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.
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