evidenceeffectiveefficientevidenceeffectiveefficientevidenceeff chiropractic care The Ontario Chiropractic Association 2012/2013 Annual Report

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1 chiropractic care The Ontario Chiropractic Association 2012/2013 Annual Report

2 02 Evidence-Based Care 04 Effective Care 06 Efficient Care 08 A Message from Our President and Chief Executive Officer 12 We re Here for Our Members 14 Ground-Breaking Chiropractic Research The concept of care is reflected in the time chiropractors spend with patients working to assess, educate and treat their conditions. 16 Raising the Profile of the Profession 18 Chiropractic in a Hospital Setting 20 The OCA and Ontario s Health Care System 22 Government Relations/ Advocacy

3 02 ontario chiropractic association Evidence-Based Care The chiropractic profession continually nurtures a research culture that informs highquality, evidence-based, patient-centred care. Dr. Carlos Ammendolia is the Director of the Chiropractic Spine Clinic and the Spinal Stenosis Program at Mount Sinai Hospital. He has developed a boot camp for spinal stenosis sufferers that aims to improve their mobility and quality of life and potentially stave off surgery. Dr. Ammendolia s research has created a program that includes specific exercises, manual therapy, and general conditioning that specifically targets the debilitating effects of spinal stenosis. Over the three years the Mount Sinai boot camp has been in operation, more than 80 patients with mild to moderate spinal stenosis have enrolled in the program. The vast majority who completed the program experienced significant improvement.

4 04 ontario chiropractic association 2012/2013 annual report 05 Effective Care Impactful care helps you get back to doing the things you love to do. Chiropractic care can bring about real change for many patients. Gary Roberts professional hockey career took a toll on his body, including a neck injury that left him with severe nerve damage and numbness in his arms. Repeated surgeries and rehab had little effect. However, after a visit to a sports chiropractor in 1996 to relieve stress and reduce scar tissue in his upper spine and neck, Roberts regained his strength and mobility. He returned to the ice to play professional hockey for another 13 years. It saved my life, says Roberts, who eventually retired from the NHL four years ago. He is now an advocate of chiropractic treatment as a complement to proper nutrition and training techniques.

5 06 ontario chiropractic association Efficient Care Chiropractors help health care teams be more efficient in dealing with musculoskeletal (MSK) issues including low back pain, by enhancing patient outcomes and saving health care dollars. The Ministry of Health and Long-Term Care has recognized the growing burden of MSK conditions and is looking for solutions. The OCA is working with the Ministry to remove the barriers that limit chiropractors from being integrated into primary care through such entities as Family Health Teams, Community Health Centres and others. Including chiropractors in primary care environments will enhance the delivery of integrated MSK patient-care models. Chiropractors collaborating with physicians can develop a plan for patients to manage their lower-back pain, which may include education, manual therapy and exercise. This can help avoid expensive and unnecessary surgeries, reliance on pharmaceuticals and diagnostic testing.

6 08 ontario chiropractic association 2012/2013 annual report 09 A Message from Our President and Chief Executive Officer Few things are more important to us than our health. As a society, health care is one of the most important government priorities. As individuals, we are constantly preoccupied with the impact our lifestyle, personal preferences and indeed our very DNA can have on our health and the care we receive. The care component of health care is worth focusing on. As chiropractors, our profession is known for bringing personalized, one-on-one care that resonates with our patients. The very notion of care or caring for someone is reflected in the amount of time that chiropractors spend with each patient, working hands-on to assess, treat and educate them on their conditions. On a larger scale, the government of Ontario looks at the care a patient receives not as a series of isolated incidents, but as a continuous, interconnected path that may involve dozens of different health care practitioners and organizations, from a local family physician to large hospital institutions. Ensuring a seamless path for a patient is an incredibly challenging task involving staggering amounts of resources and often complex bureaucracies. That is why our provincial government created Local Health Integration Networks to determine the health service priorities of Ontario s different regions, and the recently unveiled Health Links, an innovative approach that brings together health care providers in a community to better and more quickly coordinate care for high-needs patients. As complicated as our health care system is, some of the complexity can be managed if we remember a very basic idea: when different health care providers work as a team to care for a patient, it results in a better coordinated patient journey through the health system, which leads to better care for patients. This is a simple concept that the OCA wholeheartedly endorses and promotes throughout our membership. We can all do our part as health care practitioners to ensure that the care we give our patients is not an isolated occurrence but part of a continuous journey that will involve other professionals and institutions.

