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Greetings and Salutations!

February 24, 2014
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No doubt by now you have heard your friends, colleagues and various others talk about the evidence-based practice movement. You have heard them tell you it is not all about scientific research, that it incorporates clinical expertise as well as patient values, but it may not be immediately clear to you what that really means. Let us ask you a question: when you are confronted with a patient where, for once, you are not sure about how you should proceed, what do you do? You have some options; you can call a colleague, you can google the web, or you can use a more sophisticated search engine such as pubmed to locate a piece of evidence that might be of help. Our goal in this blog is to provide you, the reader and practitioner, with answers to your clinical questions, using that same strategy to find possible answers. To use the vernacular, you ask, we tell. We’ll select the best questions you send in, and we will post answers to you that are based on good science, strong evidence and exceptional clinical expertise. We hope you will use this blog and we look forward to receiving your questions.

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8 Responses to “ Greetings and Salutations! ”

  1. Craig Benton, D.C. on March 7, 2014 at 8:07 pm

    What is the best way to approach primary care providers about evidenced based chiropractic? All I see them doing is opioid prescriptions inappropriate MRI and epidural steroid injections. Seems patients still aren’t much better. Also why don’t private insurers require more evidenced based practices with back and neck pain. Surely they are looking to cut costs and improve outcomes.

    • Christine Goertz on March 11, 2014 at 2:42 pm

      You are asking some really good questions. I am working on a fact sheet right now to help facilliate dialog with primary care providers and insurers. I plan to post it on this site by the end of the month, with a link so that you can download a PDF version. In the meantime, you might be interested in reading an article published last year in Medical Care. It showed that a nationally representative sample of people with neck and back problems had slighly lower health care expenditures if they had chiropractic care (1). Payers are looking at ways to cut costs and improve outcomes and this is the kind of data we need to give them.

      Reference
      1 Martin BI, Gerkovich MM, Deyo RA, Sherman KJ, Cherkin DC, Lind BK, Goertz CM, Lafferty WE. The association of complementary and alternative medicine use and health care expenditures for back and neck problems. Med Care. 2012;50(12):1029-36

  2. Evon Barvinchack on March 9, 2014 at 10:25 pm

    It has been my ecpierence that
    FP, GP, Neuro, Ortho, etc. have to abibe bt the house rules.Who funds the most monies? That is who rules the game. Drug companys., prosetic
    develpers etc. 0

    • Christine Goertz on March 11, 2014 at 2:31 pm

      You are correct that this is often the case. However, the health care delivery environment is rapidly changing to one in which data ultimately rules. It provides the chiropractic profession with a much more level playing field than we have had in the past. A goal of this blog is to make sure that as many doctors of chiropractic as possible (and our patients) understand what the data says, and know how to use that data to deliver the best patient care possible, AND to work with policy makers to ensure that patients have access to that care.

  3. Arf_Bark_n_Woof on March 11, 2014 at 3:27 am

    Ahhh….what a refreshing breeze, to hear reasoned discourse about an otherwise tense topic. I feel relieved to know Dana is at the helm, teaching our variation on EBM at ye olde PCC.

    Looking forwards to more from this team.

    Bravo!

    • Dana Lawrence on March 11, 2014 at 1:56 pm

      Many thanks to Dr. Painter for his kind words.
      Dana

  4. Craig Benton on March 31, 2014 at 9:11 pm

    I have one more questions? Can you comment on critics of chiropractic using the Cochrane Review stating SMT is only good for chronic pain and no better than any other treatment. That does not seem to be the case with the research that I am reading.

    http://www.ncbi.nlm.nih.gov/pubmed/20393942

    http://www.ncbi.nlm.nih.gov/pubmed/21328304

    Thank you

    • Dana Lawrence on April 1, 2014 at 2:17 pm

      Hi, Dr. Benton: Without knowing the specific criticisms being lodged against our profession, what I can say is that Cochrane reviews, as elegant and as rigorous as they are, can sometimes have a question that is very narrow and hard to generalize to larger audiences. It is the nature of methodology Cochrane uses, relying on clinical trials seen to be of high quality. One issue that comes up in assessing Cochrame reviews of manipulation is to understand that there are questions in the various assessment instruments which rate quality of clinical trials that we (that is, chiropractic researchers) conduct; we cannot blind our patients to the treatment they receive, nor can we blind doctors to the treatment they give. It is something to keep in mind.

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