Attitudes, beliefs, and practices among Swiss chiropractors regarding medication prescribing for musculoskeletal conditions: a national Q-methodology study.

BACKGROUND: Swiss chiropractors have been licensed since 1995 to prescribe from a limited formulary of medications for treating musculoskeletal (MSK) conditions. In January 2018, this formulary was expanded to include additional muscle relaxant, analgesic, and anti-inflammatory medications. Internationally, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession. OBJECTIVE: The purpose of this study was to assess Swiss chiropractors' attitudes, beliefs, and practices regarding their existing medication prescription privileges. This information will provide new insights on the topic and help inform research and policy discussions about expanding chiropractic prescription rights in other jurisdictions. METHODS: A 13-item questionnaire and Q-methodology approach were used to conduct the assessment. Recruitment was conducted by e-mail between December 2019 and February 2020, and all members of the Swiss Chiropractic Association were eligible to participate. Data were analyzed using by-person factor analysis and descriptive statistics. RESULTS: In total, 187 Swiss chiropractors participated in this study (65.4% response rate). Respondents reported prescribing analgesics, anti-inflammatories, and muscle relaxants to a median of 5, 5, and 0% of patients, respectively. Forty-two percent of respondents expressed interest in further expanding the range of current medications available to Swiss chiropractors for treating MSK conditions. Only 15% expressed interest in expanding this range to include medications for treating non-MSK conditions. In the Q-methodology analysis, four salient viewpoints/groups regarding medication prescribing emerged: prescribers, non-prescribers, collaborators, and integrators. All except non-prescribers thought medication prescription privileges were advantageous for the chiropractic profession in Switzerland. There was also strong consensus among all four groups that medication prescribing should not replace manual therapy in chiropractic practice. CONCLUSION: This was the first national survey on attitudes toward prescribing medications among Swiss chiropractors since the year 2000, and the first using Q-methodology. With this approach, four unique groups of chiropractic prescribers were identified. Even with diversity among clinicians, the findings of this study showed general support for, along with conservative use of, prescribing privileges within the Swiss chiropractic profession. Studies in jurisdictions outside of Switzerland are needed to assess whether chiropractors are interested in expanding their scopes of practice to include similar prescribing privileges.

Attitudes, beliefs, and practices regarding medication prescribing for musculoskeletal conditions: a protocol for a national Q-methodology study of Swiss chiropractors.

BACKGROUND: Since 1995, chiropractors in Switzerland have been licensed to prescribe medications for treating musculoskeletal conditions. However, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession internationally. OBJECTIVE: To assess Swiss chiropractors' attitudes, beliefs, and practices regarding their existing medication prescription privileges. METHODS: A Q-methodology approach will be used to collect data for the assessment. In addition, scope expansion and frequency of prescribing by Swiss chiropractors will be queried using a 13-item questionnaire. Recruitment will be conducted by e-mail and all members of the Swiss Chiropractic Association will be eligible to participate. Data will be analyzed using by-person factor analysis and descriptive statistics. DISCUSSION: This will be the first national update on attitudes toward prescribing medications among Swiss chiropractors since 2003, and the first using Q-methodology. The results of this study are important as they will inform future directions and research regarding chiropractic prescription rights.

CONTEXTE: En Suisse, depuis 1995, les chiropraticiens sont autorisés à prescrire des médicaments pour traiter des affections musculosquelettiques. Cependant, la prescription de médicaments par les chiropraticiens à l'échelle internationale fait toujours l'objet d'une controverse. OBJECTIF: Évaluer les attitudes, les croyances et les pratiques des chiropraticiens suisses en ce qui concerne leur droit actuel de prescrire des médicaments. MÉTHODOLOGIE: Une méthodologie Q sera utilisée pour recueillir les données nécessaires à l'étude. En outre, l'élargissement du champ de pratique et la fréquence de prescription chez les chiropraticiens suisses seront étudiés à l'aide d'un questionnaire comprenant 13 questions. Le recrutement sera effectué par courriel et tous les membres de l'Association suisse chiropratique pourront participer à l'étude. Les données seront analysées par une analyse de facteurs personnels et par statistique descriptive. DISCUSSION: Il s'agira de la première mise à jour nationale sur les attitudes des chiropraticiens suisses à l'égard de leur droit de prescrire des médicaments depuis 2003, et la première étude à utiliser la méthode Q. Les résultats sont importants car ils permettront d'éclairer les orientations et les recherches futures sur le droit de prescrire des chiropraticiens.

