Duenas Richard, Carucci Gina M, Funk Matthew F, Gurney Michael W
J Manipulative Physiol Ther. 2003 Oct;26(8):510-23. doi: 10.1016/S0161-4754(03)00108-8.
The Connecticut Chiropractic Association authorized an ad hoc committee to study Connecticut chiropractic scope of practice in January 1999. This committee was chaired by Richard Duenas, DC, and included 4 other Connecticut-licensed doctors of chiropractic who responded to an appeal to participate.
Committee members investigated the terms primary care, primary care provider (PCP) (clinician, physician), neuromusculoskeletal care, neuromusculoskeletal care provider (clinician, physician), musculoskeletal care, and musculoskeletal care provider (clinician, physician) to determine which, if any, apply to the practice of chiropractic.
A literature review was performed with in-depth analysis of the definitions of these terms and an interpretation of Connecticut Statutes for chiropractic, comparing the legal description of chiropractic practice to the term definitions. The literature review produced several detailed definitions of primary care and/or primary care provider (clinician, physician); however, no accurate description of neuromusculoskeletal (NMS) care or musculoskeletal care was found.
Two opinion surveys were conducted: 1 survey included presidents of accredited chiropractic colleges, as well as leaders of chiropractic organizations throughout the world. The other survey was sent to doctors of chiropractic (DC) licensed in the State of Connecticut. Survey topics addressed definitions of primary care and PCP, the formulation of these terms, neuromusculoskeletal care and neuromusculoskeletal care provider, individual rights in selecting a PCP, and the types of practitioners considered PCPs. The consensus among chiropractic college presidents, organization leaders, and Connecticut-licensed doctors of chiropractic was that the doctor of chiropractic is qualified to provide primary care. Most considered any definition of primary care invalid if the chiropractic profession was not involved in its formulation. The overwhelming majority felt the patient should retain the ultimate choice in determining who should be their PCP. Mission statements of accredited chiropractic colleges were reviewed, paying particular attention to educational goals and professional qualifications of graduates. The committee found these institutions strive to train students in all aspects of primary care.
Upon review of the literature and term definitions, interpretation of the statutes pertaining to chiropractic practice, results of both surveys, and review of the chiropractic college mission statements, the committee concluded that the Connecticut-licensed DC, by education, licensure, definition, and intraprofessional consensus, qualifies as a PCP.
1999年1月，康涅狄格州脊椎按摩疗法协会授权一个特别委员会研究该州脊椎按摩疗法的执业范围。该委员会由脊椎按摩疗法博士理查德·杜埃纳斯担任主席，还包括另外4名在康涅狄格州获得执照的脊椎按摩疗法医生，他们响应号召参与了该委员会。
委员会成员调查了“初级保健”“初级保健提供者（PCP）（临床医生、医师）”“神经肌肉骨骼保健”“神经肌肉骨骼保健提供者（临床医生、医师）”“肌肉骨骼保健”以及“肌肉骨骼保健提供者（临床医生、医师）”这些术语，以确定哪些（如果有的话）适用于脊椎按摩疗法的实践。
进行了文献综述，深入分析这些术语的定义，并解读康涅狄格州脊椎按摩疗法法规，将脊椎按摩疗法实践的法律描述与术语定义进行比较。文献综述得出了几个关于初级保健和/或初级保健提供者（临床医生、医师）的详细定义；然而，未找到对神经肌肉骨骼（NMS）保健或肌肉骨骼保健的准确描述。
进行了两项意见调查：一项调查的对象包括经认可的脊椎按摩疗法学院的院长以及世界各地脊椎按摩疗法组织的领导人。另一项调查发送给了在康涅狄格州获得执照的脊椎按摩疗法医生（DC）。调查主题涉及初级保健和PCP的定义、这些术语的制定、神经肌肉骨骼保健和神经肌肉骨骼保健提供者、选择PCP的个人权利以及被视为PCP的从业者类型。脊椎按摩疗法学院院长、组织领导人和在康涅狄格州获得执照的脊椎按摩疗法医生的共识是，脊椎按摩疗法医生有资格提供初级保健。大多数人认为，如果脊椎按摩疗法专业没有参与初级保健定义的制定，那么任何初级保健定义都是无效的。绝大多数人认为患者在决定谁应该成为他们的PCP方面应保留最终选择权。对经认可的脊椎按摩疗法学院的使命声明进行了审查，特别关注毕业生的教育目标和专业资格。委员会发现这些机构努力在初级保健的各个方面培训学生。
在审查文献和术语定义、解读与脊椎按摩疗法实践相关的法规、两项调查的结果以及脊椎按摩疗法学院的使命声明后，委员会得出结论，经康涅狄格州许可的DC，通过教育、执照、定义和专业内共识，有资格成为一名初级保健提供者。
