Patient Satisfaction

Survey of Canadian Adults: Back Pain (2003), Environics Research Group Limited, Toronto, Canada.  A representative sample of 1500 Canadians aged 18 and over were interviewed at the end of April 2003, was conducted to examine “the extent to which Canadians suffer from back pain, the action that they take to relieve their suffering, and levels of satisfaction with various therapies.”  The survey found that 71% of Canadian adults reported having back pain within the past two years.  The most popular choice for those who consulted a healthcare practitioner for their back pain was a chiropractor.  This is particularly significant because the cost of medical care is covered in full under the Canadian healthcare system whereas patients pay a substantial co-payment or user fee for chiropractic care.  69% were “very satisfied and 92% were “very or somewhat satisfied” with chiropractic care compared to 43% very satisfied with medical and/or physiotherapy care.  Use of prescription and over the counter medication (35% and 30% respectively) were very satisfied.

 

Wolsko PM, Eisenberg DM et al.  Patterns and Perceptions of Care for Treatment of Back and Neck Pain.  Results of a National Survey.  Spine, 2003: 28(3): 292-298.  This study contained 2055 participants who reported back and neck pain problems over the past 12 months. The study was conducted by the Department of Health Care Policy, HarvardMedicalSchool. 54% consulted a complementary provider, 29% alone and 25% together with a medical doctor.  12% consulted a medical doctor alone and 34% consulted no one.  The most common provider was a chiropractor (20%), massage therapy (14%), relaxation techniques (12%).  61% of the patients rated chiropractic as very helpful while 27% gave this rating for medical care. 

 

 

2/12/2001: For approximately 2 years Blue Cross Blue Shield of Illinois, that states largest managed care plan, has given their more than 700,000 members an option of choosing a chiropractor as their primary care physician.  The goal is to evaluate a true prevention-based health care system as opposed to an after-the-fact disease care system.  The results of this program as supplied by BC/BS of Illinois, compared to similar managed care plans employing medical doctors as PCP’s is the following.  Hospitalizations reduced by approximately 60%.  Outpatient surgery reduced by approximately 85%.  Usage of pharmaceuticals reduced by approximately 56%.  Reduction of Cesarean sections by over 22 percent.  Higher patient satisfaction rates.

 

3/20/2000: The Department of Defense recently completed a congressionally mandated, multi-year pilot program to determine the feasibility and advisability of including chiropractic care in the DOD health care system.  Results were:

·        Military personnel who used chiropractic care for the treatment of common neuromusculoskeletal conditions experienced superior outcomes compared to patients who received traditional care and physical therapy. 

 

·        A higher proportion of chiropractic patients reported that they felt better, had less pain, and had fewer restrictions/physical limitations than patients receiving traditional care. 

 

·        An assessment was made that implementing chiropractic care within the military would save the Department of Defense over 25 million dollars per year. 

 

 

Eisenberg, M.D.  New England Journal of Medicine 1993; 328(4): 246-52.  A phone survey of 1539 people with a medical problem in previous year found that there were more visits to unconventional providers than general practitioners in the year of 1990.  425 million to 388 million.

 

Wiesel, M.D.  Chiropractic continues to grow.  Backletter 1997; 12(5): 60.  The chiropractic profession continues to grow in popularity worldwide.  It is now the third largest primary health care profession in the western world after medicine and dentistry.

 

Eisenberg M.D. et al.  Trends in Alternative Medicine Use in the US, 1990-1997: Journal of American Medical Association 1998; 280: 1569-1575.  National Survey of 2055 people measures utilization of alternative care in US between 1990 and 1997.  Use of alternative therapies increased from 33.8% (22 million) in 1990 to 42.1% (39 million) in 1997.  Alternative therapies were most frequently used for chronic conditions (back problems, anxiety, depression and headaches).  There was a 47.3% increase in total visits to alternative providers, from 427 million in 1990 to 629 million in 1997 and exceeds total visits to all US primary care physicians by 243 million visits.  Expenditures for alternative providers increased 45.2% between 1090 and 1997.  In 1997 five therapies had a majority of users consulting a practitioner: Chiropractic, massage, hypnosis, biofeedback and acupuncture.  Increases in use of alternative therapies for medical conditions occurred for back problems, allergies, arthritis, and digestive problems.  The highest condition specific rates of alternative care use in 1997 were: neck (57%) and back (47.6%) problems.  In 1997, 11% had seen a chiropractor with a mean number of 9.8 visits for an estimated total in the US of 191,886,000 visits

 

Chapman-Smith.  Federal funding of Chiropractic Research Projects: 8/97-11/97.  1998; Jan: N1, 2.  The office of Complementary and Alternative Medicine at the National Institutes of Health awarded over 2.5 million dollars over 5 years to William Meeker, D.C., MPH at PalmerUniversity to establish the “ConsortialCenter for Chiropractic Research”.  This is the first time the NIH will be spending its money on an ongoing basis to recognize the value and significance of chiropractic evaluation and care.

