Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study

Whedon, James M.; Toler, Andrew; Bezdjian, Serena; Goehl, Justin M.; Russell, Robb; Kazal, Louis A.; Nagare, Melissa A.

doi:10.1016/j.jmpt.2020.05.002

Cited by 8 publications

(13 citation statements)

References 16 publications

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“…Four pathways were described as regional, namely the Integrated Spine Assessment and Education Clinics (ISAEC) [30], the Saskatchewan Spine Pathway (SSP) [27][28][29], the NERP [19][20][21] and that of Fleuren et al [33]. Eleven papers considered lumbar related conditions [19-21, 24-26, 30, 34-37], eight were specific to radicular leg pain [17,18,22,23,[27][28][29]33], and eight studies included more general spine conditions [31,32,[38][39][40][41][42][43], although half of these stated that most participants had lumbar complaints [38,40,41,43].…”

Section: Overview Of Studiesmentioning

confidence: 99%

“…The reasons stated for pathway introduction are outlined in Table 3. Pathways were commonly accessed via the patient's GP, although all Canadian pathways began with a more overarching 'primary care provider' category of health professional and Whedon et al [42] used a primary spine practitioner, in this instance a chiropractor, as the first point of contact. Whilst a substantial number of studies provided minimal detail regarding primary care management, others [19,20] Mixed methods:…”

Section: Pathway Featuresmentioning

confidence: 99%

“…Interface services differed in the reported clinical management options available, although most had access to advanced imaging (Table 2). The delineation between primary care and interface services was blurred in two pathways [37,42]; for example, the primary spine practitioner was a first contact practitioner but also accepted referrals from other primary care providers in an interface capacity [42].…”

Section: Pathway Featuresmentioning

confidence: 99%

“…Few studies provided comparative data, although the higher proportion of surgical candidates amongst patients referred for surgical consultation through SSP triage clinics than the conventional route, supported the use of interface clinics to triage appropriately to surgical clinics [28]. Data regarding investigation use did not provide useful comparisons due to cohort variability; for example, studies reported on investigation use in triage clinics [37,40,43], on MRI use in patients referred for surgical consultation [30], in interface service compared to consultant clinic [41], or in primary spine care model compared to usual care [42]. Two studies reported the effect of specific measures on pathway fidelity [33,39], for example, a 'bounce back' process from secondary care consultants to community interface for referrals not following the local spinal pathway [39].…”

Section: Outcome Domainsmentioning

confidence: 99%

“…Two studies reported the effect of specific measures on pathway fidelity [33,39], for example, a 'bounce back' process from secondary care consultants to community interface for referrals not following the local spinal pathway [39]. Six studies considered cost of care with variable methodology, including costs of telehealth triage compared to rural outreach clinic [38]; implementation costs of a shared care guideline [33]; patient cost savings from telehealthassisted triage [32]; MRI costs [41]; per-person primary care expenditure compared with usual care [42]. The SCOPiC RCT presented a comprehensive cost analysis, reporting that stratified care for sciatica was more costly than usual care [17].…”

Section: Outcome Domainsmentioning

confidence: 99%

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Clinical pathways for the management of low back pain from primary to specialised care: a systematic review

et al. 2022

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Purpose Clinical pathways for low back pain (LBP) have potential to improve clinical outcomes and health service efficiency. This systematic review aimed to synthesise the evidence for clinical pathways for LBP and/or radicular leg pain from primary to specialised care and to describe key pathway components. Methods Electronic database searches (CINAHL, MEDLINE, Cochrane Library, EMBASE) from 2006 onwards were conducted with further manual and citation searching. Two independent reviewers conducted eligibility assessment, data extraction and quality appraisal. A narrative synthesis of findings is presented. Results From 18,443 identified studies, 28 papers met inclusion criteria. Pathways were developed primarily to address over-burdened secondary care services in high-income countries and almost universally used interface services with a triage remit at the primary-secondary care boundary. Accordingly, evaluation of healthcare resource use and patient flow predominated, with interface services associated with enhanced service efficiency through decreased wait times and appropriate use of consultant appointments. Low quality study designs, heterogeneous outcomes and insufficient comparative data precluded definitive conclusions regarding clinical- and cost-effectiveness. Pathways demonstrated basic levels of care integration across the primary-secondary care boundary. Conclusions The limited volume of research evaluating clinical pathways for LBP/radicular leg pain and spanning primary and specialised care predominantly used interface services to ensure appropriate specialised care referrals with associated increased efficiency of care delivery. Pathways demonstrated basic levels of care integration across healthcare boundaries. Well-designed randomised controlled trials to explore the potential of clinical pathways to improve clinical outcomes, deliver cost-effective, guideline-concordant care and enhance care integration are required.

