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
Taco A.W. Houweling, DC, MRes, PhD,
Andrea V. Braga, MD, MBA,
Thomas Hausheer, DC, arco Vogelsang, DC,
Cynthia Peterson, RN, DC, MMedEd,
B. Kim Humphreys, DC, PhD
Department of Chiropractic Medicine,
University Hospital Balgrist, Forchstrasse 340, 8008
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).
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CONCLUSION: 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.
From the FULL TEXT Article:
Pain of musculoskeletal origin represents a major health problem worldwide. In a Swiss survey conducted in 2007, back pain was a commonly reported health problem, with 43% of the population experiencing this complaint over the course of a year.  Of these, 33% reported that their symptoms led to reduced productivity at work. The burden of musculoskeletal conditions on the Swiss health care system is equally staggering, with health care expenditure resulting from this condition being estimated at 14 billion Swiss Francs (CHF) per year (US $14 billion) or 3.2% of the gross domestic product. 
First-contact care (ie, care provided at the entry point into the health care system including assessing and making appropriate referrals) for musculoskeletal conditions as covered by the compulsory Swiss health insurance (obligatorische Krankenpflegeversicherung) is provided by 2 medical professionals, that is, medical doctors (MDs) and doctors of chiropractic (DCs).  Although patients may be co-managed with other medical colleagues or paramedical providers (eg, physiotherapists), treatment for the same complaint may vary according to the type of first-contact provider. For instance, MDs tend to use medication, including analgesics, muscle relaxants, and anti-inflammatory agents, for the treatment of acute nonspecific spinal pain, whereas DCs favor spinal manipulative therapy as the primary treatment for this condition. 
Despite the importance of the role of MDs and DCs as first-contact care providers in the Swiss health care system, comparative research on outcomes and health care costs in patients initiating care with either of these 2 medical providers for musculoskeletal and other conditions has yet to be undertaken. Therefore, the purpose of this study was to compare differences in outcomes, including pain levels and perceived change in overall health, and patient satisfaction as well as related health care costs in spinal, hip, and shoulder pain patients who initiated care with MDs vs those who initiated care with DCs in Switzerland.