Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey
Abstract Background Healthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units. The integration of clinicians who provide first line, evidence-based, non-pharmacological therapies...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-01-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-024-10578-z |
| _version_ | 1797276664291393536 |
|---|---|
| author | Wren Burton Stacie A. Salsbury Christine M. Goertz |
| author_facet | Wren Burton Stacie A. Salsbury Christine M. Goertz |
| author_sort | Wren Burton |
| collection | DOAJ |
| description | Abstract Background Healthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units. The integration of clinicians who provide first line, evidence-based, non-pharmacological therapies further complicates adoption of these care pathways. This cross-sectional study explored clinician perceptions about the integration of guideline-concordant care and optimal spine care workforce requirements within an academic HCS. Methods Spine care clinicians from Duke University Health System (DUHS) completed a 26-item online survey via Qualtrics on barriers and facilitators to delivering guideline concordant care for low back pain patients. Data analysis included descriptive statistics and qualitative content analysis. Results A total of 27 clinicians (57% response) responded to one or more items on the questionnaire, with 23 completing the majority of questions. Respondents reported that guidelines were implementable within DUHS, but no spine care guideline was used consistently across provider types. Guideline access and integration with electronic records were barriers to use. Respondents (81%) agreed most patients would benefit from non-pharmacological therapies such as physical therapy or chiropractic before receiving specialty referrals. Providers perceived spine patients expected diagnostic imaging (81%) and medication (70%) over non-pharmacological therapies. Providers agreed that receiving imaging (63%) and opioids (59%) benchmarks could be helpful but might not change their ordering practice, even if nudged by best practice advisories. Participants felt that an optimal spine care workforce would require more chiropractors and primary care providers and fewer neurosurgeons and orthopedists. In qualitative responses, respondents emphasized the following barriers to guideline-concordant care implementation: patient expectations, provider confidence with referral pathways, timely access, and the appropriate role of spine surgery. Conclusions Spine care clinicians had positive support for current tenets of guideline-concordant spine care for low back pain patients. However, significant barriers to implementation were identified, including mixed opinions about integration of non-pharmacological therapies, referral pathways, and best practices for imaging and opioid use. |
| first_indexed | 2024-03-07T15:31:28Z |
| format | Article |
| id | doaj.art-2e1ed614984c43f1b1bc0417b976cada |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-07T15:31:28Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-2e1ed614984c43f1b1bc0417b976cada2024-03-05T16:24:11ZengBMCBMC Health Services Research1472-69632024-01-0124111010.1186/s12913-024-10578-zHealthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional surveyWren Burton0Stacie A. Salsbury1Christine M. Goertz2Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolPalmer Center for Chiropractic Research, Palmer College of ChiropracticImplementation of Spine Health Innovations, Department of Orthopaedic Surgery, School of MedicineAbstract Background Healthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units. The integration of clinicians who provide first line, evidence-based, non-pharmacological therapies further complicates adoption of these care pathways. This cross-sectional study explored clinician perceptions about the integration of guideline-concordant care and optimal spine care workforce requirements within an academic HCS. Methods Spine care clinicians from Duke University Health System (DUHS) completed a 26-item online survey via Qualtrics on barriers and facilitators to delivering guideline concordant care for low back pain patients. Data analysis included descriptive statistics and qualitative content analysis. Results A total of 27 clinicians (57% response) responded to one or more items on the questionnaire, with 23 completing the majority of questions. Respondents reported that guidelines were implementable within DUHS, but no spine care guideline was used consistently across provider types. Guideline access and integration with electronic records were barriers to use. Respondents (81%) agreed most patients would benefit from non-pharmacological therapies such as physical therapy or chiropractic before receiving specialty referrals. Providers perceived spine patients expected diagnostic imaging (81%) and medication (70%) over non-pharmacological therapies. Providers agreed that receiving imaging (63%) and opioids (59%) benchmarks could be helpful but might not change their ordering practice, even if nudged by best practice advisories. Participants felt that an optimal spine care workforce would require more chiropractors and primary care providers and fewer neurosurgeons and orthopedists. In qualitative responses, respondents emphasized the following barriers to guideline-concordant care implementation: patient expectations, provider confidence with referral pathways, timely access, and the appropriate role of spine surgery. Conclusions Spine care clinicians had positive support for current tenets of guideline-concordant spine care for low back pain patients. However, significant barriers to implementation were identified, including mixed opinions about integration of non-pharmacological therapies, referral pathways, and best practices for imaging and opioid use.https://doi.org/10.1186/s12913-024-10578-zLow back painClinical practice guidelinesSurveyHealth systemsChiropracticPhysical therapy |
| spellingShingle | Wren Burton Stacie A. Salsbury Christine M. Goertz Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey BMC Health Services Research Low back pain Clinical practice guidelines Survey Health systems Chiropractic Physical therapy |
| title | Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey |
| title_full | Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey |
| title_fullStr | Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey |
| title_full_unstemmed | Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey |
| title_short | Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey |
| title_sort | healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system a cross sectional survey |
| topic | Low back pain Clinical practice guidelines Survey Health systems Chiropractic Physical therapy |
| url | https://doi.org/10.1186/s12913-024-10578-z |
| work_keys_str_mv | AT wrenburton healthcareproviderperspectivesonintegratingacomprehensivespinecaremodelinanacademichealthsystemacrosssectionalsurvey AT stacieasalsbury healthcareproviderperspectivesonintegratingacomprehensivespinecaremodelinanacademichealthsystemacrosssectionalsurvey AT christinemgoertz healthcareproviderperspectivesonintegratingacomprehensivespinecaremodelinanacademichealthsystemacrosssectionalsurvey |