7 10 ontario chiropractic association 2012/2013 annual report 11 The success of this concept can be found in the stories of patients like Janet Harrop, a nurse and proud farmer for over 27 years whose two professions left her with a number of musculoskeletal issues. Along her journey of care, a family physician referred her to a chiropractor who diagnosed a hiatal hernia and referred her to surgical specialists. After some important surgeries she now enjoys a significantly improved quality of life supported with therapies and exercises from her chiropractor. The power of teamwork can also be found in the inspiring story of Robert Buren, who was paralyzed from a mountain biking accident but is currently thriving as a paraplegic athlete, completing series of incredibly challenging marathons, triathlons and charity rides. Robert s health care team, including his chiropractor, registered massage therapists and family physician, work together to provide specialized care that enables him to follow his demanding exercise regimen and fulfill some extraordinary ambitions. What about the care that our aging population receives? These are often some of the most complex patients that a health professional can encounter. As our population ages, Canada s seniors and other health care professionals are increasingly recognizing the value of chiropractic care. After all, we specialize in the musculoskeletal infrastructure: the parts of the body that wear out or weaken, growing frailer each year. Eighty-year-old Helen Evans went to her family doctor for really bad pains in her lower back. X-rays suggested a fracture but a specialist could not find anything, and her family physician eventually suggested chiropractic treatment. Once it was confirmed that Evans did not have a fracture, her treatment progressed to gentle spinal mobilization exercises. These exercises and other therapies helped relieve the pain she was suffering, improved her mobility and helped reduce her reliance on pain medication to almost zero. These are just a handful of examples of how chiropractic can be a vital part of a patient s health care journey. There are many of these cases happening every day across the province, and it is the OCA s responsibility to tell these stories. Helen Evans and Robert Buren have both been profiled as part of our recent partnership with the Toronto Star. This partnership resulted in eight articles that help raise the profile of the profession and build awareness of how important chiropractic can be to Ontarians everywhere. We are also sharing these stories and much more through social media, connecting with important stakeholders such as Local Health Integration Networks on Twitter, and with the general public through our successful Your Back Health Facebook page and website. The OCA will continue to work with the government of Ontario to ensure that chiropractic is seen as an essential component of a patient s health care team. We will also continue to tell the story of chiropractic so that Ontarians everywhere can know that we are a profession that can help bring the care into health care. Dr. Natalia Lishchyna President Dr. Bob Haig Chief Executive Officer 86% 74% 78% 86% of Canadian physicians endorsed that chiropractors provide effective therapy for some musculoskeletal complaints. Source: Busse JW, Canga A, Riva JJ, Viggiani D, Dilauro M, Kapend PI, Harvey M-P, Pagé I, Moore A, Gauthier CA, Price DJ. Attitudes towards Chiropractic: A Survey of Canadian Physicians. 74% of Ontarians agreed it would be a better use of our health care dollars if chiropractors were used more in teams with physicians to manage back pain, neck pain and other muscle and joint pain. Source: Ontario Residents Attitude towards chiropractic integration, 2012, Environics. 78% of family physicians said they are open to using a roster of allied health care professionals with an expertise in low back pain care. Source: Physicians Attitude Toward Chiropractic Integration, 2012, Environics.

