Considerations for practice-based research: a cross-sectional survey of chiropractic, acupuncture and massage practices.
BACKGROUND
Complementary and alternative medicine (CAM) use has steadily increased globally over the past two decades and is increasingly playing a role in the healthcare system in the United States. CAM practice-based effectiveness research requires an understanding of the settings in which CAM practitioners provide services. This paper describes and quantifies practice environment characteristics for a cross-sectional sample of doctors of chiropractic (DCs), licensed acupuncturists (LAcs), and licensed massage therapists (LMTs) in the United States.


METHODS
Using a cross-sectional telephone survey of DCs (n = 32), LAcs (n = 70), and LMTs (n = 184) in the Tucson, AZ metropolitan area, we collected data about each location where practitioners work, as well as measures on practitioner and practice characteristics including: patient volume, number of locations where practitioners worked, CAM practitioner types working at each location, and business models of practice.


RESULTS
The majority of practitioners reported having one practice location (93.8% of DCs, 80% of LAcs and 59.8% of LMTs) where they treat patients. Patient volume/week was related to practitioner type; DCs saw 83.13 (SD = 49.29) patients/week, LAcs saw 22.29 (SD = 16.88) patients/week, and LMTs saw 14.21 (SD =10.25) patients per week. Practitioners completed surveys for N = 388 practice locations. Many CAM practices were found to be multidisciplinary and/or have more than one practitioner: 9/35 (25.7%) chiropractic practices, 24/87 (27.6%) acupuncture practices, and 141/266 (53.0%) massage practices. Practice business models across CAM practitioner types were heterogeneous, e.g. sole proprietor, employee, partner, and independent contractor.


CONCLUSIONS
CAM practices vary across and within disciplines in ways that can significantly impact design and implementation of practice-based research. CAM research and intervention programs need to be mindful of the heterogeneity of CAM practices in order to create appropriate interventions, study designs, and implementation plans.
Department of Family and Community Medicine, University of Arizona College of Medicine, 1450 N. Cherry Avenue, Tucson, AZ, 85719, USA. lford@email.arizona.edu.
Lysbeth
L
Floden
Department of Family and Community Medicine, University of Arizona College of Medicine, 1450 N. Cherry Avenue, Tucson, AZ, 85719, USA. howerter@email.arizona.edu.
Amy
A
Howerter
Department of Family and Community Medicine, University of Arizona College of Medicine, 1450 N. Cherry Avenue, Tucson, AZ, 85719, USA. evam@email.arizona.edu.
Eva
E
Matthews
School of Anthropology, University of Arizona, 1009 E. South Campus Drive, Tucson, AZ, 85721, USA. nichtermark@gmail.com.
Mark
M
Nichter
Department of Family and Community Medicine, University of Arizona College of Medicine, 1450 N. Cherry Avenue, Tucson, AZ, 85719, USA. jkcunnin@email.arizona.edu.
James K
JK
Cunningham
Department of Family and Community Medicine, University of Arizona College of Medicine, 1450 N. Cherry Avenue, Tucson, AZ, 85719, USA. ritenbau@email.arizona.edu.
Cheryl
C
Ritenbaugh
Department of Family and Community Medicine, University of Arizona College of Medicine, 1450 N. Cherry Avenue, Tucson, AZ, 85719, USA. judithg@email.arizona.edu.
Judith S
JS
Gordon
Department of Family and Community Medicine, University of Arizona College of Medicine, 1450 N. Cherry Avenue, Tucson, AZ, 85719, USA. myram@email.arizona.edu.
Myra L
ML
Muramoto
D026881:Acupuncture; D015670:Acupuncture Therapy; D000328:Adult; D002684:Chiropractic; D000529:Complementary Therapies; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic; D008405:Massage; D026761:Physical Therapy Specialty; D011364:Professional Practice; D012107:Research Design; D011795:Surveys and Questionnaires; D014481:United States