FEATURE STORY
Public/Private Mashup: The Global Trend
IN NORWAY:
14 weeks
of chiropractic
treatment is funded.
The progression of chiropractic into
mainstream health care systems around
the world is continuing. The recent
policy changes in Ontario are yet another
example of how chiropractors are
demonstrating the greater role they can
play in individuals’ health care teams as
their conservative care MSK specialists.
As in the evolution of any
profession, there is bound to
be some uncertainty and some
growing pains. In Ontario,
challenges associated with
the details and impacts of
chiropractors joining primary
care teams, such as Family
Health Teams and Nurse
Practitioner-Led Clinics, will need
to be managed collectively by
the profession. When it comes
to patient satisfaction and
outcomes and the net impact
on the reputation and credibility
of the profession, though, the
international data does show that
chiropractic is quite well served
by partnerships in the delivery of
primary health care.
26
WINTER 2014
United Kingdom: In 2012, the United Kingdom’s National Health
The VA now provides
STUDY:
Service (NHS) began the implementation of the Any Qualified Provider
(AQP) program. Designed to provide increased choice to patients, AQP
allows individuals to choose from a list of pre-qualified practitioners
reduction in
when referred for secondary care for specific conditions by their family
orthopaedic
physician. “Muskulo-skeletal services for back and neck pain” are
included in the list of services to be provided in the AQP model.
referrals.
Dr. Mark Gurden, a chiropractor working in Colchester, Essex,
completed the process of becoming a registered AQP provider. The process
ensures that practitioners meet several requirements of the AQP program, including being
licenced by Monitor, the health sector regulator in England, complying with the terms and
conditions of the NHS Standard Contract and reaching agreements with the local commissioners
on supporting schedules to the Standard Contract. When a practitioner applies to join the AQP an
extensive review is conducted, including ensuring that appropriate integrated care pathways have
been described and that the details of clinical governance leads, processes and reporting
have been worked out.
Switzerland has
Dr. Gurden joined a group of several manual therapists to create the North East
Essex Primary Care Trust (PCT) in his application to join the AQP, which included
extended chiropractic
chiropractors, osteopaths and physiotherapists. The PCT was committed from the
coverage to include
outset to measuring the impact of their work. During a one-year pilot phase, PCT
Military and Disability evaluated their services based on several criteria including patient health outcomes
and experiences. Following an average of six treatments over eight weeks, 64.9% of
Insurance.
patients significantly improved and 99.5% reported being very satisfied or satisfied with
the treatment they received.
Dr. Richard Brown, Secretary-General of the European Chiropractors’ Union, is encouraged
both by the incorporation of chiropractors into the AQP program and the results of the PCT pilot.
Dr. Brown is especially pleased
that, consistent with other pilot
projects, the PCT work resulted
Conclusion: Each of these examples of
in a 28% reduction in referrals
chiropractic participation in the primary care
to orthopaedic outpatient
of MSK conditions is a step forward for the
departments. Not only does this
profession. That this trend has taken hold in
enhance the patient experience,
it also represents significant cost
Ontario is significant. Ontario’s chiropractors, and
savings to the NHS.
their patients, are sure to benefit. As Dr. Richard
28%
chiropractic care to
veterans of the American
military “on-station”.
Switzerland: Chiropractic
United States: The United States Department of Veterans Affairs
(VA) now provides chiropractic care to veterans of the American
military “on-station”. That means that at over 20 VA medical centres
across the United States, chiropractors are members of the health
care team. Patients who do not live near a VA medical centre are
referred to chiropractors in private practice at one of over 100
medical centres. Costs incurred b H ]Y[