• Murphy DR
• Justice B
• Bise CG
• Timko M
• Stevans JM
• Schneider MJ

• Affiliation / Brown University. Alpert Medical School. Department of Family Medicine
• Affiliation / Excellus BlueCross BlueShield
• Affiliation / University of Pittsburgh. School of Health and Rehabilitation Sciences. Department of Physical Therapy
• Affiliation(G) / United States / New York / Rochester
• Affiliation(G) / United States / Pennsylvania / Pittsburgh
• Affiliation(G) / United States / Rhode Island / Cranston
• Chiropractic / North America
• Chiropractic / United States
• Health Care Reform
• Health Policy
• Low Back Pain
• Neck Pain
• Open Access Document
• Physical Therapy Modalities
• Primary Care
• Spine

Background: In an article published in 2011, we discussed the need for a new role in health care systems, referred to as the Primary Spine Practitioner (PSP). The PSP model was proposed to help bring order to the chaotic nature of spine care. Over the past decade, several efforts have applied the concepts presented in that article. The purpose of the present article is to discuss the ongoing need for the PSP role in health care systems, present persistent barriers, report several examples of the model in action, and propose future strategies.

Main body: The management of spine related disorders, defined here as various disorders related to the spine that produce axial pain, radiculopathy and other related symptoms, has received significant international attention due to the high costs and relatively poor outcomes in spine care. The PSP model seeks to bring increased efficiency, effectiveness and value. The barriers to the implementation of this model have been significant, and responses to these barriers are discussed. Several examples of PSP integration are presented, including clinic systems in primary care and hospital environments, underserved areas around the world and a program designed to reduce surgical waiting lists. Future strategies are proposed for overcoming the continuing barriers to PSP implementation in health care systems more broadly.

Conclusion: Significant progress has been made toward integrating the PSP role into health care systems over the past 10 years. However, much work remains. This requires substantial effort on the part of those involved in the development and implementation of the PSP model, in addition to support from various stakeholders who will benefit from the proposed improvements in spine care.

Author keywords: Low back pain - Neck pain - Health care reform - Primary care - Health policy - Spine - Physical therapy - Physiotherapy - Chiropractic - Implementation science

Author affiliations: DRM: Department of Family Medicine, Alpert Medical School of Brown University, Cranston, RI, USA; BJ: Excellus BlueCross BlueShield, Rochester, NY, USA; CGB, MT, JMS, MJS: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.

Corresponding author: Michael J. Schneider: mjs5@pitt.edu

This abstract is reproduced with the permission of the publisher; click on the above link for free full text.  Online access only. PubMed Record