title: Perspectives of older adults on co-management of low back pain by doctors of chiropractic and family medicine physicians: a focus group study.
abstract: BACKGROUND
  While older adults may seek care for low back pain (LBP) from both medical doctors (MDs) and doctors of chiropractic (DCs), co-management between these providers is uncommon. The purposes of this study were to describe the preferences of older adults for LBP co-management by MDs and DCs and to identify their concerns for receiving care under such a treatment model.
  
  
  METHODS
  We conducted 10 focus groups with 48 older adults who received LBP care in the past year. Interviews explored participants' care seeking experiences, co-management preferences, and perceived challenges to successful implementation of a MD-DC co-management model. We analyzed the qualitative data using thematic content analysis.
  
  
  RESULTS
  Older adults considered LBP co-management by MDs and DCs a positive approach as the professions have complementary strengths. Participants wanted providers who worked in a co-management model to talk openly and honestly about LBP, offer clear and consistent recommendations about treatment, and provide individualized care. Facilitators of MD-DC co-management included collegial relationships between providers, arrangements between doctors to support interdisciplinary referral, computer systems that allowed exchange of health information between clinics, and practice settings where providers worked in one location. Perceived barriers to the co-management of LBP included the financial costs associated with receiving care from multiple providers concurrently, duplication of tests or imaging, scheduling and transportation problems, and potential side effects of medication and chiropractic care. A few participants expressed concern that some providers would not support a patient-preferred co-managed care model.
  
