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Chiropractic Journal of Australia : CJA June 2012
Chiropractic Journal of Australia Volume 42 Number 2 June 2012 57 Spinal Screening Do you agree that it would be appropriate to make clinical appointments for new patients at a spinal screening? “Good practice in relation to spinal screenings should not include obtaining contact information from participants or the making of appointments at the time of screening.”58 The view of respondents regarding the inability to make clinical appointments at spinal screenings was mixed as 40.2% agreed or strongly agreed with the Code, while 40.4% disagreed or strongly disagreed. Pre-Paid Care Plans Do you agree that it is appropriate to offer pre-paid chiropractic care plans? Do you agree that refunds should be offered with early termination of pre-paid chiropractic care plans? The majority of respondents (57.1%) disagreed or strongly disagreed that it was appropriate to offer pre-paid care plans. However, the Code of Conduct does not prohibit pre-paid care plans. Instead, the Code explicitly defnes the required terms and conditions including: measurable outcome measures, plans for review, and a reasonable refund policy.59 An overwhelming 92.5% of respondents agreed or strongly agreed that refunds should be offered with early termination. Two respondents strongly disagreed and one disagreed. To not offer any refunds with the early termination of a pre-paid care plan is in violation of the national Code of Conduct. Radiology Do you agree that routine x-rays are a key component of chiropractic care? How often do you order routine x-rays? The radiology guidelines require: that each procedure be justifed per individual case; that doses be optimised in order to be as low as reasonably achievable; and that radiation dose limits are not exceeded.60 Unfortunately due to ambiguity in how this survey posted the questions on radiology, the results of this study did not give any meaningful insight into the compliance or attitudes regarding radiology. Duty of Care Do you agree that a documented clinical diagnosis and management plan is required for all initial consultations? Do you agree that documented informed consent is necessary for you to treat a patient? Evidence based practice is defned as the preferential use of health interventions for which systematic empirical research has provided evidence of statistical effectiveness. In your opinion, do you practise evidence-based chiropractic? “Care of the patient is the primary concern for chiropractors in clinical practice.”61 The requirements of good care include a justifable diagnosis and reasonable management plan,61 both of which should be documented.62 While the majority of respondents (60.2%) agreed or strongly agreed that a documented diagnosis and management plan is required for all patients, 24.2% either disagreed or strongly disagreed. To not produce a documented diagnosis and management plan for all patients is in violation of the Code. The requirements of good care also include the chiropractor obtaining the informed consent of their patient and documenting that consent according to the Code.63 The support for documented consent was much stronger than that for a documented diagnosis and management plan, as 83.7% agreed or strongly agreed it was required for all patients. However, a minority (7.8%) disagreed or strongly disagreed and would consequently be in violation of the Code. The Code states that good practice involves practicing in an evidence informed context64 and defnes evidence informed context as the “integration of the best available evidence with professional expertise to make decisions, in conjunction with patient values and circumstances.”65An alternate defnition of EBP was given and the majority of respondents (61.6%) agreed or strongly agreed they practised EBP. The researchers appreciate that this alternative defnition did not sit well with some respondents. Attitudes Do you agree that the new chiropractic Code of Conduct has had a positive infuence on the way you practise? The majority (46.3%) of respondents remained neutral when asked if the new Code of Conduct had had a positive infuence on the way they practise. Several of the positive opinions of the new code given in the additional comments also stated that the Code had not changed how they practise. CHIROPRACTIC CODE OF CONDUCT SURVEY FITZGERALD • BURRELL • BULL
CJA March 2012
CJA September 2012