Patient feedback Dr. Bruce Flynn’s office wall at the Belleville Nurse Practitioner-led Clinic is full of framed letters from patients who benefitted from the low back pain pilot project. Here are excerpts from those patient letters. “I was taking Tylenol for back pain (3 per day, $21.99 per box), Tylenol Muscle Aches and Body Pain (3 per day, $15.99 per box), Tylenol Body Pain Night (3 per day, $16.99 per box), Tylenol Ultra Relief (2 per day) and sometimes Tylenol Extra Strength ($20 per box). I would get up in the morning and still have pain in my back. Since coming to the chiropractor I now take no pills and put $40 per month in my bank account. I also walk to church and back (one hour each way), and this past weekend I walked to Quinte Mall from Moira Street West and back again (one hour each way) and still have no pain. You can do it too.” – A.S., August 4, 2015 “I was under the impression that my aches and pains were a result of multiple injuries I had suffered over the course of my life. I was also under the impression that pain was permanent. I had experienced severe pain as I was growing up at the hands of other people and had come to accept that as part of life. I believed that, one, I could not afford to see a chiropractor, and two, it would not help. I probably needed surgery that would leave me crippled (drama, I know). I was blown away by the pilot project for this to be covered under OHIP. I am so very happy and amazed that I sleep through the night and do not wake up with excruciating pain. I have been more connected to my body and adjusting the way I move a bit better or sit when I need to. It has made me more aware that I need to do this regularly to stay in a better place.” – L.M., October 27, 2015 “I would like to take this opportunity to thank you for helping me with the back pain I have suffered with for over eleven years. I believed I would be stuck with this pain for the rest of my life after my accident. I was taking 6 Percocet per day, along with 6 Tylenol #3 and using marijuana to cope with the pain. After only a few adjustments I started to feel so much better. Now that I have had several more treatments I am walking and standing taller. I have eliminated the Percocet and Tylenol #3 and now have no pain. I want to thank everyone in your clinic, as you are all amazing people. I have recommended you to several of my friends. I am so grateful to you all for helping me.” – B.M., June 6, 2016 expectations regarding integration of low back pain care into primary care setting,” the ministry says in an e-mail to Ca-nadian Chiropractor. “Patient enrolment is consistent with project expectations and patients are demonstrating satis-faction with their service.” Since the launch of the pilot project, the ministry has received “positive feedback” from the pilot sites and reports more than 50 per cent of patients served have indicated “feeling satisfied with their LBP services (e.g. consult, ex-amination, care services) and have indicated an improve-ment in self-management techniques after participating in the program.” www.canadianchiropractor.ca The ministry adds it will continue to assess progress of the project and is working toward enhancing the evaluation process by adding a “qualitative component”. The World Health Organization cites low-back pain as a leading cause of disability worldwide. Up to 80 per cent of the population will experience low back pain at least once in their lifetime. Low back pain costs the health care system between $6 billion and $12 billion annually, according to Bone and Joint Canada. The costs are even greater if one factors in losses in worker productivity and associated disability payments. Sixteen DCs were involved in six of the seven pilot sites for the PCLBP program. The OCA interviewed many of the chiropractors from the pilot sites to gauge their experiences. “The chiropractors felt that the care was more compre-hensive and effective because it was a team-based model,” says Harrington from the OCA. “It also provided an oppor-tunity to learn about the contribution that other team members could make.” Through the pilot projects, chiropractors are able to demonstrate the need for a comprehensive MSK program-ming within the public health care system that incorporates a variety of health practitioners, including chiropractors. The OCA sees the pilot project as a “great opportunity” for the profession. “We are trying to maximize the exposure it gets, and we do see multiple goals,” Harrington notes. “One being en-hancement of the role, an opportunity for chiropractors within teams, but also increased awareness about the value that chiropractic and MSK programming, in general, can provide to Ontarians.” As much as the project has been an opportunity to demon-strate the role that chiropractors can play in low back pain management, it has also been a learning experience for the chiropractors who were involved in the project. Interprofes-sional collaboration and patient-centred care have been the battle cry in recent years in the quest for a better approach to health care. The pilot project gave health-care professionals the opportunity to work in that regime first hand. The experience certainly made an impact on Townsend, one of the chiropractors involved in the Mount Forest pilot site. “I’ve practiced for several years without this coordinated effort with other practitioners. And the thought 20 years ago (when I graduated) of me working with a physiotherapist and the doctors and nurse practitioners, I would have told someone there’s just no way that was ever happening. “But now, it’s not just that it happened, but how well we could work together and how happy patients were. This is what they’ve been wanting to see all along. It’s just better outcomes, pure and simple.” The health ministry recognizes these positive outcomes, as it continues to work with the pilot sites, clinician leaders and other stakeholders. So far, the province appears to recognize the need for institutionalizing a more sustainable model of care for low back pain management. A clinical handbook for non-emergent integrated spine care has been developed and is currently being reviewed for potential implementation. September 2016 Canadian Chiropractor 25
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