Fragmentation of patient care between chiropractors and family physicians

Background: Most patients using alternative practitioners also receive care from physicians. It is unclear, however, how well alternative practitioner s and physicians communicate and coordinate the care of shared patients. Objective: To describe the communication and coordination of care for share d patients between chiropractors and family physicians as well as potential barriers to effectively sharing care. Design, letting, and Participants: A cross-sectional national random sample survey of 400 chiropractors and 400 family physicians. Main Outcome Measures: Reports on shared patients including information on adverse events, treatment, and health status. Attitudes toward perceived ex pertise as well as perceived liability and economic competition involved in sharing care were also assessed. Results: Surveys were completed by 360 (49%) of the 736 eligible practition ers, including 227 chiropractors and 133 family physicians. Although a high degree of interaction occurs between the practitioners, family physicians received information from chiropractors on 26.5% of referred patients while chiropractors received information from family physicians in 25.0% of case s (P = .73). Both groups believed that they did not receive enough informat ion on adverse health. outcomes or treatment plans for shared patients. Alt hough neither group was particularly oriented toward wanting to share care, family physicians were much less likely than chiropractors to feel comfort able sharing care (P<.001). Conclusions: These findings indicate that care is fragmented between chirop ractors and the general medical sector, with little information communicate d between health care providers on issues with critical importance to quali ty of care. Further study is needed to identify ways to improve communicati on and coordination of care.