8 12 ontario chiropractic association 2012/2013 annual report 13 We re Here for Our Members The OCA responds to an average of over 1,000 member inquiries each month. These inquiries cover a wide range of questions and guide how the association structures its service offerings. This is how we re here for our members: Informing Members Over the last year the OCA has expanded the range of communications channels through which we inform our members about the work of the association and developments within the health care profession. Weekly bulletins focus on regulatory updates and practice-building tools. The new ON Chiropractic publication paints a broader picture of the future of the profession. Our LinkedIn group, member Facebook page and Town Hall meetings provide the opportunity for members to dialogue with each other and the association leadership. Knowledge Transfer Continuing education is an important endeavour for health care professionals. The OCA s works to provide members access to the latest chiropractic research through the Research Review Service and business strategies through partners like prolearning innovations. This fall the OCA invites members to go back to school with the launch of a robust new continuing education curriculum that will feature content from subject matter experts across a wide range of categories. 53% INCREASE IN OCA ADVANTAGE PARTNERSHIPS Partners in Business Development Each year the OCA adds to its roster of affinity partners. These partnerships are designed to help members operate more efficient and productive practices. In the past year the list of partners available to members has more than doubled. Some of these partners, such as electronic payment processing firm Elavon, are already saving members real money. Many others will be announced in the fall. OVER $62,000 IN MEMBER SAVINGS FROM SOFTWARE LICENSING CAP OUR EXTENDED HEALTH CARE TOOLKITS HAVE BEEN ACCESSED 2,400+ TIMES Powerful Tools Historically, the OCA has often developed tools to address specific member requests. PMP, our practice management software solution, is the best example of this trend. Use of ChiroWrite, the complimentary clinical notes software, increased last year by 15%. In the last year, new tools were developed to help members manage changes in both orthotics and acupuncture extended health claims processing policies.

9 14 ontario chiropractic association 2012/2013 annual report 15 Ground-Breaking Chiropractic Research Over the past five years, Phebe Appleton had been suffering from pain down her thighs and calves. That prevented her from walking her basset hound, Lucy, and standing for long periods of time, which cut into her joy of singing alto in her local choir. The pain got so bad that it could be relieved only by lying on the couch. I knew I was in trouble, recalls Appleton, 79, a resident of Niagara-on-the-Lake. I didn t want to end up in a wheelchair. A referral to Dr. Carlo Ammendolia at Mount Sinai Hospital resulted in a diagnosis of spinal stenosis, which she didn t know she had. He then prescribed specific back exercises that, according to Appleton, made her feel like a new person. Many spinal stenosis patients are finding relief from the condition s debilitating symptoms thanks to the boot camp approach, developed by Dr. Ammendolia, DC, PhD and his team. The program has been in the works for over three years and is showing promising results for patients who are living with pain and loss of independence. The boot camp aims to improve patient mobility and quality of life and potentially stave off surgery. Spinal stenosis is the narrowing of the spinal canal caused by the thickening of bones and ligaments in the spine, and the thinning of discs. The result is that nerves in the spine become compressed and patients experience tingling, numbness and pain down the legs. Over time, these symptoms can become debilitating. It is a disease of aging, Dr. Ammendolia notes, and with baby boomers now reaching their 60s, spinal stenosis cases are set to grow exponentially. Phebe Appleton Until now, there have been limited options for people suffering from spinal stenosis, which include surgery to open up the spinal canal to allow the nerves to be less impinged. The goal of the boot camp at Mount Sinai, which was launched almost three years ago, is to maximize mobility and decrease pain. Over the three years the Mount Sinai boot camp has been in operation, more than 80 patients with mild to moderate spinal stenosis have enrolled in the program. The vast majority who completed the program experienced significant improvement, Dr. Ammendolia reports. Some have been able to double or triple their walking distance and have less pain, improving their quality of life. The program has also helped them to avoid or delay surgery. That s certainly the case for Appleton. Now able to walk her dog for an hour at any given time, Appleton says, I feel as if I ve been liberated from the prison of pain.

10 16 ontario chiropractic association 2012/2013 annual report 17 Raising the Profile of the Profession Towards the end of the fiscal year, the OCA partnered with the Toronto Star for a series of eight paid articles that will help raise the profile of the profession and showcase examples of chiropractors playing an essential role in integrated health care in Ontario. The articles highlighted a variety of topics, including successful projects that integrate chiropractic into various health care settings, the importance of chiropractic to senior care, key research being undertaken by chiropractors and various lifestyle articles taken from our public education materials. OCA Television Advertisement The OCA continued to promote its television advertisement. The spot ran for seven weeks in early During its run, it appeared on five conventional Ontario networks and stations, and 13 specialty networks, delivering over 45 million impressions against a target audience of adults aged 35+. Public Relations Campaigns The OCA continued extensive media relations campaigns revolving around seasonal topics such as golfing, gardening and snow shovelling. A new campaign around proper luggage carrying was carried out in the early summer aimed at vacationers. These efforts resulted in over 50 million impressions and over 200 stories in publications such as the National Post, CTV, Global Television and many others. Your Back Health In 2013, the OCA launched a new online resource for consumers. Your Back Health is a website and Facebook group that informs the public about back health in all aspects of their lives, from home to work to fitness and more. The microsite yourback-health.com contains a number of lifestyle articles that are featured on the Facebook page facebook.com/yourbackhealth. The Facebook page has over 8,000 likes and a very robust community has coalesced around back health, fitness and lifestyle tips. This initiative is designed to build awareness of how important chiropractic can be to Ontarians everywhere. Members and stakeholders were encouraged to share the online articles through their own social media channels to help spread the message.

