Satisfaction-Cost-Safety

Chiropractic Care for Children Found Safe and Effective

Preliminary results of two survey studies is finding chiropractic care for children to be safe, effective and offer additional health benefits as well.

Here are the abstracts from the ICPA:

1-Treatment-related aggravations, complications and improvements attributed to chiropractic spinal manipulative therapy of pediatric patients: a practice-based survey of practitioners.

Alcantara, J, Ohm, J, and Kunz, D

Objective
To investigate the iatrogenesis and symptom improvements associated with chiropractic spinal manipulative therapy (SMT) of pediatric patients.

Conclusion
This study suggests that the chiropractic SMT care of children is safe and effective.

Read the abstract here

2-Treatment-related aggravations, complications and improvements attributed to chiropractic spinal manipulative therapy of pediatric patients: a survey of parents.

Alcantara, J, Ohm, J, and Kunz, D

Conclusion
This study provides supporting evidence on the safety and effectiveness of chiropractic SMT in children based on parental reports.   

Read the abstract here

 

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Costs Down, Patient Satisfaction Up With Chiropractic Care

Article From WebMD

The study comes from American Specialty Health Plans Inc. of San Diego. The company provides employers with health insurance coverage for complementary medicine, including chiropractic care and acupuncture.

The company compared four years of back pain claims from two groups: 700,000 health plan members with chiropractic care coverage and 1 million members with the same health plan without chiropractic care coverage. It's the largest study yet of how chiropractic care affects the cost of health care,

Compared with doctor-only health plans, the study found that:

• Chiropractic care cut the cost of treating back pain by 28%.
• Chiropractic care reduced hospitalizations among back pain patients by 41%.
• Chiropractic care reduced back surgeries by 32%.
• Chiropractic care reduced the cost of medical imaging, such as X-rays or MRIs, by 37%.

The report appears in the Oct. 11 issue of Archives of Internal Medicine.

Although the researchers did not look at patient satisfaction in this study, Dr. Metz says company studies show that 95% of chiropractic care patients are satisfied with the care they receive.

THE GALLUP STUDY

In 1991 the Gallup Organization performed a nationwide demographic study to determine the attitudes, opinions, and behaviors of both users and nonusers of chiropractic services.

Their findings?

Overall, 90% felt that chiropractic health care was effective: more than 80% were satisfied with the treatment they received; nearly 75% felt that most of their expectations were met during the last visit or series of visits; 68% said they would likely see a doctor of chiropractic again for treatment of a similar condition, and 50% would likely be willing to see a doctor of chiropractic for some other problem chiropractors treat. Nearly 80% of the chiropractic users felt that the cost of chiropractic treatment was reasonable.

Demographic Characteristics of Users of Chiropractic Services. The Gallup Organization, Princeton, New Jersey - 1991.

THE HARRIS POLL

According to this 1994 Harris Poll, patients were more satisfied with chiropractic care than care from medical doctors and other health care professionals.

Those who sought care from a chiropractor were more likely to be very satisfied with their care than those who visited any other practitioner. (Choices were between Chiropractic Doctors, Medical Doctors, Physical Therapists, or Osteopathic Doctors) Of those who have seen both types of practitioner, the majority were more likely to be satisfied with the care of the chiropractor than with that of the medical doctor.

1994 Harris Poll.

Patient Evaluations of Care from Family Physicians and Chiropractors

Findings from this study indicate that patients under chiropractic care had 3 times the satisfaction rate as did patients under the care of Family Physicians. In addition, the patient's perception of the doctor's confidence in diagnosing and treating low back pain was almost 3 times higher in patients receiving chiropractic care compared with those receiving care from family physicians.

Patient Evaluations of Care from Family Physicians and Chiropractors. Cherkin, D., MacCornack, F. Western Journal of Medicine - 1989;150:351-355.

Other studies include.....

Oklahoma State Chiropractic Independent Physicians' Association, Tulsa, Okla

BACKGROUND: Satisfaction with care is one of the variables that can be used in determining the results of medical care. Patient satisfaction surveys allow managed care plans to determine how well their providers meet certain standards.

