J Manipulative Physiol Ther. 1997 Sep; 20(7): 448-53.

A comparison between referred and nonreferred patients in chiropractic practices in Norway.

Kilvaer A, Rasmussen G, Soot T, Kalvenes S.

OBJECTIVE: This study compares patients referred to chiropractic practices by medical doctors with patients who came directly to the chiropractors offices without referral. BACKGROUND: Because Norway has legislation requiring referral as a precondition for reimbursement by the national social security system, we have a unique opportunity to examine current practice when it comes to musculoskeletal conditions and to compare demographic, diagnostic and other data between the referred and nonreferred groups. METHODS: Questionnaires recorded on a continuous basis by participating members of the Norwegian Chiropractors Association during anamnesis of the first 25 new patients after a preset date. Of 140 chiropractors, 98 participated and returned 2401 questionnaires. RESULTS: Although the referred patients had been on sick-leave an average (mean) of 22.9 days before commencing chiropractic treatment, the corresponding figure for the nonreferred was 8.5 days. Otherwise, the two groups were identical or nearly identical in all tested aspects. There were deficiencies in the medical doctor's examination procedures and referral practices. CONCLUSION: Recent studies have shown chiropractic treatment to be a cost-efficient therapy for back-related conditions. The findings in our study indicate that the result of the present system of referral is substantially longer sick-leave time and delayed onset of chiropractic treatment. It is generally accepted that early, effective intervention is the primary method of preventing chronicity. This is not promoted by the present Norwegian system of referral, which in earlier studies we have shown to be inconsistent and expensive for both the patient and the social security system.