HEALTH SERVICE RESEARCH POSTER PRESENTATION ABSTRACTS
Please note: All posters will be displayed in
Salons 10-12.
THURSDAY, 10:15-11:00 AM
Boon H, Kachan N, Vernon H.
Exploring the integration of chiropractics in a primary
care, hospital-based setting.
Leslie Dan Faculty of Pharmacy, University of
Toronto heather.boon@utoronto.ca
BACKGROUND: Primary care is increasingly being
delivered by teams of healthcare providers. Understanding how integrative
healthcare teams are formed and evolve is necessary in order to determine
how best to implement team-based approaches across Canada.
PURPOSE: The purpose of this project was to
examine and describe the integration of chiropractic services in the
Family Medicine Unit at St. Michael's Hospital (SMH) in Toronto, Canada.
METHODS: This study employed a qualitative research
design using interview-based data. Semi-structured, in-depth interviews
were conducted over a one-year period with 18 key participants (4 administrators,
2 chiropractors, 2 physiotherapists and 10 family physicians) involved
in the integration of chiropractic services at SMH. All interviews were
audio-taped and transcribed verbatim. Transcripts were then analyzed
for main themes using basic content analysis.
RESULTS: The data were organized under four
main categories, each with sub-themes. The first category is Facilitators
to Implementing the Program. Its sub-themes include: i) exposure
to the chiropractic initiative through formal, hospital-sanctioned presentations;
ii) "champions of the cause", or the importance of having
"credible" and "exceptional" leaders when implementing
a new and potentially controversial program such as this; and iii) the
culture of SMH itself, or the notion that because SMH is unique in terms
of its philosophy and urban and diverse patient population, it is more
open to incorporating forms of treatment that fall outside the sphere
of traditional Western medicine. The second category is Barriers
to Implementing the Program, with its sub-themes: i) confusion on
the part of clinicians regarding chiropractors' and physiotherapists'
respective scopes of practice; ii) MDs' perceptions of risks associated
with using chiropractics; and iii) MDs' perception that there is a lack
of evidence supporting the efficacy of chiropractic care for some conditions.
The third category is Anticipation/Expectation of Barriers to Implementation,
and contains participants' comments about those factors that they felt,
before the inception of the program, would prove to be problematic,
but which ultimately did not. Its two sub-themes are: i) staff turnover,
and ii) resistance from the hospital administration and MDs. The fourth
category of data was Referrals, and captures participants' comments
on the types of conditions referred to chiropractors and how referral
decisions are made.
CONCLUSION: The data from this study provide
both practical and theoretical knowledge as to how a new and innovative
model of health care is created, and may act as a blue print that can
be used by other types of inter-disciplinary teams.
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