Improving preventive health services training in chiropractic colleges part II: enhancing outcomes through improved training and accountability processes.

OBJECTIVE: Over the past decade, chiropractic colleges have introduced clinical prevention services (CPS) training. This has included an updated public health curriculum and procedures for student interns to determine the need for preventive services and to provide these services directly or through referral to other health professionals. The purpose of this study was to evaluate the effect of a program to train chiropractic interns to deliver CPS to patients. METHODS: Program evaluation used retrospective chart review, comparing the proportion of patients receiving CPS recommendations before and after implementation of the program. The main outcome measures were the percentage of appropriate CPS recommendations based upon chart reviews. RESULTS: Chart reviews in 2006 indicated appropriate CPS recommendations in 47.4% of cases (295/623). Chart reviews in 2007, after an additional year of sustained implementation of procedures to ensure intern and faculty accountability, showed appropriate counseling recommendations in 87% of files (137/156). CONCLUSIONS: Requiring interns to attend didactic presentations on CPS had no measurable effect on their performance. Major improvements occurred after a series of clinically relevant training interventions; new forms and audit procedures were implemented to increase intern and clinical faculty accountability.

Multinational survey of chiropractic patients: reasons for seeking care.

INTRODUCTION: This study explores the extent to which consumers seek wellness care when choosing chiropractors whose practice methods are known to include periodic evaluative and interventional methods to maintain wellness and prevent illness. METHODS: Using an international convenience sample of Sacro-Occipital Technique (SOT) practitioners, 1316 consecutive patients attending 27 different chiropractic clinics in the USA, Europe and Australia completed a one-page survey on intake to assess reason for seeking care. A forced choice response was obtained characterizing the patient's reason for seeking chiropractic care. RESULTS: More than 40% of chiropractic patient visits were initiated for the purposes of health enhancement and/or disease prevention. CONCLUSION: Although prudence dictates great caution when generalizing from this study, if confirmed by subsequent research among other similar cohorts, the present results may lend support to continued arguments of consumer demand for a more comprehensive paradigm of chiropractic care, beyond routine musculoskeletal complaints, that conceptualizes the systemic, nonspecific effects of the chiropractic encounter in much broader terms.

Treatment of obesity in the primary care setting: are we there yet?

Obesity is a significant public health issue in the US constituting an independent risk factor for morbidity and mortality as well as complicating the management of other medical conditions. Yet, traditionally most physicians receive little training in evidence-based obesity interventions. Previous literature suggests many physicians believe they do not have effective tools to address obesity and/or that obesity management is not within their scope of practice. Given the new emphasis from NIH and AAFP urging physicians to conceptualize and treat obesity as a chronic medical condition, we examined obesity-related knowledge and practices among military and civilian primary care physicians. Results were similar across these two physician groups in suggesting many physicians still may be ill-prepared to manage obesity in the primary care setting. Implications for patient care and future research are discussed.

How much health promotion and disease prevention is enough?: should chiropractic colleges focus on efficacy training in screening for family violence?

INTRODUCTION: Although family violence has been identified as a major public health issue, it has received little attention in the chiropractic literature. Accordingly, this article provides a conceptual overview on family violence, discusses the role of chiropractors in its detection, and raises several issues germane to chiropractic education that deserve further attention in future chiropractic publications. METHODS: A selective review of the empirical literature on family violence was conducted with a focus on issues relevant to chiropractic training and professional identity. RESULTS: Extrapolating from the research, several models for medical training and continuing education have been proposed that emphasize a multidisciplinary, developmental approach to infusing knowledge, skill building, and mentored practice experiences into professional education experiences. CONCLUSION: As chiropractors become more mainstream portal-of-entry providers, there is a clear need to translate the didactics of family violence into the clinical setting. Clinical education may provide students the opportunity to master basic competencies for managing challenging family violence problems. The clinical environment may be appropriate for inculcating skills commensurate with those of other primary care providers. Yet, the extent to which training priorities and approaches extrapolated from other health care disciplines should be accepted wholesale by the chiropractic profession merits further discussion, including issues around the professional identity of chiropractic, the impact of accreditation standards and practice guidelines on actual professional practice behaviors, and the possible limits and unintended consequences associated with expanding the traditional chiropractic scope of practice from a specialty to a primary care profession.

Do somatic complaints predict subsequent symptoms of depression?

BACKGROUND: Evidence suggests substantial comorbidity between symptoms of somatization and depression in clinical as well as nonclinical populations. However, as most existing research has been retrospective or cross-sectional in design, very little is known about the specific nature of this relationship. In particular, it is unclear whether somatic complaints may heighten the risk for the subsequent development of depressive symptoms. METHODS: We report findings on the link between symptoms of somatization (assessed using the SCL-90-R) and depression 5 years later (assessed using the CES-D) in an initially healthy cohort of community adults, based on prospective data from the RENO Diet-Heart Study. RESULTS: Gender-stratified multiple regression analyses revealed that baseline CES-D scores were the best predictors of subsequent depressive symptoms for men and women. Baseline scores on the SCL-90-R somatization subscale significantly predicted subsequent self-reported symptoms of depressed mood 5 years later, but only in women. However, somatic complaints were a somewhat less powerful predictor than income and age. CONCLUSIONS: Our findings suggest that somatic complaints may represent one, but not necessarily the most important, risk factor for the subsequent development of depressive symptoms in women in nonclinical populations. The results also highlight the importance of including social variables in studies on women's depression as well as conducting additional research to further examine predictors of depressive symptoms in men.