The treatment of musculoskeletal disorders like back pain varies widely across health-care specialties. Studies suggests that there is little communication between professionals – such as between chiropractors and primary-care doctors – with regards to the management of low-back pain, despite growing evidence that a multidisciplinary approach to chronic conditions improves patient outcomes and satisfaction.
Do collaborative practices result in a change in primary-care physicians’ management of low-back pain? A research team recently explored one primary-care physician’s management of low-back pain over time through data from electronic medical records. They found that the physician’s involvement in a collaborative practice incorporating chiropractic care was associated with a change in how he approached back-pain treatment.
The study analyzed data from the electronic medical records of one primary-care doctor who participated in a study of chiropractic-medical collaborative practices. The analysis involved records from 51 consecutive patients prior to the start of the study, and 49 following the end of the study.
Demographics were similar in both patient groups. However, median number of physician visits (2.5 and 1.0), average number of prescriptions per patient (1.25 and 0.47), and total number of narcotic prescriptions (14 and 6) differed significantly between pre-collaboration and post-collaboration patient groups.
The researchers concluded that significant changes were seen in the physician’s clinical management of patients with lower back pain following his involvement in a collaborative-care practice. He prescribed fewer medications, although the patients had similar pain severity. The difference may have been related to the collaborative model, which facilitated patient access to chiropractic care and other treatment modalities besides medication.
This study suggests that collaborative practices between primary-care physicians and chiropractors may influence the primary care physician’s management of patients with low-back pain, including decreasing the use of medications in treatment. Previous studies have also suggested that patients can benefit from a multidisciplinary, integrative care approach to back pain.
Mior S, Gamble B, Barnsley J, Côté P, and Côté E. Changes in primary care physician’s management of low back pain in a model of interprofessional collaborative care: an uncontrolled before-after study. Chiropractic & Manual Therapies 2013, 21:6. doi:10.1186/2045-709X-21-6.