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

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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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Keywords   chiropractic; integrative medicine; interdisciplinary communication; low back pain; patient-centered care; radiculopathy; spinal manipulation; tobacco use cessation


From the FULL TEXT Article:

Introduction

Older adults with low back pain (LBP) often represent a complex clinical picture due to the inherent challenges of treating LBP especially when combined with multiple co-morbidities. [1–4] Given the potential for such complexity, it is important for clinicians and patients to consider these elements as management plans are designed and implemented. [2, 5] Multidisciplinary collaborative care including care coordination among providers is one possible approach to the management of complex LBP. [1, 2, 6, 7]

Boon and colleagues defined collaborative care as “an interprofessional process for communication and decision making that enables the separate and shared knowledge and skills of health providers to synergistically influence patient care.” [8, 9]

Successful collaboration requires

patient interest and involvement [10–12],
mutual respect [9, 10, 12],
maintenance of professional autonomy [8, 13, 14],
understanding each team members’ practice scope [9, 13, 15–17],
goal setting [9, 10, 13], and
an openness to discussion and consensus building processes. [13]

Communication models that may support interprofessional collaboration include

telephone consultations [10, 18–20]
or face-to-face meetings [10, 16, 18, 21],
job shadowing experiences [9, 16, 20],
use of electronic medical records [9, 14, 18],
and confirming understanding among team members. [12, 19, 21]

This case presentation describes a collaborative effort between healthcare providers and a patient enrolled in a clinical trial on interdisciplinary co-management of older adults with LBP. [20, 22] The trial randomly allocated eligible participants to receive 12-weeks of LBP care under 1 of 3 professional practice models: medical care; concurrent medical and chiropractic care; or collaborative care involving the patient and a medical and chiropractic co-management team. The co-management team collaborated through scheduled phone consultations and a secure, web-based, electronic communication system to share health records between the different health systems involved. [20] The interprofessional practice model emphasized patient goal setting; provider discussions of diagnoses, complicating factors and challenges to treatment; a cooperative treatment approach; monitoring patient status and care challenges; and ongoing support of the patient’s treatment goals. [20] The co-managing practitioners in this case were a doctor of chiropractic (DC) working at a chiropractic research center and a doctor of osteopathy (DO) completing a residency in family medicine. This case report discusses the collaboration process of a DC, DO, and patient engaged in the management of complex LBP in an older adult.


Case presentation


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