A Family Legacy and Scientific Pursuit: A Chiropractor鈥檚 Journey into Research
Even before I started studying chiropractic at the AECC University College鈥, I knew that I wanted to become involved in research to help promote the chiropractic profession and the great outcomes that it can achieve for our patients. I had become well immersed into the profession through the experience and stories of chiropractic through my late father, Bryon Sanders, who practiced in his own clinic in Nottingham for nearly 20 years. What surprised me the most is that the chiropractic profession, at least in the UK, is not well-recognised and we do not appear to have a high degree of professional legitimacy, despite the extent and breadth of academic learning that is required to become a chiropractor.
This realisation drove me to undertake a CRC-funded PhD at the Faculty of Medicine at University of Southampton, of which I have now completed the first year. I joined a team of MSK researchers, including my PhD supervisors; CRC funded Research Fellows, Professor Dave Newell and Dr Jonathan Field, Dr Jane Vennik 鈥 an experienced qualitative researcher in Primary Care in the School of Medicine, and chiropractor Dr Neil Osborne, who has a rich background of experience in different types of collaboration including the setup of chiropractic services within NHS GP clinics in Bournemouth. My PhD is in Primary Care and Population Sciences, and my research topic is on the integration and collaboration of chiropractors with and within healthcare systems, with a specific focus on UK chiropractors.
Exploring the Spectrum of Integration: A Chiropractic Perspective
Integration can be defined in many ways depending on its context; therefore, it is better to see integration as a spectrum of working relationships from simple behaviours, such as referring patients via clinical letters to other healthcare professionals all the way to full immersion within a healthcare system via employment and the associated roles and scopes of practice that define those roles. Some research in this area has been published, however the reasons as to why integration is successful or not has not been clearly defined to inform how integration may occur, let alone the ways in which the UK chiropractic profession would like to integrate with the NHS.
I feel that, as a profession, whilst we would not want integration in a form of a 鈥榖org-like鈥 assimilation where we potentially lose our professional identity and skills by merging with a healthcare system, we may benefit from known and unknown opportunities by working within or align with the NHS. As well as obvious benefits to improvement of patient care through increased access to chiropractic care, there are also intraprofessional opportunities associated with integration, for example, expansion of current career pathways and roles for existing and new UK graduates. Integration can help to create new ways and structures of working, as already seen in healthcare systems in other countries, such as the well-respected employed roles in the US Veterans Health Administration, and chiropractors working in novel roles such as in radiology departments within Danish hospitals. My work will help to highlight the breadth of options of integration by giving model examples from the data I gather from different healthcare systems throughout the world.
鈥淚ntegration can be defined in many ways depending on its context; therefore, it is better to see integration as a spectrum of working relationships鈥
Unveiling the Keys to Integration: A Chiropractor鈥檚 Research Approach
I am currently in the process of conducting a systematic review using realist methodology to explore and describe current integrated care services that involve chiropractors in different international settings and contexts, more specifically the barriers and facilitators to integration. Realist methodology can be more useful than that adopted by a traditional systematic review which simply asks, 鈥榃hat works?鈥; instead, realist methods are more pragmatic as they ask, 鈥榃hat works, for whom, in what circumstances and why?鈥. This method will help to discover transposable lessons from similar healthcare contexts that we can use for the NHS in the future, with the aim to avoid repeating strategies that have already been shown not to work and to build upon existing strategies that sustain integration.
As part of this review, I undertaking short, informal chats with chiropractors who have previously or are currently working with or within the NHS during any time from the 1990鈥檚 onwards, to map these UK barriers and facilitators. The data from these informal chats will help to verify the accuracy of potential UK chiropractic integration models to help guide types of integration that we would like to be available in the future.
In the latter parts of my PhD, I intend to conduct short interviews with UK chiropractors to find out what we think about integration and what forms of integration would be most useful to us (2022), and based on this data conduct a national survey of UK chiropractors to be inclusive of as many diverse views about UK integration as possible (2023). The results from these studies will be published to help build a foundation of data upon which we can use to inform the direction we can take next as a profession towards integration.
[CALL TO ACTION BUTTON: Read more about chiropractic鈥檚 role in UK healthcare [LINK TO KH ARTICLE: How private practice can help support the Government鈥檚 Healthy Life Expectancy 2035 plan]