Across the spectrum of healthcare, there is more cooperation between providers than ever before. This includes increased collaboration between doctors of chiropractic and medical doctors in the management of patients with neuromusculoskeletal disorders. These collaborations occur in a variety of settings, from private clinics, and hospital-based patient care centers, to government-supported care for military and veterans, and federally-qualified health centers.
Complementary and alternative medicine (CAM) usage has been increasing among the general population, and scientific evidence is demonstrating a potential role of CAM in primary healthcare.
Chiropractors see the potential in collaborative care settings to practice with a variety of providers who are co-located, and utilize the same electronic health record to ensure there is not a duplication of services or conflicting care. In this collaborative setting, chiropractors may practice in a coordinated, supportive way that ensures best delivery of cost-effective, patient-centered care.
According to Dr. Mark Pfefer, director of research at Cleveland University-Kansas City, students in the University’s College of Chiropractic are already planning for a future as part of a multidisciplinary healthcare team.
“Currently, the majority of chiropractors provide care in private practice settings and increasingly receive referrals from primary care medical providers,” Pfefer said. “Much is being done in chiropractic education to prepare graduates for the current health care environment, which will feature increased collaboration, integration, and use of an evidence-based, best-practices approach.”
There is no doubt that barriers exist in establishing collaborative care delivery clinics, which include chiropractors, medical doctors, physical therapists, and other healthcare providers. Some of those barriers may include:
In his research, Dr. Silvano Mior, a chiropractor and the director of research partnerships and health policy at Canadian Memorial Chiropractic College in Toronto, described ways in which some of these barriers could be overcome in developing collaborative care models for the benefit of patients. Two key themes emerged:
(1.) Building trust is vital for success – trust between various types of providers, and trust between patients and collaborating providers;
(2.) Patient-centered focus – the focus of the successful collaboration must be on the patient rather than the personal or professional preferences of the providers…collaboration should enable patient participation in clinical decision-making and care decisions…it should be respectful of patient choice.
One area of success is the inclusion of collaborative chiropractic care within the U.S. military and veterans’ healthcare system. By the end of 2005, the U.S. Department of Veterans Affairs (VA) had complied with the requirements of Pub. L. 107-135:24, which required VA hospitals to provide chiropractic care to veterans at VA medical facilities.
This initial group of chiropractors provided patient-centered, evidence-based care that was broadly appreciated by other providers and patients. In 2015, VA chiropractors provided 160,000 chiropractic visits.
Currently, more than 225 chiropractors are practicing onsite at over 150 VA facilities, likely the largest number of chiropractors employed by any one entity in the U.S.
Students in the Doctor of Chiropractic degree program at Cleveland University-Kansas City (CUKC) participate as interns at the VA hospital in Kansas City. The in-house chiropractic VA program is staffed by two full-time, experienced chiropractic clinicians. Patients with spine and related musculoskeletal problems are referred to the Kansas City VA chiropractic clinic by their primary care physician. CUKC chiropractic students observe and participate in care delivery, gaining experience in a hospital-based, collaborative care clinic.
CUKC students also have opportunities to participate in rotations at Saint Vincent and Duchesne Clinics in Leavenworth and Wyandotte (Kan) County. Often called “safety-net” clinic, the Saint Vincent and Duchesne Clinics provide the same services as most family doctors, including acute and chronic disease management, now with the addition of collaborative chiropractic care for patients with neuromusculoskeletal problems. Patients who qualify for care at these clinics typically are low-income people who have no insurance and little ability to pay for medical care.
Additionally, CUKC has provided care at the KC CARE Health Center since 2005. Many students participate in rotations at this clinic, providing chiropractic care for patients with a variety of musculoskeletal problems. KC CARE offers quality, affordable, integrated health services to everyone in the community with the promise of dignity and personalized care.
Programs such as these offer a view of an integrative model for care that includes the use of CAM in primary healthcare. The intent of collaborative care is to provide patient-centered, evidence-based care in alignment with the patient’s values and preferences. Future integration of care will happen in a positive way when it involves the development of trust, open communication, and respect among providers and patients.