 

Drivdahl Christine F, M.D., MC et al.  The use of Alternative Health Care by a Family Practice Population.  Journal of American Board of Family Practice 1998; 11: 193-199.  Questionnaire sent to 250 randomly selected adults in a military family practice clinic got a response of 71%.  Most common methods use Chiropractic (64%), then massage at (36%). 

 

Goldberg, D.O. Gilroy Branch, Permanente Medical Group.  Medicine in the Nineties.  Alternative Care Chiropractic. Aug 14, 1997.  In reality what is happening, members are requesting chiropractic services.  Now, our large purchasers are demanding that we provide chiropractic services.  What is driving these market forces is the satisfaction issue. 

 

Elder Nancy C, M.D., MSPH et al.  Archives of Family Medicine 1997; 6(March/April): 181-184.  Use of alternative care in family practice patients.  113 family practice patients from 4 practices in Portland, Oregon were asked if they used alternative health care.  50% had or were using some form.  Chiropractic was used most at 42%, massage at 32%, herbal remedies at 30%.

 

Haldeman S, D.C., M.D., Ph.D. et al.  Spine 1999; 24(8): 785-794.  There are an estimated 250 million office visits to chiropractors in the US each year.

 

Carey, M.D., MPH.  Spine 1996; 2(3): 339-344.  Use of DC’s is so common that one hesitates to use the terms alternative or nonstandard. 

 

Kaptchuk, OMD, Eisenberg, M.D. Chiropractic Origins, Controversies, and Contributions. Archives of Internal Medicine 1998; 158: 2215-2224. (HarvardMedicalSchool- funded by NIH grant) Many large surveys leave little doubt that patient’s believe chiropractic works for them.  Patients perceive chiropractic as a valuable component of their health care. 

 

Landmark Healthcare Inc/National Market Measures Inc.  Survey conducted late Nov 1998 through Jan 1999.  Telephone interviews with 114 randomly selected senior executives at HMO’s.  43% of HMO’s do not consider chiropractic alternative further validating the mainstreaming of this approach.  65% of HMO’s offer chiropractic, acupuncture is 2^nd at 31%.  Reasons why HMO’s add alternative care, 38% say member and employer groups ask for it. 

 

Oxford launches alternative medicine network.  March 5, 1998.  Oxford Health Plans in 1997 became the first health plan in the US to offer alternative medicine coverage and now it is looking to expand and improve the program.  Referrals are strong with 500 or more coming in each week just for DC’s. 

 

Sullivan B. Los Angeles Times 1997; Sept 8.  As the population ages and baby boomers hit their 60’s in the next decade, record numbers of seniors are expected to seek out chiropractic treatment for the most common health ailment among the elderly, low back pain.  Loyal support from patients and efforts by managed care to attract enrollees has given DC’s expanded clout. 

 

MacLennan et al.  Lancet 1996; 347(March 2): 569-573.  3004 adults in South Australia were surveyed to assess rate of use and types of alternative care in 1993.  At least 1 non-medically prescribed alternative therapy was used by 48.5% of people.  20.3% had visited an alternative practitioner, most commonly DC’s (15%)

 

Millar WJ, MA, Msc.  Canadian Journal of Public Health 1997; 88(3): 154-158.  Use of alternative care practitioners in 1994-5 according to a National Population Health Survey.   Sample size of 22,000.  About 15% of Canadians used some form of alternative health care.  11% of the 15% used chiropractors. 

 

The Landmark Report on Public Perception of Alternative Care.  Sacramento, CA, Jan 27, 1998.  A nationwide phone survey of 1500 interviews in November 1997 found Americans embraced alternative care.  42% of adults in the US used some type of alternative care in the past year and many report a likelihood of future usage.  45% said they’d pay more in order to have access to alternative care.  Most prevalent types of care used in the past year were herbal therapy (17%), Chiropractic (16%).  74% using alternative care use it along with traditional care.

 

LA Times 1998; Sunday, Aug 30: A1, A12, and A13.  LA Times Poll in California April 4-9, 1998.  32% of the sample of adults in CA used chiropractic in the past year. 

 

Astin JA, PhD.  Why patients use alternative medicine.  Journal of American Medical Association 1998; 279(19): 1548-1553.  Survey of 1035 randomly selected subjects to determine reasons and frequency of using alternative health care.  40% of respondents reported using some form of alt care in the past year.  Top 4 treatments were Chiropractic (15.7%), lifestyle diet (8%), exercise/movement (7.2%) and relaxation.  The top health problem listed was back pain, second was allergies. 

