Supporting patients who want to improve their overall health is an important role that doctors of chiropractic play. In a new six-module (with 6 CE) Learn ACA on-demand course, “Implementing Health Promotion and Motivational Interviewing in Your Chiropractic Practice,” presenters Robert Leach, DC, MS, FICC, MCHES, and Will Evans, DC, PhD, MCHES, FICC, share concepts integral to health promotion: health behavior theory, communication theory, motivational interviewing, assessing behavioral needs, implementing health promotion, and wellness promotion in the practice and community. Below, ACA Blogs learns more:
Early on in the webinar, you address using terms such as “health and wellness” appropriately. Why?
Dr. Leach & Dr. Evans: “Health and wellness” is a phrase that has often been misused to mean anything from giving monthly chiropractic maintenance care to selling protein shakes. In contrast, a true health and wellness practice would screen for health-related problems and provide services and/or referrals as indicated, ranging from dietary suggestions for overweight/obesity, to counseling for depression and suicidal ideation, to smoking/alcohol/drug dependency intervention and advice on physical activity.
Are most DCs providing health and wellness promotion as part of their care?
Dr. Leach & Dr. Evans: Based on survey research it is fair to say that most DCs provide some health and wellness promotion for some of their patients. Barriers probably include failure to perceive added value to practice and clinical outcomes, lack of knowledge about health and wellness resources and pathways to coordination of care with local integrative care partners and stakeholders, and perhaps time and staffing constraints. Some may not feel their patient wants this information from them or that they don’t have the skills necessary to be effective in this space.
When do you know it’s the right time to bring up health promotion with patients?
Dr. Leach: In my practice, we wait until a progress evaluation after initial gains in care have been achieved. We ask the patient if there is any other aspect of their health they would like to make gains in and go from there.
Dr. Evans: For patients who are regular users of chiropractic care, and have a unique rapport with the doctor, information on overall health and well-being can often be provided at those “routine visits” when they are not as likely to be in pain and are more receptive to a message.
For DCs who do not do their own screening, you mention looking at patients’ primary care doctors’ test results. Is it common for PCPs to share this information?
Dr. Leach: All patients have the right to review their own medical records, whether they are held by their PCP or their chiropractor. Once lab and other results are obtained by the patient or chiropractor, they can be reviewed together to help determine potential gaps in health and wellness care.
Dr. Evans: We have found that most primary care physicians are happy to know that the DC is also encouraging the patient to take steps to gain better overall health and well-being. It may even increase cross-referrals from the PCP.
How does motivational interviewing go beyond taking a routine history?
Dr. Leach & Dr. Evans: Rather than passively reviewing the patient’s history, motivational interviewing is a method to dialogue with, and work with the patient to gradually encourage them to take a step towards new behaviors. When it is most effective, it is the patient who will voice the need to adopt more healthy behaviors and that is a positive reinforcement when they give voice to this need vs. having the doctor tell them they need to change. In addition, failures are then viewed as attempts by the patient at improving their own health to be celebrated and as learning experiences and non-judgmental encouragement can be offered to help them get back on track or stay the course.
Is health promotion, when provided by a doctor of chiropractic, covered by health insurance?
Dr. Leach & Dr. Evans: Most insurances at present probably do not include coverage for stand-alone health and wellness counseling although new CPT codes have been introduced with hopes of future coverage. That said, introducing the topic during a scheduled progress examination is both appropriate and the additional time spent is billable, since coaching for almost any secondary or tertiary prevention would likely impact spine health and outcomes for which the carrier is providing coverage. However, for plans that cover these services for other providers, when documented, the DC is typically eligible for reimbursement when those CPT codes are justified by the patient record.
Are there tools that can help a chiropractor learn more about their patients’ overall health and develop strategies to improve it?
Dr. Leach & Dr. Evans: Our course provides a brief introduction to the many techniques, questionnaires, and instruments that are advocated by health and wellness professionals to improve the patient’s overall health. We offer an array of resources for follow-up study and use, some of which can be implemented in the practice Monday morning. We try to keep it simple and allow the clinician to develop their own strategies and networks to aid in patient wellness.
Emotional health is integral to overall wellness. What about referring for mental health services? Is that something you touch on in the webinar?
Dr. Leach & Dr. Evans: Emotional health is certainly important for overall wellness, it is a critical component of good spine care, and assessment of “fear avoidance,” anxiety and depression, for example, are advocated by numerous spine treatment guidelines. We review and provide resources for understanding and making mental health referrals in our webinar.
What practical knowledge or skills can attendees expect to take away from your presentation?
Dr. Leach & Dr. Evans: More than anything, we hope attendees will begin to see health and wellness as an integral part of chiropractic practice and work with their patients over time to improve overall health and well-being. Also, that they will make referrals to local integrative care partners and providers as a key component of their practices as opposed to an “add on” or use “gimmicks” to boost visits or incomes. When chiropractors place their patients’ total health and wellness into focus, they may achieve not only longer lasting improvements in spine health but also reduce the burden of activities-of-daily-living (ADL) disability and premature degenerative disease-related mortality among their patients.
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To register for “Implementing Health Promotion and Motivational Interviewing in Your Chiropractic Practice” click here.
