Improving Access to Chiropractic Care for Low Back Pain in Underserved Primary Care Settings: A Protocol for a Pilot Study of a Multi-level Implementation Strategy
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 3
- 试验地点
- 1
- 主要终点
- Change in PCP Chiropractor Referrals for LBP
研究概览
简要总结
The goal of this study is to evaluate the feasibility of new implementation strategies designed to increase the number of Primary Care Providers (PCPs) referrals to chiropractic care for lower back pain (LBP) in underserved populations. The investigators plan to pilot the strategies in three qualified community health centers (CHCs) and compare the number of LBP patients who receive referrals before and after implementation. The implementation strategies involve PCP, patient, and organizational interventions.
Patients presenting with LBP will be provided educational materials that focus on the safety and effectiveness of chiropractic care as an evidence-based treatment for LBP. Materials will be available in CHC common areas and may be sent to patients by their PCP via patient portal.
PCPs will participate in interactive lunch seminars to allow for inter-professional learning for PCPs. They will also participate in a survey regarding their attitudes and beliefs relating to chiropractic care. Currently, many PCPs cannot make chiropractic care referrals in the electronic health record (EHR). The investigators plan to add this option, or make it easier if the referral is already available.
This multi-level, multi-component approach will last two months, and will be rolled out sequentially in three clinics using a stepped-wedge design. The ordering of clinics will be random.
The primary outcome is the proportion of patients with LBP who received a referral to chiropractic care before and after the intervention. Secondary outcomes include referral to any non-pharmacologic treatment, use of imaging, and prescribed medications.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Be a CHC in the Boston area with primary care
- •Agree to participate in study
- •Inclusion criteria for PCPs:
- •Work at a participating CHC
- •Be an MD, doctor of osteopathy (DO), nurse practitioner (NP), or physician assistant (PA)
- •Inclusion criteria for patients with LBP:
- •Has PCP at participating CHC
- •Has LBP diagnosis
- •Is 18 years of age or older
排除标准
- •There are no exclusion criteria
- •Exclusion criteria for PCPs:
- •There are no exclusion criteria
- •Exclusion criteria for patients with LBP:
- •There are no exclusion criteria for adult patients with LBP
研究组 & 干预措施
Implementation
Implementation will be deployed at the CHC, PCP, and patient level.
干预措施: Institutional interventions (Other)
Implementation
Implementation will be deployed at the CHC, PCP, and patient level.
干预措施: PCPs interventions (Other)
Implementation
Implementation will be deployed at the CHC, PCP, and patient level.
干预措施: Patient interventions (Other)
Standard of care
Usual patient care without deployment of intervention.
结局指标
主要结局
Change in PCP Chiropractor Referrals for LBP
时间窗: During the fourteen month study period
This outcome will be assessed by calculating the proportion of LBP patients receiving a chiropractic referral for the two timeframe periods will be calculated. The numerator will be those with a chiropractic referral, defined as those LBP patients who received a PCP referral in the EHR or documentation in the EHR of a visit with a chiropractor. The denominator will be the total number of unique LBP patients seen by a PCP with an LBP diagnosis in the EHR.
次要结局
- Percentage of patient participants referred to physical therapy(14 months)
- Percentage of patient participants referred to acupuncture(14 months)
- Percentage of patient participants prescribed opioids(14 months)
- Percentage of patient participants referred to magnetic resonance imaging (MRI)(14 months)
- Percentage of patient participants that receive epidural injections(14 months)