299- How to Communicate the Benefits of Maintenance Care

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. Today's episode we're back at the research with an awesome study. This thing is hot off the press. If you are interested in maintenance care, what's the latest and greatest? We're going to dive into that on today's episode and this is going to go deep into communication. This is where the science kind of rubber meets the road. A lot of clinical pearls you're going to want to pay attention on today's episode. For before we get started, I want to encourage you, if you are checking out EHR options, head over to echiroehr.com that's echiro ehr.com Scott Munsterman and his team have put together a fantastic EHR system built on documentation and compliance. So if those two words get you excited or if you know you could be better in those realms, echiro EHR is definitely a solution you want to check out. I'll drop that link down in the show notes as well. But, but as I said at the top on today's episode, we're talking maintenance care. Brand new study that just came out titled the Nordic Maintenance Care Patient Experience of Maintenance Care. A qualitative study. So this is building off the blocks of that Nordic maintenance care program. They've just put out an incredible shout out to all the researchers on this. They put out some incredible research regarding maintenance care, probably more actionable and more in totality than we've ever seen before. And this is no exception. I'll drop the link down in the show notes of course. But what is maintenance care all about? Well, they're focusing on maintenance care specifically relative to low back pain and the focus of it is research really on prevention. So why is this so important? We talk about this each and every week on the podcast. Right There is the opioid crisis going on. There's all of these challenges. So the question really becomes how can we be more proactive with things. Ties to patient Journey from a few weeks ago on the podcast here. But that's, that's where this research is going and that's why I love it. So there's emerging evidence supporting the use of long term manual care or quote unquote maintenance care for certain groups of patients with recurrent and persistent low back Pain. And that's sort of the original studies of this that came out. They started to say, man, there might be a place at this. And I believe some of the quotes at that time were on, you know, prevention, on early diagnosis, those sort of things, and the role maintenance care may have with that. So they took this study and sort of broke people up into different classifications based upon their behavior or psychology, and they classified them based upon this multidimensional pain inventory. And how, how is that defined? Well, let's sort of dive into what that means. Patients described as dysfunctional, these are the toughest customers, so to speak, in this sort of study. These are individuals with high pain severity. They're total interference with everyday life. They have, you know, high distress, you know, low perception of life control, low activity levels. You might have a few of these people in your practice right now. And they broke them up into these different categories. So one were individuals that had great coping skills, then there was a middle group, and then the dysfunctional group was all the way on the other end. So we're going to dive a little bit more into those groups in a moment. But I wanted to set the stage for really, they were taking a look at saying, okay, patients that are really the toughest people that we see in practice for all of these very specific reasons, they are truly dysfunctional. They have a lot of pain, they have a lot of challenge, they're just not able to get things going. How do they react differently than people with great coping skills? And that's really what the study was looking for. So it's estimated that up to 41% ish, 22 to 41% of all chiropractic visits are dedicated to maintenance care. So this is a pretty big deal. And it's a lot of what goes on in chiropractic practices. And there were previous studies around this. And one of the previous studies did an anonymous survey and they found that the purpose of maintenance care was to prevent pain, to remain as pain free as possible, and to prevent disease in general. And most of the patients that were asked felt as though these goals were achieved to a very high degree. So we're checking some boxes here saying, man, that's some good stuff. In the vein of the benefits of maintenance care, but we'll continue to dive deeper. So this study was looking at two primary things. They aimed to what they say, explore patients experiences and preferences regarding maintenance care, regarding, with an emphasis on barriers to and facilitators of engaging in the care. And number two, to contrast the interview data from the three psychological subgroups, Adaptive copers, those are sort of people who are very good coping skills, interpersonally distressed, sort of the middle of the road, and dysfunctional, which have a lot of the characteristics that make them difficult in practice. Right. They're in a lot of pain, they're not able to get going, and they really feel like things are out of control. So they use that multi dimensional pain inventory. And they looked at the three groups and then they had five psychological