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

By |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

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My Rotation Through a VA Pain Medicine Clinic

By |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

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Perspectives of Older Adults on Co-management of Low Back Pain by Doctors of Chiropractic and Family Medicine Physicians

By |January 26, 2018|Integrative Care|

Perspectives of Older Adults on Co-management of Low Back Pain by Doctors of Chiropractic and Family Medicine Physicians: A Focus Group Study

The Chiro.Org Blog


SOURCE:   BMC Complement Altern Med. 2013 (Sep 16); 13: 225

Kevin J Lyons, Stacie A Salsbury, Maria A Hondras, Mark E Jones, Andrew A Andresen and Christine M Goertz

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA, USA.


BACKGROUND:   While older adults may seek care for low back pain (LBP) from both medical doctors (MDs) and doctors of chiropractic (DCs), co-management between these providers is uncommon. The purposes of this study were to describe the preferences of older adults for LBP co-management by MDs and DCs and to identify their concerns for receiving care under such a treatment model.

METHODS:   We conducted 10 focus groups with 48 older adults who received LBP care in the past year. Interviews explored participants’ care seeking experiences, co-management preferences, and perceived challenges to successful implementation of a MD–DC co-management model. We analyzed the qualitative data using thematic content analysis.

RESULTS:   Older adults considered LBP co-management by MDs and DCs a positive approach as the professions have complementary strengths. Participants wanted providers who worked in a co-management model to talk openly and honestly about LBP, offer clear and consistent recommendations about treatment, and provide individualized care. Facilitators of MD–DC co-management included collegial relationships between providers, arrangements between doctors to support interdisciplinary referral, computer systems that allowed exchange of health information between clinics, and practice settings where providers worked in one location. Perceived barriers to the co-management of LBP included the financial costs associated with receiving care from multiple providers concurrently, duplication of tests or imaging, scheduling and transportation problems, and potential side effects of medication and chiropractic care. A few participants expressed concern that some providers would not support a patient-preferred co-managed care model.

There are more articles like this @ our:

Senior Care Page and the:

Low Back Pain Page and the:

Integrated Health Care Page

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A Model of Integrative Care for Low-back Pain

By |January 23, 2018|Integrative Care|

A Model of Integrative Care for Low-back Pain

The Chiro.Org Blog


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.

There are more articles like this @ our:

Integrated Health Care Page and the:

Low Back Pain Page

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

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’.

There are more articles like this @ our:

Integrated Health Care Page and the:

Low Back Pain Page

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

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.

There are more articles like this @ our:

Integrated Health Care Page and the:

Low Back Pain and Chiropractic Page

(more…)