THE BACK PAGE RESEARCH REVIEW Taking the lead as primary spine care provider (part 2) I BY SHAWN THISTLE viewed nor utilized as PSCPs. A 2009 national survey by the Canadian Chiro-practic Association revealed 60 per cent of Canadians view chiropractors as those treating back pain, and just over 40 per cent regard chiropractors as ex-perts in back pain. In addition, the uti-lization rate for chiropractors has re-mained stagnant for years (around 10 per cent according to most data). his or her name. The supermarket approach: Many practitioners (in all disciplines) see high volumes of patients while offering treatments that are of little benefit to the patients. The establishment of a PSCP would represent a significant shake-up in most health-care systems – referred to as disruptive innovation – putting some of these practitioners at risk. This is an acceptable and neces-sary consequence of improving health-care delivery. Successful practices can, and do, utilize patient-centred, evi-dence-informed care. Resistance from within: The philo-sophical and practice differences among chiropractors are well known to readers. Simply put, there are those who feel the role of PSCP would limit our perceived (and actual) expertise to spinal conditions. To this I say – so what? The vast majority of our patients see us for SRDs anyway (most surveys indicate ~90 per cent); this would not be a significant shift in our caseload or patient population. In addition, since virtually everyone will suffer a SRD at some point in their lifetime, wouldn’t it be beneficial to be the profession that patients seek for care? The burden of SRDs is significant and undeniable. As evidence-informed chiropractors, we are perfectly posi-tioned to play a key role as the PSCP of the future, or at least a critical member of a team approach to this important issue. Taking action now can raise our credibility and ensure a successful fu-ture for younger practitioners. For this to happen, we must collectively take action while remaining accountable, collaborative and open-minded. For more Research Review, visit www.canadianchiropractor.ca. www.canadianchiropractor.ca n last issue, I discussed the poten-tial for chiropractors in taking the lead in the establishment of a primary spine care provider (PSCP) designation, a clinical specialty with advanced training in the area of spine care and spine-related disorders (SRDs). It is reasonable to assume the PSCP role would offer the following benefits: Faster patient recovery through • timely patient-centred, evidence-in-formed interventions, active treat-ment plans, appropriate triage and patient education/empowerment • Cost containment and savings by avoiding unnecessary treatments and imaging/diagnostic tests • Avoidance of iatrogenic disability via consistent communication and avoiding unnecessary medicaliza-tion of imaging findings with ques-tionable significance • Increased productivity through patient activation and targeted re-turn-to-work programs • Higher patient satisfaction and shared decision-making • Unburdening family physicians and other primary care contact points, as well as ensuring more appropri-ate and necessary specialist referrals At the very least, chiropractors could lead the way in a team-based or multi-disciplinary solution. We must, however, approach this in a reflective, evaluative and logical manner. Overt reform in our profession would be required in some areas and this is something we cannot take lightly, as there are certainly other professions that would contend to be, and would be, appropriate for this role. Unfortunately, we are currently not A way forward In a society-wide effort to establish a PSCP and implement an effective pri-mary care approach for SRDs, there are some significant factors we must ac-knowledge and address: Education: Currently, educational institutions are not graduating clini-cians who meet all requirements for a PSCP. Chiropractic programs certainly check a number of the required boxes, but would have to add additional train-ing in areas such as basic pain medica-tions, indications and efficacy of vari-ous surgical interventions, advanced imaging and diagnostics. Such ad-vanced training may best be imple-mented in optional programs over and above existing chiropractic education. This is not unreasonable and such programs have been established in some regions. Professional prejudice: It is likely that the best fit for the PSCP role will come from outside the traditional allopathic disciplines. This may be met with sig-nificant resistance from some parts of the medical community. Since the solution to SRD-related problems of-ten require some non-traditional think-ing, it is crucial a competent PSCP be accepted regardless of the degree after DR. SHAWN THISTLE is the founder and president of Research Review Service, an online, subscription-based service to help busy practitioners integrate current, relevant, scientific evidence into their practice (www.researchreviewservice.com). 42 Canadian Chiropractor May 2014
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