A Survey of American Chiropractic Association Members’ Experiences, Attitudes, and Perceptions of Practice in Integrated Health Care Settings

Abstract

Objective: The purpose of this study is to examine the self-report of experiences, attitudes, and perceived educational needs of American Chiropractic Association members regarding practice in integrated health care settings. Methods: This was a descriptive observational study of the American Chiropractic Association members. Participants completed an electronic survey reporting their current participation and interest in chiropractic integrated practice. Results: The survey was completed in 2011 by 1142 respondents, for a response rate of 11.8%. The majority of respondents (82.9%) did not currently practice in an integrated setting, whereas 17.1% did. Those practicing in various integrated medical settings reported delivering a range of diagnostic, therapeutic, and case management services. Participation in administrative and scholarly activities was less common. Respondents not practicing in integrated settings reported being interested in delivering a very similar array of clinical services. Doctors of chiropractic practicing in hospital or outpatient medical facilities reported frequent engagement in interprofessional collaboration. Both nonintegrated and integrated respondents reported very similar educational interests on a range of clinical topics.

Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey

“…The investigator-designed instrument included questions similar to those contained in widely used surveys of chiropractic practice, such as the National Board of Chiropractic Examiners' Job Analysis of Chiropractic survey 11 and the American Chiropractic Association's member survey of integrated practice. 6 We also asked participants about their interest in joining a planned, broader qualitative case study of chiropractors working in integrated health care settings. The online survey was pretested for functionality by members of the research team and evaluated for face and content validity by DCs on staff at the chiropractic research center.…”

“…[3][4][5] Private sector medical settings, ranging from small primary care clinics to large health care systems in the United States, have introduced chiropractic care. [6][7][8][9][10] A survey by the National Board of Chiropractic Examiners Practice Analysis of Chiropractic reported that 9% of doctors of chiropractic (DCs) practice in settings other than chiropractic offices, including 7.8% who work in an "integrated health care facility," with 3.6% of those surveyed identifying that they hold hospital staff privileges. 11 The health care literature rarely describes characteristics of chiropractic practice in the US private sector; most reports are single-site case studies.…”

“…13 A survey of American Chiropractic Association members indicated that 17% of 1142 members reported working in integrated settings ranging from private group practices (59%), ambulatory care/outpatient clinics (15%), hospitals and medical centers (13%), and other types of facilities (11%), with 46% of these facilities located in the private sector. 6 Respondents reported that they served as musculoskeletal specialists and reported higher rates of referral to and from medical doctors (MDs) than those DCs who worked in nonintegrated settings. However, many DCs faced barriers to full participation in the health care team, which included not documenting care in the same clinical record or a lack of referrals from some medical providers.…”

“…However, many DCs faced barriers to full participation in the health care team, which included not documenting care in the same clinical record or a lack of referrals from some medical providers. 6 Health care systems are highly complex and differ considerably in their structures, processes, and outcomes. Thus, a better understanding of the existing models and characteristics of chiropractic practice in private medical settings is a key precursor to inclusion of chiropractic services in this sector and improved health care quality for persons with spine-related conditions.…”

An overview of the medical specialties most relevant to chiropractic practice and education

“…6 According to the report, chiropractors will be integrated and exposed to allopathic physicians with increasing frequency through student clerkships, residencies, and chiropractic government programs, such as the Loan Repayment Program of the National Health Service Corps. 7 There is a growing trend of chiropractors practicing in various private medically integrated settings within the United States. 8 Increased numbers of graduates and established chiropractors are seeking employment in traditional medical settings.…”