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Huluman T, Yelverton C, Peterson C. Attitudes towards limited drug prescription rights: A survey of South African chiropractors. Health SA 2022; 27:1731. [PMID: 35281290 PMCID: PMC8905459 DOI: 10.4102/hsag.v27i0.1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background Several surveys that have been published show opinions regarding a change in the scope of chiropractic practice to include prescription rights. Currently, research into the attitudes of South African chiropractors towards having this right is non-existent. Aim To ascertain the attitudes of South African chiropractors towards the inclusion of drug prescription rights in their scope of practice. Setting The study was conducted on chiropractors registered with the Allied Health Professions Council of South Africa and members of the Chiropractic Association of South Africa. Method A self-administrative online questionnaire was developed, and sent via email to all registered chiropractors in South Africa in February 2020. Descriptive statistics were used to analyse the data. Results The response rate for this study was 15.9% (n = 138). 84% (n =105) were in favour of limited prescription rights for over-the-counter medication. However, 79.6% (n = 98) did not agree to full prescriptions rights for non-musculoskeletal drugs. A total of 33.6% (n = 42) rarely recommended OTC and prescription-based analgesics, muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) to their acute patients and 37.9% (n = 52) rarely recommended these drugs to chronic patients. 68.8% (n = 86) were confident in their knowledge of musculoskeletal drugs and 91.2% (n = 112) agreed on further education and training in pharmacology for those practitioners seeking limited medication prescription rights. Conclusion The majority of South African chiropractor respondents indicated an interest in expanding their scope of practice to include limited prescription rights. Contribution These findings could indicate a shift in the attitudes of chiropractors towards drug prescription rights within the profession.
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Affiliation(s)
- Thriya Huluman
- Department of Chiropractic, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Christopher Yelverton
- Department of Chiropractic, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Cynthia Peterson
- Department of Chiropractic, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Emary PC, Oremus M, Houweling TAW, Wangler M, Akhtar-Danesh N. Attitudes, beliefs, and practices among Swiss chiropractors regarding medication prescribing for musculoskeletal conditions: a national Q-methodology study. Chiropr Man Therap 2020; 28:54. [PMID: 33076943 PMCID: PMC7574492 DOI: 10.1186/s12998-020-00341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background Swiss chiropractors have been licensed since 1995 to prescribe from a limited formulary of medications for treating musculoskeletal (MSK) conditions. In January 2018, this formulary was expanded to include additional muscle relaxant, analgesic, and anti-inflammatory medications. Internationally, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession. Objective The purpose of this study was to assess Swiss chiropractors’ attitudes, beliefs, and practices regarding their existing medication prescription privileges. This information will provide new insights on the topic and help inform research and policy discussions about expanding chiropractic prescription rights in other jurisdictions. Methods A 13-item questionnaire and Q-methodology approach were used to conduct the assessment. Recruitment was conducted by e-mail between December 2019 and February 2020, and all members of the Swiss Chiropractic Association were eligible to participate. Data were analyzed using by-person factor analysis and descriptive statistics. Results In total, 187 Swiss chiropractors participated in this study (65.4% response rate). Respondents reported prescribing analgesics, anti-inflammatories, and muscle relaxants to a median of 5, 5, and 0% of patients, respectively. Forty-two percent of respondents expressed interest in further expanding the range of current medications available to Swiss chiropractors for treating MSK conditions. Only 15% expressed interest in expanding this range to include medications for treating non-MSK conditions. In the Q-methodology analysis, four salient viewpoints/groups regarding medication prescribing emerged: prescribers, non-prescribers, collaborators, and integrators. All except non-prescribers thought medication prescription privileges were advantageous for the chiropractic profession in Switzerland. There was also strong consensus among all four groups that medication prescribing should not replace manual therapy in chiropractic practice. Conclusion This was the first national survey on attitudes toward prescribing medications among Swiss chiropractors since the year 2000, and the first using Q-methodology. With this approach, four unique groups of chiropractic prescribers were identified. Even with diversity among clinicians, the findings of this study showed general support for, along with conservative use of, prescribing privileges within the Swiss chiropractic profession. Studies in jurisdictions outside of Switzerland are needed to assess whether chiropractors are interested in expanding their scopes of practice to include similar prescribing privileges.
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Affiliation(s)
- Peter C Emary
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. .,Chiropractic Department, D'Youville College, Buffalo, NY, USA. .,Private Practice, 1145 Concession Road, Cambridge, Ontario, N3H 4L5, Canada.
