OBJECTIVE: To gain information on the issue of scope of chiropractic practice, particularly in relation to primary care and prevention.

DESIGN: A survey was administered by mail to a random sample of 753 U.S. chiropractors.

SETTING: The sampling frame was stratified into eight geographic regions with approximately equal numbers of D.C.'s to ensure that all areas of the U.S. were represented.

PARTICIPANTS: Chiropractors listed in the National Directory of Chiropractic, 1993-4 edition, comprised the sampling frame.

RESULTS: Of the 753 D.C.'s sampled, 492 completed surveys, for a response rate of 65.3%. The majority of respondents (90.4%) considered themselves primary care practitioners. Over 80% were accessible to patients at all times. Only 4.1% accepted payment in cash only. Fifty-eight percent did a regional physical exam, 29.0% a complete physical, and 71% a complete health history on every patient. Referrals to M.D.'s/D.O.'s were made by 78.1% and received by 46.0% within the last 3 months, although fewer than 20% included reports with referrals. Prevention practices related directly to musculoskeletal problems were most often designated as important to discuss with patients: lifting techniques (78.0%), postural education (76.4%), fitness exercise (69.3%) and injury prevention (68.3%).

CONCLUSIONS: In general, respondents demonstrated a number of practice characteristics associated with primary care. However, it appears that they could further strengthen their position by routinely accompanying referrals with reports, and by increasing their emphasis on prevention, especially in areas not directly related to musculoskeletal conditions.

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