title: Developing integrative primary healthcare delivery: adding a chiropractor to the team.
abstract: BACKGROUND
  The use of complementary and alternative medicine has been increasing in Canada despite the lack of coverage under the universal public health insurance system. Physicians and other healthcare practitioners are now being placed in multidisciplinary teams, yet little research on integration exists.
  
  
  OBJECTIVE
  We sought to investigate the effect of integrating chiropractic on the attitudes of providers on two healthcare teams.
  
  
  METHODS
  A mixed methods design with both quantitative and qualitative components was used to assess the healthcare teams. Assessment occurred prior to integration, at midstudy, and at the end of the study (18 months).
  
  
  METHODS
  Multidisciplinary healthcare teams at two community health centers in Ottawa, Ontario, participated in the study.
  
  
  METHODS
  All physicians, nurse practitioners, and degree-trained nurses employed at two study sites were approached to take part in the study.
  
  
  METHODS
  A chiropractor was introduced into each of the two healthcare teams.
  
  
  METHODS
  A quantitative questionnaire assessed providers' opinions, experiences with collaboration, and perceptions of chiropractic care. Focus groups were used to encourage providers to communicate their experiences and perceptions of the integration and of chiropractic.
  
  
  RESULTS
  Twelve providers were followed for the full 18 months of integration. The providers expressed increased willingness to trust the chiropractors in shared care (F value = 7.18; P = .004). Questions regarding the legitimacy (F value = 12.33; P < .001) and effectiveness (F value = 11.17; P < .001) of chiropractic became increasingly positive by study end.
  
  
  CONCLUSIONS
  This project has demonstrated the successful integration of chiropractors into primary healthcare teams.
authors.affiliation: Carlington Community and Health Services, Ottawa, Ontario, Canada. michaelgarner@gmail.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Garner
authors.forename: Michael
authors.initials: M
authors.lastname: Birmingham
authors.forename: Peter
authors.initials: P
authors.lastname: Aker
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.forename: Jeff
authors.initials: J
authors.lastname: Balon
authors.forename: Dirk
authors.initials: D
authors.lastname: Keenan
authors.forename: Pran
authors.initials: P
authors.lastname: Manga
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002684:Chiropractic / Q000458:organization & administration*; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires