Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey.

BACKGROUND: Healthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units. The integration of clinicians who provide first line, evidence-based, non-pharmacological therapies further complicates adoption of these care pathways. This cross-sectional study explored clinician perceptions about the integration of guideline-concordant care and optimal spine care workforce requirements within an academic HCS. METHODS: Spine care clinicians from Duke University Health System (DUHS) completed a 26-item online survey via Qualtrics on barriers and facilitators to delivering guideline concordant care for low back pain patients. Data analysis included descriptive statistics and qualitative content analysis. RESULTS: A total of 27 clinicians (57% response) responded to one or more items on the questionnaire, with 23 completing the majority of questions. Respondents reported that guidelines were implementable within DUHS, but no spine care guideline was used consistently across provider types. Guideline access and integration with electronic records were barriers to use. Respondents (81%) agreed most patients would benefit from non-pharmacological therapies such as physical therapy or chiropractic before receiving specialty referrals. Providers perceived spine patients expected diagnostic imaging (81%) and medication (70%) over non-pharmacological therapies. Providers agreed that receiving imaging (63%) and opioids (59%) benchmarks could be helpful but might not change their ordering practice, even if nudged by best practice advisories. Participants felt that an optimal spine care workforce would require more chiropractors and primary care providers and fewer neurosurgeons and orthopedists. In qualitative responses, respondents emphasized the following barriers to guideline-concordant care implementation: patient expectations, provider confidence with referral pathways, timely access, and the appropriate role of spine surgery. CONCLUSIONS: Spine care clinicians had positive support for current tenets of guideline-concordant spine care for low back pain patients. However, significant barriers to implementation were identified, including mixed opinions about integration of non-pharmacological therapies, referral pathways, and best practices for imaging and opioid use.

Collaborative care for a patient with complex low back pain and long-term tobacco use: a case report.

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.

Il y a peu d'exemples de collaboration interprofessionnelle entre les chiropraticiens et d'autres professionnels de la santé. Cette étude de cas décrit une personne âgée souffrant d'une lombalgie complexe et de tabagisme de longue date qui a reçu des soins de santé en collaboration pendant qu'elle participait à un essai clinique. Cette employée de bureau à la retraite âgée de 65 ans souffrait d'une lombalgie chronique. Les examens d'imagerie ont révélé des extrusions discales et une sténose rachidienne. Des comorbidités multiples et la nature complexe de ce cas ont justifié la nécessité d'une collaboration multidisciplinaire. Un chiropraticien et un ostéopathe ont fourni des soins en collaboration selon les objectifs établis pour la patiente et soutenus par une communication interdisciplinaire structurée, y compris le partage du dossier et des consultations téléphoniques. Les interventions chiropratiques et médicales étaient notamment axées sur la manipulation vertébrale, l'exercice, des conseils sur la réduction de l'usage du tabac, l'utilisation d'analgésiques, le remplacement de la nicotine, des recommandations diététiques et ergonomiques, et des stratégies de réduction du stress. Les soins en collaboration ont facilité la participation active de la patiente et ont entraîné une diminution des symptômes radiculaires, des améliorations dans les activités de la vie quotidienne, et la réduction de l'usage du tabac.