Often spine care is overly focused on specialists, imaging, high-cost/ low value procedures and ineffective communication. Primary spine care services evolved out of the need for improved primary-level, "front-end" efficiency in the diagnosis and management of patients with spine-related disorders. There is increasing evidence that a spine patient’s experience upon initially encountering the health care system has great influence on whether the patient recovers quickly, or descends into chronic pain and disability.
The focus of primary spine care is the Primary Spine Practitioner (PSP).
The Primary Spine Practitioner (PSP)
The PSP is a trained professional who serves as the point person for patients with spine related disorders, providing diagnosis and management for the majority without the need for referral and triaging the remainder based on the unique features of each patient. The PSPs who function within the Care New England Spine Program are specially-trained chiropractors.
In addition, the PSP serves to coordinate the care that is provided by other professionals and to follow the patient to maintain their track toward recovery. The PSP serves as a resource for primary care practitioners as well as serving a “primary care” role for patients with spine related disorders.
PSP Training and Certification
A training and certification program for Primary Spine Practitioners is currently underway through the University of Pittsburgh, Department of Rehabilitation Sciences. The curriculum was developed under the direction of The Care New England Spine Center’s medical director Donald R. Murphy, DC, FRCC. It is a one-year postgraduate course, with a rigorous examination process. The knowledge and skills that the PSP must master include:
- A wide ranging understanding of the etiology and mechanisms of spine pain, including the biological, psychological and social factors.
- Skills in the differential diagnosis of spine pain, including biological, psychological and social factors as well as the identification of pathological conditions such as cancer, infection and internal disorders.
- Understanding of the appropriate utilization of special tests, such as imaging and laboratory testing, and specialist consultations.
- Skills in the management of the majority of patients with spine-related disorders, including self- management strategies, manipulation and other manual therapies, directional preference/McKenzie protocols, neural mobilization techniques, soft tissue techniques, various forms of exercise, patient-specific, evidence-based education, understanding of non-steroidal anti-inflammatory, non-opioid analgesics, and nutritional approaches .
- The ability to detect and manage many of the psychological factors impacting spine recovery utilizing principles taken from Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy.
- The ability to determine when patients with impactful psychological factors require referral to a behavioral health specialist.
- An understanding of the specific factors in work-related spine disorders.
- An understanding of the methods, techniques and indications for intensive rehabilitation, interventional treatments (e.g., injections) and surgical procedures.
- A broad perspective regarding how spine problems and spine care fit in the grander scheme of public health.
- The ability to engage and coordinate the activities of a broad network of providers within an integrated spine care pathway.
- A keen appreciation for and skills in facilitating the stay-at-work, return-to-work (SAW/ RTW) process, particularly for patients with work-related spine problems.
Primary spine care services is one of the several innovations that the Care New England Spine Care Program brings to the care of patients with spine related disorders. This approach has demonstrated high value and patient satisfaction.
Learn more about the PSP here:
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