OBJECTIVE: To determine the level of satisfaction with chiropractic care in a random sample of patients seen by physician members of a chiropractic independent physicians' association.

DESIGN: A visit-specific questionnaire was mailed to a random sample of 150 patients from health insurance claims filed in the first two months of 2000.

RESULTS: The rate of return was 44%. Various aspects of chiropractic care were given a rating of "excellent" by the following percentage of respondents: Length of time to get an appointment (84.9%); convenience of the office (57.7%); access to the office by telephone (77.3%); length of wait at the office (75.7%); time spent with the provider (74.3%); explanation of what was done during the visit (72.8%); technical skills of the chiropractor (83.3%); and the personal manner of the chiropractor (92.4%). The visit overall was rated as excellent by 83.3% of responders, and 95.5% stated they would definitely recommend the provider to others.

CONCLUSION: The study demonstrated a high satisfaction rate among managed-care patients.

FROM: J Manipulative Physiol Ther 2001 (Nov); 24 (9): 556–559

1 Patient Satisfaction With Chiropractic Care
J Manipulative Physiol Ther 1993 (Jan); 16 (1): 25–32
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.

2 The Chiropractic Outcome Study: Pain, Functional Ability and Satisfaction With Care
J Manipulative Physiol Ther 1997 (May); 20 (4): 235–240
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.

3 Patient Satisfaction With the Chiropractic Clinical Encounter: Report From a Practice-based Research Program
Journal of the Neuromusculoskeletal System 2001: 9 (4): 109–117
The majority of patients were highly satisfied with their care; 85.0% reported that their chiropractor always listened carefully; 85.3% that the DC explained things understandably; 88.2% that the DC showed respect for what they had to say; and 75.6% that he/she involved them in decisions as much as they wanted. The median proportion of patients, per DC, with a chief complaint who said their doctor always spent enough time with them was 82% (IQR: 19%) and 82.3% reported that their chiropractors never recommended more visits than necessary.

4 Patient Satisfaction With Chiropractic Physicians in an Independent Physicians' Association
J Manipulative Physiol Ther 2001 (Nov); 24 (9): 556–559
Various aspects of chiropractic care were given a rating of "excellent" by the following percentage of respondents: Length of time to get an appointment (84.9%); convenience of the office (57.7%); access to the office by telephone (77.3%); length of wait at the office (75.7%); time spent with the provider (74.3%); explanation of what was done during the visit (72.8%); technical skills of the chiropractor (83.3%); and the personal manner of the chiropractor (92.4%). The visit overall was rated as excellent by 83.3% of responders, and 95.5% stated they would definitely recommend the provider to others.

5 The Outcomes and Costs of Care for Acute Low Back Pain Among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons
N Engl J Med 1995 (Oct 5); 333 (14): 913–917
The status at six months was ascertained for 1555 of the 1633 patients enrolled in the study (95 percent). The times to functional recovery, return to work, and complete recovery from low back pain were similar among patients seen by all six groups of practitioners, but there were marked differences in the use of health care services. The mean total estimated outpatient charges were highest for the patients seen by orthopedic surgeons and chiropractors and were lowest for the patients seen by HMO and primary care providers. Satisfaction was greatest among the patients who went to the chiropractors.

6 Patient Evaluations of Low Back Pain Care From Family Physicians and Chiropractors
West J Med 1989 (Mar); 150 (3): 351–355
Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66% versus 22%, respectively). Compared with patients of family physicians, patients of chiropractors were much more likely to have been satisfied with the amount of information they were given, to have perceived that their provider was concerned about them, and to have felt that their provider was comfortable and confident dealing with their problem.

7 Comparing the Satisfaction of Low Back Pain Patients Randomized to Receive Medical or Chiropractic Care: Results From the UCLA Low-back Pain Study
Am J Public Health 2002 (Oct); 92 (10): 1628–1633
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.

8 Williams B. Patient satisfaction: A valid concept? Social Science and Medicine 1994; 509-516

Other Patient Satisfaction Studies Patient satisfaction studies have consistently shown that patients are extremely satisfied with the care they receive from chiropractors and far less satisfied with the care they receive from medical practitioners. Review 4 major studies here.

