First-contact care with a medical vs chiropractic provider after consultation with a swiss telemedicine provider: comparison of outcomes, patient satisfaction, and health care costs in spinal, hip, and shoulder pain patients.
OBJECTIVE
The purpose of this study was to identify differences in outcomes, patient satisfaction, and related health care costs in spinal, hip, and shoulder pain patients who initiated care with medical doctors (MDs) vs those who initiated care with doctors of chiropractic (DCs) in Switzerland.


METHODS
A retrospective double cohort design was used. A self-administered questionnaire was completed by first-contact care spinal, hip, and shoulder pain patients who, 4 months previously, contacted a Swiss telemedicine provider regarding advice about their complaint. Related health care costs were determined in a subsample of patients by reviewing the claims database of a Swiss insurance provider.


RESULTS
The study sample included 403 patients who had seen MDs and 316 patients who had seen DCs as initial health care providers for their complaint. Differences in patient sociodemographic characteristics were found in terms of age, pain location, and mode of onset. Patients initially consulting MDs had significantly less reduction in their numerical pain rating score (difference of 0.32) and were significantly less likely to be satisfied with the care received (odds ratio = 1.79) and the outcome of care (odds ratio = 1.52). No significant differences were found for Patient's Global Impression of Change ratings. Mean costs per patient over 4 months were significantly lower in patients initially consulting DCs (difference of CHF 368; US $368).


CONCLUSIONS
Spinal, hip, and shoulder pain patients had clinically similar pain relief, greater satisfaction levels, and lower overall cost if they initiated care with DCs, when compared with those who initiated care with MDs.
Postdoctoral Research Fellow, Department of Chiropractic Medicine, University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland. Electronic address: taco.houweling@balgrist.ch.
Taco A W
TA
Houweling
CEO and Founder, bragamed GmbH, Baar, Switzerland.
Andrea V
AV
Braga
Clinician, Private Practice, Wädenswil, Switzerland.
Thomas
T
Hausheer
Clinician, Private Practice, Zürich, Switzerland.
Marco
M
Vogelsang
Professor, Department of Chiropractic Medicine, University Hospital Balgrist, Zürich, Switzerland.
Cynthia
C
Peterson
Professor and Head of Department, Department of Chiropractic Medicine, University Hospital Balgrist, Zürich, Switzerland.
B Kim
BK
Humphreys
D000328:Adult; D018771:Arthralgia / Q000191:economics / Q000534:rehabilitation; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D017048:Health Care Costs; D006282:Health Personnel / Q000191:economics; D006621:Hip Joint; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000534:rehabilitation; D008297:Male; D026882:Manipulation, Chiropractic / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000534:rehabilitation*; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics / Q000379:methods; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020069:Shoulder Pain / Q000191:economics / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D013557:Switzerland; D017216:Telemedicine / Q000191:economics*; D016896:Treatment Outcome
Chiropractic; Clinical Audit; Health Care Costs, Treatment Outcome; Patient Outcome Assessment; Physicians