Emary, Peter C., Mark Oremus, Taco A.W. Houweling, Martin Wangler, & Noori Akhtar-Danesh (2020, October). Attitudes, beliefs, and practices among Swiss chiropractors regarding medication prescribing for musculoskeletal conditions: A national Q-methodology study. Chiropractic & Manual Therapies, 28(54). 15 pp. (doi: 10.1186/s12998-020-00341-6) (Link: https://doi.org/10.1186/s12998-020-00341-6) (Open Access: https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00341-6)

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.

Peter C Emary <emaryp@mcmaster.ca> is in the Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; and Chiropractic Department, D’Youville College, Buffalo, NY, USA.

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