D r. Roger Colcman recently reviewed a paper for our readership at ScienccInBricf.com entitled "Use of chiropractic spinal manipulation in older adults is strongly correlated with supply" (Whcdon et al. 2012). Since the majority of practicing chiropractors treat Medicare patients. I think the results arc relevant. The Facts: The study looked at a number of factors for the year 2008. The use of chiropractic varied from area to area, but on average, the authors found the following: a. There are 21.5 chiropractors for every 100.000 people in an area, although regional supply of DCs varied widely. b. Out of the total Medicare beneficiaries in an area. 7.6% received chiropractic spinal manipulations. c. Of the Medicare beneficiaries who had an allowable low back/ pelvis problem. 31% received chiropractic spinal manipulations. d. Of the Medicare beneficiaries who had an allowable cervical spine problem. 46% received chiropractic spinal manipulations. e. Of the Medicare beneficiaries who had an allowable cranial problem. 19% received chiropractic spinal manipulations. f. The average number of manipulations that the average Medi care patient received was 10.6. g. The percentage of the population that received chiropractic spinal manipulations was less among older Medicare patients than among younger Medicare patients. h. Chiropractic patients age 65 to 79 had a greater number of visits than patients in the 80 to 99 age group, i. Caucasians were more likely to be patients than other ethnicities. j. There was also a strong correlation between the number of chiropractors in an area and the number of people actually seeking chiropractic care (i.e.. more chiropractors appeared to be associated with more seniors seeking chiropractic care). Reviewer's Commentary: Even in an elderly population that is likely to have suffered more spinal trauma merely as a result of having lived longer and therefore being exposed to more possible incidents, doctors of chiropractic still only sec a small percentage of the total population. In addition, they treat those seniors for just over 10 visits. Now. readers. I want you to think about the amount of care you give to your senior parents. If only a total of 7.6% of your parents arc receiving care and they only receive on average about 10.6 visits per year, then these results appear to be in line with what you believe is appropriate for your own parents. If not. then something is wrong somewhere. It seems reasonable that you. as a practitioner, should treat people with the same care and diligence you would provide to your own parents. Reviewer: Roger Coleman. DC Editor's Comments: I understand Dr. Colcman"s comments, but I had a couple of different takes on this study as well. I think that even though we arc only treating 7.6% of the total population at any given time, we still arc caring for a sizable portion of those seniors who happen to be suffering with low back pain (31%) and neck pain (46%). Obviously, the entire senior population isn't suffering with neck and back pain at any given time, so it seems to me that we arc penetrating this demographic fairly well. When experiencing neck orback pain. a fairly large percentage of seniors use our sen ices. Medicare's relatively restricted reimbursement schedules also may influence the average usage of 10.6 visits. Additionally, whether or not you view 10.6 visits per year to be a low level of individual utilization rate for these types of cases may vary with your own practice paradigm. While most doctors would probably like to sec more utilization of chiropractic sen ices. I'm sure there are also many who consider 10.6 visits to be a fair, average amount of treatment for mechanical neck/back pain cases. Although the study doesn't point this out. it seems likely to me that one reason for less utilization of chiropractic services among older seniors (age 80-99) is that a significant number of these patients arc less mobile and therefore unable to access outpatient sen ices as effectively. Many also may be confined to senior care facilities. In my opinion, if we hope to significantly increase utilization of chiropractic sen ices among seniors, then ultimately we will probably need to be treating patients for conditions in addition to the typical neck and back pain cases we sec now. To do that, chiropractic must make the case in literature and in the marketplace that our sen ices have value over and above the relief of mechanical spinal pain only. Reference: Whcdon JM. Song Y. Davis MA. Luric JD. Use of chiropractic spinal manipulation in older adults is strongly correlated with supply. Spine. 2012 15:37:1771-7. Link to Abstract: http://www.ncbi.nlni.nih.gov/pubmcd/22487711 Dr. Mark R Payne, Phenix City, AL is Editor ofScienceln-Brief.com, a scientific literature review for busy chiropractors, lie is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to ScienceInBrief.com is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are entailed weekly to subscribers.
