Should your GP be an osteopath?: Patients’ views of an osteopathy clinic based in primary care

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Summary

Background

Spinal pain is a common reason for consulting general practitioners (GPs), and complementary therapists such as osteopaths and chiropractors. Patients express greater satisfaction with the care from chiropractors and osteopaths, because they are perceived as having more empathy, diagnostic skill and effective treatment, but their attitude to a GP providing an osteopathy service is unknown.

Aim

To explore patients’ views of receiving osteopathy in contrast with usual GP care, to provide insight into the psychological benefit of treatment, and to explore their views on how such a service should be provided and funded.

Design of study

Qualitative study using semi-structured interviews preceded by short questionnaires.

Setting

Primary care osteopathy clinic treating patients from Llanfairfechan Health Centre, which also accepted referrals from neighbouring practices in North West Wales in a randomised controlled trial.

Method

Short questionnaires followed by semi-structured interviews with 20 participants. The interview transcripts were analysed by open coding into categories, axial coding to define the categories’ properties and selective coding for the final thematic account.

Results

Traditional GP skills were valued, but GP care for spinal pain was perceived as limited and ineffective. Osteopathy was attractive because it did not involve drugs, but it had short-term painful side effects, and some found it frightening. Physical benefits included increased mobility and reduced pain; psychological benefits included removal of fear and improved understanding. Provision of osteopathy by a GP was welcomed, so long as the GP was properly qualified, and had sufficient time.

Conclusion

A GP run osteopathy clinic provided additional physical and psychological benefit. GP consultation might be improved by adopting some features from the osteopathic consultation.

Section snippets

What do we know?

Patients with spinal pain are more satisfied with the care received from osteopaths and chiropractors, than from general practitioners (GPs). Their attitude to a GP providing an osteopathy service is unknown.

What does this paper add?

A GP run osteopathy clinic was perceived to provide additional physical and psychological benefit. GP consultations might be improved by adopting some features from the osteopathic consultation.

Method

Data were obtained by a short questionnaire followed by a semi-structured interview with a sample of both trial participants and patients registered with the index practice. For trial participants, all data were collected after the trial process was completed, and complemented the main trial design. Local research ethics committee approval was obtained.

Sample description

The sample consisted of 5 men and 15 women, aged from 29 to 88 years; 10 were in paid employment or students, 10 were unemployed or retired; 12 were from the index practice, 8 were trial participants from neighbouring practices. Four of the trial participants were in the usual GP care arm of the trial, and together with four patients registered with the index practice had not attended the osteopathy clinic. Most of these had experienced osteopathic treatment elsewhere; only one had never

Discussion

Participants had accessed a wide variety of treatments for their spinal pain including medical and complementary therapies. Although traditional GP skills were valued, usual GP care for spinal pain was perceived as limited, ineffective and disheartening. Osteopathy was widely thought to benefit spinal pain. Osteopathic treatment was attractive because it did not involve drug treatment, but did have side effects. Side effects included short-term pain and discomfort, and some found the treatment

Acknowledgements

We would like to thank all of the participants, their referring GPs and their practice teams, in particular the partners and staff of the Llanfairfechan/Penmaenmawr practice, and Roisin Pill for early advice about the study. This study was conducted by JW as part of her MSc in Health Service Management with the University of Wales College of Medicine. It was supported by the all Wales primary care research network (CAPRICORN), which receives funding from the Welsh Assembly Government.

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