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Health services research
Research
The role of osteopathy in the Swiss primary health care system: a practice review
  1. Paul Vaucher,
  2. Mia Macdonald,
  3. Dawn Carnes
  1. Unit of Research in Mobility & Musculoskeletal Care, School of Health Sciences Fribourg, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
  1. Correspondence to Professor Paul Vaucher; paul.vaucher{at}hes-so.ch

Abstract

Objectives The aim of this study was to describe osteopathic activity and scope of practice to understand the current and future role of osteopathy in the Swiss healthcare system.

Design A questionnaire survey that included a patient record-based retrospective clinical audit.

Setting/population Osteopaths with a national diploma (n=1086) were invited by mail to participate in an online survey. Osteopathic assistants (n=84) were identified through their national association.

Questionnaire The survey was constructed from previous surveys and tested for face validity with experts, osteopaths and patient representatives. The questionnaires were completed online in English, German and French between April and August 2017. Osteopaths anonymously reported information about themselves, their practice, and the treatment and care for four randomly selected patients they managed in 2016.

Results The response rate from the survey was 44.5% (521/1171). Data on osteopathic care were collected for 1144 patients and 3449 consultations. In 2016, osteopaths saw approximately 6.8% of the Swiss population for 1700 000 consultations and an overall estimated cost of 200 million Swiss francs. 76% of patients sought care directly without a referral from another care provider. Few osteopaths (<1%) work in a hospital setting and 46% work in isolation in private practice. Infants (under 2 years old) made up 10% of all patients and 9% of patients were ≥65 years. Patients most commonly sought treatment for musculoskeletal conditions (81%) with the spine being the most frequent location (66%). Treatments also included exercise advice (34.2%) and lifestyle management (35.4%). Fewer than 1 patient out of 10 were referred to another health profession or provider.

Conclusions In Switzerland, osteopathic care represents an important first line management for musculoskeletal conditions that alleviates some of the burden of care in the Swiss primary healthcare system.

  • survey
  • clinical audit
  • osteopathic care
  • Switzerland
  • scope of practice

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-023770

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    Footnotes

    • Contributors DC and PV: applied for the grant and wrote the protocol; wrote the manuscript. PV: served as principal investigator; ran the analysis. PV, DC and MM: developed and had the questionnaire validated; discussed the results. PV and MM: wrote and translated all the annexed documentation (Internet site, newsletters, invitation letters, continuous training certification); piloted the data collection and quality control. MM: cleaned and documented data cleaning. All authors provided feedback and accepted the final version.

    • Funding The study was funded via the Swiss Osteopathy Science Foundation (Grant 2017-R001) and by the School of Health Sciences Fribourg.

    • Competing interests The researchers work for the Unit of Research in Mobility at the School of Health Sciences Fribourg which includes the division of osteopathy.

    • Ethics approval The Lausanne Ethics Panel overviewed our protocol and the attached documents for approval (EC; 2017-00126) and concluded that Ethical Approval was not needed for this study, as all data was completely anonymised, and patient confidentiality and privacy was not compromised. All osteopathic and patient data was handled in accordance with the Swiss law on data protection (DSG/LPD 235.1). A representative of the Swiss Federation of Patients, the Federal Data Protection and Information Commissioner, and the Fribourg Cantonal Data Protection and Information Commissioner were consulted to provide their opinion on the legal aspects of the audit. Recommendations were followed to assure patients’ rights were respected.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Protocol, questionnaires, statistical code and report are available on Zenodo at the following URL: https://zenodo.org/communities/osteosurvey/. Dataset can be made available for further analysis with the approval of the University, the Swiss Osteopathy Science Foundation and the Swiss Patient Foundation.