The primary spine practitioner as a new role in healthcare systems in North America

Abstract

Background In an article published in 2011, we discussed the need for a new role in health care systems, referred to as the Primary Spine Practitioner (PSP). The PSP model was proposed to help bring order to the chaotic nature of spine care. Over the past decade, several efforts have applied the concepts presented in that article. The purpose of the present article is to discuss the ongoing need for the PSP role in health care systems, present persistent barriers, report several examples of the model in action, and propose future strategies. Main body The management of spine related disorders, defined here as various disorders related to the spine that produce axial pain, radiculopathy and other related symptoms, has received significant international attention due to the high costs and relatively poor outcomes in spine care. The PSP model seeks to bring increased efficiency, effectiveness and value. The barriers to the implementation of this model have been significant, and responses to these barriers are discussed. Several examples of PSP integration are presented, including clinic systems in primary care and hospital environments, underserved areas around the world and a program designed to reduce surgical waiting lists. Future strategies are proposed for overcoming the continuing barriers to PSP implementation in health care systems more broadly. Conclusion Significant progress has been made toward integrating the PSP role into health care systems over the past 10 years. However, much work remains. This requires substantial effort on the part of those involved in the development and implementation of the PSP model, in addition to support from various stakeholders who will benefit from the proposed improvements in spine care.

Chiropractors in interprofessional practice settings: a narrative review exploring context, outcomes, barriers and facilitators

“…Our findings are in tune with recent research conducted in a fee-for-service context and focusing on the introduction of chiropractors as primary spine care practitioners [ 3 ],). It would appear that, notwithstanding the offering being an efficient primary care service, poor reimbursement of the chiropractic clinician and high patient copayment, represent a significant structural barrier to service utilization [ 15 , 16 ].…”

Online access to spine care: do institutions advertise themselves as multidisciplinary?

“…The article highlighted the complexity of spine care involving physical, mental, social, and economic components, and variety of health care professionals and backgrounds involved in the care of these patients. Physicians and advanced practice providers from emergency medicine, primary care, neurosurgery, orthopedic surgery, physical medicine and rehabilitation, neurology, and other providers like physical therapists, chiropractors, acupuncturists could all be involved in the care of these patients ( 25 , 26 ). Among the problems existing in spine care are that non-surgical patients are commonly referred to surgeons.…”

A new role for spinal manual therapy and for chiropractic? Part II: strengths and opportunities

“…This suggests a need for someone (a healthcare professional) rather than something (a treatment) to play a pivotal role for long-term management. That someone should assume a central and directing role in a collaborative interdisciplinary setup [ 44 ]. We consider chiropractors well suited for such a role, at least in some countries and settings, and adapting chiropractic practice to the reality of MSK disorders, as it has been uncovered by growing scientific evidence, constitutes a window of opportunity for the profession.…”