 

Institute of Alternative Futures 1998.  This “wellness demand” now accounts for a significant part of some Complementary and Alternative Approaches workloads.  For DC’s, an estimated 14% to 35% of all current visits are routine maintenance or wellness visits not related to a specific problem. 

 

Wiesel, M.D.  Backletter 1996; 11(3): 36.  Given the popularity of DC’s with their patients and the depth of scientific evidence in favor of spinal manipulation, it will be interesting if DC’s begin to take a larger share of the back pain market. 

 

LANDMARK HEALTHCARE REPORT ON PUBLIC PERCEPTIONS OF ALTERNATIVE CARE, 1998. Landmark Healthcare, Inc.  45% of all adults surveyed said that they would be willing to pay more each month to have access to alternative care.  66% of those surveyed believe that the availability of alternative care is either “very important” or “somewhat important” when choosing a health plan.  Of the types of therapies used, 80% said they would be most likely to use vitamin therapy and or massage therapy.  Herbal therapy was next with 75%, then Chiropractic at 73%.

Other findings of the Landmark Study:

1.         Virtually everyone treated with chiropractic care within the past year has

been satisfied with the care they received.  73% said they were very satisfied and 23% said somewhat satisfied.

2.         Percentage of use of those surveyed was of Herbal therapy at 17%, up

from 3% in 1990.  Chiropractic at 16%, up from 10% in 1990.  Massage therapy at 14% up from 7% and vitamin therapy at 13%, up from 2% in 1990.

 

 

 

Eisenberg DM, Kessler RC, et al.  “Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use.”  The New England Journal of Medicine, Volume 328, Number 4, January 28, 1993, Pages 246-252. One third of all Americans used alternative care in 1990.

 

 

Maust A.  The Chiropractic Patient in Rural, Health Professional Shortage Areas of the United States:  An Exploratory Analysis.  Research Dimensions Incorporated, Richmond, Virginia, December 1994.  This survey showed that people depended on their chiropractic care to feel better in their day to day lives.

 

 

Maust RL.  Chiropractic Patient Satisfaction.  Research Dimensions Incorporated, Richmond, Virginia, January 1996.  Patients stated that they were very satisfied.  As a result of their chiropractic care, their physical condition has improved; they have less pain, and are taking less medication.

 

 

Carey TS, Evans AT, et al.  “Acute Severe Low Back Pain:  A Population-based Study of Prevalence and Care-seeking.”  Spine, Volume 21, Number 3, 1996, Pages 339-344.  99% of those people treated by a chiropractor were satisfied.  80% were satisfied when treated by a medical doctor.

 

70% OF THE GENERAL PUBLIC FEELS THAT CHIROPRACTIC SHOULD BE PART OF THEIR HEALTH INSURANCE COVERAGE

Balduc HA.  “Americans’ Perception of Chiropractors and Their Treatments of Back Problems.”  Journal of Chiropractic, Volume 31.  Number 11, November 1994, Pages 52-55, 100.

 

NINE OUT OF TEN CHIROPRACTIC USERS FIND CHIROPRACTIC TREATMENT EFFECTIVE

Demographic Characteristics of Users of Chiropractic Services.  The Gallup Organization, Princeton, New Jersey, 1991.

 

CHIROPRACTIC PATIENTS MORE SATISFIED THAN PHYSICIAN’S PATIENTS

Cherkin DC, MacCornack FA.  “Patient Evaluations of Low Back Pain Care from Family Physicians and Chiropractors.”  Western Journal of Medicine, Volume 150, March 1989, Pages 351-355.

 

This study found that chiropractic patients were 3 times more satisfied with their

 

treatment for low back pain than patients of family practice physicians.

 

 

FAMILY PHYSICIANS SHOULD CONSIDER REFERRING PATIENTS WITH LOW BACK PAIN TO CHIROPRACTORS

CherkinDC.  “Family Physicians and Chiropractors:  What’s Next for the Patient?”  The Journal of Family Practice, Volume 35, Number 5, November 1992, Pages 505-506.

 

These findings state that chiropractors are highly trained and are adequately

 

educated in the serious diseases that could cause low back pain.

 

 

97% AGREE TO RECOMMEND THEIR CHIROPRACTOR TO A FRIEND OR RELATIVE

Sawyer CE, Kassak K.  “Patient Satisfaction with Chiropractic Care.”  Journal of Manipulative and Physiological Therapeutics, Volume 16, Number 1, January 1993, Pages 25-32.

