1
|
Wang J, Chen L, Wang Z, Fang X, Zhen Y. Perceptions, Attitudes, Beliefs, and Practices Toward Traditional Chinese Medicine Therapies for Herpes Zoster: A Cross-Sectional Study of Healthcare Professionals. Risk Manag Healthc Policy 2024; 17:1239-1251. [PMID: 38765781 PMCID: PMC11102122 DOI: 10.2147/rmhp.s461149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Traditional Chinese medicine (TCM) holds great potential in promoting healing and relieving pain for herpes zoster (HZ) treatments. Evidence showed that both healthcare professionals' (HCPs) belief and knowledge influence their attitudes, which result in their expression and direct behavior. However, little is known in this area regarding TCM treatments for HZ. This study aimed to understand the HCPs' perceptions, attitudes, beliefs, and practices toward TCM and its services for HZ. Methods During July 2021 and October 2022, a cross-sectional study of HCPs querying demographics, perceptions, attitudes, beliefs, and practices toward TCM and TCM services for HZ was conducted. The frequency and percentage or mean and standard deviation were used to present categorical data and continuous data, respectively. A Chi-square analysis compared nurses' and doctors' views on TCM treatments for HZ. Results Out of 306 eligible respondents, 66.0% used TCM content in clinical practice less than 40% of the time. Respondents reported that there were three main advantages of TCM for HZ, including better crusting and healing, fewer side effects, and mitigating complications. A total of 41.3% (81/196) of the respondents who had cared for/treated HZ patients applied TCM treatments. The three factors most associated with referrals/providing TCM to patients were postherpetic neuralgia, early erythema or papules, and acute pain. Compared to nurses, doctors showed more endorsement of the efficacy and cost-effectiveness of TCM treatments for HZ patients. Conclusion The study found that most healthcare professionals in HZ had a favorable view of TCM, but lacked practical experience administering it to patients. Programs should be developed to provide evidence-based TCM treatments and encourage combining TCM with Western medicine for better patient care.
Collapse
Affiliation(s)
- Jiani Wang
- School of Nursing, Sun Yat-Sen University, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Liudan Chen
- Department of Traditional Chinese Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Zhuangfei Wang
- Department of Dermatology, Sun Yat-Sen Memorial Hospital, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Xiaohong Fang
- Department of Dermatology, Sun Yat-Sen Memorial Hospital, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Yan Zhen
- Department of Traditional Chinese Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou City, Guangdong Province, People’s Republic of China
| |
Collapse
|
2
|
Ma X, Wang M, Ma J, Zhang Z, Hao Y, Yan N. The association between lifestyles and health conditions and the choice of traditional Chinese medical treatment in China: A latent class analysis. Medicine (Baltimore) 2022; 101:e32422. [PMID: 36595837 PMCID: PMC9794340 DOI: 10.1097/md.0000000000032422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Traditional Chinese medicine (TCM) plays a major role in preventing and treating the disease, however, it is also facing a slice of challenges as fewer choices of TCM treatment. Although lifestyles and health conditions might be paramount influencing factors for the choice of TCM treatment, the relative evidence is scarce. The current observational study was designed to evaluate this association. A total of 24,173 Chinese individuals with a mean age of 47.3 years from the Chinese Family Panel Studies 2014 were selected. The choice of TCM treatment was acquired by the self-report questionnaire. Latent class analysis was employed to identify clusters of lifestyles and health conditions. The binary logistic regression model was employed to examine the association between lifestyles, health conditions and the choice of TCM treatment. Lifestyles and health conditions were classified into 3 classes with latent class analysis, healthy group, unhealthy behavior group, and physical inactivity group. After controlling for potential confounding factors, the results showed individuals in unhealthy behavior group (odds ratio = 1.51, 95% confidence interval: 1.35-1.68, P < .001) or physical inactivity group (odds ratio = 1.11, 95% confidence interval: 1.02-1.22, P = .019) were more likely to visit TCM doctors than healthy group. Sex-specific difference was observed, the relationship still existed among the males. The current study revealed the relationship between lifestyles, health conditions and the choice of TCM treatment. This will provide evidence for the TCM development and provide support for further research.
