When sorted by the average cost per episode, chiropractic is more cost-effective than anesthesiology; neurosurgery; neurology; registered physical therapy; orthopedic reconstructive surgery; physical medicine and rehabilitation; and rheumatology. The majority of chiropractic charges were associated with the basic office-treatment-related services performed. Eighty-nine percent of the chiropractic charges were for services related to the treatment, while only 45 percent of the family practice costs were related to treatment of the condition. The remainder of the costs were for expensive diagnostics. For each 100 episodes, the chiropractor provided 265 modalities. For each 100 episodes, the registered physical therapist provided 885 modalities: over three times as many units of physical therapy provided by RPTs than chiropractors. This is a cost that has to be globally charged to the family practice providers, since patients cannot access RPTs without a referral from a medical doctor.
Although work is in progress to control for possible variations in case mix and to compare outcomes in addition to costs, these preliminary results suggest a significant cost-saving potential for users of chiropractic care. The results also suggest the need to reexamine insurance practices and programs that restrict chiropractic coverage relative to medical coverage.
Coulter et al. studied the curriculum of six schools in California, Iowa, and Texas–– one chiropractic college and one medical school for each state. According to their methods, comparisons were drawn by examining course directories, syllabi, outlines and notes, as well as timetables, lectures, seminars, practicals, and rounds.
The test designed for this study assessed how a sample of chiropractic students compare with medical students in knowledge about primary care activities. The chiropractic test takers scored below their medical counterparts, but not by much. Considering the emphasis on primary care within medical education over the past few decades and the ambiguity with which the chiropractic profession has approached primary care, the fact that chiropractic students scored almost as well as medical students is noteworthy. A follow-up to this study using a clinical competency practical examination constructed around the identified primary care tasks should be undertaken.
The science of medicine may not provide physicians with tools that are generally effective for managing back pain. Although particular therapies, such as spinal manipulation, may in fact be effective for some patients, there is reason to think that other aspects of the patient-provider interaction may have a greater influence on the outcome of care. Greater consideration should be given to the potential for the art of medicine to provide low back pain patients with effective therapy.
Patients expressed high levels of satisfaction with their doctors and the care they received. Although women were slightly more satisfied than men, other patient characteristics such as level of education, income, employment status or previous chiropractic care did not influence response means. Future research is needed to determine if the way in which chiropractic care is rendered affects patient satisfaction.
Over the past 10 yr consumer satisfaction has gained widespread recognition as a measure of quality in many public sector services. This has become manifest in the NHS in the call by the 1983 NHS Management inquiry to ascertain how well the service is being delivered at local level by obtaining the experience and perceptions of patients and the community. Patient satisfaction is now deemed an important outcome measure for health services; however, this professed utility rests on a number of implicit assumptions about the nature and meaning of expressions of ‘satisfaction’. Through a review of past research findings this paper suggests that patients may have a complex set of important and relevant beliefs which cannot be embodied in terms of expressions of satisfaction. Consequently, many satisfaction surveys provide only an illusion of consumerism producing results which tend only to endorse the status quo. For service providers to meaningfully ascertain the experience and perceptions of patients and the community then research must first be conducted to identify the ways and terms in which those patients perceive and evaluate that service.
The Outcomes and Costs of Care for Acute Low Back Pain Among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons
Among patients with acute low back pain, the outcomes are similar whether they receive care from primary care practitioners, chiropractors, or orthopedic surgeons. Primary care practitioners provide the least expensive care for acute low back pain.
Based on these results, it seems that patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain.
Patient Characteristics, Practice Activities, and One-month Outcomes for Chronic, Recurrent Low-back Pain Treated by Chiropractors and Family Medicine Physicians: A Practice-based Feasibility Study
Patients with chronic low-back pain treated by chiropractors show greater improvement and satisfaction at 1 month than patients treated by family physicians. Nonclinical factors may play an important role in patient progress. Findings from the Health Resources and Services Administration-funded project will include a report on the influence of practice activities, including more frequent visits by chiropractic patients, on the clinical course of low-back pain and patient outcomes.
The level of satisfaction of patients with members of the chiropractic physicians of the Oklahoma State Chiropractic Independent Physicians’ Association was very high. No areas of concern were noted with the care delivered by these chiropractors.
Comparing the Satisfaction of Low Back Pain Patients Randomized to Receive Medical or Chiropractic Care: Results From the UCLA Low-back Pain Study
Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients’ satisfaction.
Pragmatic rather than affective variables played some part in predicting satisfaction through global improvement in these patients. This should help to inform future interpretation of clinical trials of chiropractic treatments for back pain. However, the nature of the “unknown” components needs further investigation. There are initial indications in the literature that information giving, and the reconfiguration of patients’ perceptions of the problem, may contribute to patient satisfaction generally. Further work is needed to confirm this and to establish where such interventions can also contribute to overall improvement.
