OCA pilot project results show quicker access to treatment and faster diagnoses for LBP patients when using chiropractors in teams with family physicians
Last year the OCA embarked on a consulting chiropractic demonstration pilot project to address current barriers to the provision of high quality and appropriate care for low back pain (LBP) in primary care. With funding from the Ministry of Health and Long-Term Care (MOHLTC) and advisory support from the Ontario Medical Association (OMA), the OCA developed, implemented and evaluated a consulting chiropractor role in primary care for LBP. Learn more about this model of care and background on the set-up of the pilot project.
With the completion of the project in the spring, evaluation of the results highlighted several positive outcomes with patients receiving quicker access to treatment and faster diagnosis for LBP when chiropractors were used in teams with family physicians.
Demonstration Project’s Key Findings at a Glance:
- High patient satisfaction
- High provider satisfaction. All Primary Care Physicians (PCPs) made reference to the value in referring LBP patients to the DCC assessment
- Quicker access and faster diagnoses of patients
- Majority of PCPs perceived the DCC assessment/management of LBP as being of higher quality than PCPs
- Increased PCPs:
- self-reported confidence in assessing and managing LBP patients
- knowledge of appropriate imaging and specialist referral for LBP patients
- identification and management of yellow flags for LBP patients
- understanding of the role of exercise and or physical activity for LBP patients
- knowledge of community resources available to LBP patients
- Increased DCCs:
- understanding of the importance of streaming the information that is given to the PCPs
- knowledge of medication management for LBP patients
- awareness of evidence-based websites and patient screening tools
- From the perspective of the PCPs, quick turnaround between PCP referrals to the Assessment Clinic resulted in:
- increased reassurance for the patient
- increased patient confidence in diagnosis and treatment options; and
- decrease in patients requesting specialist referrals
- overall decrease in referrals for imaging and specialists
Executive Summary of the Project’s Findings (PDF) >>
Final Report on the Demonstration Project (Complete Report PDF) >>
Watch the OCA President’s Video Message: Championing New Models of Care >>
In their Own Words
The following chiropractors participated in the pilot project at four locations:
Working with the family physicians in my area has enhanced the relationship between chiropractors and family docs. As an example of this, since completing the project I have received several referrals from some of the family docs involved. One family doc that I had no previous relationship with has asked me to assess several patients and make recommendations for treatments for them. He obviously developed confidence in my approach while I was working in his office. My practice is about 40km away from his practice, so treating them in my office is not a practical option. In my mind, this kind of relationship enhances patient care, and is a positive spill-over from the Demonstration Project.
Dr. Peter Aker, Belleville Location
I was excited and honoured to be a part of this pilot project. Optimizing collaboration between chiropractors and physicians will play an increasingly crucial role in patient care going forward. Being involved in this project, which helped to demonstrate the role that the chiropractic profession can have in the enhancement of patient care, was an engaging experience. Working with physicians and being able to demonstrate the chiropractic level of expertise on musculoskeletal care and provide useful advice on patient care was an outstanding opportunity.
Dr. Isaac Cristoveanu, Kingston Location
The demonstration project reinforced our clinic’s already established interprofessional collaboration and patient centered care model. Primary care physicians were thankful for the time allocated for the assessment and education of their patient's often complex and time consuming low back pain complaints, and patients were satisfied. This preliminary study is a positive step in the collaboration of care, where chiropractic is viewed as an important part of an integrative health care team in the treatment of low back pain and not as an alternative in patient care.
Dr. Candice Gibbs, Oakville Location
The demonstration project provided a number of benefits such as knowledge transfer with the MDs, specifically regarding how physicians currently manage LBP and their specific training. I also enhanced my own capabilities by thoroughly reviewing clinical guidelines as my knowledge base expanded and I personally became more efficient and effective in managing LBP. There was also a significant amount of learning around barriers to referral from MDs. The common reference was the lack of a follow-up patient consultation note from chiropractors, which made it difficult for the MD to know what happens to their patient once they leave their care. Overall my experience was very positive and because my location was a walk-in clinic, an additional value to the patients was the consistency having a single referred chiropractor. As a result I have several new relationships with MDs and have expanded my clinic, adding another chiropractor to handle the increase in referrals.
Dr. Shawn Rossi, Sudbury Location
Clinical Notes Key to Shared-Care
The majority of PCPs identified that the clinical note(s) provided by the DCC was a key benefit to this model of care. This identification of the need for clinical notes is not new and while there has been some increase in chiropractors providing clinical notes, most physicians continue to cite that they rarely receive any communication following shared patient care from chiropractors.
To assist with this issue, the OCA has put an increased focus on the importance of effective communication between professional groups as an important facilitator to successful collaboration through initiatives like our MD-DC Communications Workshops and our Consultation Note Form template, available on the OCA website.
OCA’s Patient Consultation Note Template
The form creates common terminology on charting relevant to the data elements that are most relevant to the physician, thus helping to reduce potential challenges related to sharing patient information. The OCA encourages members to use this form to send clinical/consultation notes back to the physician, at a minimum, following the first initial patient visit. This form can be found on the OCA website at www.chiropractic.on.ca. The template has also been incorporated into the OCA’s Patient Management Program (PMP), allowing users to access and complete the form electronically through the system, making the sharing of patient information much faster and more efficient.
For further information related to this project and/or interprofessional collaboration please contact Andrea Endicott, Senior Health Policy Analyst at email@example.com, or at 416-860-7188 or toll-free at 1-877-327-2273, ext. 7188.