Trends in the Use and Characteristics of Chiropractic Services in a Large Private Integrated Health Care System

Background/Significance:

In 2000, the Aurora Health Care Medical Group (AHCMG) began employing chiropractors and has expanded substantially, now employing 26 Doctors of Chiropractic. The prevalence of chiropractors working in a multidisciplinary setting has nearly doubled from 2015 to 2020. Despite increasing integration of chiropractors into medical systems, concerns persist regarding their adherence to evidence-based practices. The U.S. Veterans Health Administration (VA) reported that 27% of chiropractors practicing within the VA engaged in guideline non-concordant practices. Similar findings have been reported on chiropractors in other settings. Knowledge on the characteristics and practice patterns of chiropractors within the AHCMG is currently insufficient.

Purpose:

To investigate the demographics, professional traits, and practice habits among chiropractors employed by AHCMG.

Methods:

A cross-sectional survey with questions on demographics, professional traits, and practice habits was sent via REDCap to chiropractors employed by AHCMG between April-July of 2024. Data was de-identified and analyzed using descriptive statistics.

Results:

Surveys were distributed to 23 chiropractors and 17 responded (74%). Respondents were primarily white (94%), male (82%), and had greater than 10-years of clinical experience (82%) with no prior hospital-based training (82%). All chiropractors frequently conduct reviews of relevant medical records and physical examinations consistent with an accepted standard of practice. Commonly utilized treatment modalities included diversified manipulation, flexion-distraction, and manual myofascial techniques. Patient education on exercise, lifestyle modification, and pain neuroscience was regularly practiced. New patient consults largely originated from primary care and pain management departments. Most referrals out of chiropractic clinics were sent to pain management, orthopedic surgery, and neurosurgery departments. 29% of chiropractors endorsed patterns of imaging utilization that are non-concordant with guideline recommendations.

Conclusion:

Most chiropractors employed by AHCMG are white males with guideline consistent practice habits that deliver co-managed care with other disciplines. However, 29% did engage in imaging practices that were guideline non-concordant. The results were similar to data published by the VA except for having less prior hospital-based training.