In June 2016, the Swiss Parliament and the House of States adopted the Law on Allied Health (GesBG/LPSan) that recognised osteopathy as a primary care health profession. Future health practitioners are to be trained in state-funded Universities of Applied Sciences to obtain a Master of Science degree. Osteopaths are therefore trained as primary care practitioners and are able to investigate, detect, and triage medical conditions as well as manage and provide treatment for functional disorders. However, little is known on what osteopaths do and what role this new profession could play in our health system.
The Swiss Osteopathy Science Foundation therefore initiated a project to describe osteopathic activity and scope of practice. This report provides the results from a large-scale survey on osteopathic care provided to the Swiss population in 2016.
The collected data should help define the profession, target education and training priorities, formulate expected standards of care, fix benchmarks for future improvements, identify research priorities, and provide sound data for stakeholders to formulate policies.
Method and Design
This was a questionnaire survey of osteopaths and retrospective descriptive patient record review. All osteopaths registered to the National Registry of Allied Health Professionals (NAREG) were approached to participate in the survey (n=1086). Assistant osteopaths were approached via the Swiss Federation of Assistant Osteopaths (SVOA-FSOA; (n=84).
An online questionnaire survey was developed and used to describe osteopaths’ profile and working environments and their patients. Each participating osteopath was asked to select up to four random patients from 2016 and extract anonymised data from these records.
The response rate from the survey was 44.5% (521/ 1170) and we received data about 1’144 patients and 3’449 consultations. In 2016, osteopaths contributed to the health of the nation by providing around 1’700’000 consultations to an estimated 550’000 people at an overall estimated cost of CHF 200 million. This represents around 6.8% of the total Swiss population (8.3 million) and 2% of all costs for musculoskeletal conditions.
Nearly half of osteopaths work exclusively on their own (46%) and few work in a hospital setting (1.5%). Most osteopaths work from Monday to Friday between the hours of 8:00 and 18:00. The average length of a consultation is 45 minutes. Osteopaths see around 36 patients per week who pay ~120 CHF per consultation, with around 80% of patients using insurance to finance their care.
The average age of the adult osteopathic patient was 45 years old. Children and babies (under 2 years old) made up 10% of all patients, 9% of patients were 65 years or over. Patients can expect to have around 2 consultations for their presenting condition. Patients most commonly sought treatment for musculoskeletal complaints (81%) with the spine being the most common location (66%). The patients were relatively healthy, 65% reporting no co-morbidities and only 16% reported taking time off work or school for their complaint. Most patients (76%) referred themselves directly to the osteopath, 18% were referred by other healthcare professionals.
The most common form of manual treatment given to patients were soft tissue and articular techniques (75% of the time) with thrust techniques used ~42% of the time. Other forms of provided treatment included exercise (34.2%), psychological and lifestyle management (35.5%), and adjunct therapy (3.9%).
Analysis of consent procedures showed that most patient consent for examination and treatment was implied (60%) rather than explicit (36-38%).
The number of consultations provided to the Swiss population indicate that there is a demand for osteopathic care and that it could play a larger role in primary health care provision.
Over half of the osteopaths practice in isolation, there were issues surrounding consenting procedures and record keeping, indicating a role for more formalised regulation and professional practice standards.
Obtaining more information directly from patients will further help develop our understanding of care and the needs of the patients seeking and using osteopathic services.
Osteopathic Medicine, Delivery of Health Care, Clinical Audit, Switzerland