Secondary Logo

Institutional members access full text with Ovid®

Facilitators and Barriers to Improving Interprofessional Referral Relationships Between Primary Care Physicians and Chiropractors

Allareddy, Veerasathpurush; Greene, Barry R. PhD; Smith, Monica PhD, DC; Haas, Mitchell MA, DC; Liao, Junlin

Journal of Ambulatory Care Management: October-December 2007 - Volume 30 - Issue 4 - p 347–354
doi: 10.1097/01.JAC.0000290404.96907.e3

Objective Findings from recent studies suggest that there are poor interprofessional referral relationships between primary care physicians (MDs) and chiropractors (DCs) and this can lead to fragmentation of care. The objective of this study is to identify potential facilitators and barriers to developing positive interprofessional referrals relationships between MDs and DCs.

Methods We conducted 2 rounds of focus group interviews on a convenience sample of MDs and DCs. The focus groups were audiotaped, and transcripts were prepared for each focus group interaction. These data were analyzed through content analysis by 2 independent evaluators to determine the key themes and concepts provided by the focus groups.

Results Both MDs and DCs suggested that good communication, openness to discussion by providers, and patient interest are key factors for developing positive interprofessional referral relationships and implementing interprofessional practice–based research networks. Barriers to interprofessional relationships include lack of good communication between the 2 provider types, bias toward alternative medicine, lack of knowledge or understanding of chiropractic care, geographic constraints, and economic considerations.

Conclusions This study identified several facilitators and barriers for developing positive referral relationships between primary care physicians and chiropractors. Future studies must focus on demonstrating the role of these factors on developing positive interprofessional relationships.

From the Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City (Mr Allareddy, Dr Greene, and Ms Liao); Palmer College of Chiropractic and Iowa Palmer Center for Chiropractic Research, Davenport, Iowa (Dr Smith); and Western States Chiropractic College, Portland, Ore (Dr Haas).

Corresponding author: Barry R. Greene, PhD, Department of Health Management & Policy, College of Public Health, 200 Hawkins Dr, E212 GH, Iowa City, IA 52242 (e-mail:

This research was made possible by funding by NIH-NCCAM—Project #AT-01-001—Analysis of DC MDPCP Interprofessional Relationships. This investigation was conducted in a facility constructed with support from Research Facilities Improvement Grant Number C06 RR15433 from the National Center for Research Resources, National Institute of Health.

© 2007 Lippincott Williams & Wilkins, Inc.