To provide quality care to patients, health care practitioners must take a “the whole is greater than sum of the parts” style of approach.1 Professionals must share Information for the benefit of the patient because their care is the common goal despite the individual goals for growth of each healthcare profession.1 If professionals recognize the merits of different types of care and work together in an integrative manner to manage patients it will result in better utilization of available resources and better patient outcomes.1,2 Chiropractors may fear integration will cause a loss of autonomy for chiropractic’s unique approach to healthcare.1 For chiropractic to be truly integrated into the healthcare system there are 3 levels of integration we must achieve: patient level, practitioner/clinical level, public/private payor/ policy level.1
The US National Center for Complementary and Alternative Medicine has defined complementary and alternative medicine (CAM) as ”health care practices outside the realm of conventional medicine, which are yet to be validated using scientific methods.”.1 Inclusion of chiropractic in this designation, by definition, disregards the ever growing body of literature showing benefits of chiropractic care.1 This is a reason for interprofessional education on the merits and diverse applications of chiropractic.1 Communication between practitioners is important for clinical/practitioner level integration as a practitioners will only refer patients to a chiropractor if they have confidence in chiropractic.1,2
Critics are vocal about the slow pace of progress of research on spinal manipulation, safety, efficacy, effectiveness.1 This combined with the CAM classification and definition mean chiropractors are rarely included on healthcare policy decisions.1 It is important that chiropractors fight for inclusion in these conversations because we are affected by healthcare policy decisions.1 Disseminated knowledge of the scopes of practice, validity of each of the health care professions and input from all stake holders would greatly enhance the ability of policy makers to create fair and inclusive policies.1This is also why research is as important as ever so we chiropractors can prove they disserve a seat at the table and fight for this policy level integration.1
Patients disserve to know about what each profession can realistically offer them so they can be granted true autonomy of decisions on how to manage their conditions.1,2 Withholding information on an effective treatment offered by another practitioner in my opinion goes against the values of patient autonomy of decision and beneficence. The decision made by the patient regarding what forms of care they need is patient level integration.1 With patient education and proper communication between patients and practitioners we can achieve integrative care that truly meets the patients’ needs.1
Public health can be defined as health-related activities in its core sciences, health services administration, environmental health sciences, and behavioral health sciences used to administer health care in the public’s best interest.1 With chiropractic gaining ever more scientific evidentiary support and public acceptance it has an important opportunity for a substantial role in public health. Currently opioid and painkiller addiction is one of the most pressing public health issues in North America.3 This presents an opportunity to chiropractic because of its strength as a non-pharmaceutical pain management option.3 The study done by Wilkey et al.3 illustrates how chiropractic can be used effectively as a non-pharmaceutical alternative for patients with chronic pain.
For healthcare to progress in a truly integrative manner, healthcare professionals need to focus on our common interest in optimal patient care. For all the reasons stated above and many others, there is a place for chiropractic in the future of integrative healthcare.
- Principles and practice of chiropractic (Reserve) / editor in chief, Scott Haldeman ; associate editor, Simon Dagenais ; section editors, Brain Budgell … [et al.] [monograph on the Internet]. [place unknown]: New York : McGrawHill, 2005; n.d. [cited December 4, 2016]. Available from: CMCC Library Catalogue (OPAC
- Health Canada. Health Canada [Internet]. [place unknown]: Health Canada. ARCHIVED – Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP); 2007 May 8 [Cited 2016 Dec 4]. Available from: http://www.hc-sc.gc.ca/hcs-sss/pubs/hhrhs/2006-iecps-fipccp-workatel/index-eng.php
- Wilkey A, Gregory M, Byfield D, McCarthy P. A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. Journal Of Alternative & Complementary Medicine [serial on the Internet]. (2008, June), [cited December 4, 2016]; 14(5): 465-473. Available from: CINAHL Plus with Full Text.