This series of blogs examines innovative healthcare models that include chiropractic expertise in treating musculoskeletal (MSK) conditions as part of team-based care. Evidence shows that team-based care with integrated chiropractic services can help improve outcomes and patient satisfaction. Several innovative approaches to healthcare delivery have been developed and introduced in Canada, with many more on the horizon, for all Canadians to have better access to appropriate care for MSK conditions in their communities.
In 2004, Dr. Deborah Kopansky-Giles initiated a two-year pilot project to explore the integration of chiropractors at Toronto’s St. Michael’s Hospital. The project received $600,000 from The Ontario Ministry of Health & Long-Term Care’s Primary Health Care Transition Fund—a program supporting new, collaborative healthcare models as part of the government’s 10-year effort to renew and reform primary healthcare, specifically to improve quality of care, decrease wait times and reinforce the sustainability of the healthcare system.
Ten years later, St. Michael’s Chiropractic Program is a well-established clinic in the hospital’s Inner City Health Program, Department of Family & Community Medicine (DFCM). Kopansky-Giles, along with Dr. Igor Steiman, continue to treat patients referred by St. Michael’s family physicians, the Positive Care Clinic and the Occupational Health Clinic, but the partnership with St. Michael’s has expanded exponentially. In 2011, the Canadian Memorial Chiropractic College (CMCC), where both chiropractors serve as clinical faculty, joined the largest academic family health team in Ontario—St. Michael’s Hospital Academic Family Health Team (AFHT), but more on that later.
It’s been a decade since St. Michael’s opened Canada’s first chiropractic clinic, and hospital integration has proven successful in four important ways:
- improved clinical outcomes,
- increased patient satisfaction with the quality of care,
- lowered hospital costs, and
- reduced wait times for diagnosis and treatment.
“Our original objectives were to improve access to chiropractic services by providing free care to inner city patients,” said Dr. Kopansky-Giles, “and there was a huge uptake of chiropractic treatment by this community.” She also highlighted the clinic’s outreach to areas of the city with populations that may experience economic barriers to chiropractic treatment for MSK conditions. In fact, 80% of the clinics’ patients are from Regent Park and Moss Park — two lower-income areas of the inner city.
Chiropractic integration in hospital settings could be even more successful if chiropractic scope of practice was increased within the Canadian healthcare system. A recent study1 published in the Journal of the Canadian Chiropractic Association (JCCA) explored the use of chiropractors as primary spine care providers (PSCPs) to provide niche services to Canadians suffering from MSK conditions. This model of healthcare would significantly reduce the burden of back pain patients on primary care physicians and has been used effectively internationally. For example, chiropractors provide primary care to spinal trauma patients admitted to Lellebaelt Hospital in Denmark. Their expertise in MSK injuries is known widely and very respected, so hospital administration and physicians can confidently rely on their ability to provide diagnosis and triage within the hospital’s specialized spine care centre.
Another example of chiropractic hospital integration is the Kingsway Financial Spine Centre—a practice helping patients recover from acute spine disorders—opened as part of the Trillium Health Centre in Toronto’s Credit Valley Hospital. The Spine Centre’s interprofessional team includes both an advanced practice chiropractor and general chiropractor alongside physicians, orthopaedic and neurosurgeons, neurologists, advanced practice physiotherapists and general physiotherapists, nurse practitioners, occupational therapists, psychologists, kinesiologists, and massage therapists. The association with the Trillium Health Centre and Credit Valley Hospital ensures that patient wait times for in-hospital diagnostic testing are reduced, speeding up diagnosis, treatment and recovery.
The Trillium Health Centre’s overall delivery of spine treatment, including the work of the Spine Centre, is an award-winning model of interprofessional team collaboration on the assessment, diagnosis and treatment of MSK disorders. They were presented with the 3M Health Care Quality Team Award for providing excellence in spine care across the continuum, and 96% of their patients have rated the quality of care they received as ‘good’ to ‘excellent’.
With so much evidence confirming chiropractic contribution to positive clinical outcomes, reduced wait times and sustainable systems of care, integrating hospital-based chiropractic programs is a model of care that delivers on the decade-old promises of Canadian primary healthcare renewal and reform.
1. Erwin M, Korpela P, Jones R. Chiropractors as Primary Spine Care Providers: precedents and essential measures, J Can Chiropr Assoc. Dec 2013; 57(4): 285–291.