By Eugene A. Lewis, DC, MPH, CCGPP Chairman
The best practice initiative undertaken by the Chiropractic Guidelines and Practice Parameters is progressing at a steady pace, with the Introduction and first completed chapter of the document (lumbar spine disorders) scheduled for release in early 2005. The dedicated volunteers of the Commission who are compiling the literature strive to be as thorough as possible. The sheer volume of research gathered to date is very impressive and will no doubt result in reliable evidence-based treatment options for all types of clinicians who want to serve their patients in an appropriate manner. This initiative focuses on the “process of care” instead of arbitrary treatment recommendations found in ordinary guidelines. This article will attempt to answer the most common questions CCGPP has been receiving concerning the development of the best practice initiative. For further information please visit our website at www.ccgpp.org
Q: Will the document address chiropractic philosophy?
A: Philosophy, certainly an underpinning of everything that chiropractors do, is not a focus of best practices and would be exceptionally difficult to place in that sort of framework.
Q: “I’d like a certain piece of literature included _____."
A: CCGPP always welcomes submissions of pertinent literature from any interested party and our addresses are listed at the conclusion of this article. That being said, we are making a significant effort to be as comprehensive as possible and since our organization is employing both a professional research group as well as our own researchers examining multiple databases, it is likely that we already have the literature in question.
Q: What opportunity will exist for input by stakeholders?
A: Pre-publication comment with advance notice of this published online on our website (www.ccgpp.org) in chiropractic journals and made known by other methods will solicit input from the chiropractic profession and from others, including patients, students, the insurance industry, governmental agencies and all other stakeholders.
Q: Will COCSA or some other group “sign off” on this?
A: No, COCSA and all of the other organizations to whom CCGPP members report have already appointed the existing representatives to find the resources to write and publish this document.
Q: What’s the cost of the finished product to field doctors?
A: CCGPP is hopeful that it will be able to contract with underwriters to provide a copy or other access to the best practices document for all US practicing chiropractors at no charge. This has not been finalized yet.
Q: What is CCGPP going to do with any profits?
A: Any and all income from royalties from the sale of the best practices document will be placed in a fund used for updating this document.
Q: What if there is a significant body of research that affects this document after publication or other need to alter the document?
A: Thanks to contemporary technology, it will be a relatively simple matter to update this document. Deadlines for updating the entire document have already contractually been set for no longer than every 24 months. This is a living document and it can be modified perpetually. Any unexpected issues can be dealt with and are planned for by the design of this entire process.
Q: What's the focus of the best practices document?
A: CCGPP is placing a special focus on the process of care, identification of risk factors and case complexity, techniques of response monitoring, with benchmarks for intervening when the response is below average. This focus helps all parties to recognize that there is a broad spectrum of individuals served in chiropractic offices with varied presentations to be addressed.
Q: Best practices give information about the best care for patients but doesn’t address frequency and duration of care. How credible will it be if it doesn’t set limits?
A: First of all, there is virtually no supported literature for frequency or duration of care. Nearly all of this information used is arrived at by consensus or is quite arbitrary. CCGPP is providing a database of information from which chiropractic bodies in individual jurisdictions can arrive at guidelines for frequency and duration of care if needed. The insurance industry understands this issue also and CCGPP is taking care to place this in proper context for them, addressing their concerns as well as concerns within our own profession. We necessarily have to regard the best practices project as a problem-solving exercise for those on all sides in the chiropractic care industry and are charged with producing a document which can withstand scrutiny from all those parties.
Q: What if there isn’t enough evidence on a topic?
A: Consensus will dictate the conclusion.
Q: What if we just waited to see if there is more evidence before publishing?
A. The demand for this document is overdue and waiting longer for any reason has been deemed as unacceptable. Furthermore, although the chiropractic profession is in need of significantly more research funding, there is surprisingly quite a bit of information on many of our focus topics. CCGPP has also applied for a number of grants which we hope can pave the way for much more research in the profession, so we are addressing the issue directly.
Q: What will CCGPP say about wellness care?
A: This is an important area for our profession and will be addressed. Since there is virtually no research in this area, consensus will also be the rule.
Q: What's the budget for this process?
A: $475,000 for 2004 is the budget, as it takes a considerable amount of funding to produce a quality product.
Q: What's the timetable for this process?
A: The completed document will be released in mid 2005.
ABOUT THE AUTHOR: Eugene A. Lewis, DC, MPH, is a graduate of Logan College of Chiropractic and has practiced in Greensboro, North Carolina since 1979. He earned his Master of Public Health from the University of North Carolina at Greensboro. Dr. Lewis has served as president of the North Carolina Chiropractic Association, president of the Southeastern Chiropractic Federation and has been a member of the North Carolina State Board of Chiropractic Examiners. He has served as a Commissioner of the North Carolina State Radiation Protection Commission and as a benefits advisor to the North Carolina Health Planning Commission. Dr. Lewis was a member of the Commission for Chiropractic Quality Assurance and Practice Parameters, which published Guidelines for Chiropractic Quality Assurance and Practice Parameters in 1993. He has been a member of the Council on Chiropractic Guidelines and Practice Parameters since 1997 and has been chairman since 2002. Dr. Lewis is a Fellow of the International College of Chiropractors. He can be reached through the CCGPP office at PO Box 2054, Lexington, SC 29071, 803-808-0640, or firstname.lastname@example.org