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Will Shared Decision Making Between Patients

By |January 17, 2018|Integrative Care|

Will Shared Decision Making Between Patients with Chronic Musculoskeletal Pain and Physiotherapists, Osteopaths and Chiropractors Improve Patient Care?

The Chiro.Org Blog


SOURCE:   Fam Pract. 2012 (Apr); 29 (2): 203–212

S Parsons, G Harding, A Breen, N Foster,
T Pincus, S Vogel and M Underwood

Department of Infectious Disease Epidemiology,
School of Public Health,
Imperial College School of Medicine,
Imperial College London,
London, UK.


BACKGROUND:   Chronic musculoskeletal pain (CMP) is treated in primary care by a wide range of health professionals including chiropractors, osteopaths and physiotherapists.

AIMS:   To explore patients and chiropractors, osteopaths and physiotherapists’ beliefs about CMP and its treatment and how these beliefs influenced care seeking and ultimately the process of care.

METHODS:   Depth interviews with a purposive sample of 13 CMP patients and 19 primary care health professionals (5 osteopaths, 4 chiropractors and 10 physiotherapists).

RESULTS:   Patients’ models of their chronic musculoskeletal pain (CMP) evolved throughout the course of their condition. Health professionals’ models also evolved throughout the course of their treatment of patients. A key influence on patients’ consulting behaviour appeared to be finding someone who would legitimate their suffering and their condition. Health professionals also recognized patients’ need for legitimation but often found that attempts to explore psychological factors, which may be influencing their pain could be construed by patients as delegitimizing. Patients developed and tailored their consultation strategies throughout their illness career but not always in a strategic fashion. Health professionals also reflected on how patients’ developing knowledge and changing beliefs altered their expectations. Therefore, overall within our analysis, we identified three themes: ‘the evolving nature of patients and health professionals models of understanding CMP’; ‘legitimating suffering’ and ‘development and tailoring of consultation and treatment strategies throughout patients’ illness careers’.

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Collaborative Care for a Patient with Complex Low Back Pain

By |January 16, 2018|Integrative Care|

Collaborative Care for a Patient with Complex Low Back Pain and Long-term Tobacco Use: A Case Report

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2015 (Sep); 59 (3): 216–225


Michael B. Seidman, MSW, DC, Robert D. Vining, DC, Stacie A. Salsbury, PhD, RN

Palmer Center for Chiropractic Research,
Davenport, Iowa.


Few examples of interprofessional collaboration by chiropractors and other healthcare professionals are available. This case report describes an older adult with complex low back pain and longstanding tobacco use who received collaborative healthcare while enrolled in a clinical trial. This 65 year-old female retired office worker presented with chronic back pain. Imaging findings included disc extrusion and spinal stenosis. Multiple co-morbidities and the complex nature of this case substantiated the need for multidisciplinary collaboration. A doctor of chiropractic and a doctor of osteopathy provided collaborative care based on patient goal setting and supported by structured interdisciplinary communication, including record sharing and telephone consultations. Chiropractic and medical interventions included spinal manipulation, exercise, tobacco reduction counseling, analgesic use, nicotine replacement, dietary and ergonomic recommendations, and stress reduction strategies. Collaborative care facilitated active involvement of the patient and resulted in decreased radicular symptoms, improvements in activities of daily living, and tobacco use reduction.

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Management of Back Pain-related Disorders in a Community With Limited Access to Health Care Services

By |January 6, 2018|Integrative Care|

Management of Back Pain-related Disorders in a Community With Limited Access to Health Care Services: A Description of Integration of Chiropractors as Service Providers

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2017 (Nov); 40 (9): 635–642

Peter C. Emary, DC, MSc, Amy L. Brown, DC, Douglas F. Cameron, DC, Alexander F. Pessoa, DC, ICSSP, Jennifer E. Bolton, PhD, MA Ed

Private Practice,
Cambridge, Ontario, Canada.


OBJECTIVE:   The purpose of this study was to evaluate a chiropractic service for back pain patients integrated within a publicly funded, multidisciplinary, primary care community health center in Cambridge, Ontario, Canada.

METHODS:   Patients consulting for back pain of any duration were referred by their medical doctor or nurse practitioner for chiropractic treatment at the community health center. Patients completed questionnaires at baseline and at discharge from the service. Data were collected prospectively on consecutive patients between January 2014 and January 2016.

RESULTS:   Questionnaire data were obtained from 93 patients. The mean age of the sample was 49.0 ± 16.27 years, and 66% were unemployed. More than three-quarters (77%) had had their back pain for more than a month, and 68% described it as constant. According to the Bournemouth Questionnaire, Bothersomeness, and global improvement scales, a majority (63%, 74%, and 93%, respectively) reported improvement at discharge, and most (82%) reported a significant reduction in pain medication. More than three-quarters (77%) did not visit their primary care provider while under chiropractic care, and almost all (93%) were satisfied with the service. According to the EuroQol 5 Domain questionnaire, more than one-third of patients (39%) also reported improvement in their general health state at discharge.

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AMI Model Working in Florida

By |May 12, 2017|Chiropractic Care, Integrative Care|

AMI Model Working in Florida: Functional Improvements, Reduced Utilization Costs
by Medicaid Patients

The Chiro.Org Blog


SOURCE:   Dynamic Chiropractic


Background:   Alternative Medicine Integration (AMI) originally achieved recognition within the chiropractic community for its unique HMO model that utilized doctors of chiropractic as primary-care physicians (PCPs) and the portal of entry into an integrated health care delivery system, inclusive of hospitals, MDs and MD specialists and outpatient facilities. Contracted with Blue Cross Blue Shield’s HMO-Illinois, AMI’s integrated IPA demonstrated excellent clinical and cost outcomes.