11 18 ontario chiropractic association 2012/2013 annual report 19 Chiropractic in a Hospital Setting Back complaints are very, very common, and the number of referrals that we were receiving for back-related problems is almost insurmountable, says Dr. Nigel Clements, an orthopaedic surgeon and Spine Specialist at the Trillium Health Partners Kingsway Financial Spine Centre located at the Queensway Health Centre. The Spine Centre is among the first of its kind in Canada, where orthopaedic surgeons, chiropractors, physiotherapists and neurosurgeons work as a team to identify the best course of treatment for patients. Dr. Clements, Medical Director of the centre, says, My skill set is really focused on doing surgery, and I would have to wade through a lot of consultations to decide whether someone needs surgery or not. That inhibits the people who do need surgery from seeing me the waiting list is lengthened and it puts people on a waiting list where they re really not receiving any recommendations about what treatment may be beneficial to them. Dr. David Dos Santos, Dr. Nigel Clements This triage approach is what makes the Spine Centre so unique. Instead of a one-time consultation with a surgeon, patients referred to the facility by their family physicians are seen by a team of doctors who work together to determine the best treatment plan. The chiropractor and advance practice physiotherapist have a minimum of five years of clinical experience, as well as months of hands-on training with the neurosurgeons. Dr. Dos Santos, a chiropractor who is part of the team at the Centre, finds the experience very illuminating. The basic training was already there. It was really being exposed to patients who may be surgical candidates, and trying to understand where the surgeons come from in terms of decision-making. Our training included a six-month shadowing of the surgeon, wherein we conversed with them and talked about certain cases. That was the advantage they got a sense of what we re capable of doing and I got a sense of what their criteria are before they determine that someone needs surgery. For Dr. Dos Santos, this kind of approach is the future of health care. I think it s critical going forward. The silos of care that we ve had in the past do not fit in the new world of health care. Look at Family Health Teams and Community Health Centres. The system is evolving towards interdisciplinary care. Every health care practitioner has a skill set it s about utilizing those skill sets for maximum benefit to the patient and the system.

12 20 ontario chiropractic association 2012/2013 annual report 21 The OCA and Ontario s Health Care System Sustaining and improving Ontario s health care system requires that we make the best use of resources. Although challenging, the health care system s pressures present a number of opportunities for change chiropractic collaboration in primary health care teams is one such change where demonstrable benefits exist for patients, physicians, the health care system and chiropractors. For many years now, the Ministry of Health and Long-Term Care has been working toward improving the system, with increasingly local, patient-centred solutions. Chiropractors are aiming to support these initiatives by working to identify how we can most effectively fit in the system at each step. In June 2010, the Excellent Care for All Act was passed into law, outlining that: 1. The patient is at the centre of the health care system 2. Decisions about patient care are based on the best evidence and standards 3. The health care system is focused on the quality of care and the best use of resources 4. The main goal of the health care system is to get better and better at what it does One way the Excellent Care for All Act is being implemented is through the Ministry s three-pronged Low Back Pain Strategy, in which the OCA has had an advisory role, and in which chiropractors are significantly involved. This initiative highlights the need to provide better care for these MSK patients. And importantly, the province has established Ontario s Action Plan for Health Care, and is utilizing pre-existing structures (e.g. the Local Health Integration Networks) to help bring about the goals of the Excellent Care for All Act. Ontario s Action Plan for Health Care The Ministry of Health and Long-Term Care s Action Plan for Health Care outlines three high-level aims to improve the health care provided to Ontarians. The OCA s strategic direction is aligned with and supportive of these aims, which include: 1. Support to become healthier: Chiropractors focus on prevention and ensuring that patients do not enter the chronic phase by delivering outcomebased treatment that is driven by patient education, guided exercise, lifestyle modification and a focus on a self-management approach. 2. Faster access and a stronger link to family health care: Given that currently, at least 11% of physician visits are for MSK-related conditions, having chiropractors integrated in the primary care sector, providing assessment, diagnosis and treatment for MSK patients, ensures that patients are more quickly directed to the appropriate care for their needs, freeing up valuable time for family physicians to treat other patients. 3. The right care, at the right time, in the right place: For patients with MSK conditions, receiving MSK conservative care including patient education, the prescription of therapeutic exercise, lifestyle modifications, strategies for self-management and where necessary manual therapy from an MSK specialist such as a chiropractor, can improve their chances of having acute conditions successfully treated before they evolve into chronic conditions. And for those patients whose conditions have entered the chronic phase, seeing an MSK provider can allow them to most effectively manage their condition and prevent it from worsening.

