First-Contact Care With a Medical vs Chiropractic Provider After Consultation With a Swiss Telemedicine Provider: Comparison of Outcomes, Patient Satisfaction, and Health Care Costs in Spinal, Hip, and Shoulder Pain Patients

A commentary on the implications of medication prescription rights for the chiropractic profession

“…Namely, if patients consult one central practitioner who can effectively address and provide a range of treatment modalities for MSK pain-related matters, the number of visits to providers might be reduced, thereby resulting in better resource allocation. In Switzerland, for example, Houweling et al [19] found clinically similar pain relief, greater satisfaction levels, and considerably lower overall health care costs in patients who initiated care with a chiropractor versus a medical doctor for the treatment of spinal, hip, and shoulder complaints. In situations where patients present with more complex health problems, chiropractors in primary care could refer such cases to a general physician or specialist for additional examination and/or collaborative management.…”

“…Such an advancement has not only the potential of benefiting patients, but also the chiropractic profession as a whole by providing improved professional identity and responsibility. In Switzerland, where the chiropractic profession holds the privilege of limited medication prescription within its scope of practice, chiropractors are fully integrated into the healthcare system and have cultural authority within the MSK domain [18, 19]. Moreover, the large majority of Swiss chiropractors perceive these privileges as an advantage for the profession in that country [1, 4].…”

“…In Switzerland and Liechtenstein, the formularies are limited to analgesics, anti-inflammatories, and muscle relaxants. Swiss chiropractors have had these privileges since 1995 [1], and surveys have shown judicious use of this authority in clinical practice [1, 4, 18, 19]. Along with these privileges, chiropractors in Switzerland share primary care status with general physicians in managing patients with spine-related and other MSK complaints [18, 19].…”

“…Swiss chiropractors have had these privileges since 1995 [1], and surveys have shown judicious use of this authority in clinical practice [1, 4, 18, 19]. Along with these privileges, chiropractors in Switzerland share primary care status with general physicians in managing patients with spine-related and other MSK complaints [18, 19]. As such, limited prescriptive authority has generally been regarded by Swiss chiropractors as an advantage for the profession in that country [1, 4].…”

An Electronic Patient-Reported Outcome Measures System in UK Chiropractic Practices: A Feasibility Study of Routine Collection of Outcomes and Costs

“…In the chiropractic profession, although there are a number of clinical trials 9-12 that have addressed cost-effectiveness of care, there is little information linking costs and outcomes in large cohorts, which more readily represent routine clinical practice. 13 This study explored the implementation of a Web-based patient-driven PROM collection process and the collection of a range of valid and widely used health outcomes, including information concerning cost of care within a cohort of UK chiropractic. We sought to provide guidance as to how PROMs and cost data might routinely be gathered and reported and a rationale for the widespread and routine use of PROMs collection within the MSK care environment and, in particular, the chiropractic profession.…”