Could chiropractors screen for adverse drug events in the community?

INTRODUCTION Adverse drug events are a major problem and are often undetected. We surveyed US chiropractors in 2002-03 about their actual or potential role in advancing patient safety initiatives to monitor adverse pharmaceutical events.

METHODS Sampling Frame: Descriptive cross-sectional mail survey to three samples of U.S. chiropractors (N = 5931). Samples drawn consecutively, non-replacement, from all state board-licensed chiropractors (approximately 68,000).

Survey Items: Survey questions pre-validated by pilot-testing on 104 “key informants” drawn from leadership rosters of Congress of Chiropractic State Associations (COCSA), Federation of Chiropractic Licensing Boards (FCLB), and National Board of Chiropractic Examiners (NBCE). We surveyed demographic information, practice market service area (area from which they drew patients), and about various clinical and practice attributes, such as monitoring their chiropractic patients for adverse pharmaceutical events.

Data Collection: Following first round of survey mailing, two follow-up mailings to nonrespondents, with cover letter assuring anonymity, and a postage-paid return envelope. Final phone follow-up to encourage greater compliance, assess systematic bias in nonrespondents, and calculate a more accurate effective response rate by adjusting for invalid nonrespondents, e.g. DCs not in practice.

RESULTS The effective response rate averaged 50%. Including phone follow-up, response rate was approximately 60%. Phone follow-up queried nonrespondents' reasons for not returning the mail survey: most common reasons were that they were too busy (43%) or they don't do surveys (24%).

Many chiropractors are relatively new, 38% entered practice within the last 10 years, 34% within 20 years. Approximately 40% have certification or specialized training not specific to chiropractic, e.g. impairment rating, emergency medical training.

Approximately 60% of chiropractors serve counties designated as primary care health professional shortage areas.

Many chiropractors (60%) report that they have identified an adverse pharmaceutical event occurring in one of their chiropractic patients, reporting that such events occur frequently (24%), sometimes (31%), or seldom (40%). Such events occur less than 5 times a year for 50% of respondent DCs, 5-20 times/year for 30%, and more than 20 times/year for 20%. Adverse events were reported in relation to specific drugs (e.g., lipitor), drug classes (e.g., statins) and not specifically linked to any drug. The severity of drug-related events detected ranged from mild to severe.

DISCUSSION Our findings suggest that chiropractors may be in a position to detect potential adverse drug events in the community. These detection mechanisms should be standardized and policies related to management and referral of adverse drug events should be developed.