82017
Assessing the Predictors and Pattern of Health Care Service Utilization in Patients with Musculoskeletal Pain Presenting to a Family Health Team.
Mior, Silvano

This initiative builds on previous studies funded from grants received from the Ministry of Health and Long-Term Care and the Primary Health Care Transition Fund.(1-3) The results provided preliminary qualitative and quantitative evidence of positive clinical outcomes. These included high provider and patient satisfaction associated with collaborative practice between physicians and chiropractors. As well, communication strategies to enhance such practice were developed and tested.

More recently, one Family Health Team (FHT) was selected to advance the interprofessional collaboration established in an earlier study. In order to facilitate sustained change, a second strategy was introduced that pushed the FHT to evolve beyond physicianchiropractor collaboration. This has led to the involvement of physicians, chiropractors, mental health workers, nurses, nurse practitioners, a pharmacist, and clerical staff to develop strategies for delivering musculoskeletal care to patients with chronic pain who are also under the care of mental health workers. Feedback from physician interviews conducted in our previous study suggested that such patients are difficult to manage, may eventually make use of addictivetype medication, and require multiple visits. Preliminary anecdotal evidence suggests that the inclusion of rehabilitative services improves patient outcomes related to activities of daily living and pain and may influence medication use. Preliminary evidence also suggested different referral patterns amongst physicians that may be affected by the composition of their roster.

Several process and outcome challenges were identified in the last study including: 

1. difficulty extracting reliable data from the electronic health record;
2. unsuccessful intervention to improve physician identification of mental health patients with pain;
3. inability to collect accurate medication and economic data; and 4) failure to sustain formal change management activities.

In this proposal we will address the challenges identified above by conducting a cohort study to assess clinical outcomes associated with providing interdisciplinary care to patients with musculoskeletal pain in a FHT. We have three main objectives:

1. to determine the extent to which socioeconomic status, health status, pain, and psychological co-morbidity are associated with utilization of healthcare services, particularly physician referral to chiropractic services;
2. to determine flow and evaluate the patterns of service use in a multidisciplinary environment using systems dynamics methodology and how these could be optimized for future resource allocation; and
3. to estimate costs associated with including chiropractic services in a FHT.

It is anticipated that the study results will contribute to a further understanding of FHTs by:

1. understanding the characteristics of patients referred by physicians to chiropractors in a co-located multidisciplinary team, and how these characteristics influence utilization;
2. contributing to an understanding of how health human resources can be allocated based on specific population needs, thus contributing to policy directives; and
3. assessing the flow of patients to determine efficient team-based management of primary care patients presenting with MSC.

82018
Referral Pattern Drivers in an Integrated Intraprofessional Practice: Chief Complaint vs Sytematic H&P.
Kopansky-Giles, Deborah

Despite a decade of increasing emphasis on intraprofessional care, little is known about the drivers for the path that patients follow from first contact with a care professional. Does it vary based on mode of entry into the system; severity of complaint; familiarity of guidelines or attention to case complexity? Preliminary data by Triano and Rashbaum (ACC-RAC 2005) for a moderately integrated spine care specialty practice has been reported. Differences between patient paths were evaluated by training discipline of the supervision specialty provider (DC, Physiatrist, Surgeon). While severity of complaints were different only for physiatrists who had statistically fewer patients with severe ( VAS > 6) complaints, surgeons and DCs were similar in severity. The primary referral pattern was transfer of patients away from the surgeon, primarily to physiatry. Use of physical therapy services was similar across disciplines. Referral for diagnostic imaging and injection procedures was significantly smaller for the DC group (p < 0.01) than for other provider groups.

Recent work by Hegemeister(1) has evaluated the impact of various methods to inform providers about guideline conclusions. All forms of information provided to providers failed to alter their underlying practices and referrals.

This proposed project is a feasibility study using clinical data already collected for non-research purposes. Access has been granted by one of the investigators on this project (AP) to a one year database of entry clinical information on a population of approximately 6000 patient encounters. The purpose of this project is to evaluate whether sufficient data exists to form hypotheses on patient referral and whether a prospective observational study can be mounted. 

Reference:
1. Inefficacy of different strategies to improve guideline awareness – 5-year follow-up of the hypertension evaluation project (HEP)
Jens Hagemeister*1, Christian A Schneider1, Holger Diedrichs1,
Diana Mebus1, Holger Pfaff2, Gernot Wassmer3 and Hans W Höpp1

82023
Expert knowledge in chiropractic: A review of conference-based abstracts.
McGregor, Marion

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