survey reporting their current participation and interest in chiropractic integrated practice.

RESULTS: The survey was completed in 2011 by 1142 respondents, for a response rate of 11.8%. The majority of respondents (82.9%) did not currently practice in an integrated setting, whereas 17.1% did. Those practicing in various integrated medical settings reported delivering a range of diagnostic, therapeutic, and case management services. Participation in administrative and scholarly activities was less common. Respondents not practicing in integrated settings reported being interested in delivering a very similar array of clinical services. Doctors of chiropractic practicing in hospital or outpatient medical facilities reported frequent engagement in interprofessional collaboration. Both nonintegrated and integrated respondents reported very similar educational interests on a range of clinical topics.

There are more articles like this @ our:

Integrated Health Care and Chiropractic Page

(more…)

0

Integration of Doctors of Chiropractic Into Private Sector Health Care

By Frank M. Painter|April 13, 2018|Integrative Care|

Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2018 (Feb); 41 (2): 149–155

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

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, Iowa.

OBJECTIVE: The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic (DCs) working in private sector health care settings in the United States.

METHODS: We conducted an online, cross-sectional survey using a purposive sample of DCs (n = 50) working in integrated health care facilities. The 36-item survey collected demographic, facility, chiropractic, and interdisciplinary practice characteristics, which were analyzed with descriptive statistics.

RESULTS: The response rate was 76% (n = 38). Most respondents were men and mid-career professionals with a mean 21 years of experience in chiropractic. Doctors of chiropractic reported working in hospitals (40%), multispecialty offices (21%), ambulatory clinics (16%), or other (21%) health care settings. Most (68%) were employees and received salary compensation (59%). The median number of DCs per setting was 2 (range 1–8). Most DCs used the same health record as medical staff and worked in the same clinical setting. More than 60% reported co-management of patients with medical professionals. Integrated DCs most often received and made referrals to primary care, physical medicine, pain medicine, orthopedics, and physical or occupational therapy. Although in many facilities the DCs were exclusive providers of spinal manipulation (43%), in most, manipulative therapies also were delivered by physical therapists and osteopathic or medical physicians. Informal face-to-face consultations and shared health records were the most common communication methods.

There are more articles like this @ our:

Integrated Health Care and Chiropractic Page

(more…)

0

Conservative Spine Care: Opportunities to Improve the Quality

By Frank M. Painter|February 21, 2018|Integrative Care|

Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

The Chiro.Org Blog

SOURCE: Popul Health Manag. 2013 (Dec); 16 (6): 390–396

Thomas M. Kosloff, DC, David Elton, DC, Stephanie A. Shulman, DVM, MPH, Janice L. Clarke, RN, Alexis Skoufalos, EdD, and Amanda Solis, MS

Physical Health, Optum Health,
Kingston, New York.

Low back pain (LBP) has received considerable attention from researchers and health care systems because of its substantial personal, social, work-related, and economic consequences. A narrative review was conducted summarizing data about the epidemiology, care seeking, and utilization patterns for LBP in the adult US population. Recommendations from a consensus of clinical practice guidelines were compared to findings about the current state of clinical practice for LBP. The impact of the first provider consulted on the quality and value of care was analyzed longitudinally across the continuum of episodes of care. The review concludes with a description of recently published evidence that has demonstrated that favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care pathways.

From the FULL TEXT Article:

Introduction

The united states has the most expensive and complex health care system in the world, [1] yet the magnitude of funds spent on the system has failed to provide commensurate benefits in terms of quality, access, and cost performance. [2]

There are more articles like this @ our:

Integrated Health Care and Chiropractic Page and the:

Chiropractors as the Spinal Health Care Experts Page

(more…)

0

My Rotation Through a VA Pain Medicine Clinic

By Frank M. Painter|January 31, 2018|Integrative Care|

My Rotation Through a VA Pain Medicine Clinic

The Chiro.Org Blog

SOURCE: ACA News ~ January 29, 2018

By Stephanie Halloran, DC

Part of a series on the chiropractic residency program in the VA health care system

Some of the most valuable knowledge you gain in the Veterans Affairs (VA) chiropractic residency program comes from rotating in other specialties. Within the VA Connecticut Healthcare System, I rotate at both the West Haven and Newington locations. Thus far, I have spent time in rheumatology, physiatry, women’s clinic (primary care), neurology, pain medicine and the interventional pain clinic. Although each rotation has contributed greatly to my clinical acumen, this post will primarily focus on pain medicine.

Pain medicine is a medical subspecialty generally comprised of anesthesiologists, physiatrists or neurologists who have completed an additional one-year post-residency fellowship. As the name implies, these specialists manage overall pain with a goal of improving quality of life for patients. In the private sector, this is done through a combination of medication and interventional procedures, while in the VA the focus is primarily on the latter. This is due to the VA system allocating the majority of medication management to primary care physicians. That’s not to say a VA pain physician will not provide suggestions for medication management when indicated, but they will not prescribe or manage this medication.

Within the VA system, pain management generally manages spinal conditions such as stenosis, non-surgical disc herniation, musculoskeletal trigger points, symptomatic spondylosis and unspecified radicular pain with absence of progressive neurological deficits. Sound familiar? Essentially, this department treats very similar conditions as chiropractors treat but with interventional procedures.

If you are like me at the beginning of my residency, you are currently asking, or have already Googled, what interventional procedures are. Interventional procedures include medial branch block, radiofrequency ablation, epidural steroid injection, sacroiliac (SI) joint corticosteroid injection and musculoskeletal trigger point corticosteroid injection. Intervention selection is determined by identifying the most likely pain generator and presence or absence of radicular symptoms. Below I have broken down each procedure into axial and radicular categories and provided a brief explanation of the goal.

Axial pain: symptomatic spondylosis, SI joint arthritis/dysfunction

(more…)

0