Out of the box thinking keeps spine pain patients in mind

by Vincenzo d'Alto

by Laura Guzzo

Working together wasn’t high on the list of career goals for brothers Carlo and Paul Santaguida. The brothers’ paths were pretty divergent; Carlo pursued science to become a respected spinal neurosurgeon, while Paul was an accomplished MBA. Ironically though, Paul found himself in the healthcare field too, in hospital administration. It was their complementary skills that brought them together three years ago to create CareAxis, a nonprofit organization aiming to overhaul how the Canadian healthcare system manages back and neck pain.

As a spine specialist, Carlo was acutely aware of the long wait times for patients suffering from neck and back pain to get MRIs and to consult with specialists like him. When they did finally wind up in his office, they were often disappointed. “They wait all this time to see a specialist and they expect their whole life to be turned around only to find out that they don’t even need surgery,” he says.

Carlo knew most of these patients, particularly seniors, needed tailored physiotherapy but even if he recommended it to them, they often couldn’t afford it. The brothers say most family doctors aren’t trained to properly diagnose neck and back pain, so they often recommend an MRI or a consultation with a specialist. They also prescribe pain relief medication, often opioids, which can lead to an increased risk of addiction the longer the patient takes them.

So referrals to specialists pile up, wait times increase and patients continue to suffer. CareAxis wants to take a bite out of wait times and give patients faster relief by training physiotherapists to diagnose neck and back issues and recommend a course of action. Training is provided by specialists at the Montreal Neurological Institute, where Carlo is based. There are currently 13 clinics in Quebec that offer advanced physiotherapy services through CareAxis, with more to come this year.

Despite the small sample size, the benefits so far have been huge. “Most GP referrals to my office are correct about 15% of the time with regards to who actually needs surgery,” says Carlo. “Our physios are correct 93% of the time and have never missed a surgical patient.”

Paul adds, “With CareAxis, you can get a diagnosis quickly and can start managing your condition within days, and people who really need a surgeon get to see one more quickly. We’re averaging three weeks [to see a surgeon] through CareAxis now. The potential impact on patient wait times and outcomes, and on the costs to our healthcare system, are remarkable.” CareAxis offers its services at no cost to patients 65 years of age or older, thanks in part to funding from the Mirella and Lino Saputo Foundation.

Deciding to fund CareAxis was easy, says Gabriella Musacchio, advisor at the foundation and granddaughter of Mirella and Lino Saputo, since it tapped into the foundation’s core mission: seeing problems and trying to fund them towards a solution. “We’re always impressed with people who approach us with projects that are out of the box, try to solve an issue or try to make the system more efficient or better,” she says. “This prototype has the potential for a radical system change.”

The appeal of the CareAxis program also lay in its emphasis on the elderly, one of the Saputo foundation’s core target groups. By training physiotherapists in local clinics, they can help patients right in their own communities rather than send them downtown to the Montreal

Neurological Institute, which is often a challenge for elderly patients. The brothers hope to continue building CareAxis by adding more clinics to their ranks and eventually extending their services to cover other conditions. “Anywhere there’s a wait to see a specialist for musculoskeletal pain there’s an opportunity for the model so that surgeons can prioritize patients who truly need advanced diagnostics or surgery, and the others can get the care they need,” says Paul.