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Noori Akhtar-Danesh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,School of Nursing, McMaster University, Hamilton, ON, Canada
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Emary PC, Oremus M, Houweling TAW, Wangler M, Akhtar-Danesh N. Attitudes, beliefs, and practices regarding medication prescribing for musculoskeletal conditions: a protocol for a national Q-methodology study of Swiss chiropractors. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2020; 64:119-130. [PMID: 33012811 PMCID: PMC7500235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Since 1995, chiropractors in Switzerland have been licensed to prescribe medications for treating musculoskeletal conditions. However, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession internationally. OBJECTIVE To assess Swiss chiropractors' attitudes, beliefs, and practices regarding their existing medication prescription privileges. METHODS A Q-methodology approach will be used to collect data for the assessment. In addition, scope expansion and frequency of prescribing by Swiss chiropractors will be queried using a 13-item questionnaire. Recruitment will be conducted by e-mail and all members of the Swiss Chiropractic Association will be eligible to participate. Data will be analyzed using by-person factor analysis and descriptive statistics. DISCUSSION This will be the first national update on attitudes toward prescribing medications among Swiss chiropractors since 2003, and the first using Q-methodology. The results of this study are important as they will inform future directions and research regarding chiropractic prescription rights.
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Affiliation(s)
- Peter C Emary
- PhD Student, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Adjunct Assistant Professor, Chiropractic Department, D'Youville College, Buffalo, NY, USA
- Private Practice, Cambridge, ON, Canada
| | - Mark Oremus
- School of Public Health and Health Systems, University of Waterloo
- Department of Health Research Methods, Evidence and Impact, McMaster University
| | | | | | - Noori Akhtar-Danesh
- School of Nursing, McMaster University
- Department of Health Research Methods, Evidence and Impact, McMaster University
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Emary PC, Lamont H, Taylor JA. Attitudes Toward Medication Prescription Rights: A Survey of Chiropractic Students and Faculty at D'Youville College. J Chiropr Med 2019; 18:286-298. [PMID: 32952474 PMCID: PMC7486473 DOI: 10.1016/j.jcm.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/22/2018] [Accepted: 01/16/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The purpose of this study was to ascertain the general attitudes of students and faculty in the chiropractic department of D'Youville College, Buffalo, New York, toward the inclusion of medication prescription rights in the chiropractic scope of practice. METHODS A 15-item questionnaire was adapted from a previous instrument used in assessing chiropractors' opinions toward medication prescription rights. Invitations were sent by e-mail to all 123 chiropractic students and faculty at D'Youville College in September 2018. Data were collected and analyzed using descriptive and inferential statistics. RESULTS A total of 113 questionnaires were completed for a 92% response rate. Ninety percent of respondents agreed that chiropractors should be authorized to prescribe medications such as over-the-counter and prescription-based analgesics, anti-inflammatories, and muscle relaxants. Respondents were less in favor of chiropractors prescribing opioids or having full prescribing rights. Over half indicated that their knowledge of musculoskeletal medications was high, whereas a similar number indicated that their knowledge of nonmusculoskeletal medications was low. Most respondents indicated that further education in pharmacology should be necessary for those in the profession wishing to prescribe medications. CONCLUSION Chiropractic students and faculty at D'Youville College endorsed expanding the chiropractic scope of practice to include limited medication prescription. Surveys and qualitative studies of students and faculty from other chiropractic educational institutions are warranted.
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Affiliation(s)
- Peter C. Emary
- Private Practice, Cambridge, Ontario, Canada
- Chiropractic Department, D'Youville College, Buffalo, New York
| | | | - John A. Taylor
- Chiropractic Department, D'Youville College, Buffalo, New York
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Mirtz TA. A treatise for a new philosophy of chiropractic medicine. Chiropr Man Therap 2017; 25:7. [PMID: 28286645 PMCID: PMC5338096 DOI: 10.1186/s12998-017-0138-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 02/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The philosophy of chiropractic has been a much debated entity throughout the existence of the chiropractic profession. Much criticism has been passed upon the historical philosophy of chiropractic and propagated by contemporary adherents. To date, a new philosophy has not been detailed nor presented that demonstrates principles by which to follow. AIM The purpose of this paper is to expand upon the work of Russell Kirk (b.1918, d. 1994), an American political theorist, as a basis for principles to guide the formation of a philosophy of chiropractic medicine (PCM). Each of Kirk's principles will be explained and expounded upon as applicable to a PCM. The addition of the term "medicine" to chiropractic is indicative of a new direction for the profession. DISCUSSION The ten principles that provide a foundation for a PCM include: (a) moral order, (b) custom, convention and continuity, (c) prescription, (d) prudence, (e) variety, (f) imperfectability, (g) freedom and property linkage, (h) voluntary community and involuntary collectivism, (i) prudent restraints upon power and human passions, and (j) permanence and change. Each of these principles offers not a dogmatic approach but provides insight into the application of chiropractic medicine to the entire station of the patient and society at large especially that of the economic, social and political. These principles provide direction in not only the approach to the doctor-patient encounter but can be used to visualize the wider world and its potential impact. Instead, these principles examine many tangential issues worthy of discussion that may impact health, social, political, and economic policy and how the chiropractic profession can approach these issues. CONCLUSION This paper provides the initial steps in formulating a PCM using principles from a sociological, political and economic standpoint which may impact on how chiropractic medicine approaches the patient and society in totality. In addition, these principles provide the necessary first steps in the arena of the social, political and economic aspects and how chiropractic medicine can advance.
