Patient-centred outcomes of a community chiropractic clinic serving disadvantaged people
Creators: name: MARTHICK-HONE, Dan
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 420801
subject: Chiropractic

description: Introduction: Patient-centred outcomes have been studied for several decades through the use of patient-reported outcome measures (PROMs) for a number of different conditions and therapies, including chiropractic. Yet investigation into patient-centred outcomes of those living with disadvantage and how these outcomes may differ to the general population is lacking. This is likely due to chiropractic being a mostly privatised service within Australia, with those experiencing disadvantage typically not having access to this type of care due to financial barriers. However, some universities within Australia offer outreach clinics where students can offer their services to those living with disadvantage.<br><br>
Aim: A mixed-methods observational study was used to investigate the patient-centred outcomes of clients attending a community student chiropractic clinic and how this setting may influence the patient-centred outcomes of the clients attending.<br><br>
Methods: Three PROMs were chosen to investigate these outcomes. They were the Measure Yourself Medical Outcome Profile (MYMOP), the European Five Domain Five Level Quality of Life Questionnaire (EQ-5D-5L) and the Patient Enablement Instrument (PEI). These measures were completed by clients attending the community clinic for chiropractic care. Paired sample t-tests were used to compare baseline and follow-up scores for normally distributed data and Wilcoxon signed-rank tests were used where data were not normally distributed. Semi-structured interviews were also conducted with clients receiving chiropractic care, the chiropractic students, their clinical supervisors and the staff that assist in running the clinic. These interviews were conducted so that those involved in the clinic could offer insight as to what outcomes were important to patients and what may have influenced those outcomes. Interview data were analysed using thematic analysis and codes and themes were formed using Bronfenbrenner's ecological systems theory.<br><br>
Results: A total of 37 participants were recruited at baseline and 17 at follow-up. 71.97% of participants nominated their primary complaint to be chronic. Health and wellbeing scores for the EQ-5D-5L 100-point visual analogue scale (EQVAS) were significantly lower than those reported in the population normative data for South Australia. Significant change was noted in general health and wellbeing for the MYMOP, pain and disability for the EQ-5D-5L and index scores for the EQ-5D-5L, indicating improved health and wellbeing. Greater than 50% of all participants experienced higher levels of enablement as a result of attending the clinic according to findings from the PEI. A total of 12 participants agreed to be interviewed. Five themes were developed from the interview data. Those themes were 1) A Patient-Centred Approach for Clients at The Wellington, 2) Clients are Complex, 3) Trust, 4) The Cost of Being Disadvantaged and 5) Looking to the Future. A pattern emerging from these themes was that clients often related their lived experience to their health problems. It was suggested that these clients experience significant disability as a result of their conditions and that attending this clinic offered benefits beyond that of the improvement of pain and disability.<br><br>
Conclusion: Those living with disadvantage suffer from higher rates of chronic conditions and multimorbidities. Little work has been done to investigate how this cohort experience patient-centred care and what their outcomes might be. This study showed that as a result of a short course of treatment clients experienced better levels of health and wellbeing and decreased levels of pain and disability. Interview data suggest that this may be due to a combination of therapy, setting and relationships formed within that setting. These findings indicate that those who experience disadvantage may receive significant benefit by attending community centres that offer chiropractic care, suggesting that services such as these should be made more widely available to those less fortunate.