These outcomes were published in the June 2007 issue of JMPT and reviewed in the June 4, 2007 issue of DC. [1] In July 2007, AMI received the national endorsement of the Congress of Chiropractic State Associations (COCSA) for its outcomes-based model of chiropractic medical management.

AMI also has been documenting the clinical and cost outcomes of its holistic, patient-centered disease management program for chronic pain patients enrolled in the Florida Medicaid system. While pharmaceutically oriented disease-management programs for diabetes, hypertension, COPD and heart disease have become staples of compliance-driven, cost-containment measures offered by insurance companies and managed-care organizations, largely unnoticed by media and consumers is the growth of costs associated with chronic pain, which has become the number-one cost driver for Medicaid and the commercial populations. Coupled with the national health care trend of increased pharmaceutical usage and its associated issues of prescription drug complications, contraindications, addiction to painkillers and accidental death inherent and measurable within the conventional medical model, treatment costs for chronic pain-related diagnoses continue to escalate.

AMI’s initial three-year findings suggest integrating complementary and alternative medicine with conventional care management approaches in the Florida Medicaid system reduces the cost of care for the payer and improves the quality of life for the patient. All indications point to the conclusion that an integrative approach to treating the “whole” person is effective in this patient population.

To chiropractors and other practitioners of natural medicine, this is not a surprise. Chances are you have anecdotal stories of patient improvement within this vulnerable and challenging population. However, what is noteworthy is that since April 2004, AMI has successfully worked with the state of Florida to provide services to those beneficiaries who have been diagnosed with chronic fatigue syndrome, chronic back pain, chronic neck pain and/or fibromyalgia. AMI’s holistic nurse case managers integrate the conventional medical care these beneficiaries receive with CAM services from providers including chiropractors, acupuncturists, massage therapists, nutritionists, pharmacists and registered nurse care managers.

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An Integrated Approach to Chronic Pain

By |May 11, 2017|Chiropractic Care, Integrative Care|

An Integrated Approach to Chronic Pain

The Chiro.Org Blog


SOURCE:   Dynamic Chiropractic ~ May 2017


By Peter W. Crownfield, Executive Editor


A Rhode Island Medicaid pilot program is yielding
significant benefits and savings.

Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state’s Department of Health, [1] demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.

Since 2012, Rhode Island Medicaid “Community of Care” enrollees suffering from chronic pain have participated in an integrated chronic pain program administered by Advanced Medicine Integration. Longtime readers will recall that for nearly two decades, AMI has been coordinating chiropractic and integrated care services in various states to help address the chronic pain epidemic in a community-based, integrated fashion. [2-3]

AMI’s integrated chronic pain program is designed to “reduce pain levels, improve function and overall health outcomes, reduce emergency room costs, and through a holistic approach and behavioral change models, educate members in self-care and accountability.”

The program features holistic nurse case management with referrals to CAM providers including chiropractors, massage therapists and acupuncturists; and patient education including stress-reduction tips and more.

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A Culture of Collaboration at an Integrative Health Center

By |January 8, 2015|Integrative Care|

A Culture of Collaboration at an Integrative Health Center –
An Interview with David Fogel, MD –
Interviewed by Daniel Redwood, DC

The Chiro.Org Blog


SOURCE:   Topics in Integrative Health Care 2014, Vol. 5(3)


Daniel Redwood, DC


David Fogel, MD, is the cofounder (with his wife, Ilana Bar-Levav, MD), of the Casey Health Institute (CHI) in Gaithersburg, Maryland, a nonprofit integrative primary care practice that includes Internal Medicine, Family Practice, Chiropractic, Acupuncture, Massage Therapy, Yoga Therapy, Naturopathic Medicine and more. He is board certified in Internal Medicine with additional specialty training in mind/body focused individual and group psychotherapy.

As an internist, he served in the National Health Service Corps and on the staff at Johns Hopkins University School of Medicine, providing primary care to medically underserved inner city Baltimore residents. He has held positions as Medical Director of Employee Health at NASA Headquarters and as Medical Director of Integrative Medicine Associates in Washington, DC. Dr. Fogel holds a B.A. from Hampshire College and is a graduate of the George Washington University School of Medicine. He completed his residency at Washington Hospital Center.

In this interview, Dr. Fogel describes his journey from conventional to integrative medicine, the unique circumstances surrounding CHI’s founding, the collaborative relationships that comprise its core, and the ways he hopes it can serve as a model for new methods of healthcare delivery that are both effective and cost-effective.


Tell us how you first branched out from the conventional approaches you were taught in medical school.

I was first exposed to the concept of chi as a teenager. It’s kind of the classic story — I was beaten up, and as a result I got into the martial arts. There, I learned this incredible concept, that there was energy running through your body. That you can channel it, that it can be used for healing. So that opened me up at a young age to exploring other things. Then, I went to a kind of hippie college, Hampshire College, which opened me up to non-conventional alternatives of all kinds. This included mind-body approaches. I concentrated in humanistic psychology.

I went on to medical school. This was the era when Nixon went to China, and suddenly there were acupuncturists in the DC area. I said to myself, I need to go to an acupuncturist just to experience what it is. The Traditional Acupuncture Institute in Columbia, Maryland was just opening up (now Maryland University of Integrative Health). I kept reading and exploring these sorts of things throughout medical school. Then, in the 1990s, when David Eisenberg published his landmark article in the New England Journal of Medicine, about how many people were using complementary and alternative approaches, that gave a lot of people permission to start experimenting with different models, in a more mainstream or public way.

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