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

J Manipulative Physiol Ther. 2015 Sep;38(7):477-83. doi: 10.1016/j.jmpt.2015.06.015. Epub 2015 Aug 16.


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).

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.

Keywords: Chiropractic; Clinical Audit; Health Care Costs, Treatment Outcome; Patient Outcome Assessment; Physicians.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arthralgia / economics
  • Arthralgia / rehabilitation
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Health Care Costs*
  • Health Personnel / economics
  • Hip Joint
  • Humans
  • Low Back Pain / economics
  • Low Back Pain / rehabilitation
  • Male
  • Manipulation, Chiropractic / economics*
  • Manipulation, Chiropractic / methods
  • Middle Aged
  • Musculoskeletal Pain / diagnosis
  • Musculoskeletal Pain / rehabilitation*
  • Odds Ratio
  • Patient Outcome Assessment*
  • Patient Satisfaction / statistics & numerical data
  • Primary Health Care / economics
  • Primary Health Care / methods
  • Referral and Consultation / economics
  • Retrospective Studies
  • Severity of Illness Index
  • Shoulder Pain / economics
  • Shoulder Pain / rehabilitation
  • Surveys and Questionnaires
  • Switzerland
  • Telemedicine / economics*
  • Treatment Outcome