Care (OMHLTC) how integrated fam-ily health teams or nurse-practitioner-led clinics are envisioned to function with chiropractors and other professionals on board. “As with other professions on the team, the role of chiropractors is to be defined based on the needs of the patient population and how their involvement in interprofessional programs and ser-vices will help to address these needs,” says OMHLTC spokesperson David Jensen. “The specific process through which patient needs are identified and met may vary across teams, but a team-based approach to care is common across all family health teams and nurse practitioner-led clinics.” When asked who will define the role of chiropractors and identify patient needs, Jensen responds, “The board of directors is ultimately accountable for services and programs delivered by the family health team. However, as a team-based model of care, several team mem-bers (clinical and administrative) are likely to have input into the roles that are needed to be performed to address pa-tient needs.” With regard to the PCLBP, Jensen says, “interprofessional teams operating in a primary care setting can receive funding to create a new, or enhance an existing, low-back pain program that fits within their organizational context and addresses the needs of their patient population.” Under the program, an interdiscipli-nary team will manage the assessment, referral, treatment and education of patients, says Jensen. Commenting on the chiropractic in-tegration in the PCLBP initiative, the Ontario Chiropractic Association (OCA) says it’s important to first clarify the actual opportunity and context of these health-care initiatives. OCA external relations manager Miguel Pacheco points out the ministry has established a low-back pain strategy which includes new, innovative models of care that the OCA helped to design, and that the request for proposals in the pilot program is intended to eventually inform the implementation of one or more provincial models. This, when combined with Minister Matthews’ October announcement that chiropractors will be added to the list of www.canadianchiropractor.ca health professionals that are eligible to work in family health teams and nurse practitioner-led clinics, signifies to the OCA “that chiropractors are viewed by the ministry as an important component of the health-care system, and further paths for our inclusion are being ex-plored,” says Pacheco. “The approach to the RFPs, given that this is only the beginning of a pilot project, is that different primary care settings will likely have different needs depending on their patient population and their staffing complement. Either way, you can expect that there will al-ways be someone who will complete an initial assessment, but the specific care approach will depend on the needs of referral by the chiropractor.” The OCA works to ensure that every Ontarian who can benefit from chiro-practic has the ability to do so, Pacheco notes. “These announcements represent a very positive trend in that direction, but there is more work to be done. For example, there is a greater understand-ing and recognition by both govern-ments and health-care stakeholders for disease prevention and health promo-tion programs. Chiropractic is known for both treatment of acute conditions but also for an educational, preven-tion-based approach to managing conditions. There is work to be done from within the profession and the “Ideally, a chiropractor would have a meaningful, fulsome role as part of the care cycle of assessment, diagnosis, planning, treatment, evaluation of a patient.” the organization,” he adds. In terms of OCA’s preference, he says, “Ideally, a chiropractor would have a meaningful, fulsome role as part of the care cycle of assessment, diagnosis, planning, treatment, evaluation of a patient.” Pacheco says the OCA expects there will be a wide range of diversity in the proposed models of care in the pilot program. One example could be a com-munity health-care centre where the target population are vulnerable com-munity members such as the homeless and low-income group. “A chiropractor could be involved… providing patient education, assessment and treatment,” he says. “If referral to a specialist is needed, it [could be] done through one of the nurse practition-ers. Also, kinesiology students [could] provide simple exercises and stretches following chiropractic treatment. Access to massage therapy by RMT students [could be] provided free-of-charge via a RMT program in the area, based on a health-care system so that chiroprac-tors are seen as both musculoskeletal experts and experts in health promo-tion and disease prevention.” BCCA’s Robinson says these types of inclusive government initiatives help sidestep “a big problem that has been developing slowly in Canadian health care. As more services become availa-ble to the public, outside of the provin-cial government coverage, the potential for inappropriate services being sold, or upsold to patients, increases. The best of the integrated care models en-sure that patients receive exactly the care they need.” “However,” he adds, “We are only at the beginning in creating and imple-menting integrated health care, and there are many years of development ahead.” For more on practice management, visit www.canadianchiropractor.ca. February 2014 Canadian Chiropractor 25
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