Improving Primary Care, Spine Specialist Relationships

To ensure the best treatment for patients requires providers in different specialties and practices to work collaboratively. But the level of collaboration needed to ensure optimal patient outcomes requires all provider participants throughout a patient's continuum of care to put in the time and effort to make the partnership between divergent specialty practices and physicians efficient and beneficial for all parties involved, especially the patients.

Coordination of care between primary-care physicians (PCPs) and spine specialists is of paramount importance. A close collaboration of the triage, diagnostic workup, treatment paradigm, and post-care follow up between these providers is critical. If they do not work well together, patients may not receive the care they need in a timely manner, impacting the optimal outcome for treatment.

Here are four ways PCPs can collaborate with spine specialists.

1. Learn when to refer.
The most important component of PCPs working well with spine specialists is a timely referral for care. This is an educational process for both physicians and their practices. The conservative care pathway should be analyzed and discussed by both physicians to identify the entry points or treatment failures that should lead to a referral to a spine specialist. Sending patients prematurely isn't optimal, nor is sending them late.

PCPs and spine specialists should be collaborating through the process of diagnosis to treatment of a patient to optimize coordination of services and, more importantly, expected outcomes from care. A mutually agreed up triage process allows the PCP to comfortably know when to - and not to - refer the patient.

PCPs should come away from these discussions with a clear understanding of when in the treatment process they should send patients to see a spine specialist. The parameters should address all types of patients and scenarios a PCP is likely to face, such as patients with a chronic condition or failed back surgery, or individuals suffering from neurologic pain and radiculopathy.

Note: An important part of the collaboration between PCPs and spine specialists should address who will be tasked with managing medications following treatment and the identification of next steps in the algorithm for care when failure to achieve benefits from any treatment, including medication, occurs.

2. Communicate to improve care coordination and patient outcomes.
When a PCP screens patients and determines they need a spine consult, oftentimes the PCP will fill out a referral form and send patients on their way. But if a PCP and spine specialist only communicate through documentation, there may be missed opportunities to improve patient outcomes.

Diagnostic, pre-consult, pre-operative treatment planning, clearance for surgery, as well as patient expectations are better managed through a collaborative dialogue between the PCP and the spine specialist. A review of the patient's history, therapies tried to date, diagnostic studies and current findings are of paramount importance in treatment planning and must be an ongoing process between these two specialties to ultimately reduce treatment failure. In addition, non-procedural issues that will need to be addressed by both the PCP and surgeon either before or after surgery must be part of the paradigm for optimal care coordination.

3. Develop an efficient, comprehensive workup package.
It is a common practice for PCPs to order diagnostic tests and have consults with secondary specialists prior to referring a patient to a spine specialist. When it becomes time for the referral, PCPs will want to make sure their patients' records includes the results of all tests already performed and information provided by the specialists. Spine specialists also have their pre-established workup protocols for new patients. The entire process is significantly improved by mutual discussion and agreement regarding the screening of patients from diagnosis to discharge to avoid duplication of services and tests.

By PCPs and spine specialists working together to develop this plan, PCPs will be able to advise patients on the treatment pathway and what diagnostic work to expect.

4. Receive education post-treatment.
The interaction and teamwork between the PCP and a spine specialist is an ongoing process. Regular communication and follow up should be established at preset intervals post care.

It is important for PCPs to not only know when spine specialists will send the patient back but also what is needed in the protocol post-treatment process for patients to maximize the care they have received; when reassessment should occur; what education patients' families should receive; and what developments should trigger the PCPs sending patients back to the specialists.

These coordination efforts will help further create a team approach for care, which is ultimately a win-win-win for PCPs, spine specialists and patients.

Marcy T. Rogers, M.Ed.,is president and CEO of SpineMark Corp., with more than 30 years experience in developing specialty centers of excellence in niche surgical fields like craniofacial surgery, neurosurgery, orthopedic surgery, interventional pain and spine. E-mail her here.