Multidisciplinary integration has greatly evolved since its realization at the beginning of the twentieth century. With a goal of providing collaborative patient care from clinicians and physicians from all types of healthcare backgrounds, the multidisciplinary approach is widely advantageous. As a chiropractor working in a multidisciplinary setting, I can attest to the benefits experienced by my patients, the healthcare system, and my fellow clinicians.
After completing my fellowship at Logan University in 2017, I began working at a community health center as an attending clinician before assuming a leadership role. In this position, I oversee community health and hospital-based partnerships with multidisciplinary organizations. I also provide clinical care and resident and student training within various community health center sites.
In 2019, I was appointed to the Clinical Working Group (CWG) for the Academic Collaborative for Integrative Health (ACIH), an organization that supports education, clinical care, research, and policy that transforms the healthcare system to emphasize the importance of health and well-being. The CWG is committed to promoting integrated and collaborative patient care by identifying and advancing projects in clinical education that foster interdisciplinary understanding and respect among professions to enhance the knowledge, skills, attitudes, and behaviors of individuals involved in integrated clinical settings.
Historically, many people could not access chiropractic care, largely because of financial barriers, including lack of public-payer coverage. This is especially true for marginalized populations. Thankfully, this is changing, and I am hopeful it will accelerate chiropractic integration, including into community health centers, which serve as patients’ primary medical homes.
As one of the most common diseases in the United States, chronic spinal pain affects hundreds of thousands of people each year. Underserved patients are most afflicted and have a greater tendency to use opioid pain medications because they lack access to other methods of treatment. Integrating nonpharmacologic clinicians, such as chiropractors, into primary medical homes immediately improves access and greatly reduces this important health inequity.
After I began working with a broader patient base in the city of St. Louis, Missouri, I saw the importance of expanding chiropractic care to people who traditionally would not have been able to receive it. This experience sparked my passion to advocate for the integration and utilization of chiropractic in an expanded healthcare landscape.
Being able to provide chiropractic care to a wider patient base begins with eliminating access barriers. Logan University does this by partnering with healthcare organizations across the St. Louis area. By providing care at multiple locations in and around the city and county, Logan has eliminated the locational access barrier. Through these long-standing partnerships, chiropractic care is provided at sites such as the St. Louis County Department of Public Health, Affinia Healthcare, CareSTL Health, Mercy Hospital JFK Clinic, and the newest Logan Health Center at the Stephen A. Orthwein Center at Paraquad.
Multidisciplinary integration in a primary care setting offers a multitude of benefits to the patients and healthcare system. Patients with chronic pain are far more likely to have other chronic conditions, such as diabetes, hypertension, osteoarthritis, and others. Optimizing a patient’s health requires an all-hands-on-deck approach. For example, on an average clinical day, I will receive a referral from podiatry for a patient with a foot complaint thought to be related to a spinal issue. I will make warm hand-offs to optometry for diabetic eye exams, primary care for hypertension management, and social work for behavioral health support. These are just some examples of the dynamic collaboration needed to best care for patients, and it is only possible when all clinicians are under the same roof.
Another beneficial aspect of multidisciplinary integration is the cost savings provided to patients and the healthcare system. For patients, having all care in one place reduces the need for and costs of travel. It also helps them avoid overtesting and overtreatment, especially with invasive procedures. For the healthcare system, diagnostic testing such as MRIs, surgical procedures and injections, and medication generate the greatest costs. These include upfront costs, such as the price of the test, and downstream costs. For example, patients who undergo a lumbar MRI for an episode of acute low back pain are significantly more likely to have spinal surgery. Despite the overwhelming price tags, the patient outcomes from these measures are not always justifiable.
On the other hand, chiropractic care is conservative. Methods used to treat the most common conditions that chiropractors see, such as spinal and musculoskeletal disorders, are not expensive. Most do not require expansive amounts of equipment, tools, or medications. The care chiropractors provide is efficacious for many pain complaints, and it is safe and cost-effective. Patients who do not improve with chiropractic care are more likely to be suitable candidates for select procedures, ultimately improving outcomes.
This is another example of why integration is so important: it provides patients and clinicians conservative options before more expensive, risky, and invasive alternatives are tried. Our colleagues in primary care and the administrators of the healthcare system are strong advocates for our integration. I think this reflects not only the demand for more conservative options to care for patients with chronic pain but also satisfaction with the services provided.
Patrick J. Battaglia, DC, DACBR, Director of Health Policy and Interdisciplinary Care at Logan University, facilitates community health center and hospital-based partnerships. He earned his Doctor of Chiropractic from Logan and is a staff chiropractor within Affinia Healthcare and the St. Louis County Department of Public Health, providing patient care, student, and resident training. Contact info: [email protected], 636-222-4392.
