The Foundation for Chiropractic
Education and Research

List All News Items

Subscribe to FCER's The Week in Chiropractic

Amidst a changing climate of healthcare delivery and financing in the United States, a comprehensive study from a leading health policy think tank has just been published with major implications as to how primary care may be effectively delivered. Abt Associates of Cambridge, MA, convened two expert panels—one interdisciplinary (consisting primarily of allopathic physicians) and the other comprised entirely of chiropractors. Through a consensus process to develop a list of primary care activities, both panels concluded that with respect to a list of 53 primary care functions found to occur daily in medical offices, chiropractors are capable of making diagnoses in 92% of these activities and making therapeutic contributions in more than 50% of them.

Both panels agreed upon the terms of taxonomy used for primary care, which emphasize such aspects as information gathering with assessments, screening and prevention activities, additional diagnostic procedures and techniques, counseling and education, management of acute and chronic illnesses, services to special population groups such as geriatric or pregnancy care, coordination and referrals, and counseling on complementary modalities of care. This represents the overcoming of a substantial barrier built upon the paradigms of healthcare which separate the chiropractic and allopathic physician communities. It addresses a basic suspicion by the authors of the study that "much of what is generally considered primary could be provided by professionals other than medical doctors (MDs) and osteopaths (DOs)."¹ It also confirms other recent findings that between 60-90% of diagnoses seen in outpatient primary care settings can be handled by certain alternative providers.² It also underscores the importance of distinguishing primary health care from primary medical care.³

The chiropractic panel perceived medical doctor involvement as being required more frequently than did the interdisciplinary panel. Moreover, chiropractors appeared to display some limits with regard to their assumption of total care for some frequently occurring primary care activities.

A predominant aspect of this study was the overarching sense of agreement between the allopathic and chiropractic physicians with respect to the scope of primary care activities. This would bode well for the capacity of chiropractors and medical doctors to work together in the areas of patient care and organizational strategy. Some limits for the assumption of total primary care are evident from the levels of self-assessed competence and interest on the part of some chiropractors regarding many frequently occurring primary care activities.

This publication represents a portion of a larger study to assess the primary care capabilities of the chiropractor, supported by a grant from the NCMIC Insurance Company and administered by the Foundation for Chiropractic Education and Research.

REFERENCE:

¹Gaumer GL, Walker A, Su S. Chiropractic and a new taxonomy of primary care activities. Journal of Manipulative and Physiological Therapeutics 2001; 24(4): 239-259.

²US Government Accounting Office. Health care access: innovative programs using non-physicians. Report to the Chairman, Special Committee on Aging, US Senate: August 1993.

³Bowers LJ, Mootz RD. The nature of primary care: The Chiropractors' role. Topics in Clinical Chiropractic. 1995; 2: 66-84.