Patient Satisfaction With the Chiropractic Clinical Encounter
Data were collected from 2986 adult patients of 172 U.S. and Canadian chiropractors in a practice-based research program over a one-week period in November 1999. Of the 1822 patients reporting pain, 56.2% rated the care they received for it as "excellent," 30.6% "very good;" 9.5% "good;" 1.3% "fair;" and 0.2% "poor;" 2.0% did not respond. Patients were quite satisfied with the care they received with 85% reporting that their chiropractor always listened carefully to them and always explained things in a way they could understand; 88% reported their chiropractor always showed respect for what they had to say; 78% felt their chiropractor always spent enough time with them.

Patient Satisfaction With Back & Neck Problems
High levels of patient satisfaction was reported by those who went to chiropractors with severe to moderate pain in either the back or neck. In a clinical survey, a total of 369 patients who had gone to chiropractors with these problems were sampled.

" ...Despite economic disincentives for use of chiropractic services, chiropractic has met the
market test of consumer choice and preference."
Manga Report, 1993.

"By every test of cost and effectiveness, the general weight of evidence shows chiropractic
to provide important therapeutic benefits. Additionally, these benefits are achieved with
apparently minimal, even negligible, impacts on the costs of health insurance."
Schifrin, LG. 1992. Mandated health insurance coverage for chiropractic treatment: aneconomic arrangement with implications for the Commonwealth of Virginia.

"Payments to chiropractors represent only 1.8% of total payment and 'as a result would
account for very little of the nation's (U.S.) rapid growth rates of health care spending."
Journal of American Health Policy 1992; 2:39-45.

"...The wide gap in the overall cost experience between chiropractic and medical patients
cannot easily be dismissed even by skeptics of the chiropractic profession."
JMPT 1993;16:291-9.

The authors concluded:
Of the available conservative treatments, chiropractic management has been shown through multiple studies to be safe, clinically effective, cost-effective, and to provide a high degree of patient satisfaction. As a result, in patients . . . for whom the surgical indications are not absolute, a minimum of 2 or 3 months of chiropractic management is indicated.

More Studies On Chiropractic
Cost Effectiveness

Chiropractic Care Gets Patients Back To Work Faster

This paper reports on time loss incurred by chiropractic (DC) and medical (MD) claimants with disabling low back work-related injuries in Oregon. Clinical categorization was accomplished using medical records and was based on reported symptomatology, objective clinical findings and functional impairment. The median time loss days for cases with comparable clinical presentation (severity) was 9.0 for DC cases and 11.5 for MD cases. Chiropractic claimants had a higher frequency of return to work with 1 wk or less of time loss. No difference was seen in time loss days for MD or DC claimants with no documented history of low back pain. However, for claimants with a history of chronic low back problems, the median time loss days for MD cases was 34.5 days, compared to 9 days for DC cases. It is suggested that chiropractors are better able to manage injured workers with a history of chronic low back problems and to return them more quickly to productive employment.

Nyiendo J. Disabling low back Oregon Workers' Compensation claims. Part II: Time loss. J Manipulative Physiol Ther. 1991 May;14(4):231-9.

Chiropractic Care Saves Money

OBJECTIVE: To compare the health care costs of patients who have received chiropractic treatment for common neuromusculoskeletal disorders with those treated solely by medical and osteopathic physicians.

DESIGN: Retrospective statistical analysis of 2 yr of claims data on various categories of utilization and insurance payments for a large national sample of patients.

SETTING: Ambulatory and inpatient care.

PATIENTS: A total of 395,641 patients with one or more of 493 neuromusculoskeletal ICD-9 codes.

OUTCOME MEASURES: Hospital admission rates and 10 categories of insurance payments.

RESULTS: Nearly one-fourth of patients were treated by chiropractors. Patients receiving chiropractic care experienced significantly lower health care costs as represented by third party payments in the fee-for-service sector. Total cost differences on the order of $1,000 over the 2-yr period were found in the total sample of patients as well as in subsamples of patients with specific disorders. The lower costs are attributable mainly to lower inpatient utilization. The cost differences remain statistically significant after controlling for patient demographics and insurance plan characteristics.