constructs. Pain severity, interference, life control, effective distress and support, and three behavioral constructs. And those were punishing responses, salacious responses, and distracting responses. So those were sort of the groups and how they laid it out. So let's take a look at those three profiles again. Adaptive copers, they're characterized by low pain severity, low interference with everyday life, low life distress, and a high activity level. And they feel like they have control of what's going on. So these are obviously, as you can imagine, great people to take care of in your practice because they're proactive with what's going on. They have, and they're as active as possible and they feel like they have control, which is such an important part. And I think really we're gonna go with the communication aspects of this. The middle group were interpersonally distressed and they report challenges in close relationships and often describe distrust. Others who they view them as responsible, they view as responsible for their problems. And then the dysfunctional group, as we kind of talked about high pain severity, interference with daily life, you know, high distress, low perceptions of control, low activity levels. They got all the pain avoidance strategies of catastrophizing, what's going on, fear, avoidance, you name it, the dysfunctional group has it and they become challenging to take care of and treat. So they broke them apart into those groups. They, these individuals received maintenance care. And then the questions were, well, how'd it go? Right? What happened? What are those barriers, what are those facilitators, and how are people interacting with the care? The feedback that they got was pretty impressive in many ways. They found. I'll read a couple quotes directly from the study subjects. Quote, maintenance care can act as a springboard to start moving more, start exercising, which you see can contribute to one's overall health. This can impact the whole family. You might start eating and drinking healthier. That was one of the participants. Another one said, quote, I would have never been able to continue my line of work if my back had felt the way it used to. And then another quote, well, apart from the physical aspect, not having Pain and how should I put it, Being more confident that my back and body can handle the things I need to do. Maintenance care has also helped my mental state. To know I can carry, play and have fun with my kids, be able to participate in physical activities without having to be left on the sideline wondering whether I can do it, has been invigorating mentally. So these things probably, these aren't surprising. If you're listening, you're saying, okay, I've had patients say stuff similar to that to me. Great, now we get into how did it really play out. It seems like people were super jazzed on the care, but there were a few question marks and barriers. And a lot of the question marks and barriers, I'm gonna say, have to do with setting agreements and expectations. It has to do with communicating clearly why these people are doing it and why you're making these recommend. So they were able to classify people into two big buckets. One is people that had high value perception of the care and the others that didn't. And there were some characteristics in each bucket as you can imagine. So people that had a high value of care, they felt as though things were structured, they felt as though it was accessible. They appreciated a patient centered approach. Now people that had a low value, they were questioning whether the benefits outweighed the cost. They perceived it as kind of inaccessible and not delivered in a patient centered approach. So these are really, really big take homes that I wanna make sure that you are totally in line with because a lot of this has to do in my mind with communication. So again, high value of care. These people, it was structured, AKA they knew what was going on. There was a plan, there was a program, it was accessible, hey hour, you know, easily accessible. They were able to get in and out of the practice, the hours were good and they had a patient centered approach. Are you asking questions with those individuals? Do they understand the plan so important? Because on the other end, if you have people with low value and they're like, I don't know if this is helping, I don't know if the benefit outweighs the cost. Well, there's clearly not a description of the benefits to them. Right. If it's inaccessible, they might, that might be a perception issue and a communication issue. Not actually true. So are you over communicating? There's a. And a patient centered approach. If they don't think that they're the, they're the superstar and you're the guide. As you know, the hero's journey once said, you're going to have Challenges. So if we break down these different categories of people based upon psychological profiles, you know, the adaptive copers, they're thought to have, of course, the best coping strategies and they, here's an interesting antidote. They did not mention reimbursement as anything. Right. So what does that mean? That means that they took a lot more personal responsibility. So that's an important component of this. Now, all subgroups identified cost, logistical challenges and a lack of effectiveness as barriers to engaging in and following. So even these people that