Attitudes toward drug prescription rights: a survey of Ontario chiropractors

Abstract

Background: Several published surveys have shown that chiropractors are generally split in their opinions regarding the right to prescribe drugs in chiropractic practice. Many of these studies have been limited by low response rates, leaving the generalizability of their findings open to question. The aim of the current study was to ascertain the general attitudes of chiropractors in Ontario, Canada toward the inclusion of drug prescription rights in their scope of practice. Relationships between these attitudes and the number of years in practice including differences in philosophical orientation were also explored.

Methods: A 14-item questionnaire was developed and invitations sent via e-mail to all eligible 2,677 chiropractors in active practice registered electronically with the College of Chiropractors of Ontario in February 2015. Data were collected and analyzed using descriptive and inferential statistics.

Results: 960 questionnaires were completed for a 36 % response rate. The majority of respondents agreed that chiropractors should be permitted to prescribe musculoskeletal medications such as over-the-counter and prescription-based analgesics, anti-inflammatories, and muscle relaxants. Over two-thirds also felt that with limited prescriptive authority chiropractors could help reduce patients' reliance on these types of drugs. Over three-quarters were opposed however to chiropractors having full prescribing rights. The majority indicated they recommend over-the-counter medications to acute and chronic patients to some extent in clinical practice. Nearly two-thirds perceived their knowledge of musculoskeletal medications as high or very high, while a similar proportion perceived their knowledge of drugs for non-musculoskeletal conditions to be low or very low. A majority of respondents felt that further education in pharmacology would be necessary for those in the profession wishing to prescribe medications. More recent graduates and those who espoused a broad scope of chiropractic practice were most in favour of limited prescribing rights for the profession.

Conclusions: A majority of responding Ontario chiropractors expressed interest in expanding their scopes of practice to include limited drug prescription. These results together with those of other recent surveys could indicate a shift in chiropractors' attitudes toward drug prescription rights within the profession. Further surveys and/or qualitative studies of chiropractors in other jurisdictions are still needed.

Keywords: Attitudes; Chiropractic; Cross-sectional survey; Drug prescription; Knowledge.

Fig. 1

Ontario chiropractors’ attitudes to drug prescription rights. (a) Responses regarding attitudes to chiropractors prescribing over-the-counter musculoskeletal medications (n = 958), median value = ‘agree.’ (b) Responses regarding attitudes to chiropractors prescribing prescription-based musculoskeletal medications (n = 952), median value = ‘agree.’ (c) Responses regarding attitudes to chiropractors prescribing any and all medications (n = 958), median value = ‘disagree.’ (d) Responses regarding attitudes to chiropractors counselling patients on musculoskeletal medication use (n = 955), median value = ‘agree’

Fig. 2

Frequency of over-the-counter drug recommendation by Ontario chiropractors. (a) Responses regarding the frequency of over-the-counter drug recommendation to acute patients in clinical practice (n = 955), median value = ‘sometimes.’ (b) Responses regarding the frequency of over-the-counter drug recommendation to chronic patients in clinical practice (n = 957), median value = ‘rarely’

Fig. 3

Ontario chiropractors’ current perceived knowledge of drug prescription. (a) Responses regarding Ontario chiropractors’ perceived knowledge of musculoskeletal drug prescription (n = 956), median value = ‘high.’ (b) Responses regarding Ontario chiropractors’ perceived knowledge of non-musculoskeletal drug prescription (n = 955), median value = ‘low.’ (c) Responses regarding Ontario chiropractors’ perception of whether or not a formal certificate program in pharmacology/drug administration would be necessary for those in the profession wishing to prescribe medications (n = 952), modal value = ‘yes’