[Norwegian physicians and referral to chiropractors]

Area of Science:

• Health Services Research
• Chiropractic Medicine
• Public Health Policy

Background:

• Norway uniquely links National Health Insurance reimbursement for chiropractic care to medical practitioner referrals.
• Previous studies highlighted potential inefficiencies in the medical-chiropractic referral system.

Purpose of the Study:

• To evaluate the practice of medical practitioner referrals to chiropractors in Norway over a decade (1979-1989).
• To assess attitudes towards the referral system, standardization of care for musculoskeletal disorders, and types of referred conditions.
• To identify changes in referral practices and patient choices between 1979 and 1989.

Main Methods:

• Two comparable surveys of medical practitioners conducted in 1979 and 1989.
• Investigation of referral practices, diagnostic procedures, and treatment approaches for musculoskeletal disorders.
• Analysis of patient examination timing relative to referral and communication of diagnostic information.

Main Results:

• A significant percentage of patients (41.6%) were not examined by a medical doctor before referral, and 23.9% received referrals after treatment began.
• Medical diagnoses were provided in 84.3% of cases, with x-ray findings communicated to chiropractors for 35.5% of x-rayed patients.
• Chiropractic care increasingly became the first choice for musculoskeletal problems, with low back pain remaining the primary referral reason. Regional variations in standardization and urban-rural disparities in sick-leave and drug use were noted.

Conclusions:

• The current medical referral system for chiropractic care in Norway is not functioning optimally.
• The working relationship between medical doctors and chiropractors may require restructuring.
• Increased patient preference for chiropractic care suggests a shift in treatment seeking for musculoskeletal conditions.