Grant: Fellowship Award - Primary Care

Over 4 million Canadian consult 6000 chiropractors each year for back and neck problems. While x-rays are often prescribed for these complaints, research indicates that routine x-rays of the spine are unnecessary during the initial evaluation unless specific signs and symptoms are present. Inappropriate use of spine x-rays in primary care settings has a number of potential adverse outcomes, including incorrect diagnosis, poor management, unnecessary radiation exposure to patients, increased waiting time, and poor utilization of resources. A more conservative approach to the diagnostic evaluation is therefore advisable, both from a health risk perspective and from a resource control perspective. This research project will develop a quality Knowledge Translation intervention to improve on the appropriate use of x-rays for patients with back and neck problems presenting to chiropractors. In collaboration with the "American Specialty Health Network", a health maintenance organization, we will first describe the baseline use of x-rays among chiropractors and estimate the impacts of the initial release of a diagnostic imaging guideline for adult spine disorders. We will then assess factors likely to influence the use of the guideline for patients with common conditions of the spine. A tailored intervention to address barriers to utilization (ex. lack of knowledge, lack of control over patient demands for x-rays) will be developed in collaboration with the group of clinical leaders and pilot-tested in one US state. This project will contribute to the development of new knowledge on the evaluation of spine disorders by chiropractors and on how research can be moved into action.