Podcast episode (Evidence Based Chiropractor, host Dr. Jeff Langmaid) discussing a 2016 BMC Complementary and Alternative Medicine qualitative study titled "Primary Care Physicians, Acupuncture and Chiropractic Clinicians, and Chronic Pain: A Qualitative Analysis of Communication and Care Coordination Patterns." The host summarizes the study's main findings: deficiencies in communication between PCPs and CAM providers (chiropractors and acupuncturists), patients left to manage information, and the likelihood that poor inter-provider communication contributes to suboptimal chronic pain outcomes. The episode offers practical steps for chiropractors to improve referral relationships: provide timely case notes (evaluation, re-evaluation, discharge), send monthly research updates to PCPs, and arrange face-to-face MD meetings using a planned (Socratic) approach.
Questions this video answers
"Primary Care Physicians, Acupuncture and Chiropractic Clinicians, and Chronic Pain: A Qualitative Analysis of Communication and Care Coordination Patterns."
BMC Complementary and Alternative Medicine, 2016.
Nearly 90% of primary care providers reported patients inquiring about chiropractic care, yet only 11% had initiated a formal referral.
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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid and on today's episode we have a piece of research that gets to the heart of what we do at the Evidence Based Chiropractor. And it is about the communication, or I should say the research that behind the communication between your primary care doctors and your chiropractors. So if you've been following the evidence Based chiropractor, you know what we are all about is making sure that there's accurate communication and that it is the building and progression of building referral relationships throughout your community. And today we're talking about the research associated with that. So without further ado, we'll dive into today's episode. And again I touched on it at the top. The title of this research paper is Primary Care Physicians Acupuncture and Chiropractic Clinicians and Chronic Pain A Qualitative Analysis of Communication and Care Coordination Patterns. And this was released by BMC Complementary and Alternative Medicine in 2016. So this is a brand new article which came out just this year in 2016 and it highlights the communication patterns between chiropractors and primary care physicians and acupuncturists in a true clinical setting. And of course that communication is the foundation by which research and referral relationships are built. So we know of course here at the Evidence Based Chiropractor that research continually indicates that quality interdisciplinary communication combined with evidence based care contributes to positive outcomes for patients that are suffering from chronic health conditions. Accurate communication, the sharing of information and certainly the co management of patients with chronic conditions leads to the best outcomes possible. This article from BMC showcases the challenges that still exist between primary care physicians and CAM providers. And our definition of CAM providers today of course is acupuncturist and chiropractors. So while vast strides have been made each and every week we touch on the breadth and depth, depth of the research that exists for chiropractic. There still is a great divide and there's a lot of myth and conjecture that splinters the relationships between primary care doctors and chiropractors. And you know, I think all of the offices that work with the evidence based chiropractor take a proactive approach to these challenges by talking about case notes for evaluation, reevaluation and discharge. And we're certainly going to dive into that on upcoming episodes of the Evidence Based Chiropractor podcast and the video aspect of that as well. But providing monthly research briefs and certainly maintaining accurate communication. I always talk about the three legs of the stool. One of them is providing research updates, providing value for the other care providers in your community. That's what positions your practice. That's one leg of the stool providing case notes, second leg of that stool, showcasing the social proof behind the results patients get in your practice. There's a good way and a bad way, or should I say a efficient and a less efficient way to go about providing those case notes. And as I talked about and teased. We'll kind of talk about that later. Not on today's episode, the second leg of the stool is case notes, the third leg of the stool and really the accelerator to that progress and the building of the rapport is of course a face to face meeting. So when we look at the three legs of the stool, of bridging that gap, bridging that divide and establishing that referral relationship, we look towards case notes, we look towards monthly research updates that position your practice in your local community. And. And of course we look towards the third aspect of that being the MD meeting. And there's some tactical tips that you can do regarding that that we're gonna touch on as well in future episodes that I think really create much better efficiencies in building those referral relationships. I know I've spoken to chiropractors practically weekly that tell me I met with a doc and it didn't go very well or I never saw anything, or it was a waste of time. And often I ask them, well, what was your plan of action? And the result I get is not much. They don't have an accurate plan and they certainly aren't using the Socratic method. So again, the three legs of the stool towards building these relationships are truly case notes, meeting face to face and sending your research updates. But as far as this paper found, there's a couple quotes that I want to dive into. And they really analyzed the fracturing or the splintering of that relationship and what they found in this