Changes in primary care physician’s management of low back pain in a model of interprofessional collaborative care: an uncontrolled before-after study

Data from the electronic medical record of one primary care physician who participated in a study of a model of chiropractic-medical collaboration were retrospectively collected. Records of a sample of consecutive patients prior to the start (i.e. pre-study, n = 51) and at the end of the collaborative study (i.e. study, n = 49) were collected.Demographics were similar in both groups but median number of physician visits (2.5 and 1.0), average prescriptions per patients (1.24 and 0.47), and total number of narcotic prescriptions (14 and 6) differed between pre-study and study groups, respectively. Separate analysis of only the records of low back pain study patients revealed that 61% were referred for chiropractic care during the study period. Patients who were not referred had more neurological deficits and leg pain but back pain severity and average number of prescriptions was about the same. Referred patients in the study group had about 25% fewer physician visits and imaging requests.Based on this study of a single primary care physician, we hypothesize that doctors may change their prescribing behaviours and consultation rate for patients with low back pain when engaged in interprofessional collaborative care. Further research is required to test this observation in the population.Chronic musculoskeletal conditions are a significant cause of disability and health care utilization [1,2]. C？té et al. reported that 31% of people with low back or neck pain seek care from both physicians and chiropractors [3]. The nature of this care varies greatly across health care specialities. For example, patients with chronic musculoskeletal conditions who consult a physician and chiropractor take more medication than those who only consult a chiropractor [4]. But it is unknown if there was any level of interprofessional collaboration in the management of patients attending both health care providers. However, evidence suggests that communication between chiropractors and physi