Under one roof

Convenience and integration are two words we hear a lot today.

Convenience and integration are two words we hear a lot today. There is an increasing trend in many areas of life – including health-care – to offer integrated services, easily accessible in one building. Some Canadian chiropractors are among those leading the charge.

Integrated health care is increasingly being embraced by many health-care practitioners for efficiency. Photo credit: Port Moody Integrated Health Advertisement

At this point in time, there are many different interpretations and models of integration. And it is early days. “How integrated health-care will evolve, where it’s going, is hard to say at this point,” notes British Columbia Chiropractic Association president Dr. Jay Robinson. “It’s about efficiency. True integrated care is more cost-effective, treating what needs to be treated, with virtually no duplication. We are only at the beginning right now, and some are embarking on this in a fantastic way.”

Dr. Robinson adds, “At its best, integrated health-care is treating patients with no bias with regard to the treatment they need to receive, and at its worst, it is the creation of an environment of upselling – pressure on patients to purchase more services or products. Will integrated health care be good for chiropractic over the next decade or in decades to come? Who knows. But it will be good for patients. It is the way of the future, and patients will win.”

“Working in an integrated setting is something that I envisioned way back in chiropractic school,” says Dr. Michael McCann, owner of Port Moody Integrated Health, in Port Moody, B.C. “In my mind, the reasons were obvious: to have like-minded professionals from different disciplines working together for the benefit of the patient under a single roof.”

In addition to chiropractic treatment, the clinic offers massage therapy, naturopathic medicine, custom orthotics and “holistic” counselling.

“I started this in 2001, after 10 years of practice,” Dr. McCann explains. “I bought a building and set it up to provide an environment and space that would care for both the patients and our team.”

Dr. Nikhil Bair-Patel – who owns Integrated Health Centre in Pembroke, Ont., with his wife and clinic director Rebecca Bair-Patel – has also long held a desire to offer integrated care.

“I always, from the start in 1992, had a small gym and was recommending good shoes and always had a focus on nutrition, but it was fragmented,” he notes. By 1997, he had added a nutrition store, and in 2011, the couple bought a building and had it gutted and rebuilt to create the present centre. The centre’s treatment clinic offers chiropractic, acupuncture, laser therapy, massage therapy, lifestyle/weight management, custom/semi-custom orthotics, gait analysis, body composition analysis and more. The centre also offers a nutrition store (including specialty foods and natural body care products), a fitness centre and a footwear division.

Integrated philosophy
Being able to truly integrate services begins with understanding what this concept really means.

“I have heard those from all sorts of health-care disciplines talk about how they are integrated practitioners, because they prescribe behaviours outside of their ‘normal’ script, but that is not integration to me,” says Dr. McCann. He says integration is not about how many tools you have in your box, but the awareness of how different stressors can manifest, and of how the treatment modalities required to bring the body, mind and spirit back into balance and create optimal health and function with that person.

Dr. McCann believes integrated care in a conservative setting is what health-care should aspire to – a patient-centric approach administered by a group of like-minded practitioners.

“The progression from dis-function to dis-ease is not ‘measurable’ until the disease state is reached or almost reached, and oftentimes patients are only motivated to take action when some crisis arises,” he notes. “In conservative health-care, money is often a factor for people. We are all competing for the discretionary spending of our patients, and they need the right information to decide how to achieve the best bang for their buck. Otherwise, their best bang is generally focused on the relief – instant, if possible – of their symptom, and rarely on their overall health. But overall health should be the focus.”

In terms of his development of integration, Dr. Bair-Patel was influenced early on by his post-graduate training in applied kinesiology.

“This philosophy of care integrates the best knowledge from chiropractic, medicine, dentistry, functional medicine and acupuncture to develop an integrated approach to the whole patient under the care of one person,” he explains. His approach enables patients to access a comprehensive set of services that weren’t as easily accessible previously. For example, Dr. Bair-Patel offers the largest laser therapy clinic in eastern Ontario, and its creation was based on the growing need for arthritis treatment options.

Dr. Bair-Patel says it was not a business model decision, but a care model decision, to create an integrated centre.

“If making the maximum amount of money was the goal, we would not have done this,” he states. “It was all about being able to provide the best care possible to the people here, and that is integrated care.”

