Elsevier

EXPLORE

Volume 4, Issue 1, January 2008, Pages 18-24
EXPLORE

Clinical article
Original research
Developing Integrative Primary Healthcare Delivery: Adding a Chiropractor to the Team

https://doi.org/10.1016/j.explore.2007.10.003Get rights and content

Background

The use of complementary and alternative medicine has been increasing in Canada despite the lack of coverage under the universal public health insurance system. Physicians and other healthcare practitioners are now being placed in multidisciplinary teams, yet little research on integration exists.

Objective

We sought to investigate the effect of integrating chiropractic on the attitudes of providers on two healthcare teams.

Design

A mixed methods design with both quantitative and qualitative components was used to assess the healthcare teams. Assessment occurred prior to integration, at midstudy, and at the end of the study (18 months).

Setting

Multidisciplinary healthcare teams at two community health centers in Ottawa, Ontario, participated in the study.

Patients/Participants

All physicians, nurse practitioners, and degree-trained nurses employed at two study sites were approached to take part in the study.

Intervention

A chiropractor was introduced into each of the two healthcare teams.

Main Outcome Measures

A quantitative questionnaire assessed providers’ opinions, experiences with collaboration, and perceptions of chiropractic care. Focus groups were used to encourage providers to communicate their experiences and perceptions of the integration and of chiropractic.

Results

Twelve providers were followed for the full 18 months of integration. The providers expressed increased willingness to trust the chiropractors in shared care (F value = 7.18; P = .004). Questions regarding the legitimacy (F value = 12.33; P < .001) and effectiveness (F value = 11.17; P < .001) of chiropractic became increasingly positive by study end.

Conclusion

This project has demonstrated the successful integration of chiropractors into primary healthcare teams.

Section snippets

Study Population

This project was implemented in two CHCs in Ottawa, Ontario, Carlington Community and Health Services and South-East Ottawa Centre for a Healthy Community, from July 2004 until March 2006. All physicians, nurse practitioners and degree-trained nurses employed at the two study sites were approached to participate in the study. Each center hired a chiropractor, who was integrated as a part-time member of the healthcare team and received salary and full benefits. Chiropractic services were

Results

Twelve providers were followed for the full 18 months of integration. Eight other providers were eligible for inclusion at the beginning of the study: three left their job; four took new positions at the centers, and one nurse refused involvement in the study. The results reported only pertain to the twelve providers followed for the full 18-month integration. The mean age of the providers was 44.1 years, and they all had worked at their centers between two and five years (Table 1). Each

Discussion

Our results indicate that integrating chiropractic care into an established conventional medical setting, specifically a CHC, can be achieved with a high degree of comfort, as reported by healthcare providers and patients alike. These data are in sharp contrast to other published opinions. Kelner and colleagues11 saw the integration of CAM as a distant possibility that would be extremely difficult to achieve. They did not favor this kind of integration and raised doubts about the competence of

Conclusion

This project demonstrated the importance of structuring and scheduling interactions between the established healthcare team and the chiropractors to facilitate a successful integration. We used formal education sessions to help dispel misconceptions about chiropractic and had the chiropractor scheduled into weekly clinical rounds. This integration had a positive impact on providers’ individual practices and changed opinions and views of healthcare practitioners toward chiropractic, resulting in

References (21)

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    Over the past decade, the chiropractic profession has seen expanded collaboration with and participation in mainstream health care delivery systems. Previous investigators have described chiropractic clinical services in the Department of Veterans Affairs, the Department of Defense, and private health care systems.1–10 It has been recommended by the Institute of Alternative Futures that the chiropractic profession continue to emphasize integration into mainstream health care to ensure a strong future.11

  • Health Care Transitions: A Review of Integrated, Integrative, and Integration Concepts

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