title: Primary care physicians, acupuncture and chiropractic clinicians, and chronic pain patients: a qualitative analysis of communication and care coordination patterns.
abstract: BACKGROUND
  A variety of people, with multiple perspectives, make up the system comprising chronic musculoskeletal pain (CMP) treatment. While there are frequently problems in communication and coordination of care within conventional health systems, more opportunities for communicative disruptions seem possible when providers use different explanatory models and are not within the same health management system. We sought to describe the communication system surrounding the management of chronic pain from the perspectives of allopathic providers, acupuncture and chiropractor (A/C) providers, and CMP patients.
  
  
  METHODS
  We collected qualitative data from CMP patients (n = 90) and primary care physicians (PCPs) (n = 25) in a managed care system, and community acupuncture and chiropractic care providers (n = 14) who received high levels of referrals from the system, in the context of a longitudinal study of CMP patients' experience.
  
  
  RESULTS
  Multiple points of divergence and communicative barriers were identified among the main stakeholders in the system. Those that were most frequently mentioned included issues surrounding the referral process (requesting, approving) and lack of consistent information flow back to providers that impairs overall management of patient care. We found that because of these problems, CMP patients were frequently tasked and sometimes overwhelmed with integrating and coordinating their own care, with little help from the system.
  
  
  CONCLUSIONS
  Patients, PCPs, and A/C providers desire more communication; thus systems need to be created to facilitate more open communication which could positively benefit patient outcomes.
authors.affiliation: South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA. Lauren.Penney@va.gov.
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Penney
authors.affiliation: The University of Arizona-Department of Family and Community Medicine, 1450 N Cherry Ave, Tucson, AZ, 85719, USA. ritenbau@email.arizona.edu.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ritenbaugh
authors.affiliation: Kaiser Permanente-Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227-1098, USA. Charles.Elder@kpchr.org.
authors.forename: Charles
authors.initials: C
authors.lastname: Elder
authors.affiliation: Kaiser Permanente-Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227-1098, USA. Jennifer.Schneider@kpchr.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Oregon Health and Science University-Department of Family Medicine, Oregon Health and Science University, Mail Code FM, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA. deyor@ohsu.edu.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.affiliation: Kaiser Permanente-Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227-1098, USA. lynn.debar@kpchr.org.
authors.forename: Lynn L
authors.initials: LL
authors.lastname: DeBar
mesh_terms: D015670:Acupuncture Therapy; D019090:Case Management; D002684:Chiropractic; D059350:Chronic Pain / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D019538:Health Care Surveys; D058015:Health Communication; D006801:Humans; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D012017:Referral and Consultation
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