physicians from Ontario participated in the survey. A prob-ability sample of the same size would yield a margin of error of ±9.76 per cent, 19 times out of 20. The Ontario resident survey was completed online from April 25, 2012, to May 7, 2012, using Environics Research Group’s online panel. A total of 1,231 Ontario residents participated in the study. A prob -ability sample of the same size would yield a margin of error of ±2.79 per cent, 19 times out of 20. Dr. Bob Haig tells Canadian Chiropractor : “The OCA com-missioned the Environics Research Group to conduct market research of both physicians and Ontario residents. All physi-cians were screened to ensure that they saw at least 50 patients in an average week. Ontario residents and physicians were not limited to any specific areas of the province – all participants came from a variety of geographical areas and demographic profiles.” Three quarters of residents surveyed indicated they felt that if professionals such as chiropractors were used more in teams with family physicians, this would be a better use of health-care dollars. The OCA has reported that the survey shows the vast major-ity (93 per cent) of family physicians frequently treat patients with low back pain and more than half (55 per cent) find it challenging to treat these patients on their own. Three-quarters (75 per cent) say they think their patients suffering from low back pain could benefit from treatment options offered by oth-er health-care professionals. Three quarters (74 per cent) of residents surveyed indicated they felt that if professionals such as chiropractors were used more in teams with family physicians, this would be a better use of health-care dollars. other disciplines prior to the study. “I’ve worked in this envi-ronment for more than four years,” she tells Canadian Chiro-practor , “and we already have an established working relation-ship. We utilize the same electronic medical records (EMR) system allowing for easy and effective communication when dealing with mutual patients. “For this study, we were able to see the patients before a referral for advanced imaging and medical specialists, and of-ten, the patient could be managed effectively with conserva-tive care. The importance of physical activity was central in many cases. Having the time to spend with the patient to walk through the guidelines was paramount and resulted in strong patient satisfaction and provider value”. “Following the assessment, I would connect with the fam-ily physician to share my findings and discuss the patient care plan. At this point, having a community network allowed us to make recommendations for conservative treatment, if appro-priate, from providers we know and trust. At the end of the ses-sion the patient would complete an evaluation form, on which they could give their impressions of their experience with this model.” THE CONSULTING PROFILE PILOT PROJECT “The objective of the pilot project was to test the feasibility, acceptability and value of this model of care in the Ontario context,” continues Dr. Haig. “With the exception of one site, the DCs were not co-located with the MDs prior to the project.” Jan Kasperski adds, “Many of the family physicians who participated in the project were already fairly engaged with chi-ropractors in their communities, though, and already had an appreciation for their services.” “For a six-month duration,” Dr. Haig explains, “the chiro -practors assessed patients in the physician’s office two half-days a month. Acute, recurrent or chronic LBP patients were referred to the assessment clinic by the physicians and the chiroprac-tor performed an assessment of approximately 30 minutes in length. The assessment clinic included a thorough, guideline-driven assessment and a patient education component.” Dr. Candice Gibbs was the one chiropractor who was al-ready co-located with physicians and health care workers of 24 • Canadian ChiropraCtor | SEptEMBEr 2012 RESULTS, REACTIONS AND RECOMMENDATIONS Dr. Gibbs notes that the patients’ evaluations forms demon-strated a 95 per cent satisfaction rate with the collaborative consultation model. “Patients liked that they had time with the chiropractors,” she explains. “Family physicians are very busy and the DC was able to take time to talk and explain concepts to the pa-tient. For instance, sometimes MRIs are provided to patients, for a variety of reasons, that they don’t really need. Having a chiropractor there to explain to the patients why, given their findings, an MRI may not tell us anything that we didn’t already know is very helpful to both the patient and the family physi-cian.” Dr. Haig expands on this: “Chronic recurrent LBP patients who do not respond to usual physician care are a particular challenge for both physicians and the health-care system and are cited as the most common reason for referrals to orthope-dic surgeons and neurosurgeons. 1 The vast majority of patients referred for specialist medical consultation receive advanced imaging – MRI – prior to the consultation. However, less than 10 per cent of patients referred by primary care physicians to spine surgeons are surgical candidates. 2 This means that most of these MRIs were not required. Those non-surgical patients are generally referred back to the family doctor. “Wait-times to see a spine surgeon are among the highest in Canada (average waiting time is more than seven months). 3 But, evidence suggests that as many as 90 per cent of patients who are referred to the surgeon would not benefit from surgi-cal care. Chiropractors have a valuable role to play in effective primary care triaging of LBP patients and can reduce morbidity related to prolonged waiting times and optimize use of limited resources.” Jan Kasperski adds, “This consultation model allows the patient to bypass the long wait times and make important de-cisions regarding referral and treatment strategies right in the family physician’s office. Evidence suggests that the sooner an intervention is made available, the better the prognosis for a www.canadianchiropractor.ca
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