Chiropractic in the Health System

Primary Care Low Back Pain Pilot Programs

On November 26, 2014, Dr. Eric Hoskins, Ontario’s Minister Health & Long-Term Care, announced $2.3 million in funding for seven pilot projects designed to improve the quality and delivery of treatment for low back pain and make a life-changing difference to thousands of people in the province. As experts in low back pain, and a range of other musculoskeletal conditions, Ontario chiropractors will play leading roles in six of the pilot projects.

The Honourable Dr Eric Hoskins (left) receives an assessment from chiropractor Dr Craig Jacobs (right) during the announcement of new PCLBP pilot. November 26, 2014
The Honourable Dr Eric Hoskins (left) receives an assessment from chiropractor Dr Craig Jacobs (right) during the announcement of new PCLBP pilot. November 26, 2014

The PCLBP Pilot program enables interprofessional primary care teams to provide better patient care through more effective treatment and management of low back pain. The pilot will provide $2.3 million in funding over two years for seven primary care organizations across seven different Local Health Integration Networks in the design, planning and implementation of a LBP management program within their organizational context.  Chiropractors will have a significant role in six of those pilot projects.

The following organizations are participating in the pilot:

  • City Centre Health Care in Windsor in partnership with Essex Court Nurse Practitioner-Led Clinic in Essex,
  • A partnership between Family Health Teams in Mount Forest, East Wellington and Minto-Mapleton,
  • Couchiching Family Health Team in Orillia,
  • TAIBU Community Health Centre in Scarborough,
  • Shkagamik-Kwe Aboriginal Health Access Centre in Sudbury,
  • Belleville Nurse Practitioner-Led Clinic, and
  • Centre du santé communautaire de l’Estrie.

Chiropractic contributions to the PCLBP pilot will include:

  • a thorough MSK assessment that may curtail the requirement for further  expensive diagnostic testing,
  • evidence based treatment including manual therapy to help manage low back pain and reduce the need for opioids, and,
  • a focus on self-management and education leading to high levels of patient engagement.

“A collaborative, team-based approach can be very beneficial to Ontarians with low back pain,” said Dr. Kristina Peterson, President of the Ontario Chiropractic Association. “Chiropractors bring tremendous expertise to the team-based care of musculoskeletal conditions. We look forward to contributing to the Primary Care Low Back Pain Pilots announced by Minister Hoskins today and providing the best possible care to Ontarians.“

“Improving the quality and delivery of treatment for low back pain can make a life-changing difference to thousands of people in the province. Expanding the availability of low back pain supports means that more Ontarians will get the right care, at the right time, in the right place.”  — Dr. Eric Hoskins, Minister of Health and Long-Term Care.

Read the OCA’s press release » (November 26, 2014)

Read the Ministry of Health and Long Term Care’s press release » (November 26, 2014)

Developments in 2013

In the fall of 2013, the Ministry of Health and Long-Term Care made two announcements with respect to chiropractors:

  1. As a component of the MOHLTC’s Low Back Pain (LBP) Strategy, the Ministry will run a new pilot, funding selected primary care teams to design, plan and implement Primary Care Low Back Pain Programs. Learn more »
  2. Chiropractors have been added to the list of health professionals who are eligible to work in Family Health Teams (FHTs) and Nurse Practitioner-Led Clinics (NPLCs). Learn more »

Notably, chiropractors have already been working with other health professionals in a variety of relationships for many years. While these models have not been publicly funded, they often involve robust collaboration in an effort to provide high quality, coordinated care for patients. Learn more »

Announcement 1:

Following the first announcement—that the Ministry will fund Primary Care Low Back Pain pilot programs—the MOHLTC sent a Request for Proposals to all interprofessional primary care teams, including Aboriginal Health Access Centres (AHACs), Community Health Centres (CHCs), FHTs, and NPLCs, to design, implement and run low back pain programs. As part of this pilot, teams are required to partner with local allied health providers: chiropractors, physiotherapists, occupational therapists, and/or kinesiologists, or some combination of these providers.

The proposals for the PCLBP pilot were due to the Ministry on November 21st, 2013. Successful applicants were announced on November 26, 2014.

Learn more about the Primary Care Low Back Pain Pilot »

Learn more about the Provincial Low Back Pain Strategy »

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Announcement 2:

The second announcement—that chiropractors have been added to the list of health professionals who are eligible to work in FHTs and NPLCs—was followed by confirmation from the Ministry that chiropractors were already and will continue to be eligible to be employed in AHACs and CHCs as well.

Teams will be given the flexibility to employ chiropractors on a salary or sessional basis.

These opportunities to include chiropractors in interprofessional primary care teams is a positive step forward in supporting complex patient populations. It is very common for patients with multiple comorbid chronic conditions to suffer from MSK challenges. This can reduce strength and prevent patients from engaging in the active phase of their care, thereby exacerbating existing conditions. Chiropractors can play a key role in the shared care of complex patients with MSK conditions through bolstering complex patients’ efforts to manage pain, prevent injury and improve physical function. Given the prevalence of MSK visits in primary care practices, an increased role for chiropractors can serve to allow a team’s primary care providers to spend more time with other patients, potentially reducing wait times and allowing a team to increase their patient roster.

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Existing Chiropractic Collaboration

While the recent government announcements offer new opportunities for chiropractors to formally integrate into primary care teams in a funded capacity, chiropractors have already been collaborating with primary care providers in a variety of unfunded structured referral and co-location arrangements for many years. Existing models of collaboration between chiropractors and primary care providers and teams include:

  1. Co-location arrangements in which chiropractors provide MSK services which are embedded in primary health care settings. In these particular models, the chiropractors are, effectively, part of the team, but are not publicly funded; they bill patients as they would in other settings, pay rent or other overhead to the practice, and they also may offer some pro-bono consultations and treatment to rostered patients who are unable to pay.
  2. Structured referral networks in which chiropractors provide MSK services as an off-site referral resource. In such relationships, physicians and nurse practitioners refer patients to existing chiropractic practices. In this case, the chiropractors may still attend onsite team meetings and participate in rounds to strengthen collaboration amongst the providers.

Click here for resources the OCA has developed on how chiropractors are working collaboratively in the health system.

If you are interested in having someone from the OCA or a chiropractor present to your organization on how we can work collaboratively to provide high quality, cost-effective, patient-centred care, please contact us by email at oca@chiropractic.on.ca or by phone at 1-877-327-2273.

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