Attitudes toward drug prescription rights: a survey of Ontario chiropractors

Abstract

BackgroundSeveral published surveys have shown that chiropractors are generally split in their opinions regarding the right to prescribe drugs in chiropractic practice. Many of these studies have been limited by low response rates, leaving the generalizability of their findings open to question. The aim of the current study was to ascertain the general attitudes of chiropractors in Ontario, Canada toward the inclusion of drug prescription rights in their scope of practice. Relationships between these attitudes and the number of years in practice including differences in philosophical orientation were also explored.MethodsA 14-item questionnaire was developed and invitations sent via e-mail to all eligible 2,677 chiropractors in active practice registered electronically with the College of Chiropractors of Ontario in February 2015. Data were collected and analyzed using descriptive and inferential statistics.Results960 questionnaires were completed for a 36 % response rate. The majority of respondents agreed that chiropractors should be permitted to prescribe musculoskeletal medications such as over-the-counter and prescription-based analgesics, anti-inflammatories, and muscle relaxants. Over two-thirds also felt that with limited prescriptive authority chiropractors could help reduce patients’ reliance on these types of drugs. Over three-quarters were opposed however to chiropractors having full prescribing rights. The majority indicated they recommend over-the-counter medications to acute and chronic patients to some extent in clinical practice. Nearly two-thirds perceived their knowledge of musculoskeletal medications as high or very high, while a similar proportion perceived their knowledge of drugs for non-musculoskeletal conditions to be low or very low. A majority of respondents felt that further education in pharmacology would be necessary for those in the profession wishing to prescribe medications. More recent graduates and those who espoused a broad scope of chiropractic practice were most in favour of limited prescribing rights for the profession.ConclusionsA majority of responding Ontario chiropractors expressed interest in expanding their scopes of practice to include limited drug prescription. These results together with those of other recent surveys could indicate a shift in chiropractors’ attitudes toward drug prescription rights within the profession. Further surveys and/or qualitative studies of chiropractors in other jurisdictions are still needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12998-015-0066-7) contains supplementary material, which is available to authorized users.

Attitudes, beliefs, and practices among Swiss chiropractors regarding medication prescribing for musculoskeletal conditions: a national Q-methodology study

“…In general, respondents were divided over being able to prescribe opioids, while most were opposed to incorporating medications into their formulary for treating non-MSK conditions. These findings are consistent with the results of several international chiropractic surveys [1,[9][10][11][12]. In the current study, several respondents from all four groups of ChiroSuisse members further commented that non-MSK conditions were outside of the chiropractic scope of practice and that more training in pharmacology would be required for Swiss chiropractors if their prescriptive scope were to include opioid analgesics.…”

“…The purpose of this study was to assess Swiss chiropractors' current attitudes toward, the frequency of, and indications for, medication prescribing for MSK conditions in clinical practice. Based on previous literature [1,2,5,[9][10][11][12], this study also aimed to explore Swiss chiropractors' beliefs toward their current pharmacology training, as well as their interest in expanding the current Swiss prescribing formulary to include additional medications for MSK and non-MSK conditions.…”

“…The results of this study are important because they can be used by clinicians, educators, decision-makers, and health policy-makers to inform future directions and research regarding prescribing practices for chiropractors in Switzerland, and possibly in other jurisdictions. For instance, reports indicate that a growing number of chiropractors from countries outside Switzerland are also interested in expanding their scopes of practice to include similar prescribing privileges [ 10 – 17 ]. However, debate continues over the standards of pharmacology training for chiropractors internationally, as well as the extent to which medication prescribing rights should be expanded within the profession [ 1 , 2 , 9 – 12 ].…”

A commentary on the implications of medication prescription rights for the chiropractic profession

“…Much of this disagreement stems from philosophical differences within the profession [6, 24]. Elements of this discord amongst chiropractors may also be reflective of the number of years in practice, chiropractic college attended, or both [6, 8].…”

The new chiropractic

“…Indeed, chiropractors should be prepared to alter how they as individual practitioners communicate with patients, the diagnostic tests used or ordered, the prevention strategies recommended and the therapies administered including the use of medication and other interventions that are synergistic with musculoskeletal disorders. With respect to medication there has been a significant shift in attitudes within the profession regarding the use of medication in chiropractic practice [9, 10]. Notwithstanding restrictive laws in various jurisdictions regarding medication prescribing rights what will matter in the future is cost-effectiveness not an anti-drug dogma.…”