The utilisation of regulated standardised care packages by Danish chiropractors: a mixed methods study

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Abstract

Background

In Denmark, chiropractors in primary care work as independent private contractors regulated by the Danish National Health Authorities. The regulation includes partial reimbursement intended for standardised care packages for lumbar and cervical radiculopathy and lumbar spinal stenosis. Random checks have shown lower use than expected. This study aimed to describe and explore the utilisation of standardised chiropractic care packages and identify barriers to uptake.

Methods

A convergent mixed-method design was conceptualised. The use of standardised care packages was collected by register data. Potential determinants of difference in utilisation were assessed using a modified version of the Determinants of Implementation Behaviour Questionnaire (DIBQ) divided into 13 domains and sent to chiropractors in private clinics in Denmark in 2019. An open-ended question was added to the questionnaire, and thematic content analysis was applied. Qualitative findings were used to expand on the DIBQ data providing further insight into the clinicians’ perspective on standardised care packages.

Results

Registry data of 244 included chiropractic clinics showed limited and inconsistent use of the standardised chiropractic care packages. A total of 269 chiropractors (44%) answered the DIBQ, and 45 provided data for the qualitative analyses. At least 60% of the clinicians answered ‘Strongly agree’ or ‘Agree’ in 10 out of 13 DIBQ domains suggesting a positive attitude towards using the standardised care packages. Three domains were identified as ‘problematic’ as more than 20% of clinicians disagreed or strongly disagreed: ‘Socio-political context’, ‘Goals’ and ‘Innovation’. Qualitative findings indicated that lack of usage of the standardised care packages was mainly related to the practical organization of standardised care, the chiropractor’s role when managing patients, and the patient population of interest to the clinic (e.g., children, athletes).

Conclusion

In general, Danish chiropractors displayed positive attitudes towards standardised packages of care. However, considerable variation in the use of the standardised care programs was observed. Low utilisation seemed mainly related to logistics, the chiropractor’s role, collaboration with GPs, and the patient population of interest to the clinic. These findings should be further explored in more extensive qualitative studies to inform implementation initiatives to increase and rectify utility.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12998-022-00423-7.

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Most cited references 14

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Validation of the theoretical domains framework for use in behaviour change and implementation research

James Cane, Denise O’Connor, Susan Michie (2012)

Background An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research, has been applied across a wide range of clinical situations. This study tests the validity of this framework. Methods Validity was investigated by behavioural experts sorting 112 unique theoretical constructs using closed and open sort tasks. The extent of replication was tested by Discriminant Content Validation and Fuzzy Cluster Analysis. Results There was good support for a refinement of the framework comprising 14 domains of theoretical constructs (average silhouette value 0.29): ‘Knowledge’, ‘Skills’, ‘Social/Professional Role and Identity’, ‘Beliefs about Capabilities’, ‘Optimism’, ‘Beliefs about Consequences’, ‘Reinforcement’, ‘Intentions’, ‘Goals’, ‘Memory, Attention and Decision Processes’, ‘Environmental Context and Resources’, ‘Social Influences’, ‘Emotions’, and ‘Behavioural Regulation’. Conclusions The refined Theoretical Domains Framework has a strengthened empirical base and provides a method for theoretically assessing implementation problems, as well as professional and other health-related behaviours as a basis for intervention development.

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The quality of mixed methods studies in health services research.

Alicia O'Cathain, Elizabeth Murphy, Jon Nicholl (2008)

To assess the quality of mixed methods studies in health services research (HSR). We identified 118 mixed methods studies funded by the Department of Health in England between 1994 and 2004, and obtained proposals and/or final reports for 75. We applied a set of quality questions to both the proposal and report of each study, addressing the success of the study, the mixed methods design, the individual qualitative and quantitative components, the integration between methods and the inferences drawn from completed studies. Most studies were completed successfully. Researchers mainly ignored the mixed methods design and described only the separate components of a study. There was a lack of justification for, and transparency of, the mixed methods design in both proposals and reports, and this had implications for making judgements about the quality of individual components in the context of the design used. There was also a lack of transparency of the individual methods in terms of clear exposition of data collection and analysis, and this was more a problem for the qualitative than the quantitative component: 42% (19/45) versus 18% (8/45) of proposals (p = 0.011). Judgements about integration could rarely be made due to the absence of an attempt at integration of data and findings from different components within a study. The HSR community could improve mixed methods studies by giving more consideration to describing and justifying the design, being transparent about the qualitative component, and attempting to integrate data and findings from the individual components.

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National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy

Peter Frost Silbye, Morten Zebitz Steiness, Morten Vaagholt … (2017)

To summarise recommendations about 20 non-surgical interventions for recent onset (<12 weeks) non-specific low back pain (LBP) and lumbar radiculopathy (LR) based on two guidelines from the Danish Health Authority.

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Author and article information

Contributors

Rikke Krüger Jensen:

ORCID: http://orcid.org/0000-0001-7528-3234

rikkekruger@kiroviden.sdu.dk

Inge Ris: iris@health.sdu.dk

Elisabeth Linnebjerg: elisabethlinnebjerg@msn.com

Henrik Wulff Christensen: h.wulff@kiroviden.sdu.dk

Corrie Myburgh: cmyburgh@health.sdu.dk

Journal

Journal ID (nlm-ta): Chiropr Man Therap

Journal ID (iso-abbrev): Chiropr Man Therap

Title: Chiropractic & Manual Therapies

Publisher: BioMed Central (London )

ISSN (Electronic): 2045-709X

Publication date (Electronic): 8 March 2022

Publication date PMC-release: 8 March 2022

Publication date Collection: 2022

Volume: 30

Electronic Location Identifier: 14

Affiliations

[1 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Department of Sport Science and Clinical Biomechanics, , University of Southern Denmark, ; Campusvej 55, 5230 Odense M, Denmark

[2 ]Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark

[3 ]GRID grid.460785.8, ISNI 0000 0004 0432 5638, Univerity College Lillebaelt, ; Niels Bohrs Allé 1, 5230 Odense M, Denmark

Author information

Rikke Krüger Jensen http://orcid.org/0000-0001-7528-3234

Article

Publisher ID: 423

DOI: 10.1186/s12998-022-00423-7

PMC ID: 8903550

PubMed ID: 35260181

SO-VID: 1f3df9e3-0005-442f-8212-e1ed84d2ab06

License:

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