J Manipulative Physiol Ther. 1997 Nov-Dec; 20(9): 577-82.

Working together in rural South Dakota: integrating medical and chiropractic primary care.

Barnett K, McLachlan C, Hulbert J, Kassak K.

Providence General Medical Center, Everett, WA, USA.

OBJECTIVE: To describe the practice of chiropractic in South Dakota and to examine the extent to which they provide primary health care services to the rural population. DESIGN: Survey data from 113 (72%) of the 156 licensed chiropractors in South Dakota (1994). RESULTS: Rural DCs view themselves as primary care physicians and make up one third of the total number of rural primary medical and chiropractic physicians in the state. Rural DCs are more professionally cooperative with medical providers than are urban DCs and, as such, offer services more closely related to primary care. A greater portion of rural DCs, compared with urban DCs, offer in-office laboratory facilities for such services as urinalysis and blood work. Both rural and urban DCs treat large numbers of patients with neuromusculoskeletal (NMS) and non-NMS conditions, with rural DCs being more likely to treat patients with non-NMS conditions, especially skin conditions. CONCLUSIONS: Chiropractors are providing a broad scope of health services in South Dakota, especially in rural areas, indicating that DCs serve as important resources to the South Dakota primary health care system. Chiropractors and general practice medical physicians are increasingly complementing each other in the health care delivery system, especially in rural areas of the state. As such, each profession enhances the system's capacity to offer primary care, with DCs offering primarily NMS care. Continuing increase in the number of medical and chiropractic collaborations is consistent with the imperative to include cooperation with other primary care disciplines to improve health care delivery to rural populations.