J Manipulative Physiol Ther 2006 (Jul); 29 (6): 455–462 ~ FULL TEXT
Gary Gaumer, PhD
School of Health Studies,
Department of Health Care Administration,
Boston, Mass. 02115, USA
Chiropractic patient satisfaction has been reported to be very high in the scientific literature. A review of the literature found 8 studies that compared chiropractic care to care from medical doctors (MD). 6 studies showed higher satisfaction with chiropractic care while 1 found higher satisfaction with MD care and 1 was equivocal. The data for this study was collected by a national phone survey and involved contacting 400 adults who had received chiropractic services and 400 who never received chiropractic care. The 22-minute phone interview found that 50% of all former chiropractic patients had seen a chiropractor in the past year. Family or friends had referred 66% of chiropractic patients while 12% were referred by their MD. Further analysis concluded that 12% of the adult US population had visited a chiropractor in the past 12 months. 83% of the chiropractic patients reported they were satisfied or very satisfied while only 9% were dissatisfied with care received. The researchers concluded that the chiropractor’s communication quality appeared to be a significant predictor of patient satisfaction. Patients responded that the doctors of chiropractic explained health problems and choices and seemed to be concerned about them as individuals in addition to their overall health.
OBJECTIVE: The purpose of this study is to review the recent literature on satisfaction with chiropractic care and offer a multivariate analysis of a national household survey data to understand which aspects of care and behavior contribute most to patient satisfaction with chiropractors.
METHODS: A national phone survey of households was done to measure attitudes, utilization, and health practices of chiropractic users and nonusers. A 73% response rate was achieved. Satisfaction with chiropractic services is analyzed using both descriptive and multivariate methods.
RESULTS: Satisfaction levels with chiropractic care are quite high (83% of persons are satisfied or very satisfied). High satisfaction is related to several factors, including whether the chiropractor orders and interprets laboratory tests, whether the chiropractor displays concern about patient's overall health, and the extent to which the chiropractor explains the condition and the treatment.
CONCLUSIONS: The evidence about the factors that underlie high levels of chiropractic satisfaction is not consistent. Communication quality seems to be a consistent predictor of patient satisfaction with chiropractors. More research is needed to understand the role of perceived effectiveness of treatment, intensity of use, accessibility, and financing issues in determining patient satisfaction levels.
From the FULL TEXT Article:
The results here generally confirm the findings elsewhere in the literature. Of the 23% of the adult population who have ever visited a chiropractor, overall rates of satisfaction are once again found to be quite high (83% satisfied or better) and the number dissatisfied is quite low (less than 10% dissatisfied or very dissatisfied). This is remarkable given the fact that much of the financial burden of the care is borne by patients, and the preponderance of care is for difficult chronic problems of back and neck.
What factors are most highly correlated with high (or low) satisfaction? Here, little is added to the somewhat ambiguous literature about what aspects of practice and patients influence overall satisfaction with providers. The present study finds that some factors are positively correlated (P < .05) with overall satisfaction including “understandable explanation of treatment and choices,” “ordering and interpretation of laboratory results,” and “concern about me as a person.” These notions of communication quality and empathy are strongly correlated with overall satisfaction with chiropractic care (eg, persons who rate these aspects of their DC high are also very likely to rate their chiropractor highly overall; similarly, persons who rate their chiropractor low on these traits are likely to rate their chiropractor low overall). That is to say that these aspects of chiropractic care tend to discriminate between high and low levels of overall satisfaction. The importance of good communication by providers does stand out as a consistent determinant of overall satisfaction here and elsewhere in the literature.
Many aspects of chiropractic care are not found to be good consistent discriminators of overall provider satisfaction. Willingness to refer, accessibility and timeliness issues, and providing good well-care advice are not found to be correlated with overall satisfaction. One access measure has a surprising negative association with overall satisfaction: “my chiropractor allows appointment to be made in a timely way.” The implication is that persons who disagreed with the statement (ie, they experienced difficulty in getting timely appointments) had higher levels of overall satisfaction. This makes sense if the most satisfying providers are also the busiest, and if patients overlook the access difficulty when rating satisfaction. This is possible but cannot be tested here. More likely, the “difficulty in getting appointment” measure is serving as a proxy for some other excluded variable (size of practice, employed or not, etc). More research is clearly needed on this matter.
Perceived effectiveness as a provider is ambiguously related to overall satisfaction. Perceived effectiveness in dealing with serious problems is not correlated at all with overall satisfaction (P < .625), but being perceived as effective in dealing with less serious problems is marginally associated with overall satisfaction (P < .055). As noted above, being effective in providing good well-care advice is not associated with overall satisfaction score (P < .961), even though the “amount” of self-care advice was found to be a strong correlate with satisfaction in 1 prior study.  Overall, it is not clear that perceived effectiveness is correlated with overall satisfaction. This ambiguity is troubling but is a reflection of the ambiguous literature, where perceived outcomes are found to be associated with satisfaction [1, 2, 6] and yet not to be associated with measured outcomes. 
More research will be needed to clarify the relationships among outcomes, perceived effectiveness, and satisfaction. One important kind of study would be of “switchers” of chiropractic providers. This somewhat difficult-to-find group may be useful in understanding and isolating those factors that are important in determining patient satisfaction with providers. This sample was simply too small to have a large nested sample of switchers to study. However, doing large-scale quantitative or even randomized studies is not the only way to make progress here. Careful qualitative research will also be needed to help understand how attitudes and perceptions about health care and providers relate to expectations.
More research will be also needed to fully understand the satisfaction gap between DCs and other providers. Two parameters need to be researched using satisfaction surveys of large samples of persons getting care in offices of different types of providers. More needs to be known about which factors consistently drive satisfaction for office-based care (regardless of type of provider). And, second, we also need to know the extent to which some subsets of these factors are actually different between the MDs and DCs, favoring the DCs. At this writing, it seems that the gap is best explained (though only partially) by DCs providing more self-care advice and providing better explanations of condition and treatment.
The evidence about the factors that underlie high levels of chiropractic satisfaction is not consistent. Communication quality seems to be a consistent predictor of patient satisfaction with chiropractors.