A recent study compared the difference in acute low back pain outcomes in patients treated by primary care physicians, orthopedic surgeons, or chiropractors. The study reports that there were no differences in treatment outcome among the different types of care, but that chiropractic and orthopedic care was the most expensive. When the patients were asked about the quality of care, however, the chiropractic patients reported their satisfaction as considerably higher. The chiropractic patients ranked higher: the information provided, their treatment, the results, the detailed history their doctor took, their examination, and having their problem explained clearly. Chiropractic patients also used significantly fewer medications for their pain.
The focus of this study, however, seems not to be on quality, but cost. The lowest cost provider in the study was the HMO primary care physician, and the study suggests that acute back pain patients should be sent to managed care providers. To wit: “Patients and insurers need to address the trade-off between the substantially lower charges by primary care practitioners and the higher the level of satisfaction with the care that chiropractors and orthopedic surgeons provide.” Unfortunately, the decisions are typically made on the basis of cost, not what the patient wants. Interestingly, when the patient satisfaction was reported in this study, all non-chiropractic providers were compared with chiropractors, so that no information is given on the HMO patient’s level of satisfaction. Is it accidental that the HMO satisfaction information was left out?
The results of a recent British study, on the other hand, suggest that the extra cost and longer treatment time of chiropractic results in better outcome. The trial conducted by the UK Medical Council followed a group of randomly assigned hospital outpatient and chiropractic low back pain patients for three years. The study reports that the chiropractic patients were significantly more improved than the medically treated patients.