Transcript Concepts in Nutrition - The West Hartford Group

Chiropractic Physicians
Filling the Role of
Non-surgical Spine Specialists
A West Hartford Group Presentation
Agenda
 LBP Management and the Need for a
Nonsurgical Spine Specialist
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Current Strategies in LBP management
Evidenced-based interventions
Fiscal Impact
Access
 DC’s as the Nonsurgical Spine Specialist
 Integration
 WHG MVV
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Common LBP Management
Strategies
 Medications, bed rest, recommended
inactivity
 Possible directed exercise programs (PT)
 Imaging/ advanced imaging
 Facet/ Epidural injections
 Surgical intervention – discectomy, fusion,
rhizotomy, etc.
© 2009 West Hartford Group
LBP Interventions Lacking
Evidence
 Bed rest and inactivity
 Most prescription meds for LBP
 Epidural and other spinal injections
 Surgery for many acute LBP/sciatica
conditions.
 Rhizotomy
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LBP Interventions with Good
Supporting Evidence
 Manipulation
 Exercise
 Biopsychosocial approach to activating
patients and reducing fear of movement.
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Implications of Current NonEvidence Based Recommendations
 Catastrophizes LBP and induces passive
coping strategies in the patient
 Leads to increased chronicity due to
inappropriate application of therapies and the
patient’s psychological outlook on their ability/
disability
 Creates a high cost-burden on the healthcare
system overall
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Fiscal Impact of LBP
 Back pain management in the USA is
extremely costly primarily due to the lack of
application of the best available evidence to
clinical practice.
 The most expensive aspects of LBP care are
prescription drugs and
advanced diagnostic imaging/testing.
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Fiscal Impact of LBP
 By applying evidence-based back pain
management protocols, patients will have
greatly improved outcomes at a lower overall
cost individually and to the healthcare system
as a whole.
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Access to Appropriate Care
 There has been a trend of an overall decline
of doctors going into general practice
medicine.
 With LBP being the one of the highest
presenting complaints into a GP’s office,
there will be a growing need for access to
appropriate care.
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DC’s – Fulfilling a need
 Evidence-based DCs as non-surgical spine
specialists can fulfill this need in the
healthcare system of the 21st century.
 By applying the evidence, DC’s can serve as
portal of entry physicians to improve patient
outcomes and reducing current cost burden
of spine care.
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Integration
 Integration of DC’s in the general healthcare
community is key to the success of this
model.
 Current examples:
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Hospital-based back pain programs
Integrated private group practices (MD, DO,
DC)
ER-based DC care
Integrated referral systems for private
practices
© 2009 West Hartford Group
West Hartford Group, Inc
Mission, Objectives, Values
West Hartford Group, Inc Mission
 WHG, Inc. is a think tank dedicated to the
acquisition of social, cultural and professional
authority for the chiropractic
profession, where the Doctor of
Chiropractic serves within the mainstream
health delivery system as a patient-centered,
evidence based musculoskeletal specialist.
© 2009 West Hartford Group
West Hartford Group, Inc –
Objectives (Vision)
 To provide the profession with a viable model of
integrative practice.
 To foster inclusion of WHG members in the fabric
of the profession to promote WHG’s mission.
 To create a public and professional image of
chiropractic as a profession dedicated to
scholarship, research and the patient-centered,
evidence-based practice paradigm.
 To advance chiropractic education
(undergraduate & graduate) and scholarship
consistent with WHG’s mission.
© 2009 West Hartford Group
West Hartford Group, Inc - Values
 Chiropractors are healthcare providers who
provide non-surgical clinical management of
musculoskeletal (MS) conditions, with an
emphasis on the spine.
 Chiropractic clinical management includes
diagnosis and treatment, with an emphasis
on prevention, rehabilitation, wellness and
holism.
 Objective measurable treatment effectiveness
must be demonstrated.
© 2009 West Hartford Group
West Hartford Group, Inc - Values
 A Bio-psycho-social (BPS) approach is essential
for the management of pain and dysfunction.
 Treatment must focus on active care that
empowers the patient toward management of
his/her own healthcare.
 Treatment goals must be functional, and focused
on return to normal activities of daily living (ADL)
and improved quality of life.
 Treatment must be based upon the best
evidence available.
© 2009 West Hartford Group
Questions and Discussion
© 2009 West Hartford Group