Integrative Chiropractic Services in VA: A Pilot Study (VICCS)

Despite its increasing prominence and acceptance, the chiropractic profession has functioned outside of mainstream medicine for most of its history. Chiropractic training, research and clinical services have not commonly been incorporated within hospital settings. Nevertheless, chiropractic care, which is the largest CAM service, is increasingly viewed as mainstream and increasingly integrated into traditional healthcare, and thus sits at the confluence of mainstream medicine and CAM. The US Department of Veterans Affairs (VA) introduced chiropractic services into its healthcare delivery system in 2004. Before this directive, chiropractic was available only as an off-site (fee-for-service) clinical service. In 2001, the Department of Veterans Affairs Health Care Programs Enhancement Act required the VA to provide chiropractic services at a minimum of one facility in each of its regions (i.e., Veterans Integrated Service Networks (VISNs)). To comply with this law, VA-Directive-2004-035 was issued in July 2004, establishing the provision of on-site chiropractic services within the VA healthcare system. By directive, all patients seen in VA chiropractic clinics are referred by medical providers. Thus, the delivery of chiropractic services within VA is likely to be substantially different from that seen in private practice settings. This session discusses the emphasis on integrated care implemented in the VA (i.e. integrative chiropractic services) for veterans returning from ongoing operations in Afghanistan and Iraq (i.e., VA's Post-Deployment Integrated-Care Initiative) as well as a national palliative care program (Comprehensive End-of-Life Care Initiative), and is modifying current care delivery arrangements as part of an ongoing primary care-mental health care integration initiative.