The nuts and bolts
Dr. McCann wasn’t sure initially about what professionals he really wanted at his centre. “I left a couple of the rooms empty while I worked through that,” he says. “I was not willing to have a discipline that I don’t typically refer to, or have too much in the way of redundant care.”

Integrated Health Centre in Pembroke has always had a small gym and  has always focused on nutrition for patients.

He adds, “Twelve years later, I have learned that having a truly functioning integrated setting is really hard to accomplish. Just because there are lots of different professions under one roof doesn’t mean that the clinic is integrated. Integrated means just that, that there are differing disciplines, working together, using their skills and expertise and recognizing and appreciating that of their colleagues in the endless pursuit of what is best for the patient.

“In my mind, for an integrated setting to be truly effective, no matter which portal of entry a patient chooses, the practitioner in contact must look at the patient as a complete person, not just a list of symptoms. And once she or he has decided the problem is of a functional nature, steer the patient to the right discipline within the clinic.”

At Port Moody Integrated Health, new patients choose to book an appointment with a chiropractor, naturopathic doctor, massage therapist or counsellor. Port Moody Integrated Health has two chiropractors, four registered massage therapists and a naturopathic doctor.

During this initial visit, the practitioner engages in a discussion with the patient about the factors impacting the patient’s health, explains his/her approach and works with the patient to develop a wellness program, with discussion of how other practitioners/disciplines might support their program.

“Patients are asked why they chose to come to our clinic and what they know about our approach,” says Dr. McCann. “We ask them about their expectations, short-term and long-term.”

He adds, “When a patient is recognized as a candidate for an integrated approach and they follow through, we get to watch their lives change as a result of all they have done and the work of different disciplines, including family physicians and specialists. They shift their paradigms from looking at themselves as sick or broken, to ‘I’m getting better and I feel empowered and hopeful about my health.’ And that is truly health care.”

At the Integrated Health Centre in Pembroke, all new patients see one of the two chiropractors, the primary care providers who employ what they call “top-down” integrated care. That is, the chiropractor sees patients, evaluates them and treats them either directly or through delegation to others working under their direction.

On its website, Intergrated Health Centre outlines its mission and vision: to educate as an integral component of the healing process; maximize its clients’ health potential; provide a range of alternative health solutions; optimize opportunities for healing; work towards the ultimate goal of wellness; engage clients in preventive health care; and restore life’s balance.

“The role of the doctor is to assess, treat, plan and monitor the care while overseeing the team,” says Dr. Bair-Patel. “For example, if a client comes in with a disc herniation, they will receive chiropractic care for associated injuries, laser therapy for the disc herniation, nutrition counselling to speed healing, and eventually, once the pain is under control, they will be placed on an active rehabilitation program and given ergonomic modifications in order to minimize the risk of recurrence.” 

Integrating the four businesses under one roof, however, was not an easy task. “Integration doesn’t just happen because you move in together,” says Rebecca, the clinic director. “It takes work. At the start, we hashed out the vision, mission and values, why we’re here – to create a culture of health. It took some time for our care providers and employees (about 20) to build consensus and a sense of team.”

It’s taken about two years to get out of silos, she says, “but we are now where we want to be, and feel true to our name.”

They have ongoing quarterly meetings with all staff. The first three were all about developing the mission and vision, and nowadays, they are focused on team building, education and improvements.

“All the staff are knowledgeable about all areas,” says Rebecca. “Staff is everything, and we are very happy with our team. We encourage staff to take advantage of all that the centre has to offer.”

More and more patients are presenting to the centre, attracted to the broad-based approach and the ability to receive many services under one roof. “We continue to work on how to stay true to our values and grow at the same time,” she says. “We are looking for a physiotherapist, but we are figuring out how that role will integrate.”

Another area of ongoing growth is the footwear division. “So many people in the area still don’t know it’s there,” she notes.

Why Integrate?
From the website of Port Moody Integrated Health:
“Integrated medicine is not simply a synonym for complementary medicine. Complementary medicine refers to treatments that may be used as adjuncts to conventional treatment and are not usually taught in medical schools. Integrated medicine has a larger meaning and mission, its focus being on health and healing rather than disease and treatment. It views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment. It also involves patients and doctors working to maintain health by paying attention to lifestyle factors such as diet, exercise, quality of rest and sleep, and the nature of relationships.”
– Dr. David Wang, ND