  
  CONCLUSIONS
  Older adults are interested in receiving LBP treatment co-managed by MDs and DCs. Older adults considered patient-centered communication, collegial interdisciplinary interactions between these providers, and administrative supports such as scheduling systems and health record sharing as key components for successful LBP co-management.
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA. stacie.salsbury@palmer.edu.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Lyons
authors.forename: Stacie A
authors.initials: SA
authors.lastname: Salsbury
authors.forename: Maria A
authors.initials: MA
authors.lastname: Hondras
authors.forename: Mark E
authors.initials: ME
authors.lastname: Jones
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Andresen
authors.forename: Christine M
authors.initials: CM
authors.lastname: Goertz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D006801:Humans; D017116:Low Back Pain / Q000523:psychology* / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D018802:Patient-Centered Care
references.citation: J Manipulative Physiol Ther. 2012 Mar-Apr;35(3):168-75
references.pmid: 22386915
references.citation: J Am Geriatr Soc. 2012 Feb;60(2):332-7
references.pmid: 22211768
references.citation: J Ambul Care Manage. 2007 Oct-Dec;30(4):344-6
references.pmid: 17873666
references.citation: Natl Health Stat Report. 2008 Dec 10;(12):1-23
references.pmid: 19361005
references.citation: JAMA. 2010 Apr 7;303(13):1259-65
references.pmid: 20371784
references.citation: Pain Manag Nurs. 2010 Mar;11(1):26-34
references.pmid: 20207325
references.citation: Gerontologist. 2005 Aug;45(4):516-24
references.pmid: 16051914
references.citation: Spine (Phila Pa 1976). 2003 Feb 1;28(3):292-7; discussion 298
references.pmid: 12567035
references.citation: Ann Fam Med. 2011 Sep-Oct;9(5):447-53
references.pmid: 21911764
references.citation: Pain. 2007 Oct;131(3):293-301
references.pmid: 17317008
references.citation: Ann Fam Med. 2009 Mar-Apr;7(2):139-47
references.pmid: 19273869
references.citation: BMC Public Health. 2010 Nov 22;10:718
references.pmid: 21092218
references.citation: BMC Complement Altern Med. 2012 Nov 27;12:234
references.pmid: 23186539
references.citation: J Comorb. 2011 Dec 27;1:11-18
references.pmid: 29090132
references.citation: Arch Intern Med. 2000 Jun 26;160(12):1825-33
references.pmid: 10871977
references.citation: Adv Data. 2004 May 27;(343):1-19
references.pmid: 15188733
references.citation: Health Expect. 2003 Dec;6(4):332-41
references.pmid: 15040795
references.citation: Disabil Rehabil. 2007 Dec 30;29(24):1899-909
references.pmid: 17852259
references.citation: Ann Fam Med. 2004 Jul-Aug;2(4):305-9
references.pmid: 15335128
references.citation: BMC Complement Altern Med. 2013 May 31;13:122
references.pmid: 23721054
references.citation: Chiropr Osteopat. 2006 Jul 06;14:12
references.pmid: 16824214
references.citation: JAMA. 2008 Dec 24;300(24):2867-78
references.pmid: 19109115
references.citation: Pain Med. 2009 Apr;10(3):521-30
references.pmid: 19207235
references.citation: Health Expect. 2005 Mar;8(1):54-63
references.pmid: 15713171
references.citation: BMC Complement Altern Med. 2004 Jul 19;4:9
references.pmid: 15260884
references.citation: Lancet. 2012 Dec 15;380(9859):2163-96
references.pmid: 23245607
references.citation: BMC Health Serv Res. 2004 Jul 01;4(1):15
references.pmid: 15230977
references.citation: J Am Geriatr Soc. 2011 Apr;59(4):610-4
references.pmid: 21410444
references.citation: Spine (Phila Pa 1976). 2006 Nov 1;31(23):2724-7
references.pmid: 17077742
references.citation: Ann Fam Med. 2008 Jul-Aug;6(4):331-9
references.pmid: 18626033
references.citation: J Am Geriatr Soc. 2012 Oct;60(10):E1-E25
references.pmid: 22994865
references.citation: BMC Fam Pract. 2013 Jan 10;14:8
references.pmid: 23305144
references.citation: Spine (Phila Pa 1976). 2009 Sep 1;34(19):2077-84
references.pmid: 19675510
references.citation: J Am Geriatr Soc. 2000 Dec;48(12):1560-5
references.pmid: 11129743
references.citation: Chiropr Osteopat. 2007 Sep 06;15:12
references.pmid: 17822549
references.citation: Arthritis Rheum. 2008 Sep 15;59(9):1306-13
references.pmid: 18759261
references.citation: J Am Geriatr Soc. 2006 Nov;54(11):1772-7
references.pmid: 17087707
references.citation: J Manipulative Physiol Ther. 2005 Jun;28(5):336-44
references.pmid: 15965408
references.citation: BMC Complement Altern Med. 2013 Jun 03;13:124
references.pmid: 23731970
references.citation: Arthritis Rheum. 2009 Jan 15;61(1):124-31
references.pmid: 19116958
references.citation: Chiropr Osteopat. 2010 Dec 21;18:34
references.pmid: 21176137
references.citation: Spine (Phila Pa 1976). 2012 May 15;37(11):E668-77
references.pmid: 22146287
references.citation: Lancet. 2012 Dec 15;380(9859):2197-223
references.pmid: 23245608
references.citation: Age Ageing. 2006 May;35(3):229-34
references.pmid: 16547119
references.citation: Fam Pract. 2008 Aug;25(4):287-93
references.pmid: 18628243
references.citation: BMC Public Health. 2011 Feb 14;11:101
references.pmid: 21320345
references.citation: Trials. 2013 Jan 16;14:18
references.pmid: 23324133
references.citation: Clin Rehabil. 2009 Mar;23(3):270-80
references.pmid: 19218301
references.citation: JAMA. 2008 Feb 13;299(6):656-64
references.pmid: 18270354
references.citation: J Manipulative Physiol Ther. 2009 Nov-Dec;32(9):715-22
references.pmid: 20004798
references.citation: Pain Med. 2006 Mar-Apr;7(2):143-50
references.pmid: 16634727
references.citation: Rheumatology (Oxford). 2011 Sep;50(9):1645-53
references.pmid: 21606130
references.citation: J Am Geriatr Soc. 2009 Feb;57(2):225-30
references.pmid: 19207138
references.citation: J Behav Med. 2013 Jun;36(3):246-58
references.pmid: 22476813
references.citation: BMC Complement Altern Med. 2007 Dec 18;7:42
references.pmid: 18088435
references.citation: Pain Med. 2006 Jan-Feb;7(1):60-70
references.pmid: 16533199
references.citation: J Gerontol Nurs. 2006 Mar;32(3):32-8
references.pmid: 16544455
references.citation: Pain Med. 2008 Mar;9(2):240-8
references.pmid: 18298708
references.citation: J Am Geriatr Soc. 2000 May;48(5):534-45
references.pmid: 10811547
references.citation: J Am Geriatr Soc. 2009 Jan;57(1):62-9
references.pmid: 19054196
references.citation: Am J Geriatr Pharmacother. 2007 Mar;5(1):31-9
references.pmid: 17608245
references.citation: Pain. 2010 Sep;150(3):458-461
references.pmid: 20705213
references.citation: BMC Complement Altern Med. 2006 Mar 01;6:5
references.pmid: 16509963
references.citation: J Am Geriatr Soc. 2003 Dec;51(12):1710-7
references.pmid: 14687348
references.citation: Ann Fam Med. 2008 Jul-Aug;6(4):315-22
references.pmid: 18626031
references.citation: Pain Med. 2009 Oct;10(7):1280-90
references.pmid: 19818038
references.citation: Ann Fam Med. 2008 Jul-Aug;6(4):307-14
references.pmid: 18626030
references.citation: BMC Complement Altern Med. 2013 Jun 03;13:125
references.pmid: 23731997
references.citation: Soc Sci Med. 2006 Jun;62(12):2973-87
references.pmid: 16414164