Characteristics of Veterans Health Administration Chiropractors and Chiropractic Clinics
SOURCE: J Rehabil Res Dev. 2009; 46 (8): 997–1002
Anthony J. Lisi, DC; Christine Goertz, DC, PhD; Dana J. Lawrence, DC, MMedEd; Preeti Satyanarayana, MD, MPH
Veterans Health Administration,
Office of Rehabilitation Services,
Washington, DC
Chiropractic services have been delivered on station at select Veterans Health Administration (VHA) medical facilities since late 2004. No published data describing the characteristics of VHA chiropractic physicians (chiropractors) and chiropractic clinics exist at a national level. This study was designed to examine elements of the structures of chiropractic services in VHA settings. Web-based survey methods were used to question all chiropractors in VHA facilities (N = 36). Data were obtained from 33 providers, yielding a 91.6% response rate. Most respondents were full-time VHA employees, while others were part-time employees or contractors. Differences were found in prior training, integrated practice, and academic or research experience. Of the respondents, 88% ranked low back pain as the most common patient complaint seen in practice and 79% ranked cervical pain the second most common complaint. Of the new patient consultations, 67.6% originated from primary care, 9.4% from pain management, and 6.2% from physiatry. Most respondents were similar in their reported use of diagnostic and therapeutic procedures, but their reported rates of participation in various facility activities were different. Further work is needed for researchers and policy makers to more fully understand the integration and delivery of chiropractic services in VHA settings.
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Key words: chiropractic clinics, chiropractors, Department of Veterans Affairs, health services, integration, physical medicine, providers, rehabilitation services, survey research, veteran.
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Introduction
In July 2004, the Veterans Health Administration (VHA) Directive 2004–035 established the provision of chiropractic services on station within VHA. [1] This directive was issued in response to a Congressional mandate (Public Law 107-135), advocated by Veterans Service Organizations and chiropractic professional associations. The directive specifies that chiropractic services are for management of neuromusculoskeletal conditions and are included in the standard Medical Benefits Package for all enrolled veterans. Furthermore, these services are to be delivered on station at a minimum of one facility in each Veterans Integrated Service Network, by full- or part-time hiring or contracting with licensed chiropractic physicians (chiropractors).
By late 2004, VHA had identified 26 facilities at which to introduce these services and the first chiropractic clinics were established. In fiscal year 2005, more than 4,000 veterans received on-station chiropractic services in VHA. By fiscal year 2008, the program had expanded to 36 clinics and more than 12,000 veterans received services. During this period, the number of clinics increased by 38 percent and the number of veterans seen at these clinics tripled.
To date, no national-level data have been presented regarding the characteristics of VHA chiropractors and related clinical structures. Previous work has described chiropractors and their patients in private practice in the United States and Canada. [2–5] This research has shown significant variation among providers regarding professional training, practice parameters, academic experience, and scholarly activity.
Chiropractors typically manage spinal pain or other musculoskeletal complaints. In private practice settings, the average chiropractic patient is aged 40 to 50, slightly more than half are female, and less than 10 percent are referred by medical physicians. [2] In VHA, almost half the patient population is aged 60 and only about 7 percent are female. [6] By directive, all patients seen in chiropractic clinics must be referred by medical providers. Thus, VHA chiropractic patients are likely to represent a substantially different demographic than those seen in private chiropractic practice. Moreover, since the introduction of chiropractic services was centrally mandated yet locally implemented, natural variation is expected in clinical structures.
This study describes characteristics of the chiropractors serving in VHA, as well as other elements of chiropractic service delivery in VHA.
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