like loved it, it was like, well, you know, is, is the cost? Is, is it, it's a barrier. Doesn't mean that they weren't doing it. But it was a friction point. The logistical challenges, potential friction point, lack of effectiveness. I feel great. What's going on now? Right? These are communication opportunities. Now most, here's, here's another thing. Now this is somewhat embarrassing, I'll say, but I think it's very true. Most participants had a very poor understanding of what maintenance care was, even though they had all received the intervention during the randomized control trial. So these people went through it, they said yes to maintenance care, they received maintenance care, and then they were unable to answer, well, what exactly is it and what are the goals? So all of this comes down to, and this is, this is not isolated to this paper. This is what goes on in real life. This is why I love this paper is it's such a great reflection of, I think, the challenges many of us deal with. We know what's going on, right? As chiropractors, as healthcare providers, we kind of know what's going on. We know what's going on with the patient, we know where we'd like to guide them towards. But if that's not being clearly communicated, again, I think we have such perception bias of like, well, most people, they'll know. They won't know unless you really describe it simply clearly. And again and again and again. So all of these things come down to, in my opinion, a lot of them, communication issues. Do people understand the cost benefit analysis? Do they understand why they should be continuing to come and the benefits that they can expect? They understand how to engage with your practice very clearly. If not, these are gonna be barriers. And that is a big, big challenge. So some of those factors, again, cost demanding, low sense of value, perceived unavailable, and fear of treatment. Now the one factor facilitating maintenance care in all the subgroups was when care was thought to be patient centered. So what do we know about that? How do we action? That means that if the person Believes that it's patient centered. That's going to be a lever that you can pull, not in a sales way, but in a being the being patient centric, no pun intended, and as ironic as that sounds, but really take that patient centered approach. What are their goals? What are you seeing on your examination? Why are you recommending the care at the intervals that you are. These sort of things are super, super important so that you're able to address this value proposition. You're able to address the cost, you're able to address any. Well, I feel good right now. I don't want it to get messed up by coming in here. Quote, unquote. We've all had patients and we've all heard these things. The questions become, when you're going through a wellness care, when you're going through a maintenance care conversation with a patient, are you clearly describing this? And I want to be very clear, if somebody's on a maintenance care program, they might not be coming in as frequently by definition, right? You might be coming in once a month, once a quarter, twice a month, whatever it might be for you, do they understand why? The second part about that is, when you're seeing them at that duration, that is there's a good amount of time between visits. You have to reinforce it when they're coming in. If it's been a month, if it's been a few weeks, what you talked about last time, wow, that was probably gone within 30 minutes when they walked out the door. It's just the way it is. People are busy. So are you clearly communicating with your patients? The why Are you listening to the questions that they have and are you taking the most patient centered approach possible? Because if you do all of those things, it seems like you can not only have a fantastic practice from a business perspective, but you definitely can help people. And as we started this out, we know all of these things that we talk about each and every week on this podcast. You know, millions back surgeries per year, opioid epidemic injections to the tune of 25,000 ESIs a day. These are huge, huge challenges. The guidelines support what we do. The question is, are you getting in there and having really, really good conversations with your patients? Are you meeting them where they're at with your conversations? And do they believe perceptions, reality, do they believe you are taking a patient centric approach with your career? One of the easiest ways to do that is to ask questions. My partner Jason always says the answer is a question. The more questions you ask, the more you're able to understand what that person's going through and guide them, which is so critically important to the perception of patient centered care. And really perception is reality, the reality of patient centered care. So I hope there was a lot of great clinical nuggets in this. I thought this paper was awesome. Again, shout out to the researchers that put this together and they continue to produce this fantastic studies on this Nordic maintenance care line of research studies. It is absolutely awesome. Thank you for tuning into this podcast. If you have not left us at rating or review and you're listening on an iPhone, you can scroll on down and tap how many stars. Throw in a few words. We really, really appreciate. 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