title: Acupuncture and chiropractic care: utilization and electronic medical record capture.
abstract: OBJECTIVE
  To describe acupuncture and chiropractic use among patients with chronic musculoskeletal pain (CMP) at a health maintenance organization, and explore issues of benefit design and electronic medical record (EMR) capture.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Kaiser Permanente members meeting EMR diagnostic criteria for CMP were invited to participate. The survey included questions about self-identified presence of CMP, use of acupuncture and chiropractic care, use of ancillary self-care modalities, and communication with conventional medicine practitioners. Analysis of survey data was supplemented with a retrospective review of EMR utilization data.
  
  
  RESULTS
  Of 6068 survey respondents, 32% reported acupuncture use, 47% reported chiropractic use, 21% used both, and 42% used neither. For 25% of patients using acupuncture and 43% of those using chiropractic care, utilization was undetected by the EMR. Thirty-five percent of acupuncture users and 42% of chiropractic users did not discuss this care with their health maintenance organization (HMO) clinicians. Among chiropractic users, those accessing care out of plan were older (P < .01), were more likely to use long-term opioids (P = .03), and had more pain diagnoses (P = .01) than those accessing care via clinician referral or self-referral. For acupuncture, those using the clinician referral mechanism exhibited these same characteristics.
  
  
  CONCLUSIONS
  A majority of participants had used acupuncture, chiropractic care, or both. While benefit structure may materially influence utilization patterns, many patients with CMP use acupuncture and chiropractic care without regard to their insurance coverage. A substantial percentage of acupuncture and chiropractic use thus occurs beyond detection of EMR systems, and many patients do not report such care to their HMO clinicians.
authors: Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227. E-mail: Charles.Elder@kpchr.org.
authors: Charles
authors: C
authors: Elder
authors: Lynn
authors: L
authors: DeBar
authors: Cheryl
authors: C
authors: Ritenbaugh
authors: William
authors: W
authors: Vollmer
authors: Richard A
authors: RA
authors: Deyo
authors: John
authors: J
authors: Dickerson
authors: Lindsay
authors: L
authors: Kindler
mesh_terms: D015670:Acupuncture Therapy / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data*; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid