Open Access Highly Accessed Research article

Perspectives of older adults on co-management of low back pain by doctors of chiropractic and family medicine physicians: a focus group study

Kevin J Lyons1, Stacie A Salsbury2*, Maria A Hondras23, Mark E Jones4, Andrew A Andresen4 and Christine M Goertz2

Author Affiliations

1 Office of Institutional Research, Thomas Jefferson University, Philadelphia, PA, USA

2 Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA

3 Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

4 Genesis Quad Cities Family Medicine Residency Program, Davenport, IA, USA

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BMC Complementary and Alternative Medicine 2013, 13:225  doi:10.1186/1472-6882-13-225

Published: 16 September 2013

Abstract

Background

While older adults may seek care for low back pain (LBP) from both medical doctors (MDs) and doctors of chiropractic (DCs), co-management between these providers is uncommon. The purposes of this study were to describe the preferences of older adults for LBP co-management by MDs and DCs and to identify their concerns for receiving care under such a treatment model.

Methods

We conducted 10 focus groups with 48 older adults who received LBP care in the past year. Interviews explored participants’ care seeking experiences, co-management preferences, and perceived challenges to successful implementation of a MD-DC co-management model. We analyzed the qualitative data using thematic content analysis.

Results

Older adults considered LBP co-management by MDs and DCs a positive approach as the professions have complementary strengths. Participants wanted providers who worked in a co-management model to talk openly and honestly about LBP, offer clear and consistent recommendations about treatment, and provide individualized care. Facilitators of MD-DC co-management included collegial relationships between providers, arrangements between doctors to support interdisciplinary referral, computer systems that allowed exchange of health information between clinics, and practice settings where providers worked in one location. Perceived barriers to the co-management of LBP included the financial costs associated with receiving care from multiple providers concurrently, duplication of tests or imaging, scheduling and transportation problems, and potential side effects of medication and chiropractic care. A few participants expressed concern that some providers would not support a patient-preferred co-managed care model.

Conclusions

Older adults are interested in receiving LBP treatment co-managed by MDs and DCs. Older adults considered patient-centered communication, collegial interdisciplinary interactions between these providers, and administrative supports such as scheduling systems and health record sharing as key components for successful LBP co-management.

Keywords:
Older adults; Low back pain; Health services for the aged; Interprofessional relations; Chiropractic; Family medicine; Musculoskeletal disorders; Complementary/alternative medicine; Patient preferences; Qualitative research