Integrative Care

A Model of Integrative Care for Low-back Pain

By Frank M. Painter|January 23, 2018|Integrative Care|

A Model of Integrative Care for Low-back Pain

SOURCE: J Altern Complement Med. 2012 (Apr); 18 (4): 354–362

David M. Eisenberg, MD, Julie E. Buring, ScD, Andrea L. Hrbek, Roger B. Davis, ScD, Maureen T. Connelly, MD, Daniel C. Cherkin, PhD, Donald B. Levy, MD, Mark Cunningham, Bonnie O’Connor, PhD, and Diana E. Post, MD

Division of General Medicine and Primary Care,
Beth Israel Deaconess Medical Center,
Harvard Medical School,
Boston, MA 02115, USA.

OBJECTIVES: While previous studies focused on the effectiveness of individual complementary and alternative medical (CAM) therapies, the value of providing patients access to an integrated program involving multiple CAM and conventional therapies remains unknown. The objective of this study is to explore the feasibility and effects of a model of multidisciplinary integrative care for subacute low-back pain (LBP) in an academic teaching hospital.

DESIGN: This was a pilot randomized trial comparing an individualized program of integrative care (IC) plus usual care to usual care (UC) alone for adults with LBP.

SUBJECTS: Twenty (20) individuals with LPB of 3-12 weeks’ duration were recruited from an occupational health clinic and community health center.

INTERVENTIONS: Participants were randomized to 12 weeks of individualized IC plus usual care versus UC alone. IC was provided by a trained multidisciplinary team offering CAM therapies and conventional medical care.

OUTCOME MEASURES: The outcome measures were symptoms (pain, bothersomeness), functional status (Roland-Morris score), SF-12, worry, and difficulty performing three self-selected activities.

RESULTS: Over 12 weeks, participants in the IC group had a median of 12.0 visits (range 5-25). IC participants experienced significantly greater improvements at 12 weeks than those receiving UC alone in symptom bothersomeness (p=0.02) and pain (p=0.005), and showed greater improvement in functional status (p=0.08). Rates of improvement were greater for patients in IC than UC in functional status (p=0.02), bothersomeness (p=0.002), and pain scores (p=0.001). Secondary outcomes of self-selected most challenging activity, worry, and the SF-12 also showed improvement in the IC group at 12 weeks. These differences persisted at 26 weeks, but were no longer statistically significant.

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Will Shared Decision Making Between Patients

By Frank M. Painter|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 Frank M. Painter|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 Frank M. Painter|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 Frank M. Painter|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 Frank M. Painter|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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Integrative Care

A Model of Integrative Care for Low-back Pain

A Model of Integrative Care for Low-back Pain

Will Shared Decision Making Between Patients

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

Collaborative Care for a Patient with Complex Low Back Pain

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

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

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

AMI Model Working in Florida

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

An Integrated Approach to Chronic Pain

An Integrated Approach to Chronic Pain

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