About
An Introduction to National Spine Care
Over the past several years, the number of referrals to dedicated spinal surgeons has grown exponentially. At the time NSC was conceived there were over 4000 patients on the collective waiting list of seven surgeons. These requests for consultation had not been given appointments due to overloaded scheduling. Ironically more than 80% of these referrals are of a non-surgical nature. This backlog created a significant degree of frustration in patients, referring physicians, spinal surgeons, and the Calgary Health Region. Yet this is not a local phenomenon. The prevalence of spinal complaints within the community has overwhelmed the adolescent specialty of spinal surgery across all of Canada. In those spinal surgeon’s offices accepting new patients, waiting times for pain related complaints are commonly in excess of 3 years from St. John’s to Victoria.
A Public Private Partnership
In January of 2002, the University of Calgary Spine Program conceptualized an initiative designed to improve both the efficiency and quality of spinal care in the Calgary Health Region. Recognizing the fiscal restraints of a public health care system and the predicted demand of over 70,000 new patients accessing spinal care per year for Southern Alberta alone, the program was envisioned to create a “Public Private Partnership” between those of us in a University based practice with a number of spinal specialists working in the community. It consisted of a streamlined triage system with rapid access to medical and surgical care for appropriately selected patients, making use of objective clinical outcome tools to gauge the success or failure of treatment based on diagnostic category. The model was to be built within the economic constraints of a non-hospital based system in the way the majority of community medicine is currently practiced. Specifically all avenues of revenue generation from spinal care were to be pursued to fund the program. Today, fiscal independence remains a cornerstone in this initiative for two main reasons: (1) to avoid competition with other more important and expensive Regional programs and (2) to allow the model to expand or contract in response to constraints of supply and demand.
In moving forward with this initiative we carefully engaged the College of Physicians and Surgeons of Alberta, the Alberta College and Association of Chiropractors, The Alberta Physiotherapy Association, Alberta Health and Wellness, the Alberta Medical Association, and the Calgary Health Region in discussions about our plans. To date we remain in close contact with these stakeholders to ensure the interests of all Albertans are met or exceeded.
From November of 2002 through March of 2003 an interdisciplinary team consisting of spinal surgeons, a physiatrist, a chiropractor and spinal physiotherapist began training and seeing patients in the surgeon’s hospital clinics.
Heightened Efficiency in Patient Referrals
Since its inception, NSC has seen increased activity. Patients who would otherwise be placed on lengthy to indefinite waiting lists through the usual referral processes are notified by telephone and in writing of the option of visiting the multidisciplinary clinic. Public information sessions are also offered to provide you with the latest approaches and most appropriate treatments for your spine-related health condition.
The benefits of rapid access, multidisciplinary assessment, and a spectrum of medical and surgical treatments are immediately obvious. What is unique to NSC, because of the background training and interdisciplinary approach taken at the clinic, depending on their particular condition, patients may not see a physician at all during their encounter. Because the initial assessment and workup is performed by chiropractors and physiotherapists, which are not fully covered by Alberta Health and Wellness, a primary assessment fee is levied on behalf of the physiotherapist or chiropractor who sees them.
Patients who indicate to us that they cannot afford the fee associated with the neurosurgical triaging assessment are brought to the attention of the surgeon's office. The surgeon's office will then contact you with respect to alternative referral routes.
The benefits of this partnership to the specialist have become readily apparent. First, access for those patients truly requiring surgery has improved. In this triage system the number of patients receiving surgical consultation actually found to be surgical candidates approaches 90% (as opposed to less than 20% in the traditional system). Second, a spine focused history and physical has been largely completed by the primary physiotherapy or chiropractic assessment. This allows the surgeon (for example) to spend a dedicated ½ hour with the patient going through risks and benefits of surgery compared to 1 ½ hours for an H&P/consent in the traditional system. Accordingly, we have seen the efficiency of surgical consultation increase by up to 3 fold within this model.
Comprehensive Spinal Care
The scope of services available at NSC is wide. In addition to chiropractic and physiotherapy, acupuncture, IMS (Intramuscular stimulation) and rehabilitation are available. Psychology and dietary counseling services are offered to help with issues ranging from pain control, to smoking and obesity. If you require spinal injections to assist with pain control, the staff at NSC can assist you through direct referral to Interventional Diagnostic Radiology.
Summary
In summary, we believe that National Spine Care provides a realistic opportunity to improve accessibility and quality for patients requiring spinal care. Although growing pains are to be expected, both patients and the medical community have reacted to this initiative in a predominantly supportive way. Much ground remains to be covered over many months and years. As treating specialists we feel this is a viable and sustainable strategy to meet the changing expectations of a community otherwise constrained in traditional health care delivery.
