Integration of Chiropractic Pediatrics into Managed Health Care

Managed care is a system of health care which is rapidly exerting influence over the way in which an increasing number of health practitioners treat their patients. The "bean counters" within the managed care organizations are dictating to doctors how often they should see patients and what procedures they should perform for a given diagnosis. Many doctors resent this intrusion into their area of expertise as interference with their professional decision-making skills but the process, once started, is difficult to reverse.

The goals of managed care are to provide good quality health care at the cheapest possible cost, and so the search by managed care organizations for alternatives to high cost procedures continues. Although this interference is resented by many doctors, in certain instances, the final outcomes might ultimately produce some efficiencies in the selection and delivery of the most appropriate patient care.

This brings us to the point of this month's pediatric column. In the search for more efficient and cost effective ways to treat patients, the managed care organizations are looking at all possibilities. This includes chiropractic care. It seems that if there is a dollar profit to be made on the bottom line then any effective procedure is closely considered, even if it is provided by nonmedical specialists. In this case it's chiropractors.

Just recently, I had the opportunity to address the national conference of the American Association for Preferred Provider Organizations, a conference for medical directors and executives of PPOs from throughout the US. The conference organizers had heard that chiropractors were treating children and wished to know more about the possibilities that chiropractic presented. The requested topic of the presentation was the "Integration of Chiropractic into Managed Health Care." In particular, my presentation was to focus on chiropractic care for children.

My initial thoughts in preparation of the paper revolved around my previous discussions with MDs and especially with pediatricians. Discussions usually centered on the ability of chiropractors to identify problems in children which may be outside our scope of treatment. These conversations usually involve a discussion of the chiropractor's education and training, before addressing the issue of scope of practice. So often in these discussions, we find that the MDs knowledge of our level of training and expertise is so inaccurate that they are amazed to learn of the many parallels between the chiropractic curriculum and that of medical school.

One area in which the conference participants were particularly interested was a discussion of the Quebec study. This study, "Use of Alternative Medicine by Children," published in the Journal of Pediatrics, December 1994, looked at the increasing trend of parents taking their children to alternative health care practitioners. Conducted in Quebec in 1992, the researchers asked parents attending a regional medical center to complete a questionnaire which was designed to assess the incidence of utilization of alternative medicine by children. Of 1911 responses received, 208 (11%) indicated that their children had at some time used the services of an alternative health practitioner. An analysis of those 208 patients, shown here in Table 1, indicated that the type of therapy most frequently used was chiropractic, followed by homeopathy, naturopathy, acupuncture and osteopathy.

An analysis of the reasons for consulting an alternative medicine practitioner, shown in Table 2, revealed that more than half of the visits were for upper respiratory or ear, nose and throat problems. These findings are consistent with the results of previous surveys conducted through this column ("DC" 10/9/92 and "DC" 12/4/92).

In Table 3, the reason for using alternative medicine is analyzed by type of practitioner. These figures show a clear preference for either chiropractic or homeopathy for upper respiratory conditions. When it comes to ear, nose and throat conditions, there is a clear preference for chiropractic over all other types of treatment. For musculoskeletal conditions also, there is a clear preference for chiropractic.

Another interesting statistic emanating from this study, one that I am sure we can all relate to, is that those children who visited alternative practitioners needed less visits to the hospital outpatient department (OPD). Thirty four percent of the AM group used OPD services compared to 56% for the non-AM users.

The final analysis presented in this study was a review of the factors influencing choice of alternative medicine over conventional medicine. Table 5 shows that word of mouth is the strongest determinant of choice for alternative medicine, followed by fear of drug side-effects, chronic medical problem, dissatisfaction with conventional medicine and more personalized attention.

The utilization of chiropractic services as the most popular form of alternative therapy for children has not escaped the attention of the managed care organizations, nor has the increasing emphasis on chiropractic care for children over the past few years been entirely missed. It seems that members of the health care profession, outside of chiropractic, are beginning to realize that we might just have some cost effective, safe and efficacious solutions to children's common health problems. As the medical director of one large drug company whose granddaughter has suffered with earaches for three years said, "I think I'll take my granddaughter to a chiropractor."

Peter Fysh, DC
San Jose, California

Editor's note: Dr. Fysh is currently conducting pediatric seminars. He may be contacted at 1-800-999-7337.