Lower Back Pain
Conditions
Keywords
Chiropractic care, Primary care provider, Chiropractor referrals, Chronic pain, Non-pharmacologic treatment, Community health centers
Brief summary
The goal of this study is to evaluate the feasibility of new implementation strategies designed to increase the number of Primary Care Providers (PCPs) referrals to chiropractic care for lower back pain (LBP) in underserved populations. The investigators plan to pilot the strategies in three qualified community health centers (CHCs) and compare the number of LBP patients who receive referrals before and after implementation. The implementation strategies involve PCP, patient, and organizational interventions. Patients presenting with LBP will be provided educational materials that focus on the safety and effectiveness of chiropractic care as an evidence-based treatment for LBP. Materials will be available in CHC common areas and may be sent to patients by their PCP via patient portal. PCPs will participate in interactive lunch seminars to allow for inter-professional learning for PCPs. They will also participate in a survey regarding their attitudes and beliefs relating to chiropractic care. Currently, many PCPs cannot make chiropractic care referrals in the electronic health record (EHR). The investigators plan to add this option, or make it easier if the referral is already available. This multi-level, multi-component approach will last two months, and will be rolled out sequentially in three clinics using a stepped-wedge design. The ordering of clinics will be random. The primary outcome is the proportion of patients with LBP who received a referral to chiropractic care before and after the intervention. Secondary outcomes include referral to any non-pharmacologic treatment, use of imaging, and prescribed medications.
Interventions
OTHERInstitutional interventions
Intervention will include, but not be limited to, the following: adding a referral option to chiropractic care in the electronic health record (EHR), optimizing referral option, e.g., creating a list of preferred providers. Additional strategies may be added depending on community health center staff engagement prior to implementation.
OTHERPCPs interventions
Two one-hour interactive grand rounds/lunch seminars that allow for inter-professional learning for PCPs with optional continuing education credits for PCPs. Short teaching cases involving clinical vignettes developed with local doctors of chiropractic (DCs), information about DCs (e.g., evidence-base for treatments), and logistics of the referral process (e.g., geographic location of community-based DCs who accept Medicaid) sent to participating providers unable to attend the seminars. Additional strategies may be added depending on primary care provider engagement prior to implementation.
Printed and electronic educational materials (e.g., brochures) written at a sixth grade reading level in English and Spanish that present chiropractic as a safe and effective evidence-based treatment for LBP. These materials will be written, reviewed, and revised by the researchers with CHC patient input. Additional strategies may be added depending on patient engagement prior to implementation.
Sponsors
Boston Medical Center
National Center for Complementary and Integrative Health (NCCIH)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
This is a stepped-wedge design. 3 CHCs will be randomized to receive the intervention either first, second, or third two months apart.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
for CHCs: * Be a CHC in the Boston area with primary care * Agree to participate in study Inclusion criteria for PCPs: * Work at a participating CHC * Be an MD, doctor of osteopathy (DO), nurse practitioner (NP), or physician assistant (PA) Inclusion criteria for patients with LBP: * Has PCP at participating CHC * Has LBP diagnosis * Is 18 years of age or older
Exclusion criteria
for CHCs: * There are no
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in PCP Chiropractor Referrals for LBP | During the fourteen month study period | This outcome will be assessed by calculating the proportion of LBP patients receiving a chiropractic referral for the two timeframe periods will be calculated. The numerator will be those with a chiropractic referral, defined as those LBP patients who received a PCP referral in the EHR or documentation in the EHR of a visit with a chiropractor. The denominator will be the total number of unique LBP patients seen by a PCP with an LBP diagnosis in the EHR. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of patient participants referred to physical therapy | 14 months | Information for this outcome will be abstracted from the participants' medical records |
| Percentage of patient participants referred to acupuncture | 14 months | Information for this outcome will be abstracted from the participants' medical records |
| Percentage of patient participants prescribed opioids | 14 months | Information for this outcome will be abstracted from the participants' medical records |
| Percentage of patient participants referred to magnetic resonance imaging (MRI) | 14 months | Information for this outcome will be abstracted from the participants' medical records |
| Percentage of patient participants that receive epidural injections | 14 months | Information for this outcome will be abstracted from the participants' medical records |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATOREric J Roseen, DC
Boston Medical Center
Outcome results
None listed