Spinal manipulation has been used for its therapeutic effects for at least 2500 years. Chiropractic as we know it today began a century ago in a simplistic manner but has developed into to a well-established profession with 33 colleges throughout the world. During the initial, bumpy years, many people thought it had little more value than a placebo. Nevertheless, there have always been satisfied recipients of chiropractic care during the years, and the profession slowly gained prominence–mostly by word of mouth. More recently, personal opinions based on isolated incidents have given way to the results of numerous clinical and basic science studies, primarily regarding low back pain.
As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective. Other studies have shown that chiropractic care compared with medical care is safer, costs no more and often costs much less, and has consistently greater patient satisfaction for treatment of similar conditions. Consequently, there is now better public and professional opinion of chiropractic with coverage by insurance companies and government agencies. That trend is likely to continue.
Symptomatic Outcomes and Perceived Satisfaction Levels of Chiropractic Patients with a Primary Diagnosis Involving Acute Neck Pain
Patients with acute neck pain involved in this study seemed to be satisfied with chiropractic treatment and reported reductions in associated pain levels and activity restrictions. However, because of the study’s design and limitations, care must be taken before drawing firm conclusions from the data presented.
Factors Associated With Patient Satisfaction With Chiropractic Care: Survey and Review of the Literature
The evidence about the factors that underlie high levels of chiropractic satisfaction is not consistent. Communication quality seems to be a consistent predictor of patient satisfaction with chiropractors. More research is needed to understand the role of perceived effectiveness of treatment, intensity of use, accessibility, and financing issues in determining patient satisfaction levels.
This article reports on satisfaction associated with the introduction of chiropractic services within a military hospital, through a Canadian Armed Forces Pilot Project. We distributed a 27-item survey that inquired about demographic information and satisfaction with chiropractic services to 102 military personnel presenting for on-site chiropractic services at the Archie McCallum Hospital in Halifax, Nova Scotia. We provided a second 3-item survey, designed to explore referral patterns and satisfaction with chiropractic services, to all referring military physicians. A multivariable linear regression model was constructed to explore which factors were associated with patients’ satisfaction with chiropractic services. The response rate to the patient and physician satisfaction surveys was 67.6% (69 of 102) and 83.3% (10 of 12), respectively. Chronic low back pain accounted for most presentations to the hospital chiropractic clinic.
About 80 percent of U.S. adults have at some point been bothered by back pain. The Consumer Reports Health Ratings Center recently surveyed more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery. More than half said pain severely limited their daily routine for a week or longer, and 88 percent said it recurred through the year. Many said the pain interfered with sleep, sex, and efforts to maintain a healthy weight.
Back pain can be tough to treat. Most of our respondents tried five or six different treatments. They rated the helpfulness of the treatments tried and their satisfaction with the health-care professionals visited.
Hands-on therapies were among the top-rated. Fifty-eight percent of those who tried chiropractic manipulation said it helped a lot, and 59 percent were “completely” or “very” satisfied with their chiropractor. Massage and physical therapy were close runners-up.
Many of those who tried spinal injections found them to be very helpful, although the techniques their doctors used varied. Most respondents had used some type of medication. Forty-five percent of those who took prescription drugs said they helped a lot, double the percentage of those who said they were helped by over-the-counter medications.
The final report to Congress also includes information on the costs of expanding chiropractic services in the demonstration sites. The report indicates that in all but one of the demonstration sites, patients’ health care costs were not significantly changed by expanding coverage of chiropractic services. In contrast, a cost increase was found in the Chicago metropolitan area. Further research into the reasons why the results in Chicago differ from the rest of the demonstration project sites is needed to better understand these findings.
“We already know that Medicare costs in general tend to be higher in Chicago than other similar areas of the country. We must find the underlying cause of the cost difference found in the chiropractic demonstration project and determine whether it had anything at all to do with the expansion of chiropractic services,” Dr. McMichael noted.
To further analyze the results of the demonstration project, ACA is creating a taskforce of Medicare experts and researchers who will review the report and develop a response for the Centers of Medicare and Medicaid Services.
Exploring Patient Satisfaction: A Secondary Analysis of a Randomized Clinical Trial of Spinal Manipulation, Home Exercise, and Medication for Acute and Subacute Neck Pain
This study provides a greater understanding of satisfaction with care in acute neck pain patients receiving spinal manipulation, home exercise and advice, and medications. A consistent advantage for spinal manipulation and home exercise was identified in terms of satisfaction with general care (including provider concern, quality of treatment recommendations, and overall care) and information provided (including cause, prognosis, activities to hasten recovery, and prevention). Patients receiving spinal manipulation were also more satisfied with general care than the home exercise group. Although these secondary analyses also revealed the HEA group to be as satisfied overall with information received as the SMT group, more HEA patients were satisfied with the information received related to activities to hasten recovery and prevention. These results highlight how global satisfaction measures may mask important nuances of how patients view and experience treatments and point to the use of multidimensional satisfaction instruments in future research.