Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Chiropractic Department, D'Youville College, Buffalo, NY, USA.
Chiropr Man Therap. 2020 Oct 20;28(1):54. doi: 10.1186/s12998-020-00341-6.
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.
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.
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.
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.
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.
自 1995 年以来，瑞士脊医获准从有限的药物处方中开出治疗肌肉骨骼（MSK）疾病的药物。2018 年 1 月，该处方扩大到包括其他肌肉松弛剂、镇痛药和抗炎药。在国际上，关于脊医是否应该在其专业范围内开处方，争议仍然存在。
本研究旨在评估瑞士脊医对其现有药物处方特权的态度、信念和做法。这些信息将为这一主题提供新的见解，并有助于为其他司法管辖区扩大脊医处方权利的研究和政策讨论提供信息。
采用 13 项问卷和 Q 方法学方法进行评估。2019 年 12 月至 2020 年 2 月期间通过电子邮件进行招募，瑞士脊骨疗法协会的所有成员都有资格参加。通过个人因素分析和描述性统计数据对数据进行分析。
共有 187 名瑞士脊医参加了这项研究（65.4%的回应率）。受访者报告称，分别有中位数为 5%、5%和 0%的患者使用镇痛药、抗炎药和肌肉松弛剂。42%的受访者表示有兴趣进一步扩大瑞士脊医治疗 MSK 疾病的现有药物范围。只有 15%的受访者表示有兴趣将这一范围扩大到治疗非 MSK 疾病的药物。在 Q 方法学分析中，出现了四个关于药物处方的突出观点/群体：处方者、非处方者、合作者和整合者。除了非处方者外，所有群体都认为药物处方特权对瑞士脊医行业有利。所有四个群体也都强烈认为，药物处方不应取代脊医实践中的手法治疗。
这是自 2000 年以来瑞士脊医对药物处方态度的首次全国调查，也是首次使用 Q 方法学。通过这种方法，确定了四个独特的脊医处方群体。尽管临床医生之间存在多样性，但这项研究的结果表明，瑞士脊医行业普遍支持并谨慎使用处方特权。需要在瑞士以外的司法管辖区进行研究，以评估脊医是否有兴趣扩大其实践范围，包括类似的处方特权。
