An article by Cote P et al in Med Care 2001 entitled, “The treatment of neck and low back pain: who seeks care? who goes where?” is quite interesting and definitely can impact our outcomes and results. You can access the abstract here
The authors performed a mail survey looking at the characteristics of individuals who seek care from healthcare professionals: medical doctors, chiropractors or both. They were looking to see if patients sought care in the previous month from a healthcare provider, which was 25%; but one particular conclusion jumped out at me:
Patients consulting chiropractors alone report fewer comorbidities and are less limited in their activities than those consulting medical doctors.
This can have many implications but the one that first comes to mind is that the patients we get from the usual referral patterns seen in the past several decades are worse off than ones who seek care from chiropractors. This can mean it will take longer to get them better and this definitely affects outcomesand results. Or, does this mean that individuals who seek chiropractic care are overall just healthier?? Do chiropractors keep them healthier and in return less comorbidities? Maybe so but I am hoping not.
I can tell you from working in a rural environment and with a population of older age and definitely more comorbidities (high blood pressure, obesity, type II diabetes mellitus); it does affect outcomes. It is more frustrating on the therapist (me) and harder to make goals. I can’t change lifestyle behaviors when all you do is sit on the couch, which in turn leads to having more comorbidites; and resulting in you seeking me for neck and back pain.
Continue to promote Direct Access and this can be another argument for its benefit in physical therapy profession. Patient can bypass the middle man.