Scenes from a Forced Marriage: Update on the Chiro-Veteran's Administration Integrated Care Program

Transcription

1 Scenes from a Forced Marriage: Update on the Chiro-Veteran's Administration Integrated Care Program Contributed by John Weeks The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM Scenes from a Forced Marriage: Data Update on the Chiro-Veteran's Administration Integrated Care Program Summary: In 2004, the chiropractic profession and various Veterans' Service Organizations shouldered their way into the Veterans Health Administration through an act of Congress. Now, 4 years later, what do we know? How experienced are the VHA chiropractors? With what conditions are patients presenting? From which specialties are referrals originating? Via what models are the chiropractors employed and how much as they being paid? How well integrated are they with the other medical services? To what extent are they using these positions to educate others? Here is an at-a-glance chart of answers to these and other questions as reported by a team including Anthony Lisi, DC, Christine Goertz, DC, PhD and others. Lisi heads up the VHA's chiropractic program. Send your comments to johnweeks@theintegatorblog.com for inclusion in a future Integrator. The nation's largest, governmental integrative care initiative is the chiropractic program in the Veteran's Health Administration mandated by the US Congress in The project, now in over 40 sites did not, for the most part, have a consensual beginning. Chiropractic organizations, working with Veterans Service Organizations, pushed the measure through Congress. A prior interview in the Integrator with Anthony J. Lisi, DC, who directs the program for the VHA, speaks to the early challenges. (See Chiropractors in the Largest Health System: Anthony Lisi, DC on Integration in Veterans' Facilities, April 15, 2008.) Lisi notes that, while the program is "centrally mandated," it is "locally implemented" and "natural variation is expected in clinical structures." So: - How experienced are the VHA chiropractors? - What conditions are patients bringing to them? - From which specialties are referrals originating? - Via what models are the chiropractors employed? - What conditions are they seeing? - How much are they earning? - How well integrated are they with the other medical services?

2 - To what extent are they using these positions to educate others? In the Journal of Rehabilitation Research and Development, Lisi, Christine Goertz, DC, PhD, Dana Lawrence, DC, MMedEd and Preeti Satyanarayana, MD recently published Characteristics of Veterans Health Administration chiropractors and chiropractic clinics. Here is the data snapshot of what they found. The full PDF is available here. Characteristics of the VA Chiropractic Integrative Program: At a Glance Total surveyed 36 Responses 33 General characteristics VA facilities with DCs in

3 VA facilities with DCs in Veterans served in FY ,000 Veterans served in FY ,000 Referral origination Primary care 67.6% Pain management 9.4% Physiatry

4 6.2% Orthopedic surgery 3.7% Neurology 3.6% Integration markers Often/always multidisciplinary rounds 33% Seldom/never multidisciplinary rounds 48% Often/always hospital committee work 21% Seldom/never hospital committee work

5 64% Often/always in-service presentations 27% Seldom/never in-service presentations 45% Often/always hospital committee work 21% Seldom/never hospital committee work 64% Patient characteristics Age of typical chiro patient years old Ages of VA patients >60% over 60 years

6 Sex of typical chiro patient >50% female Sex of VA patients 7% female Chief conditions seen Low-back complaint 47.7% Neck complaint 21.4% Thoracic complaint 9.8% Lower-limb complaint 7.4%

7 Headache 6.4% Upper-limb complaint 6.2% Wellness 0.8% Visceral complaint 0.3% Non-manipulative modalities used Often/always patient education 88% Often/always exercise 76%

8 Often/always physical modalities 36% Often/always acupressure 30% Often/always massage 27% Often/always orthoses 15% Often/always acupuncture 6% Often/always nutritional supplements 0% Often/always homeopathy 0%

9 Employment characteristics VHA employees 67% (22) Contracted providers 12% (4) Non-compensated academic affiliate appointees 12% (4) On-station fee-based consultants 9% (3) Worked 40-hr week 58% Worked part-time (ave hr/wk)

10 33% Based at medical centers 88% Based at outpatient clinics 6% Both centers and outpatient 6% Were the only chiropractor 67% 1 or 2 others DCs at hte facility 30% Gross compensation $100, ,000 6%

11 $80,001-$100,000 36% $60,001-$80,000 21% Up to $60,000 27% Prior practice experience of the DCs 16 or more years 48% 6 to 15 years 36% <=5 years 12% Post grad. hospital-based training

12 18% Had 0-6 consultations with MDs/mo. prior to the VA 67% No previous authorship of scientific papers 67% Involvement in teaching Often/always train chiropractic students 39% Seldom/never train chiropractic students 58% Often/always train other trainees 9%

13 Seldom/never train other trainees 78% Source: Characteristics of Veterans Health Administration chiropractors and chiropractic clinics. Comment: These data begin to create a multidimensional portrait of the VHA-chiropractic service. This is a generally very experienced bunch of practitioners, but with little prior routine co-management of care with other practitioners or in hospital or health system environments. Given the continuous campaign from the American Chiropractic Association and supporters like US Senator Patty Murray (D-WA) to broaden the service, hopefully the teaching component of these practitioners' responsibilities will expand. Here's hoping there will be additional qualitative analysis of patient experience and of practitioner experience of the service, and that analysis of practitioner experience extends to both chiropractors and the healthcare staff on whose turf the chiropractors are the newcomers. (An abstract of an initial case series is here.) Send your comments to johnweeks@theintegatorblog.com for inclusion in a future Integrator.