Chiropractors¿ attitudes toward drug prescription rights: a narrative review

Abstract

Background: The right to prescribe drugs remains a contentious issue within the chiropractic profession. Nevertheless, drug prescription by manual therapy providers is currently an important topic. Notably, physiotherapists in the United Kingdom were recently granted limited independent prescribing rights. Reports suggest that physiotherapists in Australia now want those same rights, and as such a review of chiropractors' general attitudes toward drug prescription is needed. Objective: To examine the literature concerning chiropractors' attitudes toward drug prescription rights and to compare the opinions of chiropractors currently licensed to prescribe medication with those in the profession who are not. Methods: This was a narrative review, consisting of a formal literature search and summary of included articles. Electronic databases searched included the Cumulative Index to Nursing and Allied Health Literature, PubMed, and the Index to Chiropractic Literature. Inclusion criteria consisted of prospective studies published in English in peer-reviewed journals. Studies were required to contain data on chiropractors' opinions toward medication prescription rights. Results: Of 33 articles identified, a total of seven surveys were included in the review. Of these, there was a general split in opinion among chiropractors regarding the right to prescribe drugs in chiropractic practice. Those supportive of prescribing rights favoured a limited number of over-the-counter and/or prescription-based medications such as analgesics, anti-inflammatories, and muscle relaxants. When questioned on full prescribing rights, however, chiropractors were generally opposed. In jurisdictions where chiropractors are currently licensed to prescribe from a limited formulary, such as in Switzerland, the majority perceived this right as an advantage for the profession. Moreover, continuing education in pharmacology was viewed as a necessary component of this privilege. Conclusions: Based on the literature to date there is a general split in chiropractors' attitudes toward drug prescription rights. This split is most pronounced in countries where chiropractors are not licensed to prescribe medications. Notwithstanding, this is an important topic in chiropractic currently and warrants both further discussion and research to determine future directions and the implications of either pursuit or denial of prescription rights by chiropractors. Future surveys and/or qualitative studies of other chiropractors' opinions toward gaining prescription privileges would be timely.

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

“…Qmethodology has also been shown to be useful in eliciting subjective viewpoints [18,19]. This is particularly advantageous in topic areas, such as prescribing rights in chiropractic, where more conventional methods (i.e., closed-ended quantitative surveys) have not elucidated a clear definition or consensus on the subject matter [1,2,18,19]. A further advantage of Q-methodology is that a low response rate does not bias a study's results.…”

“…A concourse is a list of comprehensive descriptive statements on the topic of interest [18,19]; these statements are used to build the final set of items, or Q-sample, that are included in the Q-methodology survey (see below). We added 54 additional statements to the chiropractors' initial list of 271; these statements were informed by the literature [1,2,4,5,8,[10][11][12] and our content expertise. Using structured and inductive thematic analysis methods [18][19][20], the statements were then categorized into eight major themes and 13 sub-themes.…”

“…The right to prescribe medications is a controversial topic within the chiropractic profession [1,2]. At present, only nine countries, including Switzerland, Liechtenstein, Guatemala, Panama, United Arab Emirates, India, Iran, Namibia, and the United States (New Mexico and Oklahoma, only) allow for such privileges [3].…”

“…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.…”

“…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][11][12][13][14][15][16][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][10][11][12].…”