CAM-Oriented Primary Care Providers Result in Cost Savings,
High Patient Satisfaction, Study Suggests
Arlington, Va. (June 7, 2007) - Patients visiting chiropractors and other holistically-oriented physicians who serve as primary care providers (PCPs) have lower utilization costs and higher patient satisfaction levels than patients treated by conventional medical doctors, according to a study published in the May issue of the Journal of Manipulative and Physiological Therapeutics that tracked data from a unique Independent Physicians Association (IPA) where chiropractors serve as first-contact, primary care physicians.
"The escalation of medical expenditures remains an urgent problem in the United States and it's becoming quite clear that cost containment strategies by conventional medical providers are failing to achieve even mediocre results," said study coauthor James Winterstein, DC. "This study confirms that integration of allopathic, chiropractic and other complementary and alternative medicine (CAM) providers can positively impact patient quality of care while limiting overall costs. This approach to patient care has great potential to improve the U.S. healthcare system."
Led by Richard Sarnat, MD, researchers directly compared cost and clinical utilization data from an integrative CAM Independent Physicians Association (IPA) with conventional medical IPA data from members enrolled in a traditional health maintenance organization (HMO). The recent report analyzes data from 2003 to 2005 and is a follow up to the original report published in 2004, which compared data from 1999 to 2002. "Our most recent analysis supports earlier findings that patients visiting CAM-orientated primary care physicians (PCP) - primarily chiropractors - experienced fewer hospitalizations, underwent fewer surgeries and used considerably fewer pharmaceuticals than HMO patients who received traditional medical care," Dr. Winterstein said. "Moreover, doctors of chiropractic succeeded in diagnosing and treating patients at a level nearly equal to medical doctors."
Researchers found that over the course of the seven-year study, patientsvisiting chiropractors and other CAM-oriented PCPs had 60 percent fewer hospitalizations, 62 percent fewer outpatient surgical cases, and 85 percent lower pharmaceutical costs when compared with total network HMO utilization rates and costs. The chiropractors and other CAM doctors treated and managed cases ranging from upper respiratory tract infections and allergies to headaches, orthopedic and other medical conditions.
In 2005, the chiropractic PCPs managed 60 percent of their enrolled patients without requiring a referral to a conventional medical specialist. These data mirror the 2001 findings, which also demonstrated that 60 percent of the patient population within the integrative IPA was solely managed by their chiropractic PCPs.
"The most current data from our ongoing study suggests that doctors of chiropractic are well-suited to provide patients with valuable primary-care services," Dr. Winterstein notes. "We have demonstrated that it is possible to deliver CAM-oriented primary care in a highly regulated environment without compromising either quality or safety."
Patients reported on the quality of care they received through the use of annual patient satisfaction surveys. On average, data from patients enrolled between 2003 and 2005 demonstrated a high degree of satisfaction (96 percent, 94 percent, and 91 percent, respectively). These findings were similar to data from 1999 through 2002 (100 percent, 89 percent, 91 percent, and 90 percent, respectively). The integrative CAM patients consistently rated their experiences more positively than did members enrolled within the HMO's conventional medical IPAs.
To receive an electronic copy of the study, contact Angela Kargus at akargus@acatoday.org.
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Pain,Volume 112, Issue 3 , December 2004, Pages 289-298
Randomised trial of long term effect of acupuncture for shoulder pain
Juan Antonio Guerra de Hoyosa, , , Maria del Carmen Andrés Martínb, 1, Elena Bassas y Baena de Leonc, d, 2, , Miguel Vigára Lopeze, 3, Teresa Molina Lópezf, 4, Francisco Antonio Verdugo Morillag, 5, and Maria José González Morenoh, Abstract The objective of the study is to compare the efficacy of electro acupuncture with placebo-acupuncture for the treatment of shoulder pain. This study comprised of a prospective, randomized, placebo controlled trial, with independent evaluator set in a Public primary care clinic in Spain. The participants are patients aged from 25 to 83 years with shoulder pain. Patients were randomly allocated to two treatments over eight weeks, with electro-acupuncture or skin non-penetrating placebo-acupuncture, both able to take diclofenac if needed for intense pain. Primary outcome measure was the difference between groups in pain intensity (visual analogue scale--VAS). Secondary outcomes were differences between groups in pain intensity measured by Lattinen index, in range of motion (goniometer), functional ability (SPADI), quality of life (COOP-WONCA charts), NSAIDS intake, credibility (Borkoveck and Nau scale) and global satisfaction (10 points analogue scale). Assessments were performed before, during and three and six months after treatment. At six month follow-up after treatment the acupuncture group showed a significantly greater improvement in pain intensity compared with the control group [VAS mean difference 2.0 (95% CI 1.2–2.9)]. The acupuncture group had consistently better results in every secondary outcome measure than the control group.Acupuncture is an effective long-term treatment for patients with shoulder pain (from soft tissues lesions) in a primary care setting.
Analgesic Overuse
According to a study published in the May 11, 2004 issue Neurology, daily or near-daily use of analgesics (i.e., ibuprofen, acetaminophen, aspirin, etc.) is associated with chronic headaches, especially chronic migraines, and to a lesser extent, with other common chronic pain conditions, such as neck and back pain.These analgesics may not only be prolonging your pain, but may also be causing other long term consequences, including gastrointestinal bleeding, acid reflux, liver and kidney damage.If you have chronic pain, we would be glad to help you set up an exercise and nutritional plan to improve your lifestyle and decrease your daily pain.
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