The role of osteopathy in the Swiss primary health care system: a practice review

Abstract

ObjectivesThe aim of this study was to describe osteopathic activity and scope of practice to understand the current and future role of osteopathy in the Swiss healthcare system.DesignA questionnaire survey that included a patient record-based retrospective clinical audit.Setting/populationOsteopaths with a national diploma (n=1086) were invited by mail to participate in an online survey. Osteopathic assistants (n=84) were identified through their national association.QuestionnaireThe survey was constructed from previous surveys and tested for face validity with experts, osteopaths and patient representatives. The questionnaires were completed online in English, German and French between April and August 2017. Osteopaths anonymously reported information about themselves, their practice, and the treatment and care for four randomly selected patients they managed in 2016.ResultsThe response rate from the survey was 44.5% (521/1171). Data on osteopathic care were collected for 1144 patients and 3449 consultations. In 2016, osteopaths saw approximately 6.8% of the Swiss population for 1700 000 consultations and an overall estimated cost of 200 million Swiss francs. 76% of patients sought care directly without a referral from another care provider. Few osteopaths (<1%) work in a hospital setting and 46% work in isolation in private practice. Infants (under 2 years old) made up 10% of all patients and 9% of patients were ≥65 years. Patients most commonly sought treatment for musculoskeletal conditions (81%) with the spine being the most frequent location (66%). Treatments also included exercise advice (34.2%) and lifestyle management (35.4%). Fewer than 1 patient out of 10 were referred to another health profession or provider.ConclusionsIn Switzerland, osteopathic care represents an important first line management for musculoskeletal conditions that alleviates some of the burden of care in the Swiss primary healthcare system.

Determinants of health, health behaviours and demographic profile of patients attending an Australian university student-led osteopathy clinic

“…The use of this diagnostic system on a consistent basis across the profession, may help to provide a more accurate picture of the breadth of conditions treated by Australian osteopaths [28]. This finding is consistent with the literature suggesting that the management of spinal complaints forms a core aspect of the practice of osteopathy in Australia and internationally [1,15,16,[18][19][20][21]. More patients presented with acute presentations of less than 3 months duration (52%) than chronic presentations.…”

“…These practice profiles utilised different methodologies, however all three studies suggested that patients sought care for complaints predominantly affecting the cervical and lumbar spine. Burke et al [1] also identified that over one-third of patient's seeking osteopathy care also present with one or more co-morbid chronic diseases and this appears to be consistent with international practice profiles [16,19]. These studies reported characteristics of osteopathic patients in private practice settings.…”

“…The current work builds on these studies by utilising consecutive patient data over a 22-month period from a student-led osteopathy clinic. This data therefore adds another dimension to our understanding of this patient profile and contributes to the international discourse with respect to osteopathic patient characteristics, conditions and behaviours [19]. As Australian osteopathy students are trained as primary care professionals, they are well placed to screen and manage some aspects of the patients' care, to refer when appropriate to do so, or participate in multidisciplinary care.…”

“…More patients presented with acute presentations of less than 3 months duration (52%) than chronic presentations. Previous studies have reported lower rates of acute presentations (45.1% [19] and 48.2% [1]) where acute was defined as less than 4 weeks duration. Therefore, it is difficult to compare this data due to these temporal definition differences.…”

“…There is an emerging literature on the patient profile of those who seek osteopathy care internationally [17][18][19][20]. However, what is known about the profile of those patients seeking care from an osteopath in Australia is limited to work in 2009 by Orrock [21] and 2013 by Burke et al [1].…”