title: Referral patterns and attitudes of primary care physicians towards chiropractors.
abstract: BACKGROUND
  Despite the increasing usage and popularity of chiropractic care, there has been limited research conducted to examine the professional relationships between conventional trained primary care physicians (PCPs) and chiropractors (DCs). The objectives of our study were to contrast the intra-professional referral patterns among PCPs with referral patterns to DCs, and to identify predictors of PCP referral to DCs.
  
  
  METHODS
  We mailed a survey instrument to all practicing PCPs in the state of Iowa. Descriptive statistics were used to summarize their responses. Multivariable logistic regression analyses were conducted to identify demographic factors associated with inter-professional referral behaviors.
  
  
  RESULTS
  A total of 517 PCPs (33%) participated in the study. PCPs enjoyed strong intra-professional referral relationships with other PCPs. Although patients exhibited a great deal of interest in chiropractic care, PCPs were unlikely themselves to make formal referral relationships with DCs. PCPs in a private practice arrangement were more likely to exhibit positive referral attitudes towards DCs (p = 0.01).
  
  
  CONCLUSIONS
  PCPs enjoy very good professional relationships with other PCPs. However, the lack of direct formalized referral relationships between PCPs and chiropractors has implications for efficiency, continuity, quality, and patient safety in the health care delivery system. Future research must focus on identifying facilitators and barriers for developing positive relationships between PCPs and chiropractors.
authors.affiliation: Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, Iowa, USA. barry-greene@uiowa.edu
authors.forename: Barry R
authors.initials: BR
authors.lastname: Greene
authors.forename: Monica
authors.initials: M
authors.lastname: Smith
authors.forename: Veerasathpurush
authors.initials: V
authors.lastname: Allareddy
authors.forename: Mitchell
authors.initials: M
authors.lastname: Haas
mesh_terms: D002684:Chiropractic / Q000706:statistics & numerical data*; D000529:Complementary Therapies / Q000706:statistics & numerical data / Q000639:trends; D007722:Health Knowledge, Attitudes, Practice; D007400:Interprofessional Relations; D007484:Iowa; D015999:Multivariate Analysis; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*