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Section: Overview Of Studiesmentioning

confidence: 99%

Section: Pathway Featuresmentioning

confidence: 99%

Section: Pathway Featuresmentioning

confidence: 99%

Section: Outcome Domainsmentioning

confidence: 99%

Section: Outcome Domainsmentioning

confidence: 99%

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Clinical pathways for the management of low back pain from primary to specialised care: a systematic review

et al. 2022

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The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline

Amorin-Woods

Evans

Whedon

et al. 2021

The Journal of Alternative and Complementary Medicine

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Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice.Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive services.Methods: Synthesizing the results of a literature search for relevant clinical practice guidelines and systematic reviews, a multidisciplinary steering committee with training and experience in health promotion, clinical prevention, and/or evidence-based chiropractic practice drafted a set of recommendations. A Delphi panel of

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Neck pain service utilization and costs: association with timing of non-pharmaceutical services for individuals initially contacting a primary care provider. A retrospective cohort study

Elton

Zhang

2023

Preprint

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Background: Neck pain (NP) is prevalent and costly. NP clinical practice guidelines are similar to those for low back pain (LBP), emphasizing non-pharmaceutical and non-interventional first-line approaches. Primary care providers (PCP) are frequently consulted by individuals with NP. Objective: Examine the association between guideline concordant incorporation of non-pharmaceutical therapies, use of imaging, pharmaceutical, and interventional services, and total episode cost for individuals with NP initially contacting a PCP. Design: Retrospective cohort study using identical methods to a previous LBP study Setting/Patients: National sample of individuals with non-surgical NP occurring in 2017-2019. Measurements: Independent variables were initial contact with a PCP, and the timing of incorporation of 5 types of non-pharmaceutical therapies. Dependent measures included use of 13 types of health care services and total episode cost. Results: 70,252 PCPs were initially contacted by 124,780 individuals with 137,274 episodes of non-surgical NP. 30.9% of PCPs and 22.1% of episodes included at least one of five non-pharmaceutical services at any time during an episode. Active care (13.7% of episodes), manual therapy (10.8%), and chiropractic manipulative therapy (9.4%) were the most common non-pharmaceutical services. 7.4% of episodes included a non-pharmaceutical service during the first 7 days with these episodes associated with a modest reduction (risk ratio 0.28 to 0.78) in the use of prescription pharmaceuticals. Younger individuals from ZIP codes with higher adjusted gross income were more likely to receive a non-pharmaceutical service in the first 7 days of an episode. When included during an episode, non-pharmaceutical services were associated with an increase in total episode cost with the smallest increase associated with chiropractic and osteopathic manipulation. Limitations: As a retrospective observational analysis of associations there are numerous potential confounders and limitations. Conclusions: Non-pharmaceutical services are infrequently provided to individuals with non-surgical NP initially contacting a PCP. For these individuals, non-pharmaceutical services, if provided, are most commonly introduced later in an episode after receiving pharmaceutical, imaging, and interventional services. For individuals with NP initially contacting a PCP there is an opportunity to increase the guideline concordant incorporation of non-pharmaceutical services early in an episode.

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Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study

Cited by 8 publications

References 16 publications

Clinical pathways for the management of low back pain from primary to specialised care: a systematic review

Clinical pathways for the management of low back pain from primary to specialised care: a systematic review

The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline

Neck pain service utilization and costs: association with timing of non-pharmaceutical services for individuals initially contacting a primary care provider. A retrospective cohort study

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