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Affiliation(s)
- Timothy A Mirtz
- Department of Secondary and Physical Education, Bethune-Cookman University, 640 Dr. Mary McLeod Bethune Blvd., Daytona Beach, FL 32114 USA
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Emary PC, Houweling TAW, Wangler M, Burnie SJ, Hood KJ, Erwin WM. A commentary on the implications of medication prescription rights for the chiropractic profession. Chiropr Man Therap 2016; 24:33. [PMID: 27559468 PMCID: PMC4995740 DOI: 10.1186/s12998-016-0114-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/17/2016] [Indexed: 12/21/2022] Open
Abstract
There is a growing desire within the chiropractic profession to expand the scope of practice to include limited medication prescription rights for the treatment of spine-related and other musculoskeletal conditions. Such prescribing rights have been successfully incorporated into a number of chiropractic jurisdictions worldwide. If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the healthcare system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine / musculoskeletal disorders. However, if the chiropractic profession wishes to lobby to expand the scope of practice to include limited prescriptive authority, several issues must first be addressed. These would include changes to chiropractic education and legislation, as well as consideration of how such privileges could impact the chiropractic profession on a more theoretical basis. In this commentary, we examine the arguments in favour of and against limited medication prescription rights for chiropractors and discuss the implications of such privileges for the profession.
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Affiliation(s)
| | - Taco A W Houweling
- Department of Chiropractic Medicine, University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Martin Wangler
- Medizinisches Zentrum KurWerk, Poststrasse 9, CH 3400 Burgdorf, Switzerland
| | - Stephen J Burnie
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | | | - W Mark Erwin
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada ; Department of Surgery, Divisions of Neurological and Orthopaedic Surgery, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, KD 5-407, Toronto, ON M5T 2S8 Canada ; Krembil Research Institute, 60 Leonard Street, Toronto, ON M5T 2S8 Canada
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Abstract
Background Physical manipulation and manual therapies are thousands of years old. The most popular western world iteration of these therapies is delivered by chiropractors. It can be argued that the collective public health benefit from chiropractic for spinal pain has been very substantial, however as chiropractic has transitioned from craft to profession it has encountered many internally and externally driven machinations that have retarded its progress to a fully accepted allied health profession. This article sets out a ten point plan for a new chiropractic that will achieve full acceptance for this troubled profession. Discussion This article is based on a keynote speech known as the FG Roberts Memorial Address delivered on October 10, 2015, in Melbourne, Australia at the Chiropractic & Osteopathic College of Australasia and Chiropractic Australia national conference. The ten point plan consists of the following: improving the pre-professional education of chiropractors, establishing a progressive identity, developing a special interest for the profession, marginalising the nonsensical elements of the profession, being pro-public health, supporting the legitimate organised elements of the profession, improving clinical practice, embracing evidence based practice, supporting research and showing personal leadership. Conclusion Adherence to this fresh ten point plan will, over time, see the chiropractic profession gain full legitimacy in the allied health field and acceptance by other health providers, policy makers and the public at large.
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Affiliation(s)
- Bruce F Walker
- Discipline of Chiropractic, School of Health Professions, Murdoch University, Murdoch, Western Australia 6150 Australia
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Emary PC, Stuber KJ. Relationship between Ontario chiropractors' attitudes toward drug prescription rights and Canadian versus non-Canadian college of graduation: results from an online survey. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2016; 60:13-20. [PMID: 27069262 PMCID: PMC4807685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate differences between chiropractors' attitudes toward drug prescription rights based on chiropractic college of graduation. METHODS A secondary data analysis of a 2015 survey of chiropractors from Ontario, Canada was performed. The questionnaire included 14 items concerning chiropractors' knowledge and attitudes toward drug prescription including demographics. RESULTS 960 of 2,677 deliverable questionnaires were completed (36% response rate). The majority of respondents favoured limited prescribing rights for chiropractors regardless of college of graduation. Respondents who graduated from Canadian institutions were significantly more in favour of these privileges compared to graduates from non-Canadian schools. Over three-quarters of all respondents opposed the idea of chiropractors having full prescribing rights. No significant association was found between respondents' philosophical orientation and school attended. CONCLUSION Ontario chiropractors who graduated from Canadian chiropractic institutions were most interested in obtaining limited drug prescription rights for the profession compared to non-Canadian chiropractic institution graduates.
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Affiliation(s)
| | - Kent Jason Stuber
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College
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