1. Chiropractic Practice in Military & Veterans’ Health Care

2. Joe Keating, Jr., PhD Friend Teacher Mentor Chiropractic historian
Memorial 31 Jan 2008

3. Chiropractic Practice in Military & Veterans’ Health Care

4. Contributors Bart Green, DC, MSEd Claire Johnson, DC, MSEd
Naval Medical Center San Diego
Claire Johnson, DC, MSEd
So Cal University of Health Sciences
National University of Health Sciences
Anthony Lisi, DC
VA Connecticut Healthcare System

5. Background Active duty Veterans Approximately 100 DCs working
Health care benefit for 12 years
49 military treatment facilities
Veterans
Health care benefit for 3 years
29 veteran treatment facilities
Approximately 100 DCs working
Expansion taking place

6. Purpose
Summarize the literature that describes chiropractic practice, utilization, and policy in active duty and veteran health care environments
Improve health care for beneficiaries
Guide integration and expansion efforts
Identify areas for future research
Identify the current evidence base
Provide guidance for administrators

7. Methods Searched MEDLINE, CINAHL, ICL Through March 2007
‘Chiropractic’ + list of relevant terms
Looked through references
Inclusion: All languages, all designs
Excluded: Non-peer reviewed, non-operating situations, non-DoD/VA
Consensus of all authors

8. Search Term Examples chiropractic + military chiropractic + navy
chiropractic + sailor
chiropractic + marines
chiropractic + marine
chiropractic + Department of Defense
chiropractic + Department of Veterans Affairs
chiropractic + veterans
chiropractic + veteran
alternative medicine + military
complementary medicine + military

9. MEDLINE Search
CINAHL Search
ICL Search
Search Terms
Total Hits
Potentially
Relevant Hits
New Hits
chiropractic + military 10 7 54 3 26 4
chiropractic + navy 1
chiropractic + sailor
chiropractic + marines
chiropractic + marine 2
chiropractic + Department of Defense 53 5
chiropractic + Department of Veterans Affairs 6
chiropractic + veterans 9 68 12
chiropractic + veteran
alternative medicine + military 11 17
complementary medicine + military
TOTAL 25

10. Results 30 articles met inclusion criteria 26 articles excluded
4 articles reviewed
1 description of how a VA clinic runs and description of student intern program
1 practice demographic report
1 comparison of DoD vs non-DoD student interns
1 case report

11. Results
Dunn A. Chiropractic internship program in the DVAHCS. J Chiropr Educ 2005.
Description of student intern training program integrated in VA: no program evaluation
Description of how clinic functions
Identifies similar programs at 2 DoD hospitals

12. Results
Dunn et al. Chiropractic consultation requests in the VAHCS. J Manipulative Physiol Ther 2006.
Retrospective chart review
First 100 consultation requests submitted to 1 VHA chiropractic clinic
Quality improvement measures made to improve consults in integrative environment
Description of clinic operations, access to care, origin of consults
Patient demographics

13. Results
Dunn. DoD chiropractic internships: a survey of internship participants and nonparticipants. J Chiropr Educ 2006
Survey of graduates who had completed a DoD student internship vs those who had not
Null hypothesis accepted
No difference in income, job satisfaction, demographics

14. Results
Green et al. Use of conventional and alternative treatment strategies for a case of low back pain in a F/A-18 aviator. Chiropr Osteopath 2006
Described coordinated multidisciplinary treatment (including chiro) of a Marine pilot with acute LBP

15. Discussion Paucity of publications 50% report on education in VA/DoD
Little to inform practice
Need more to inform health care policy
Clinical research non-existent
Based on publications, chiropractic does not exist in the DoD or VA
Much more could be done to report on integration with other health care disciplines

16. Why so few? No dedicated time for research/scholarship
Most DCs not trained to do any research, even a case report
Most not trained to write
Research time not encouraged/recognized
Barriers to contractors bringing in research $

17. Potential Solutions Provide research training
Provide authorship training
Build collaborations for contractors to bring research funding into the military/VA hospital
Negotiate scholar-practitioner positions within the VA and DoD
50% time research
Trained candidates w/track records

18. VA Progress Research efforts in progress
Funded
VA Intramural (Dougherty)
HRSA (Dougherty)
In review
VA Intramural (Lisi)
Efforts underway to assess current research capacity of VA DCs
Build culture of research and train clinicians
Research experience part of VA DC qualifications
Those w/research track records may be strong candidates for future positions

19. Conclusion
Small, but growing, descriptive evidence base to support those working in this environment
Efforts should be focused on clinical research for DoD/VA patient populations and research related to the integration and implementation of chiropractic services