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The beginning of a brand new century brings tremendous change. Nowhere is this more evident than in healthcare. The past decade has seen significant change in technology, patient care, and chiropractic itself. There has been explosive growth in the biomedical sciences, major change in the way healthcare is delivered, and significant developments in information technology. As the healthcare system continues to evolve, the Los Angeles College of Chiropractic (LACC) must adapt to provide the best chiropractic physician possible for the new millennium (see note). Although LACC has long been an innovator in chiropractic education, the last substantive change in the curriculum occurred with the implementation of the ADVANTAGE program during the fall of 1990. This program involved significant shifts in pedagogy, particularly in how information is generated and disseminated in the classroom.
With nearly 10 years of experience with this program, and in preparation for the coming century, the time has come to review what we teach. As the curriculum is reshaped, the following traits should be emphasized:
primary care
person/patient-centered care
evidence-based care
health-oriented/wellness care
This article attempts to articulate a practice model for the chiropractice physicians at LACC that will lead them into the next century.
PRIMARY CARE.
Primary care is defined as the provision of integrated, accessible health services by clinicians who are accountable for addressing a large majority of healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community.
One of the primary components of the LACC Practice Model is to define clearly the chiropractic physician's role in the healthcare system. Currently, chiropractic physicians are licensed as direct contact, portal-of-entry healthcare providers, which requires them to be able to assess the general health status and most health complaints and problems in patients of all ages and both sexes. This assessment should produce an accurate diagnosis and/or reasonable clinical impression. As part of this process, chiropractic physicians must triage patients into one of the following categories:
* Individuals with uncomplicated conditions who are directly amenable to chiropractic care without the necessity of medical intervention and/or any form of collaborative care. Although many patients in this category are likely to suffer from a range of conditions affecting the neuromusculoskeletal (locomotor) system, it is important to emphasize...