Chiropractic and a new taxonomy of primary care activities.
OBJECTIVE
To specify the procedural and cognitive content of primary care and to discuss potential chiropractic primary care roles.


METHODS
Data were collected through use of two expert panels and a consensus process to create a list of primary care activities. The first panel was an interdisciplinary mix of physicians, mainly allopathic ones; most of the members of the second panel were chiropractors. Each panel rated primary care activities across a number of dimensions, such as importance for good health, frequency in a typical office-based practice, necessity for medical doctor involvement in the activity, competence of the majority of chiropractic physicians, and interest among chiropractors in performing the activity.


RESULTS
There was no real difference between the panels in terms of taxonomy scope or importance of the activities for good health. Many of the activities are performed more frequently in a typical medical office than in a typical chiropractic office. With respect to a set of primary care activities that occur daily in medical offices, chiropractors are able to make diagnoses in 92% of the activities and to make therapeutic contributions in more than 50% of the activities. Medical doctor involvement was perceived as required more frequently by the chiropractic panel than by the interdisciplinary panel. Moreover, chiropractors' interests and self-assessments of competence showed some limits with regard to their assumption of total care for some frequently occurring primary care activities.


CONCLUSIONS
The most important finding of this activity is the overriding sense of agreement between allopathic and chiropractic physicians in terms of the scope of primary care activities, suggesting that there is opportunity for chiropractors and medical doctors to work together on patient care and organizational strategy. However, the levels of self-assessed competence and interest on the part of chiropractors for many frequently occurring primary care activities reveal some important limits for assumption of total primary care.
Gaumer
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Abt Associates, Inc, Cambridge, Mass 02138, USA.
Walker
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D002684:Chiropractic; D002983:Clinical Competence; D003695:Delivery of Health Care / Q000379:methods*; D006801:Humans; D011320:Primary Health Care / Q000145:classification* / Q000458:organization & administration / Q000592:standards; D009626:Terminology as Topic