Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-Year Changes in Health and Satisfaction With Care

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SOURCE:   J Manipulative Physiol Ther. 2014 (Oct); 37 (8): 542-551 ~ FULL TEXT

Paula A.M. Weigel, PhD, Jason M. Hockenberry, PhD,
Fredric D. Wolinsky, PhD

Research Associate,
Department of Health Management and Policy,
College of Public Health,
The University of Iowa, Iowa City, IA.
Paula-Weigel@uiowa.edu


OBJECTIVE:   The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

METHODS:   Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS:   The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

CONCLUSION:   This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.


From the Full-Text Article:

Introduction

National surveys and other data show chiropractic use prevalence rates among those 18 years and older, ranging between 5.6% and 8.6% in the United States. [1-3] Among Medicare beneficiaries 70 years and older, chiropractic use is less prevalent, with 2 studies indicating annual rates ranging between 4.1% and 5.4%. [4, 5] For younger Medicare beneficiaries, chiropractic prevalence rates are closer to national rates, ranging between 6% and 7%. [6] Although informative, these estimates are not reflective of the population that commonly seeks care from doctors of chiropractic — namely, persons seeking treatment of spine-related health conditions. [2, 7-9] Prevalence of chiropractic use is likely higher in the population of Medicare beneficiaries with back and neck conditions, but how much higher is not known.


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