Healthcare has evolved greatly from being primarily an agglomeration of solo practitioners to now embracing the importance of collaboration and team-based care. Evidence suggests that interprofessional collaboration in primary care can significantly improve health outcomes, as well as patient and practitioner satisfaction while decreasing overall costs.
Notably, in this age of information and technological advancement, ideally most healthcare settings allow for fluid communication between managing practitioners and patients. In reality, electronic health records (EHR) can be a valuable tool to facilitate communication by providing immediate availability of patients’ records and related information to all attending healthcare providers. In fact, some healthcare settings, like St. Michael’s Academic Family Health Clinic (MAFHC), have instituted a comprehensive EHR system. Patient records are stored electronically on a customized and protected database within the hospital network so that any provider affiliated with St. Michael’s Hospital, whether in the Emergency Room or in a specialty clinic off site, can retrieve vital health data and make informed treatment decisions.
Also, when providers are co-located, collaboration can be enhanced through “hallway consultations”. During the course of their daily routine, it is not uncommon for healthcare providers to engage in face-to-face informal discussions about their patients with co-treating providers. This allows for providers to share ideas, discuss concerns or challenges, and ensure that the best treatment options are available to the patient.
Dr. Igor Steiman, Clinician at the St. Michael’s Academic Family Health Clinic (MAFHC), told us that he is often asked by surgeons to “run upstairs” to help consult on the appropriateness of surgery for patients suffering from musculoskeletal (MSK) conditions. The integrated Chiropractic Program in St. Michael’s Hospital makes this kind of collaboration easy.
However, when a patient’s family physician and chiropractor work in independent practices, communication and referrals become more difficult. The traditional model of solo practices is evolving to team-based care where family physicians and chiropractors, among others, can collaborate and work to deliver better outcomes for patients.
In fact, many Canadian physicians acknowledge the benefit of chiropractic services as part of collaborative care in managing MSK conditions including low back pain (LBP). As well, with increasing rates of aging patients presenting with LBP, chiropractic services can reduce the burden on primary care physicians in the treatment of MSK conditions.
For example, a 2011 pilot demonstration program carried out by the Ontario Chiropractic Association (OCA) in collaboration with the Ministry of Health and Long Term Care’s (MOHLTC) showed great results when chiropractors were used as consultants on cases of acute, recurrent or chronic low back pain. Called “Consulting Chiropractor Role in Primary Care for Low Back Pain”1, the program involved chiropractors providing 30-minute assessments of low back pain patients in the office of their primary care physicians. The chiropractor then consulted with the referring physician to provide advice on the patient’s condition and support on physician’s treatment decisions.
The outcomes were positive for both providers and LBP patients.
Primary care providers reported:
- Increased confidence in the assessment and management of LBP
- Increased recognition of appropriate imaging
- Enhanced awareness about the role of exercise in LBP management
- Significantly increased ability to target treatment
- More knowledge of community resources available for both providers and patients
The chiropractors reported:
- Increased understanding of medication management of LBP
The LBP patients reported:
- High rate of satisfaction in their treatment
The demonstration used elements proven to contribute to success in interprofessional collaboration, such as provider co-location, understandings of competencies, each provider working in the full scope of practice and the ongoing communication and facilitation of knowledge transfer.
Interprofessional collaboration goes beyond DCs and MDs working together. For instance, a promising new initiative at the French River Nurse Practitioner-Led Clinic (NPLC) in Ontario reports strong collaboration between a recently hired chiropractor and other team members in the treatment of patients with MSK issues.
How do patients fare when healthcare providers collaborate? This infographic follows a patient’s journey to health when healthcare professionals collaborated about her case and, although it is based on a case report2 published in Journal of the Canadian Chiropractic Association (JCCA), the patient’s name and some of the details have been changed.
1. Rogers, J. Consulting Chiropractor Role in Primary Care Demonstration Project, Executive Summary, Centre for Effective Practice April 30, 2012. 2. Riva J, Muller G, Hornich A, Mior, Gupta A, Burnie S. Chiropractors and collaborative care: An overview illustrated with a case report. J Can Chiropr Assoc. Sep 2010; 54(3): 147–154.