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December 2003, Vol 93, No. 12 | American Journal of Public Health 2111-2117
© 2003 American Public Health Association

RESEARCH AND PRACTICE

Patient Attitudes, Insurance, and Other Determinants of Self-Referral to Medical and Chiropractic Physicians

Rajiv Sharma, PhD, Mitchell Haas, DC and Miron Stano, PhD

Rajiv Sharma is with the Department of Economics, Portland State University, Portland, Ore. Mitchell Haas is with the Division of Research, Western States Chiropractic College, Portland. Miron Stano is with the Department of Economics, School of Business Administration, Oakland University, Rochester, Minnesota.

Correspondence: Requests for reprints should be sent to Mitchell Haas, DC, Professor and Dean of Research, Division of Research, Western States Chiropractic College, 2900 NE 132nd Ave, Portland, OR 97230 (e-mail: mhaas{at}wschiro.edu).

Objectives. This study identified predictors of patient choice of a primary care medical doctor or chiropractor for treatment of low back pain.

Methods. Data from initial visits were derived from a prospective, longitudinal, nonrandomized, practice-based observational study of patients who self-referred to medical and chiropractic physicians (n = 1414).

Results. Logistic regression showed differences between patients who sought care from medical doctors vs chiropractors in terms of patient health status, sociodemographic characteristics, insurance, and attitudes. Disability, insurance, and trust in provider types were particularly important predictors.

Conclusions. The study highlights the importance of patient attitudes, health status, and insurance in self-referral decisions. The significance of patient attitudes suggests that education might be used to shape attitudes and encourage cost-effective care choices.






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