Belleville Nurse Practitioner-Led Clinic (NPLC) is one of the seven sites implementing Ontario’s Primary Care Low Back Pain Pilot Program, which is supporting inter-professional primary care teams deliver better care to patients experiencing low back pain. The successful implementation of this pilot has improved patient outcomes and strengthened collaboration both within the team and with other organizations.
In recognition of this work, Belleville NPLC was the 2017 recipient of the Association of Family Health Teams of Ontario’s (AFHTO) Bright Lights award for the category Planning Programs for Equitable Access to Care.
Health Quality Ontario had a chance to catch up with Dr. Bruce Flynn, the chiropractor who joined Belleville NPLC to implement the pilot, alongside the nurse practitioners, to gain a better understanding of the impact this program has had on client outcomes.
How did the pilot first get off the ground?
The Ontario government launched the Primary Care Low Back Pilots in November 2015 to support inter-professional primary care teams to deliver better care to patients experiencing low back pain. Belleville NPLC was one of seven sites awarded the pilot.
After I first started at Belleville NPLC in early 2016, our first step was to identify clients diagnosed with, or identified as having, low back pain through the electronic medical record (EMR). We contacted these clients to let them know that chiropractic services were now available and asked if they wanted to make use of these services.
The Belleville NPLC team: Seated in front left to right: Sara Reviczky-Steeves, Shaune Bernier, Sharon Goldfarb. Standing left to right: Rick Steeves, Anne Marie Manlow, Karen Clayton-Roberts (Chief Nurse Practitioner/Clinic Director), Malcolm Jones, Colleen McNutt, Kristy Naulls, Anita Chard, Dr. Bruce Flynn, Arif Ahamed Abdul Samad.
What type of clients access your chiropractic services?
Belleville NPLC serves clients in the South East Local Health Integration Network (SE LHIN), which has the fourth highest opioid use in all of Ontario. A lot of the clients I see are on pain medication, including opioids. Many of our clients are either receiving assistance through the Ontario Disability Support Program (ODSP), Ontario Works, or are receiving pensions. They would not otherwise have access to musculoskeletal care including chiropractic services because of financial restrictions. This program allows more equitable access to chiropractic care.
Our clients also have existing co-morbidities, such as obesity and diabetes, which can tie in to low back pain. For instance, if you have low back pain, you may not want to be physically active and go for a walk. This, in turn, may limit our clients’ ability to manage their weight or diabetes.
Can you give an example of how your chiropractic services have made an impact?
One of the first clients I assessed was a 75-year-old woman who spoke English as a second language. She was apartment bound because of her low back pain. She was not able to do her own grocery shopping or even take a walk to the nearby mall. She had diabetes as well as kidney problems that developed due to multiple daily doses of different types of Tylenol she was taking to help manage her pain.
After about a month, her pain started to improve. I asked her what surprised her most about having chiropractic treatment, and she replied being surprised that she could put $40 a month into her bank account! These savings were directly attributable to the reduced amount of Tylenol she needed to take.
This client now walks approximately 2.8 km to the mall and has lost 50 lbs. Her diabetes management and kidney function have also greatly improved. These are all health benefits that she would otherwise not be able to experience if it weren’t for the equitable access to chiropractic services this pilot provides.
The evaluation of the pilot by the Centre for Effective Practice also provided some Belleville NPLC pilot patient narratives, including this patient quote:
“Thank you for helping me with the back pain I have suffered with for over eleven years. I believed I would be stuck with this pain for the rest of my life after my accident…I am (now) walking and standing taller. I have eliminated the Percocet and Tylenol 3 and now have no pain. I want to thank everyone in your clinic, as you are all amazing people.”
Were there any challenges you faced?
Initially the nurse practitioners hadn’t had much exposure to chiropractic services.However, after I started seeing clients, their low back pain started improving and the amount of pain medication needed reduced. This helped demonstrate the benefits of chiropractic care, which increased the nurse practitioners’ awareness of the impact of chiropractic care, and they started referring more clients to me.
A great benefit of the interprofessional environment at Belleville NPLC is the ability of our allied professional team to learn about each other’s professions, and the timely referrals between the team that can happen. This creates comprehensive and effective co-management of conditions, and puts our clients first.
What have been the outcomes of this pilot?
The collective pilot evaluation results of all seven pilots have shown that 83% of clients surveyed report less reliance on medications, including opioids. Additionally, patients of the Belleville NPLC pilot experienced an average decrease of 51% in disability at re-exam compared to their initial exam. We’ve also seen a decrease in emergency room visits and diagnostic tests.
Has the pilot expanded beyond Belleville NPLC?
Yes. We recently expanded the pilot in partnership with Quinte West Community Health Centre (CHC) who now refers eligible patients to us. This partnership has increased access to care for patients with low back pain that they were previously unable to receive and has also resulted in a strong relationship with the CHC’s pharmacist, which has led to significant reductions in opioid use at their centre.
At the LHIN and provincial levels, there has been significant interest in, and support for, this pilot project due to its impact on reducing patient dependence on opioids. The pilot has provided real and meaningful options for non-pharmacological pain management and we are hoping to see the Ministry roll the program out provincially.