 

Patients were surveyed on satisfaction, availability, affordability, and

 

professionalism.

 

 

PATIENTS WHO SAW CHIROPRACTORS HAD A MUCH HIGHER SATISFACTION RATING

Carey.  New England Journal of Medicine.  1995; October 5:  913-917.

 

Study of 1633 acute low back pain patients.  Treated by primary care M.D.’s, D.C.’s,

 

Orthopedic M.D.’s, and Managed Care.

 

 

Verhoef, Ph.D.  et al.  Journal of Manipulative and Physiological Therapeutics; 1997; 20(4); May:  235-240.  The Chiropractic Outcome Study.  Study of 278 patients with back and or neck pain from 13 chiropractic practices in Canada evaluating the changes from baseline to 6 week follow up in terms of 1) Pain, 2) Functional ability, 3) Patient Satisfaction as measured by the Visual Analog Scale, Oswestry, and Neck Disability Index.  Results:  Satisfaction questionnaire indicated high levels of satisfaction with care.

 

Eisenberg, M.D.  Annals of Internal Medicine, 1997; 127(1):  61-69.  Advising patients who seek alternative medical therapies.  More than 70% of patients who used alternative therapy never mentioned it to their MD’s.  We as a profession must address the challenge of discussing alternative therapies with out patients and put an end to the “don’t ask, don’t tell” approach that characterizes communication in this area.  This makes for relationship centered care.

 

Wiesel, M.D., Backletter.  1995; 10(10):  113.  Managed care organizations find the key to financial success lies in customer satisfaction.  A survey in August compared patient satisfaction with membership growth in 5 New York HMO plans.  The highest rated plan ranked 13% above average satisfaction and had 112% growth in 1994.

 

Petersen.  Dynamic Chiropractic.  1995; 13(21); Oct. 9:  1, 27.  In its 50 years Kaiser Permanente has never offered Chiropractic services, but as a result of keen competitive market, and in order to attract more members by offering consumers greater health care options, it has negotiated with a chiropractic PPO to provide Oregon and southwest Washington members an option to choose a chiro benefit.  Patients in Southern California will not need a referral from a primary care physician to see a chiropractor.

 

Goldberg, D.O.  Gilroy Branch, Permanente Medical Group.  Medicine in the Nineties.  Alternative Care:  Chiropractic.  August 14, 1997.  In reality what is happening, members are requesting chiropractic services.  Competitors are providing chiro services.  Now, our large purchasers are demanding that we provide chiro services.  What is driving this satisfaction issue?  The patients perceived they had a much better history, a better explanation with doctors of chiropractic.

 

Shekelle, M.D., Ph.D.  Medical Care 1995; 33(8):  842-850.  Evidence continues to accumulate that doctors of chiropractic (D.C.’s) are more popular than M.D.’s with their back pain patients.  Of 1020 episodes of back pain care made by 686 patients encompassing 8825 visits, D.C.’s were the primary providers for 40% of the episodes.  D.C.’s retain a greater percent of their patients who have a subsequent episode of back pain than do other providers.  D.C.’s retained 92% of their patients for a second episode.  General Practitioners retained 75%.  Doctors of Osteopathy retained 75%.  Orthopedists retained 50%.  Internists retained 22%.

 

Cowley, Going Mainstream, Newsweek 1995; June 26:  56-57.  There is a growing awareness among health insurers that patients seeking unconventional care represent a huge potential market and that alternative are doesn’t cost the insurer very much.  As one managed care executive said, “3 visits to a chiropractor are a lot less expensive than an MRI or back surgery.”  To appeal to this large market, insurers increasingly providing prevention and wellness plans in order to attract people interested in alternative care.

 

Shelton M.D.  American Medical News 1997; April 7: 13-18.  American Medical Association recognizes the demand for alternative health care.  There are now many practices offering integrated medical care - conventional allopathic along with alternative care.  This is mixed marriage forced by the public’s growing demand for access to alternative care options and the health care markets search for ways to reduce costs.  “It’s a tremendous consumer movement, a social phenomenon and a reality in health care today.”  Says Micozzi, M.D., Ph.D., editor of Fundamentals of Complimentary and Alternative Medicine, an introductory medical school textbook.

 

In 1992 in response to increasing demand, Congress created the Office of Alternative Medicine at the National Institute of Health to facilitate the evaluation of alternative modalities and efficacy of treatment, support research and establish information clearing house for the public.

 

Oxford Health Plan, (1.4 million members), created an alternative health care program, in January of 1997, including a network of credentialed alternative providers.  “It’s about consumer demand,” says the MD manager of the program.  75% of the members surveyed want access to alternative therapies.