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Open Access Research

Changes in primary care physician’s management of low back pain in a model of interprofessional collaborative care: an uncontrolled before-after study

Silvano Mior14*, Brian Gamble23, Jan Barnsley3, Pierre Côté14 and Elie Côté1

Author Affiliations

1 Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada

2 Private practice, Chatham, ON, Canada

3 Department of Health Policy, Management & Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Canada

4 Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada

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Chiropractic & Manual Therapies 2013, 21:6  doi:10.1186/2045-709X-21-6

Published: 1 February 2013

Abstract

Background

Tracking how clinicians treat patients provides an opportunity to explore how the clinical management of common musculoskeletal disorders evolves over time. We present an uncontrolled before-after study of a primary care physician’s management of low back pain and describe how his involvement in an interprofessional collaborative practice was associated with a change in the management of patients with low back pain.

Method

Data from the electronic medical record of one primary care physician who participated in a study of a model of chiropractic-medical collaboration were retrospectively collected. Records of a sample of consecutive patients prior to the start (i.e. pre-study, n = 51) and at the end of the collaborative study (i.e. study, n = 49) were collected.

Results

Demographics were similar in both groups but median number of physician visits (2.5 and 1.0), average prescriptions per patients (1.24 and 0.47), and total number of narcotic prescriptions (14 and 6) differed between pre-study and study groups, respectively. Separate analysis of only the records of low back pain study patients revealed that 61% were referred for chiropractic care during the study period. Patients who were not referred had more neurological deficits and leg pain but back pain severity and average number of prescriptions was about the same. Referred patients in the study group had about 25% fewer physician visits and imaging requests.

Conclusion

Based on this study of a single primary care physician, we hypothesize that doctors may change their prescribing behaviours and consultation rate for patients with low back pain when engaged in interprofessional collaborative care. Further research is required to test this observation in the population.

Keywords:
Interprofessional collaboration; Medication use; Provider behaviour; Chiropractic