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PubMed2002

Barriers to expanding primary care roles for chiropractors: The role of chiropractic as primary care gatekeeper.

OBJECTIVE: To examine the feasibility of broader and more frequent primary care roles for chiropractors. DATA COLLECTION: Literature review and analysis of existing databases. Six types of barriers were examined, including legal, financial, professional, accessibility or geographic location, consumer preference, and self-imposed barriers. RESULTS: Although research into the barriers of an expanded primary care role for chiropractors is inconclusive, several inferences can be drawn from this analysis. First, prevailing state practice acts preclude only a limited number of activities that are necessary for chiropractors to serve in a primary care capacity. The self-perception by a portion of the chiropractic profession that as neuromusculoskeletal system specialists, they are either uninterested or ill-prepared for providing primary care serves as a second barrier. Third, payment provisions that do not permit chiropractors to be reimbursed for primary care services significantly limit their ability to expand primary care capacity. Fourth, consumer perceptions of chiropractors as neuromusculoskeletal system specialists are a persistent barrier to expanding status. Given the current importance of managed care, the fifth and most crucial barrier for chiropractic may be managed care organizations' lack of interest in having chiropractors in primary care roles. CONCLUSION: Research on the barriers to a more expanded primary care role for chiropractors is incomplete. The available research helps little in ruling out plausible barriers that might make it possible to narrow the scope of subsequent research.

Chiropractic↗
PubMed2005

Gatekeepers in sickness insurance: a systematic review of the literature on practices of social insurance officers.

Decisions concerning entitlement to sickness benefits have a substantial impact on the lives of individuals and on society. In most countries, such decisions are made by staff of private or public insurance organisations. The work performed by these professionals is debated, hence more knowledge is needed on this subject. The aim of the present study was to review scientific studies of the practices of social insurance officers (SIOs) published in English, Danish, Norwegian and Swedish. Studies were searched for in literature databases, in reference lists, and through personal contacts. Analyses were made of type of study, areas investigated, research questions, theories used, and the results. Sixteen studies were included. SIOs and several other actors are responsible for applying measures to minimise sick-leave and promote return to work (RTW). The studies focusing on coordination of such measures revealed that SIOs felt unsure about how to handle their contacts with clients and other actors. One study indicated that the SIOs, partly due to lack of time, accepted the recommendations of physicians instead of making their own judgments about granting sickness benefits. While all SIOs must make decisions concerning entitlement to sickness benefits on a daily basis, few of the reviewed studies scrutinised the actual granting of sickness compensation. The studies were also deficient in that they investigated the decision latitude of the SIOs from a very limited perspective, mainly on an individual level and often primarily in relation to colleagues and/or clients rather than to the laws and regulations of the sickness insurance. The concepts and framework in this area of research need to be developed to facilitate elucidation of the interaction between different actors in local spheres, professionals in different disciplines, and between welfare staff and individual citizens.

Certification↗
PubMed2002

Medico-legal reports and gatekeeping: one year of referrals to a forensic service.

Forensic psychiatrists and the services they provide have been subject to recent scrutiny and high public profile. This study examined part of the work of a regional and district forensic service by looking at a one-year cohort of referrals, and the factors contributing to patient admission, including requests for medico-legal reports. The sample consisted of all referrals to the East Midlands Centre for Forensic Mental Health, Leicester from 1 January 1998 to 31 December 1998. Information on referrals was collected retrospectively using a proforma to collate data from referral letters and the reports prepared by assessing clinicians. Two hundred and eighty referrals relating to 260 individuals were received. The sample characteristics were broadly similar to those reported in previous studies. The finding that 70% of those assessed were referred for medico-legal reports by courts or solicitors, and the fact that only 20% of this group finally entered the forensic service, led us to consider whether this work was legitimate use of National Health Service time. We examined this group more closely, and found that referral for a medico-legal report could be considered as a screening test for entry into the forensic services and there are good arguments for this work continuing.

Cohort Studies↗