An assessment of patient-centred care in patients with chronic musculoskeletal conditions attending chiropractic practice

Background: Patient-centred care is seen as an increasingly important component of health care quality, particularly for patients with chronic conditions. Chiropractors frequently see patients with chronic musculoskeletal conditions and the chiropractic profession is often described as patient-centred. Objectives: To assess how patient-centred chiropractic care is for patients with chronic musculoskeletal conditions and gain an understanding of patient and chiropractor experiences and perspectives of how chiropractic care is patient-centred. Design: Mixed methods Methods: An explanatory sequential mixed methods design with quantitative priority was used. Quantitative data was collected from 885 chiropractic patients with chronic musculoskeletal conditions who attended 1 of 20 Canadian chiropractic clinics. The patients each completed a questionnaire that included a modified version of the Patient Assessment of Chronic Illness Conditions (PACIC) to assess the patient-centredness of chiropractic care. Chiropractors from the study clinics completed a questionnaire that included the Patient-Practitioner Orientations Scale (PPOS) to assess chiropractor attitudes and orientation towards patient-centred care. Facilitated focus group interviews were conducted with patients, while individual semi-structured interviews were conducted with chiropractors. Interviews were transcribed and analyzed using thematic analysis. Results: Patient perceptions of more patient-centred care provided by chiropractors were significantly associated with patient satisfaction, younger patient age, having a mental health condition, attending the chiropractor's clinic for fewer years, and the number of chiropractic visits and other healthcare providers seen in the past year. More positive chiropractor attitudes toward patient-centred care were significantly associated with seeing more patients per week and more years in practice. Interview findings largely confirmed the survey findings. Patients described chiropractors as good listeners who provide holistic care. Chiropractors and patients both emphasized the importance of a close, trusting relationship. While chiropractors generally encourage patient engagement, patient involvement in treatment decisions and goal setting typically occurs earlier in their relationship. Follow-up by chiropractors mostly takes place in regular maintenance care visits. Conclusion: The study suggests that patients with chronic musculoskeletal conditions are highly satisfied with the care that they receive from their chiropractors and it incorporates numerous elements of patient-centred care including a close therapeutic relationship, shared decision making and individualized treatment plans tailored to their specific context.