Collaborative care and an opportunity for community chiropractic teamwork during the COVID-19 crisis
The covid-19 pandemic has raised meaningful discussion and debate about what it means to be classified as essential providers in the health care system. Throughout the United States, in all states except one, DCs are considered community chiropractic integral team members whose continued functioning is critical to treating acute pain and other conditions during this challenging period. The only state restricting chiropractors to non-essential status has been, inexplicably, Kentucky.
‘They want to see their chiropractor’
An executive order by Kentucky Governor Andy Beshear shuttered chiropractic practices across the state, despite the considerable opposition voiced by the chiropractic profession, patients and legislators.
Representative Kevin Bracher of Louisville said, “I’ve got policemen, I’ve got firefighters and I’ve got nurses that are on the floor 14, 15 hours a day and they want to see their chiropractor.”¹
The classification (or declassification) of chiropractic as an essential health care service has significant ramifications not only for chiropractors, but for the hospital system, the patients they both serve and community chiropractic working together.
What is essential?
“Essential services” include those that are deemed vital to the health and welfare of the population and therefore are essential to maintain even in a disaster like the novel coronavirus pandemic. It is easy to understand why medical doctors, nurses and other health care providers on the front line of combating the effects of the virus in emergency rooms and hospitals must be considered as essential in status.
The news outlets and the media regularly remind one of the horrible tolls COVID-19 has taken, and the sacrifices these brave individuals make for the health and safety of the community.
While COVID-19 has everyone’s attention, it cannot be forgotten that health care and non-opioid pain management provided by chiropractors is essential and should not be curtailed or restricted during the pandemic. Chiropractors provide necessary care following evidenced-based protocols and they maintain the highest level of hygienic protection in order to care for community chiropractic patients as well as prevent the spread of the coronavirus. They work together in collaboration with conventional health care providers and are attuned to the red flags that alert them when there is the need to refer to health care providers outside of their scope of practice.
Community chiropractic: decreasing the burden on hospitals
The health care system is under a level of stress it has never had to endure. The sheer volume of patients, coupled with a shortage of equipment and treatment options, is taxing the system to its maximum. Doctors of chiropractic serve a vital role in the health care system by relieving the volume of patients seen in emergency rooms and hospitals by providing conservative care for patients with neuromusculoskeletal conditions who otherwise would seek care in the ER.
According to a recent study published on JAMA Network Open, patients with newly diagnosed low-back pain (LBP) with or without lower-extremity pain (LEP) represent one of the most common reasons for seeking medical care. LBP or LEP are associated with a significant economic burden in the United States. Patients who obtain early imaging or receive surgery for LBP and LEP without exhausting conservative therapies account for a disproportionate amount of total costs associated with this common condition.2
The BMC Musculoskeletal Disorders Journal published a systematic review of the literature that indicates that low-back pain is consistently a top presenting complaint in the emergency room setting.3
A July 2019 publication by UnitedHealth Group reported that $18 million in avoidable hospital emergency department visits, including for low-back pain, add $32 billion in costs to the health care system each year.4
These financial burdens are reduced significantly when patients are free to receive care in chiropractic facilities.
Will health care change post-COVID-19?
COVID-19 has altered how we think about health and medicine — but will these changes outlast the pandemic? Today’s health care system is in the midst of an undeniable crisis. The call to reform health care is at the forefront of political and economic discussions worldwide. The public is calling for more affordable health care. Viral outbreaks like the novel coronavirus have been increasing in frequency and will continue to present risks and challenges in the future. The best way to respond and mitigate the effects of a viral epidemic is to develop comprehensive preparedness plans in advance of the next outbreak.
Health care providers who learn to work together in collaboration will be better able to respond to the full range of health care needs future crises will demand. The development of an integrated health care system that is supported by rigorous scientific evidence is the direction that many models of health care are moving toward.
A December 2019 study published in The Journal of Alternative and Complementary Medicine has shown that more than half of office-based physicians in the U.S., across specialty areas, recommended at least one complementary health approach to their patients in the previous 12 months.5
In addition, a National Health Interview Survey reports that among U.S. adults who used chiropractic or osteopathic manipulation, approximately 67% used it to treat a specific health condition, and 53% used it for wellness.6
Time for change
This is the perfect time for the chiropractic research agenda to shift its collective focus toward examining improved quality-of-life measures in addition to pain relief that patients experience. Expanded research will help expand medical colleagues’ knowledge of the benefits reported by patients receiving community chiropractic care. This is also the right time for legislators, the conventional health care delivery system, and the public to acknowledge the essential role that chiropractic and other complementary health care disciplines provide.
Mark Sanna, DC, ACRB Level II, FICC, is a member of the Chiropractic Summit and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching and can be reached at mybreakthrough.com or 800-723-8423.
- Lily H. Kim, BA; Daniel Vail, BA; Tej D. Azad, MS; Jason P. Bentley, PhD; Yi Zhang, AB; Allen L. Ho, MD; Paras Fatemi, MD; Austin Feng, BA; Kunal Varshneya, BA; Manisha Desai, PhD; Anand Veeravagu, MD; John K. Ratliff, MD: Expenditures and Health Care Utilization Among Adults With Newly Diagnosed Low Back and Lower Extremity Pain. JAMA Network Open. 2019;2(5):e193676.doi:10.1001/jamanetworkopen.2019.3676
- Jordan Edwards, Jill Hayden, Mark Asbridge, Bruce Gregoire, and Kirk Magee; Prevalence of Low Back Pain in Emergency Settings: A Systematic Review and Meta-Analysis. BMC Musculoskelet Disord. 2017; 18: 143. Published online 2017 Apr 4. doi: 10.1186/s12891-017-1511-7
- Barbara J. Stussman, Richard R. Nahin, Patricia M. Barnes, and Brian W. Ward: U.S. Physician Recommendations to Their Patients About the Use of Complementary Health Approaches. The Journal of Alternative and Complementary Medicine 26, No. 1.Published Online:20 Jan 2020https://doi.org/10.1089/acm.2019.0303
- Adams J, Peng W, Cramer H, Sundberg T, Moore C, Amorin-Woods L, Sibbritt D, Lauche R. The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey. Spine (Phila Pa 1976).2017 Dec 1;42(23):1810-1816. doi: 10.1097/BRS.0000000000002218.