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

There is a growing desire within the chiropractic profession to expand the scope of practice to include limited medication prescription rights for the treatment of spine-related and other musculoskeletal conditions. Such prescribing rights have been successfully incorporated into a number of chiropractic jurisdictions worldwide. If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the healthcare system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine / musculoskeletal disorders. However, if the chiropractic profession wishes to lobby to expand the scope of practice to include limited prescriptive authority, several issues must first be addressed. These would include changes to chiropractic education and legislation, as well as consideration of how such privileges could impact the chiropractic profession on a more theoretical basis. In this commentary, we examine the arguments in favour of and against limited medication prescription rights for chiropractors and discuss the implications of such privileges for the profession.

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.

OBJECTIVE: The purpose of this study was to identify differences in outcomes, patient satisfaction, and related health care costs in spinal, hip, and shoulder pain patients who initiated care with medical doctors (MDs) vs those who initiated care with doctors of chiropractic (DCs) in Switzerland. METHODS: A retrospective double cohort design was used. A self-administered questionnaire was completed by first-contact care spinal, hip, and shoulder pain patients who, 4 months previously, contacted a Swiss telemedicine provider regarding advice about their complaint. Related health care costs were determined in a subsample of patients by reviewing the claims database of a Swiss insurance provider. RESULTS: The study sample included 403 patients who had seen MDs and 316 patients who had seen DCs as initial health care providers for their complaint. Differences in patient sociodemographic characteristics were found in terms of age, pain location, and mode of onset. Patients initially consulting MDs had significantly less reduction in their numerical pain rating score (difference of 0.32) and were significantly less likely to be satisfied with the care received (odds ratio = 1.79) and the outcome of care (odds ratio = 1.52). No significant differences were found for Patient's Global Impression of Change ratings. Mean costs per patient over 4 months were significantly lower in patients initially consulting DCs (difference of CHF 368; US $368). CONCLUSION: Spinal, hip, and shoulder pain patients had clinically similar pain relief, greater satisfaction levels, and lower overall cost if they initiated care with DCs, when compared with those who initiated care with MDs.

Comparison of two methods of collecting healthcare usage data in chiropractic clinics: patient-report versus documentation in patient files.

BACKGROUND: The use of patient-reported questionnaires to collect information on costs associated with routine healthcare services, such as chiropractic, represents a less labour intensive alternative to retrieving these data from patient files. The aim of this paper was to compare patient-report versus patient files for the collection of data describing healthcare usage in chiropractic clinics. METHODS: As part of a prospective single cohort multi-centre study, data on the number of visits made to chiropractic clinics determined using patient-reported questionnaires or as recorded in patient files were compared three months following the start of treatment. These data were analysed for agreement using the Intraclass Correlation Coefficient (ICC) and the 95% Limits of Agreement. RESULTS: Eighty-nine patients that had undergone chiropractic care were included in the present study. The two methods yielded an ICC of 0.83 (95% CI = 0.75 to 0.88). However, there was a significant difference between the data collection methods, with an average of 0.6 (95% CI = 0.25 to 1.01) additional visits reported in patient files. The 95% Limits of Agreement ranged from 3 fewer visits to 4 additional visits in patient files relative to the number of visits recalled by patients. CONCLUSION: There was some discrepancy between the number of visits made to the clinic recalled by patients compared to the number recorded in patient files. This should be taken into account in future evaluations of costs of treatments.