There is no shortage of complaints about the health care system, whether in this country or abroad. Unfortunately, practitioners don't get as much press attention for those things that are actually innovative and working well. However, there is a movement afoot whereby practitioners are looking at ways to offer the optimum means of treatment in a patient-centered health care approach. This method of integrated care is an exciting departure from what we have seen previously as the dominant model in our health care system.
While there are many situations in offices and clinics in which health professionals in different fields work together, more frequently, the complementary medical professions tend to work and exist in separate silos. Each profession has a unique culture, literature, attitude and perception, and we tend to view the other professions through the lens of bias created by our own profession. Yet for any patient to derive the best care, in many situations the skills of a diverse team of professionals are needed. In order for this to work, we must get out of our silos and learn more about each other as health care professionals.
Two Integration Models
Several years ago, I began working with the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). This is one of the most passionate and interesting groups I have ever worked with. Its mission is this: to "create and sustain a network of national complementary and alternative medicine educational organizations and agencies, which will promote mutual understanding, collaborative activities and interdisciplinary health care education."
The ACCAHC was formed in 2004 as a project of the Integrated Healthcare Policy Consortium (IHPC), an organization dedicated to promoting policies and action to advance integrated health care. ACCAHC was part of a broader IHPC educational initiative titled the National Education Dialogue to Advance Integrated Healthcare: Creating Common Ground (NED). The goal of both efforts was to fulfill educational directions recommended by the White House Commission on Complementary and Alternative Medicine Policy and the IHPC's National Policy Dialogue to Advance Integrated Health Care.
Learn What Others Do
The primary focus of the ACCAHC is to encourage a patient-centered health care model that includes integration of all health care modalities to find the most effective and appropriate care for each individual. In order for this to occur effectively, the practitioners, educators and researchers from each of these professions must first learn a great deal about what others in different fields do. While I thought I had a pretty good understanding of the other alternative health care professions, it became very clear early on that there was so much I didn't know about how care was delivered in these other fields.
One of the major projects currently underway for the ACCAHC is a focus on interprofessional education (learning about what other professions do and how to effectively communicate with them). When you think about referring a patient to someone else for care, it is essential that you have a thorough grasp of the treatment approaches used by those to whom you are referring.
For example, we must understand how chiropractic interfaces with other types of care, such as massage therapy, acupuncture or physical therapy. Similarly, when a patient is referred to us from some other health care practitioner, we need to understand the approaches that have been used previously and why they may or may not have been effective. Interprofessional education is at the core of this understanding and the initiatives of the ACCAHC are highly valuable in bringing alternative health care practices to the forefront.
Unfortunately, not all organizations in the alternative health care profession have recognized the crucial importance of ACCAHC's work. There has been good representation from certain educators, clinicians and researchers, but in order for any alternative health care modality to move forward within this organization, there must be a strong and proactive participation from the accreditation and certification bodies.
The chiropractic profession is vitally interested in interprofessional education and interprofessional practice, as it seeks its place on the health team as a rightful member. For far too long, chiropractic has been considered "separate and distinct."
End Isolationism
While the profession is proud of its heritage and the unique approach it takes toward the care of patients, it must move toward participation on health care teams and away from the isolated practices of the past. Several chiropractic educational associations are affiliated with the ACCAHC, including the Association of Chiropractic Colleges, the Council on Chiropractic Education and the National Board of Chiropractic Examiners.
[pb]The second group that illustrates a great model of integrated care is one that I've very recently become involved with. It is called TRIARQ and is headquartered in New York. TRIARQ was started by a number of physicians and physical therapists who recognized that they were both working with the same patients, but in many instances not benefiting from a thorough and comprehensive understanding of the treatment approaches they were each using. As the TRIARQ Web site states:
"TRIARQ is a community of Physicians, Patients, Physical Therapists, and other healthcare professionals working together to create new standards in clinical and service excellence through continuing education, research, and cross-discipline collaboration.
"Healthcare for patients with musculoskeletal injuries is fragmented among physicians, physical therapists, occupational therapists, and patients. Historically there has been limited communication or coordination of care amongst these groups. We are seeing fundamental changes in the philosophy of patient care including stress on continuity, quality, scientific based treatment and performance of healthcare professionals. The success of treatment, measured by patient satisfaction, needs to improve."
TRIARQ has recently opened up its membership to massage therapists, and actively encourage the participation of massage professionals in this interprofessional dialogue.
After speaking at a recent symposium with members of TRIARQ in New York, I was once again thoroughly impressed by the degree of respect and mutual collaboration among all the individuals representing their own unique perspectives. It is this type of integrated health care that will provide patients the most effective opportunities to enhance their health and well-being.
TRIARQ Philosophy
The TRIARQ research philosophy is simple. It states:
"In order to advance the science of rehabilitation and the standards in musculoskeletal healthcare a collaborative approach to clinical research is necessary. As part of the TRIARQ community we foresee unprecedented opportunities for cross discipline research in at least 4 primary categories:
The TRIARQ model espouses the triumph of collaboration, quality and continuity of musculoskeletal healthcare. Our approach is to effect change in three (TRI) key areas (ARQs):
Collaboration: We provide the platform for seamless integration and coordination of care amongst physicians, therapists and patients.
Education: We develop and provide 'evidence based' educational material for therapists and their assistants.
Practice Management: In the constantly changing and complex landscape of managing a practice and your patients - we provide the tools and support to ensure that key success factors are addressed."
I would encourage all chiropractors to seek out not only these organizations, but any opportunities to enhance your own understanding and awareness of what people in other health care fields do so you can best understand how to integrate those practices with your own. Visit the TRIARQ Web site (www.triarq.com) to see what you can learn or how your can contribute to its integration philosophy. To learn more about the ACCAHC and its partner organizations, visit www.accahc.org.
We are at a place in our health care system where we must get out of our individual silos and find ways to deliver optimal integrated care. The more we learn about each other, the better we will be in our own approaches to treating patients. One of the stated values of the ACCAHC sums it up best when it quotes the Institute of Medicine statement that "the goal of integrating care should be the provision of comprehensive care that is safe and effective care, that is collaborative and interdisciplinary, and care that respects and joins effective interventions from all sources."
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