Chiropractic is the first complementary or alternative health care practice to become an integral part of the Arkansas Community Health Centers. Marilyn Gaston,MD, director of the Bureau of Primary Health Care in Washington, D.C., stated in 1998, "Like the rest of the world, we are getting more involved in complementary medicine and alternative health care practices. We think it is not only the right thing to do, but the smart thing to do."
Dr. Gaston's statement opened the doors for community health centers to add complementary care. In 1999, in Augusta, Arkansas, the White River Rural Health Centers, Inc., (WRRHC) took the first step in this state to include chiropractic services in the Kensett Family Medical Center, one of 13 centers it operates. WRRHC is private and nonprofit, with a mission to meet the primary health care needs of all residents of the service area, and educational and preventive services. It also works with other agencies in the area to give the highest quality service to patients. The center is affiliated with Baptist Health, the largest health care provider in the state, which has also been very supportive of this new venture.
Being a community health care facility means that we see patients who are uninsured or underinsured, regardless of their ability to pay. Our center prides itself on serving all citizens. Our minimum sliding-scale fee is $10 for most services, but we also accept private insurance, Medicare, and Medicaid.
We have 18 medical physicians, four dentists, three advanced nurse practitioners, and one chiropractic physician. Our clinics cover seven counties. WRRHC has a 15-member board of directors representing the 15 communities covered. An executive director and management staff operate the corporation. I practice three days a week in Kensett, at the Kensett Family Medical Center, and two days in McCrory at the McCrory Chiropractic Clinic. To illustrate how this arrangement works, I will describe the Kensett Family Medical Center, located about 50 miles north of Little Rock in Kensett (population: 1,700).
Our patients have their choice of the type of care they receive at the clinic. We offer physical health care services from a medical doctor, nurse practitioner, and chiropractor; and mental health care services from a psychiatrist, child psychologist, and other mental health professionals. All providers are under one roof. The clinic has about 400 patient visits a week, and continues to grow. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredits all of our clinics. Every three years, we have an extensive review to make sure we are in compliance with federal and JACHO regulations. All of our providers are required to use the SOAP format for progress notes, and share the common medical record. This is important in treating the patient as a whole and providing a seamless system of care.1
M.K. Brand notes: "Rural health professionals who function as part of an interdisciplinary team better utilize their colleagues and resources, resulting in the provision of coordinated cost-effective patient care. In addition, improved collaboration between rural providers may improve the quality of patient services in rural communities."2
Here is an example of how the staff at our clinic works together: I had a female patient, 25, who presented with migraine headaches. She had been to several neurologists with little help. She was taking so much pain medication that her daily functions were impaired, and her quality of life was poor. She responded well to chiropractic care, and followed up with our medical doctors for occasional pain relief. We see her now on an "as-needed" basis, or once a month.
The medical doctors in our clinics wanted an option other than narcotics for patients in chronic pain or the occasional drug-seekers, so I accepted referrals from our medical doctors for patients with problems other than musculoskeletal disorders. WRRHC applies for a federal grant every year. Our grants are not specifically for chiropractic care, but are given for operational costs, which include chiropractic care. Our staff of interdisciplinary professionals has agreed that the integration of chiropractic into the clinic is useful for reducing pain and restoring function, but also as preventive care that improves the quality of life for our patients. I believe our model could be readily implemented for the benefit of patients throughout the U.S.
Note: On April 29, Ray Miller Cockrill, of Searcy, Arkansas passed on. He was the executive director of the White River Rural Health Center; chairman of the board of Community Health Centers of Arkansas, the Southwest Primary Care Association, and White River Regional Housing Authority, Inc.; and a board member for the National Association of Community Health Centers and the Central Arkansas Radiation Therapy Institute.
He was a retired Major in the Arkansas Army National Guard, and a graduate of Ouachita Baptist University. His passing leaves a legacy of bridge building with the medical community, and I was proud to have worked with him.)
References
- Evans R. Multidisciplinary and interdisciplinary approaches to practice. Proceedings of the American Public Health Association's 129th Annual Meeting, Atlanta GA, October 2001.
- Brand MK. Nurses are key members of rural interdisciplinary teams. Am Nurse 1993;25:7-9.
- Hawk C, Nyiendo J, Lawrence D, Killinger L. The role of chiropractors in the delivery of interdisciplinary health care in rural areas. J Manipulative Physiol Ther 1996;19:82-91.
Russell Evans,DC
Kensett, Arkansas