paper, again, I'll repeat the title and it'll be in the episode. Show notes is primary care physicians, acupuncture and chiropractic clinicians, and chronic pain patients. So patients who have been in pain longer than three months, a qualitative analysis of communication and care coordination patterns. So how are these providers communicating together and what kind of care jointly are they providing for their patients? And they found, quote, our analysis of the main players in the CAM Healthcare Triad highlight deficiencies of communication between PCPs and AC providers, with patients being left to manage the information and communication. So that statement really says it all and it's unacceptable. The patient is left trying to determine who's telling what and what care pattern or course of action they should go through. When the care providers themselves should truly have those relationships and the communication between themselves to set the patient in the right direction on a unified front, that's what's going to get the best outcomes. Secondly, the researchers found CAM plays a major role in the management of chronic pain for many patients. Thus the inefficiencies and quality of care deficiencies inherent in such a dysfunctional communication system may be contributing materially to sub optimal outcomes. And that basically takes what we just talked about and truly puts it into action. They found through research, through true, true research, peer reviewed, that the sub optimal outcomes for chronic pain patients may be actually stemming from communication deficiencies between the providers. And again, that's unacceptable. And us as chiropractors, we really need to take the onus on ourselves to bridge that gap and to make sure we're providing accurate information on the co management of these patients so the patients have the best outcomes possible, not only in our office, but for their long term care. Finally, the researchers found, quote, notably many PCPs stated they did not know enough about AC nor about the practitioners who are treating the patients to feel qualified to make decisions about the referrals. So I've said it before, and I'll say it again on this episode that drives to the heart of what we do in our monthly membership at the evidence based chiropractor. These researchers found unequivocally that there is a fractured communication pattern, number one, that secondarily it could be contributing materially to suboptimal outcomes for chronic pain patients. And third, they found that the primary care providers don't know very much about what we do as chiropractors. They also touched on acupuncture, of course in this study, but bringing it to chiropractic specifically. They don't know a lot about what we do and that makes a referral for them extraordinarily difficult. And previous research had showcased that nearly 90% of primary care providers had reported patients inquiring about chiropractic care in their office, yet only 11% had initiated a formal referral. So that's another bit of the research that really showcases that divide. And that's why it's exquisitely important to take, number one, a stepwise approach to building those referral relationships and number two, establishing the communication on the co management of these patients. So if you were co managing patients, we need to be able to scream it from the rooftops. Now of course you want to have the patient's consent to share protected health information, but showcasing your work and the social proof of your practice through case notes is exquisitely important. As we touched on evaluation, reevaluation and discharge, making sure that those primary care providers obtain case note information is again exquisitely important. Number two, positioning your practice. You want to be thought of and showcased as a leader in musculoskeletal care in your town or city. So providing research updates that provide value for them and for their clinical decision making. There's no better avenue to build trust and to build rapport than providing value to them to make the best clinical decisions for their patients. And third, of course meeting face to face just drives at home. I always say the MD meeting as the accelerator and during that meeting as we'll touch on deeply in the next few episodes, it's truly about establishing how you can help them and their patients. So it's about learning about their practice, it's about using the Socratic method and and truly overcoming what I refer to as the three big hindrances to chiropractic referrals. That's really all three legs of the stool are what's going to drive your relationship building. And ultimately as you build those relationships, it's going to substantiate a referral base of patients. It's going to make your community healthier, it's going to make your community happier and it's going to provide better outcomes for the patients in your community. So again this week I think the research that we touch on provides a true heart, a true look into the heart of what we do at the evidence based chiropractor each and every week and each and every month. So if you're listening to this in audio form, I certainly would ask you please subscribe, leave some feedback on itunes or within Stitcher and let us know how we're doing. It helps us keep at the top of the charts and helps expose what we do to more and more chiropractors. If you are watching this on YouTube, it was a recently launched YouTube channel. Subscribing to the channel will help you stay up to date on the weekly research and it certainly will provide you with the most up to date content, probably bi weekly at some point in time here regarding chiropractic marketing and chiropractic research. So until then I hope you have a fantastic week in practice. Doc and I 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@the evidencebasedchiropractor.com youm 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.
