Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-Year Changes in Health and Satisfaction With Care

Abstract

Objective The purpose of this study was to examine how chiropractic care compares to medical treatments on one-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries. Methods Logistic regression using generalized estimating equations (GEE) is used to model the effect of chiropractic relative to medical care on decline in five functional measures and two measures of self-rated health among 12,170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on six satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models. Results The unadjusted models show chiropractic is significantly protective against one-year decline in ADLs, lifting, stooping, walking, self-rated health, and worsening health after one year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching. Conclusion This study provides evidence of a protective effect of chiropractic care against one-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

Comparing Propensity Score Methods for Creating Comparable Cohorts of Chiropractic Users and Nonusers in Older, Multiply Comorbid Medicare Patients With Chronic Low Back Pain

“…In a study that found that most CIHS treatment for back and neck problems was provided by DCs, Martin et al used the Medicare Expenditure Panel Survey to compare costs of treatment for back and neck problems for patients who did and did not use CIHS: propensity scores for the 2 groups were used to match patients who had propensity scores within a ‘region of common support’ and then identify the ‘nearest neighbor’ as a method to develop 2 matched groups for comparison. 19 Weigel et al have applied inverse propensity score weighting to data from ‘Medicare Current Beneficiary Survey’ 20 respondents and to ‘Assets and Health Dynamics among the Oldest Old’ interviews 21 when comparing utilization and outcomes of chiropractic and conventional medical treatment of back pain in the Medicare population. However, to date, propensity score methods have not been applied directly to Medicare claims data to evaluate costs of care for patients seeking back pain treatment.…”

Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

“…38 There is some evidence that individuals become accustomed to seeking chiropractic care, possibly because of lower satisfaction with medical care. 37,39,40 Our findings may indicate that chiropractic care may be used as a substitute for (rather than in addition to) medical care.…”

“…Among the Medicare population, chiropractic care may be beneficial in improving functional status among older adults. 35–37 A provoking finding was that <10% of chiropractic users also use other medical services for the same episode of care. 38 There is some evidence that individuals become accustomed to seeking chiropractic care, possibly because of lower satisfaction with medical care.…”

Chiropractic Identity: A Neurological, Professional, and Political Assessment

“…Even with the recognition of the benefits of spinal manipulation in various government guidelines,107, 108, 109, 110, 111 the rise of the alternative health care movement, advances in the US military and Veterans Administration, and persistently high levels of patient satisfaction, 112 the chiropractic profession remains underrepresented in most discussions of health care delivery. Hopefully, a clarification of chiropractic’s identity and a greater unity of practitioners in delivering this message will help to rectify this problem.…”