Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.
Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas.
Gerontologist. 2018 Mar 19;58(2):376-387. doi: 10.1093/geront/gnw188.
Older adults seek health care for low back pain from multiple providers who may not coordinate their treatments. This study evaluated the perceived feasibility of a patient-centered practice model for back pain, including facilitators for interprofessional collaboration between family medicine physicians and doctors of chiropractic.
This qualitative evaluation was a component of a randomized controlled trial of 3 interdisciplinary models for back pain management: usual medical care; concurrent medical and chiropractic care; and collaborative medical and chiropractic care with interprofessional education, clinical record exchange, and team-based case management. Data collection included clinician interviews, chart abstractions, and fieldnotes analyzed with qualitative content analysis. An organizational-level framework for dissemination of health care interventions identified norms/attitudes, organizational structures and processes, resources, networks-linkages, and change agents that supported model implementation.
Clinicians interviewed included 13 family medicine residents and 6 chiropractors. Clinicians were receptive to interprofessional education, noting the experience introduced them to new colleagues and the treatment approaches of the cooperating profession. Clinicians exchanged high volumes of clinical records, but found the logistics cumbersome. Team-based case management enhanced information flow, social support, and interaction between individual patients and the collaborating providers. Older patients were viewed positively as change agents for interprofessional collaboration between these provider groups.
Family medicine residents and doctors of chiropractic viewed collaborative care as a useful practice model for older adults with back pain. Health care organizations adopting medical and chiropractic collaboration can tailor this general model to their specific setting to support implementation.
老年人因腰痛会向多位医疗服务提供者寻求治疗，而这些提供者可能并未对他们的治疗方案进行协调。本研究评估了一种以患者为中心的腰痛治疗模式（包括促进家庭医生和脊椎按摩医生之间开展跨专业合作的因素）的可接受性。
本定性评估是腰痛管理的 3 种跨学科模式（常规医疗照护、同时接受医疗和脊椎按摩照护、以及开展跨专业教育、临床记录交换和以团队为基础的病例管理的协作式医疗和脊椎按摩照护的一项随机对照试验的组成部分。数据收集包括临床医生访谈、图表摘要和现场记录，采用定性内容分析方法进行分析。一个针对医疗保健干预措施传播的组织层面框架确定了支持模式实施的规范/态度、组织结构和流程、资源、网络联系以及变革推动者。
接受访谈的临床医生包括 13 名家庭医学住院医师和 6 名脊椎按摩师。临床医生对跨专业教育持欢迎态度，他们表示该体验使他们结识了新同事，并了解了合作专业的治疗方法。临床医生交换了大量的临床记录，但发现后勤工作繁琐。以团队为基础的病例管理增强了信息流动、社会支持以及患者个体与合作提供者之间的互动。老年患者被视为这些提供者群体之间开展跨专业合作的积极变革推动者。
家庭医学住院医师和脊椎按摩师认为协作式护理是一种针对腰痛老年患者的有用的实践模式。采用医疗和脊椎按摩合作的医疗保健组织可以根据其特定情况对这种通用模式进行调整，以支持实施。
