• HouwelingTaco A WTAPostdoctoral Research Fellow, Department of Chiropractic Medicine, University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland. Electronic address: taco.houweling@balgrist.ch., Andrea V Braga, Thomas Hausheer, Marco Vogelsang, Cynthia Peterson, and B Kim Humphreys.
• Postdoctoral Research Fellow, Department of Chiropractic Medicine, University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland. Electronic address: taco.houweling@balgrist.ch.
• J Manipulative Physiol Ther. 2015 Sep 1; 38 (7): 477-83.

ObjectiveThe purpose of this study was to identify differences in outcomes, patient satisfaction, and related health care costs in spinal, hip, and shoulder pain patients who initiated care with medical doctors (MDs) vs those who initiated care with doctors of chiropractic (DCs) in Switzerland.MethodsA retrospective double cohort design was used. A self-administered questionnaire was completed by first-contact care spinal, hip, and shoulder pain patients who, 4 months previously, contacted a Swiss telemedicine provider regarding advice about their complaint. Related health care costs were determined in a subsample of patients by reviewing the claims database of a Swiss insurance provider.ResultsThe study sample included 403 patients who had seen MDs and 316 patients who had seen DCs as initial health care providers for their complaint. Differences in patient sociodemographic characteristics were found in terms of age, pain location, and mode of onset. Patients initially consulting MDs had significantly less reduction in their numerical pain rating score (difference of 0.32) and were significantly less likely to be satisfied with the care received (odds ratio = 1.79) and the outcome of care (odds ratio = 1.52). No significant differences were found for Patient's Global Impression of Change ratings. Mean costs per patient over 4 months were significantly lower in patients initially consulting DCs (difference of CHF 368; US $368).ConclusionSpinal, hip, and shoulder pain patients had clinically similar pain relief, greater satisfaction levels, and lower overall cost if they initiated care with DCs, when compared with those who initiated care with MDs.Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

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