CONCLUSIONS: 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.

Stano M. A comparison of health care costs for chiropractic and medical patients. J Manipulative Physiol Ther. 1993 Jun;16(5):291-9.

Chiropractic Care Results in 1/10th the Cost

This study assessed the total cost per case of chiropractic claims and medical claims for conditions with identical diagnostic codes. The sample consisted of 3062 claims or 40.6% of the 7551 estimated back injury claims from the 1986 Workers' Compensation Fund of Utah. For the total data set, cost for care was significantly more for medical claims, and compensation costs were 10-fold less for chiropractic claims.

Jarvis KB; Phillips RB; Morris EK. Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes. J Occup Med. 1991 Aug;33(8):847-52.

NEW STUDY PROVIDES PROOF OF CHIROPRACTIC'S COST-SAVING IMPACT ON MEDICARE PROGRAM

A new study of Medicare cost data completed in June by the well-known Washington, DC-based firm Muse & Associates helps prove the cost-saving impact that chiropractic care has on the current federal Medicare program.

"The results strongly suggest that chiropractic care significantly reduces per beneficiary costs to the Medicare program. The results also suggest that Chiropractic services could play a role in reducing costs of Medicare reform and/or a new prescription drug benefit."

The study specifically found that:
• Beneficiaries who received chiropractic care had lower average Medicare payments for all Medicare services than those who did not ($4,426 vs. $8,103); That is a 46% reduction!
• Beneficiaries who received chiropractic care averaged fewer Medicare claims per capita than those who did not; and
• Beneficiaries who received chiropractic care had lower average Medicare payments per claim than those who did not.

Chiropractic Care More Effective Than Medical

OBJECTIVE--To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin.

DESIGN--Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years.

SETTING--Chiropractic and hospital outpatient clinics in 11 centres.

PATIENTS--741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month.

INTERVENTIONS--Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both.

MAIN OUTCOME MEASURES--Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion.

RESULTS--Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial.

CONCLUSIONS--For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.

Meade TW; Dyer S; Browne W; Townsend J; Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. Brithish Medical Journal. 1990 Jun 2;300(6737):1431-7.

Comparative efficacy of conservative medical and chiropractic
treatments for carpal tunnel syndrome: a randomized clinical trial.

Davis PT, Hulbert JR, Kassak KM, et al. Journal of Manipulative and Physiological Therapeutics, June 1998, vol.21/no.5, pp317-26.

This study showed that chiropractic was as effective as medical treatment in reducing symptoms of CTS. Chiropractic care included spinal adjustments, ultrasound over the carpal tunnel, and the use of nighttime wrist supports. Carpal tunnel syndrome (CTS) can affect just about everyone, but particularly people involved in occupations requiring repetitive use of the hands and wrists (i.e., office and skilled labor jobs). Medical doctors commonly prescribe anti-inflammatory drugs, which prove ineffective in some patients and cause adverse side effects in others, for patients diagnosed with carpal tunnel syndrome.

Disc Herniation and Chiropractic Care

BenEliyahu DJ, Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations [see comments]

RESULTS: Clinically, 80% of the patients studied had a good clinical outcome with post care visual analog scores under 2 and resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation. There was a statistically significant association (p < .005) between the clinical and MRI
follow-up results. Seventy-eight percent of the patients were able to return to work in their predisability occupations.

CONCLUSION: This prospective case series suggests that chiropractic care may be a safe and helpful modality for the treatment of cervical and lumbar disc herniations. A random, controlled, clinical trial is called for to further substantiate the role of chiropractic care for the nonoperative clinical management of intervertebral disc herniation.
Comment in: J Manipulative Physiol Ther 1997 Sep;20(7):495-7
ISSN: 0161-4754

Low back pain and the lumbar intervertebral disk: Clinical consideration for the doctor of chiropractic.

Troyanovich SJ, Harrison DD, Harrison DE. Journal of Manipulative and Physiological Therapeutics, Feb. 1999; vol. 22, no. 2, 96-104.

