"The Chiropractic Clinical Encounter"
A Fall 1999 Palmer PBR Project
Participant Doctors needed!

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Although spinal adjustment is central to chiropractic practice, the chiropractic clinical encounter is made up of much more than spinal adjustments. Chiropractors do not only adjust patients spines they also talk to their patients, educate them, counsel them about their health problems and about wellness and prevention, and many provide other nonadjustive procedures. Chiropractors, according to the mission statements of all U.S. chiropractic colleges, are primary health care providers, which encompasses all the above aspects and more.

It is well-known that chiropractic patients are usually very satisfied with their care, and that several aspects in addition to the adjustment itself contribute to this satisfaction. However, many aspects of the chiropractic clinical encounter have not yet been studied extensively. Since patient satisfaction is becoming an increasingly important consideration in the competitive health care marketplace, it is important to investigate the chiropractic clinical encounter in more detail, in relation to patient satisfaction.

The purpose of the fall 1999 Palmer PBR project is to describe the chiropractic clinical encounter, including aspects specifically related to primary care, in diverse practices, and investigate which aspects are associated with patient satisfaction.

 

Overview of Study Design

This observational study will be conducted in two parts: 1) a qualitative study analyzing aspects of the doctor-patient encounter; and 2) a quantitative study collecting data on patient satisfaction and practice characteristics.

 

Qualitative Study: Videotaping of the Clinical Encounter

Five to ten chiropractic offices will be selected from the offices already participating in the Palmer Practice-Based Research Program on the basis of geographic diversity and diversity in practice style. Under the direction of Robert Jansen, PhD, of Palmer West, clinical encounters will be videotaped and coded using the Davis Observation Code. This code has been used to categorize clinical behaviors and has been used extensively in family medicine for analyzing physician-patient interactions

 

Quantitative Study:

Components of Primary Care, Practice Characteristics, and Patient Satisfaction

Data will be collected by the established methods of the Palmer Practice-Based Research Program, which has been in operation since 1995. We will attempt to achieve geographic representation from all states and participation of DCs with a variety of practice styles, with approximately 150-200 offices expected to participate.

 

 

Data Collection

Each participating practice will be asked to enroll all patients into the study on the given dates, until 20 patients have been enrolled. Patients who complete the four-page booklet will receive a spine keychain as an incentive. Each participating practice and practitioner will be asked to complete a two-page survey about practice characteristics. The practice and practitioner questionnaires are only completed once, not for each patient.

 

The Questionnaires

The patient questionnaire is composed of two main instruments: the Components of Primary Care developed by the Department of Family Medicine at Case Western Reserve University, and used with their permission. The satisfaction questionnaire was developed by researchers at RAND corporation specifically for chiropractic patients, and is used with permission of its authors (Ian Coulter, et al.). The practice and practitioner forms are adapted from those used in previous Palmer PBR projects.

 

Time Frame

The study will be conducted during one week in the fall of 1999. Since only 20 patients per practice will be included, data collection will often be completed in 1-2 days.

 

Recruitment

Doctors of chiropractic who are licensed and in practice in the U.S. or Canada are eligible. Since we want to achieve geographic diversity, we are actively recruiting doctors in the following states: Alabama, Delaware, Hawaii, Louisiana, Mississippi, Nevada, South Dakota, Utah, and Wyoming. We have representation from all other states, although this does not rule out doctors in those states who wish to participate.

For further information about participating please call or e-mail:

Contact Program Coordinator,   Karen Boulanger

1-800-682-1625

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