011- Reduced Medication Use with Collaborative Care

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Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. @ the Evidence Based Chiropractor we talk a lot about building referral relationships with other providers. Today we're actually going to take a look at a piece of research that dives into that exact topic. The research is titled Changes in Primary Care Physicians Management of Low Back Pain in a Model of Interprofessional Collaborative Care. It's an uncontrolled before after study and and it was produced by Chiropractic and Manual Therapies in the year 2013. Before we dive in, let me say a few words about Rocktape. Rocktape is proud to be a sponsor of the Evidence Based Chiropractor. Rock Tape offers the world's best kinesiology tape, pain relief topicals, mobility tools and functional fitness accessories. New from Rocktape is Rocksauce Chill, a powerfully cool pain relief topical in a convenient roll on with 6% menthol, it's stronger than the freeze competition. They are more than a tape company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape.com so as we touched on at the top, the piece of research that we're going to look at today involves collaborative care, Interprofessional collaborative care between primary care physicians and chiropractors. So medical doctors MDDO and DCs. This study again released by Chiropractic and manual therapies in 2013. It examined interdisciplinary collaborative care between a physician and a chiropract for low back pain specific patients. They identified four key attributes, communication, defined scope of practice, service delivery and patient centered care as items that are essential to building that relationship. One area of particular note is that even though the severity of presenting conditions were similar between the groups, the group which was referred for chiropractic care was able to significantly reduce the prescription of narcotic medications. Now that's probably something that the study was on the top looking for. But again, let me repeat that the group of participants that were involved with chiropractic care, they did find that there is a significant reduction in the prescription of narcotic medications and that's in a collaborative care setting. And research like this continues to show superior patient outcomes and patient satisfaction when primary Care providers are actively communicating, referring and working with chiropractors. So these are all things that we know. Let's look at those four key attributes of of the relationship. Communication, defined scope of practice, service delivery and patient centered care. The researchers found in this study evidence suggests that communication between chiropractors and physicians is limited, which may foster fragmentation of care and impact its continuity and quality. They also found evidence also suggests that a multidisciplinary approach to chronic conditions improves patient outcomes and patient and provider satisfaction. Finally, they found the physician referred 61% of patients in the study group for chiropractic services when compared to none in the pre study group. So let me put that in perspective. This study looked at that collaborative care model and what they found was that prior to the study, prior to the institution of collaborative care, the md, the physician, primary care physician, referred zero patients to chiropractic care. However, once there was a collaborative care agreement arrangement, essentially once the study started, and again it was built on the four key attributes of communication, scope of practice, service delivery and patient centered care. That physician then referred 61% of patients during that time for chiropractic care. So that's really, really, really important. The average age of the patient, whether it was pre study or during the study was 59 years old. The severity symptomatology was exactly the same. Here are three other points that I think are very interesting in this study. The nsaid. The rate of NSAID prescriptions pre study meaning no Collaborative Care 27% of patients received it. NSAIDS for patients that had the collaborative care 18% so almost a 10% drop. Narcotic prescription percentages nearly 28% 27.5% when there was no chiropractor involved 11.8% when collaborative care care was followed in Cox 2 drugs 25% without collaborative care 14% with collaborative care. So I'm just going to pause for a minute here on the research and talk a little bit about the evidence based chiropractor because I think this really gets to the heart of what we do. At the evidence based chiropractor. I've helped docs build practices all around the world. If you are a chiropractor looking to boost your practice or just get prepared before starting then take a look at our membership site. It's a monthly site. It costs less per month than a dinner for two. Inside the membership area you're going to get templates for patients. Some templates to communicate with MDs. Monthly research papers white labeled with all of your practice information These work unbelievably well and are really worth the cost just by themselves. Even during that time is personal consultation with me. We want to make sure you get up and running. So check out the evidencebasedchiropractor.com join to get started. I think it's the best investment that you could possibly make in your practice. But let's get back to some of the research here. So again, at the evidence based chiropractor we always talk about what needs to be done, improved upon or the avenues to improve the relationships between MD do DC and this study with collaborative care. The four key attributes that they found really mirror what we talk about with the evidence based chiropractor. So communication. So for me that means actively positioning and communicating through research. It also means sending case notes and keeping docs up to date with where their patients are in your active or passive care program during re eval. So we send case notes on eval, re eval or discharge from active care. Discharge from active care may mean advancement to wellness or maintenance care, or it might mean referral out of the office or until active care starts again. But that's the crux of communication. The second attribute that they found was a defined scope of practice. To me, again, it comes down to positioning. This is about letting those referral partners, those MDs, DOs who you're trying to build those relationships with, to let them know what you do in your office and inherently what you don't do. So really establishing the active care protocols, talking a little bit about and informing them, you don't need to beat them over the head with chiropractic. Chiropractic, they're not going to be familiar with the techniques, they're not going to be familiar with a lot of the intricacies of chiropractic care. But letting them know the patients, they're patients, whom you could serve best is what's key. So that scope of practice is essential for the communication component and they play together. Because when the doc knows the kind of care that a patient will receive in your office and what your focus is, whether it's wide or thin, they're going to feel a lot more comfortable and confident. Referring to your practice, service delivery is number three. I won't touch on this too much. I think everybody out there clean, clean windows. Make sure your office is in tip top shape. Make sure that your ship and everything in your house is the way it should be. And that's going to of course lead to paramount service delivery. So I hope everybody out there has that component down pat. The fourth component, patient centric care to me, chiropractic's had a huge, huge, huge advantage with patient centered care since the beginning because chiropractic historically has been direct to consumer and less about referrals within. I think we have always been at the forefront of patient centric care, but I think it's important not to get lost in things as time goes on. Whether that's in your own career as a chiropractor, as time goes on, or the scope of healthcare over the last 10, 20, 50 years as you've been involved in chiropractic practice. So patient centered care to me comes down to serving the patient at the highest level possible. When you have communication with these other providers, when you position your practice, when you define where you are going to be and what you are going to and how you are going to serve the patients and when you are able to do it with the best delivery in a patient centric model, you are going to set yourself up for success. Also a huge thank you to everybody that's picked up Marketing Chiropractic to Medical Doctors on Amazon. It is the number one book in chiropractic on Amazon, which is completely wild to me. If you haven't picked it up, make sure to do so marketing chiropractictictomedical doctors on Amazon.com have a great week in practice doc. We will talk to you soon.

We appreciate you joining us for this episode of the Evidence Based Chiropractor. Learn more tips for explosive practice development at theevidencebasedchiropractor.com you can also join the Premier MD monthly membership enabling you to use what you just heard to maximize results in your office. We look forward to providing you with more dynamic communication tools for immediate growth right here on the Evidence Based Chiropractor.