Evaluating rates of chiropractic use and utilization by patient sex within the United States Veterans Health Administration: a serial cross-sectional analysis

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Within the United States Veterans Health Administration (VHA), the number of patients using healthcare services has increased over the past several decades. Females make up a small proportion of overall patients within the VHA; however, this proportion is growing rapidly. Previous studies have described rates of VHA chiropractic use; however, no prior study assessed differences in use or utilization rates between male and female veterans. The purpose of this study was to assess rates of use and utilization of chiropractic care by sex among VHA patients receiving care at VHA facilities with on-station chiropractic clinics.

Methods

A serial cross-sectional analysis of VHA national electronic health record data was conducted in Fall 2021 for fiscal year (FY) 2005–2021. The cohort population was defined as VHA facilities with on-station chiropractic clinics, and facilities were admitted to the cohort after the first FY with a minimum of 500 on-station chiropractic visits. Variables extracted included counts of unique users of any VHA on-station facility outpatient services, unique users of VHA on-station facility chiropractic services, number of chiropractic visits, and sex. To calculate use, we determined the proportion of patients of each sex who received chiropractic services to the total patients of the same sex receiving any outpatient care within each facility. To calculate utilization, we determined the number of chiropractic care visits per patient per fiscal year. A linear mixed effects model was applied to examine the difference in chiropractic care utilization by sex.

Results

The percentage of female VHA on-station chiropractic patients increased from 11.7 to 17.7% from FY2005–FY2021. Among VHA facilities with on-station chiropractic care, the percentage of female VHA healthcare users who used chiropractic care (mean = 2.3%) was greater than the percentage of male VHA healthcare users who used chiropractic care (mean = 1.1%). Rates of chiropractic utilization by sex among VHA facilities with on-station chiropractic clinics were slightly higher for females (median = 4.3 visits per year, mean = 4.9) compared to males (median = 4.1 visits per year, mean = 4.6).

Conclusion

We report higher use and utilization of VHA chiropractic care by females compared with males, yet for both sexes rates were lower than in the private US healthcare system. This highlights the need for further assessment of the determinants and outcomes of VHA chiropractic care.

Related collections

Most cited references 20

Record: found
Abstract: found
Article: not found

Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey.

D M Eisenberg, R B Davis, S L Ettner … (1998)

A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. To document trends in alternative medicine use in the United States between 1990 and 1997. Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. A total of 1539 adults in 1991 and 2055 in 1997. Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.

0 comments Cited 566 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007.

Barbara Stussman, Alexander Bloom, Richard Nahin … (2009)

This report presents selected estimates of costs of complementary and alternative medicine (CAM) use among U.S. adults, the frequency of visits made to CAM providers, and the frequency of purchases of self-care CAM therapies. Data from the 2007 National Health Interview Survey (NHIS), which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, are used in this report. Estimates were derived from the Complementary and Alternative Medicine Supplement of the 2007 NHIS, sponsored by the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health. Estimates were generated using the SUDAAN statistical package to account for the NHIS complex sample design. In 2007, adults in the United States spent $33.9 billion out of pocket on visits to CAM practitioners and purchases of CAM products, classes, and materials. Nearly two-thirds of the total out-of-pocket costs that adults spent on CAM were for self-care purchases of CAM products, classes, and materials during the past 12 months ($22.0 billion), compared with about one-third spent on practitioner visits ($11.9 billion). Despite this emphasis on self-care therapies, 38.1 million adults made an estimated 354.2 million visits to practitioners of CAM. About three-quarters of both visits to CAM practitioners and total out-of-pocket costs spent on CAM practitioners were associated with manipulative and body-based therapies. A total of 44% of all out-of-pocket costs for CAM, or about $14.8 billion, was spent on the purchase of nonvitamin, nonmineral, natural products.

0 comments Cited 97 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided

Peter J. H. Beliveau, Jessica Wong, Deborah A Sutton … (2017)

Background Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided. Methods Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition. Results The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%). Conclusions This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged. Electronic supplementary material The online version of this article (10.1186/s12998-017-0165-8) contains supplementary material, which is available to authorized users.

0 comments Cited 91 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Sarah E. Graham: Doc.sarah.graham@gmail.com

Brian C. Coleman: Brian.coleman2@va.gov

Xiwen Zhao: Xiwen.zhao@yale.edu

Anthony J. Lisi:

ORCID: http://orcid.org/0000-0003-1153-967X

Anthony.lisi@va.gov

Journal

Journal ID (nlm-ta): Chiropr Man Therap

Journal ID (iso-abbrev): Chiropr Man Therap

Title: Chiropractic & Manual Therapies

Publisher: BioMed Central (London )

ISSN (Electronic): 2045-709X

Publication date (Electronic): 10 August 2023

Publication date PMC-release: 10 August 2023

Publication date Collection: 2023

Volume: 31

Electronic Location Identifier: 29

Affiliations

[1 ]GRID grid.281208.1, ISNI 0000 0004 0419 3073, VA Connecticut Healthcare System, ; West Haven, CT USA

[2 ]GRID grid.47100.32, ISNI 0000000419368710, Yale School of Medicine, ; New Haven, CT USA

[3 ]GRID grid.47100.32, ISNI 0000000419368710, Yale Center for Analytical Sciences, ; New Haven, CT USA

Author information

Anthony J. Lisi http://orcid.org/0000-0003-1153-967X

Article

Publisher ID: 497

DOI: 10.1186/s12998-023-00497-x

PMC ID: 10416500

PubMed ID: 37563677

SO-VID: c4d187ba-f0b7-4751-a3b1-e3e5fb991696

Copyright © © Chiropractic and Osteopathic College of Australasia, European Academy of Chiropractic, The Royal College of Chiropractors, Nordic Institute of Chiropractic and Clinical Biomechanics and BioMed Central Ltd. 2023

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 11 April 2023

Date accepted : 3 July 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100007517, NCMIC Foundation;

Funded by: FundRef http://dx.doi.org/10.13039/100015534, Office of Patient Care Services, Department of Veterans Affairs;

Funded by: Palmer College Foundation

Custom metadata

issue-copyright-statement © Chiropractic and Osteopathic College of Australasia, European Academy of Chiropractic, The Royal College of Chiropractors, Nordic Institute of Chiropractic and Clinical Biomechanics and BioMed Central Ltd. 2023

ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: veterans health services,chiropractic,facilities and services utilization,usage,sex distribution

Data availability:

ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: veterans health services, chiropractic, facilities and services utilization, usage, sex distribution

Evaluating rates of chiropractic use and utilization by patient sex within the United States Veterans Health Administration: a serial cross-sectional analysis

Read this article at

Abstract

Background

Methods

Results

Conclusion

Related collections

The International Journal of Person Centered Medicine

Most cited references 20

Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey.

Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007.

The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 647

Most referenced authors 388