This review of the literature distills and synthesizes previously published research. The article lists various causes of low back pain, noting what findings in patient histories, physical examinations, and diagnostic imaging represent "red flags" that indicate the need for referral to a specialist for surgical intervention.

After patients are screened for red flags, conservative treatment should be the first line of treatment for patients without absolute signs for surgical intervention.

Studies on Chiropractic: Patient Satisfaction
In today’s consumer driven health care environment, patient satisfaction is an important health outcome measure. There have been several surveys conducted in recent years assessing patient satisfaction with chiropractic care, which was found to be extremely high. In addition, these surveys invariably found that the level of satisfaction was significantly higher for care received from chiropractors in comparison to the medical profession. Surveys have also indicated that chiropractic patients are willing to return for chiropractic treatment for a similar condition and would recommend chiropractic treatment to friends, family and colleagues.

Safety

THE MANGA REPORT

The Ontario Ministry of Health commissioned Manga Report represents the largest analysis of scientificliterature on the most effective and cost effective treatments for low back pain. After reviewing all of the international evidence on the management of low back pain, lead investigator Pran Manga, Ph.D., found the treatments provided by Doctors of Chiropractic were exceptionally safe - much safer than for standard medical treatments of similar conditions.
• "There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain."
• "Indeed, several existing medical therapies of low back pain are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by nonchiropractic professionals"
• "Chiropractic manipulation is safer than medical management of low back pain. Chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction."

The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.

Efficacy and Risks of Chiropractic Adjustments:
What Does the Evidence Suggest?

Ian Coulter, Ph.D. The Int'l Journal Integrative Medicine, volume 1, number 2, The Journal
Integrative Medicine, volume 1, number 2, March/April 1999 pp.61-66. Cost-benefit calculations also take in the cost of the risk of a procedure. In this article is a discussion of the Rand data in this area.

In the article is stated that over 90% of the manipulation in the United States is performed by chiropractors. The risk of complication with cervical adjusting is 6.39 per 10 million cervical adjustments and for lumbar adjustments, the risks are 1 in 100 million. The risks of cervical spine surgeries is 15.6 per 1,000 and for use of NSAIDs (non aspirin pain killers) is 3.2 per 1000.
Put in another way, the risk of complication is 6.39 per 10 million cervical adjustments
versus 156,000 per 10 million cervical spine surgeries. This makes the likelihood of complication with surgery 24,413 times greater than a complication from a cervical spine adjustment.
From the paper: "The research now, however, should go beyond simply the question of
whether chiropractic, or any manipulation, has efficacy for acute low-back pain and neck
pain to a consideration of what type of manipulation for what type of patient for what type of
condition and provided by what type of provider."

THE AGENCY ON HEALTH CARE POLICY AND RESEARCH STUDY

On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain.

The guidelines were created by the AHCPR panel to provide primary care clinicians with information and recommended strategies for the assessment and treatment of acute low back problems. The AHCPR panel was made up of 23 members consisting of medical doctors, chiropractic doctors, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.

Their findings included:
• The risk of serious complications from lumbar spinal manipulation is rare;
• Conservative treatment such as spinal manipulation should be pursued in most cases before considering surgical intervention;
• Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.

Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S, et al. Agency for Health Care Policy and Research Publication No. 950642 (1994) - U.S. Department of Health and Human Services.

THE NEW ZEALAND COMMISSION REPORT

The government of New Zealand published a 377 page report which assessed the efficacy and safety of chiropractic care. The report was a result of almost 2 years of conducted hearings from recognized health care experts.

Their principal findings included:
• "Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy (spinal adjustments)."
• "Chiropractors carry out spinal diagnosis and therapy at a sophisticated and refined level."
• "Spinal manual therapy in the hands of a registered chiropractor is safe."
• "The duration and training of a registered chiropractor are sufficient to enable him/her to determine whether there are contraindications to spinal manual therapy in a particular case, and whether that patient should have medical care instead of, or as well as, chiropractic care."

New Zealand Report. Hasselberg PD. Government Printer, Wellington - 1979.