13 22 ontario chiropractic association 2012/2013 annual report 23 Government Relations/Advocacy Provincial On behalf of our members, the OCA advocates to the public, to insurers, to third-party payers such as WSIB and to government, including the Ministry of Health and Long-Term Care and the Ministry of Finance. One of the goals of OCA s government advocacy work is to create opportunities for chiropractic within the health care system in two key areas: 1. OCA is working with the Ministry to remove the barriers that limit chiropractors from being integrated into primary care through such entities as Family Health Teams, Community Health Centres and others. Including chiropractors in primary care environments will allow for the delivery of better integrated MSK patient-care models. 2. The Ontario government s low back pain strategy is an opportunity for chiropractors to take a leadership role in a key Ministry initiative, a step towards enhanced chiropractic integration and involvement in the province s health care system transformation. OCA is providing input into multiple elements of the province s Low Back Pain Strategy, including primary care. Regional In 2006 the Local Health Integration Networks (LHINs) were established based on the view that certain health services could be more effectively planned and funded at the local level. While the LHINs were initially mandated to focus on select services such as hospitals and long-term care homes, in 2012 it was announced that greater responsibility for primary care would be shifted to them. One way this is being expressed is through the province s new Health Links initiative, aiming at providing highly coordinated care for Ontario s most complex patients, in which the LHINs play a significant role. Over the past year, the OCA has sought to more actively work with the LHINs, in an effort to better support local health care planning and foster regional partnerships across the province. Among other things, this involved the identification and recruitment of 1-2 volunteer chiropractors in each region to serve as LHIN Liaisons, who act as the OCA s regional representative. The Liaisons are making great gains in working with key committees, collaborating with other health professionals, engaging with local Health Links, and educating a range of providers and health care planners on how chiropractors and other health professionals can work collaboratively on health system goals and providing patient-centred care. The OCA s Health Care System Advocacy Provincial Advocating and advising Ontario s government on new models of care Regional Engagement with regional health administrations such as LHINs Local Partners in primary care management of patients with MSK challenges Patient-Centred Care

14 24 ontario chiropractic association Community Outreach In addition to supporting member engagement with primary health care teams and developing structured collaborative models, the OCA provides tools, support and education to help our members in their efforts to cultivate structured referral networks with organizations such as FHT s and FHO s. This level of community support will also help position the profession to integrate with Health Links as they evolve. The OCA works hard to increase awareness of the profession across Ontario through its Community Outreach Program. This can include hosting a booth at a conference, speaking to physicians and other health providers, and participating in local activities and events. This year, the association was able to maintain the same level of involvement with its member volunteers participating in 170 outreach activities across the province. The association saw volunteer participation increase by 14% over last year, with 10% of those volunteers participating in more than three outreach activities and events. 170 COMMUNITY OUTREACH ACTIVITIES AND EVENTS, INCLUDING SPEAKING ENGAGEMENTS, TRADESHOWS AND CONFERENCES, AND LOCAL COMMUNITY EVENTS AND ACTIVITIES.

15 The Ontario Chiropractic Association Victoria Street, Toronto, Ontario M5C 2N or