Inter-Professional Collaborations: Chiropractic Medicine and Urgent-Care Medicine. DCs and NPs.

By: Dr. Carlos M. Barrera, DC, Dr. Mardochee K. Augstuine, DC, and Christian DeFournoy, MSN, FNP. 

The top three diagnoses/chief complaints that present to most outpatient urgent care centers, primary care clinics, and medical settings can be arguably categorized as gastrointestinal complaints, respiratory complaints, and musculoskeletal complaints. With MSK being in the top three addressing these complaints with an accurate diagnosis, treatment, and intervention times is imperative in the delivery of high-quality healthcare. The NP-DC duo is a powerhouse. Nurse practitioners are highly trained mid-level providers being recognized in today’s healthcare system as integral team players. Nurse practitioners or NPs undergo an intensive six-eight-year education/training equivalent to the training physicians receive. Chiropractors or DCs (Doctor of Chiropractic) are categorized as physicians by CMS (center for Medicare/Medicaid services). Chiropractors undergo an intensive seven-eight-year education/training. Both professionals are trained in diagnosis, pharmacology, physiology, pathology, laboratory interoperations, radiological interpretations, etc. Both professions are a direct portal of entry providers, meaning they practice autonomously and do not need a referral from an MD/DO. Both professionals have optional residencies/fellowships leading to designations in emergency medicine, sports medicine, orthopedics, neurology, healthcare executive administration, primary care, etc. 

This duo is a powerhouse because the NP can manage all medical care of the patients and evaluate patients for the proper referral/treatment of MSK complaints. The DC can also evaluate the patient and make the proper medical referral when needed in instances of infections, emergency conditions such as osteomyelitis, visceral conditions, etc. Let’s utilize the model of urgent care that employs an NP and DC. We will examine a case study of a condition that presented to OneCare Health- Advanced Practice Health & Wellness of a 63-year-old female who presented with hip pain. Upon initial evaluation and inspection of the bilateral legs, the DC noted grade two pitting edema and was able to in-house make the referral to the NP for medical clearance to rule out any cardiological/pulmonology pathologies. The NP was able to evaluate the patient in-office and clear the patient for chiropractic care. This model should be incorporated into more urgent-care centers nationwide.

Interdisciplinary collaborations have been an intricate part of healthcare for decades. Nurse practitioners collaborating with other disciplines have helped with continuity of care and has also resulted in better patient outcomes. Urgent cares are the middle ground between the doctor’s office and the emergency room. Urgent cares are helpful in many ways, they help decompress the emergency room for non-life-threatening complaints, such as sprains, upper respiratory infections, and urinary tract infections to name a few. This in turn helps providers in the emergency room attend to more serious cases that present themselves to the emergency room. Nurse practitioners working alongside chiropractors are beneficial to patients that come

in with complaints that may both involve interventions by both disciplines. Nurse practitioners, would obtain a full history, assess and physically examine the patient. Patients complaining of musculoskeletal pain, often have poor ergonomic practices in their perspective work environments which can cause muscle spasms, muscle pain, and tenderness. Nurse practitioners working alongside chiropractors allow patients to see a doctor that specializes in relieving these complaints with various manipulative techniques and equipment. This bridges the gap of long waits for referrals. Chiropractors’ high-touch approach to patient treatment has been proven to have positive outcomes for patients suffering from musculoskeletal pains such as upper/lower back pain, neck pain, and leg pain, just to name a few.

The future of health care is interdisciplinary collaborations. Plenty of research has shown it leads to better health outcomes. Interdisciplinary collaboration is teamwork across different disciplines to learn each other’s field of expertise. One of the branches of medicine that research has shown numerous times to provide good health outcomes for patients, is chiropractic medicine. Chiropractic medicine specializes in neuromuscular skeletal care and pain management. Traditionally DCs have done an interdisciplinary collaboration with physical therapists, acupuncturists, massage therapist, etc. and those have led to the best patient outcomes. Research has shown that patients with chronic neuromusculoskeletal dysfunctions get the best outcomes when they get treatment from these various disciplines together. In recent times there have been calls for interdisciplinary collaboration between chiropractors and traditional medicine to address the ongoing opioid epidemic.

Policymakers, regulatory bodies, and national organizations have pressured medical professionals to explore conservative alternatives for the management of acute and chronic pain. There have been models to show the collaboration between medical professionals and chiropractors. The biggest model is the VA system, within the VA hospital system chiropractors work side by side with medical doctors, NPs, PAs, and other medical professionals to give veterans suffering from pain a wide range of treatment. The outcomes have been very successful leading to significant pain reduction and increased ADL. This is an example of the successful execution of interdisciplinary collaboration and this model can and should be carried over into hospitals, urgent cares, health clinics, etc.