Collapse
Affiliation(s)
- Xueping Ma
- Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Mohan Wang
- Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Juan Ma
- Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhengjun Zhang
- Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yu Hao
- Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- * Correspondence: Ning Yan, Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China (e-mail: ) and Yu Hao, Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China (e-mail: )
| | - Ning Yan
- Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan, Ningxia, China
- * Correspondence: Ning Yan, Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China (e-mail: ) and Yu Hao, Heart Centre & Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China (e-mail: )
| |
Collapse
|
3
|
Kim PW, Kim S, Kim DI, Cha J, Lee HS, Ko MM, Jang S, Yang C, Lee MS. Development of the Korean Medicine Core Outcome Set for Primary Dysmenorrhea (COS-PD-KM) for Herbal Medicine Treatment of Primary Dysmenorrhea in Primary Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15321. [PMID: 36430040 PMCID: PMC9690837 DOI: 10.3390/ijerph192215321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to develop a Korean medicine (KM) core outcome set (COS) for primary dysmenorrhea to evaluate the effectiveness of herbal medicine (HM) in treating primary dysmenorrhea in patients visiting KM primary clinics. Previously reported outcomes were identified through a literature review to define outcomes and effect modifiers (EMs) for the questionnaire. Experts were invited to conduct modified Delphi consensus exercises, and primary care clinicians were invited to conduct Delphi consensus exercises to evaluate suitability and feasibility. Finally, an additional round of a modified Delphi exercise was conducted with experts to obtain a final agreement on the COS. Seventeen outcomes and 15 EMs were included from a literature review, and one effect modifier was suggested by the experts (Phase 1). In Phase 2, after the modified Delphi consensus exercises by experts, 10 outcomes and 11 EMs were included in the COS. The clinicians all agreed on the feasibility of COS (Phase 3). Finally, 10 outcomes and 6 EMs were included in the COS-PD-KM after the final modified Delphi consensus exercise (Phase 4). The effectiveness of HM used in primary clinics could be evaluated with this COS in patients with primary dysmenorrhea. Further studies that involve more relevant stakeholder groups, such as patient representatives and gynecological experts, are needed.
Collapse
Affiliation(s)
- Pyung-Wha Kim
- R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Sungha Kim
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Dong-Il Kim
- Department of Obstetrics & Gynecology, College of Korean Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Jiyun Cha
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - He-Sol Lee
- R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Mi Mi Ko
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Soobin Jang
- Department of Preventive Medicine, College of Korean Medicine, Daegu Haany University, Gyeongsan 38610, Republic of Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Myeong Soo Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| |
Collapse
|
4
|
Tian X, Zhang S. Expert or experiential knowledge? How knowledge informs situated action in childcare practices. Soc Sci Med 2022; 307:115195. [PMID: 35810691 DOI: 10.1016/j.socscimed.2022.115195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
The study examines how alternative health information affects the professional authority of doctors. Drawing on in-depth interviews with mothers in Hong Kong and focusing on child-rearing practices, we find that mothers glean expert knowledge from doctors and experiential knowledge from online resources, social networks, and direct observations. Despite the prevalence of information online and traditional Chinese remedies, mothers do not use experiential knowledge to challenge doctors. Instead, they self-interpret medical advice and set self-determined courses of action based on their own practical situations. Generally, they dichotomize child-rearing and caring issues into medical versus non-medical domains to which they apply expert and experiential knowledge, respectively. How a condition is categorized depends on whether their individualized experiential knowledge is adequate to allow them to manage the health of their child. This study concludes that mothers with alternative health information still respect professional authorities in clinical interactions, which accords with previous sociological studies, but mothers often consider expert knowledge overly generic, so they take initiative to translate generic health-related knowledge into individualized knowledge for their child and determine their own course of action. Our theoretical contribution is to bring situational concerns into the debate of professional authority by revealing how the accumulation of experiential knowledge informs situated action.
Collapse
Affiliation(s)
- Xiaoli Tian
- Department of Sociology, The University of Hong Kong, China.
| | - Sai Zhang
- Department of Sociology, The University of Hong Kong, China
| |
Collapse
|
5
|
Zhu G. A neoliberal transformation or the revival of ancient healing? A critical analysis of traditional Chinese medicine discourse on Chinese television. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1919290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ge Zhu
- School of Journalism and Mass Communication, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
6
|
He AJ, Tang VFY. Integration of health services for the elderly in Asia: A scoping review of Hong Kong, Singapore, Malaysia, Indonesia. Health Policy 2021; 125:351-362. [PMID: 33422336 DOI: 10.1016/j.healthpol.2020.12.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
Against the backdrop of rapid ageing populations, there is an increasing recognition of the need to integrate various health services for the elderly, not only to provide more coordinated care, but also to contain the rapid cost inflation driven primarily by the curative sector. Funded by the Asia-Pacific Observatory on Health Systems and Policies, this scoping review seeks to synthesize the received knowledge on care integration for the elderly in four Asian societies representing varying socioeconomic and health-system characteristics: Singapore, Hong Kong, Malaysia, and Indonesia. The search for English-language literature published between 2009 and 2019 yielded 67 publications in the final sample. The review finds that both research and practice regarding health service integration are at a preliminary stage of development. It notes a marked trend in seeking to integrate long-term elderly care with curative and preventive care, especially in community settings. Many distinctive models proliferated. Integration is demonstrated not only horizontally but also vertically, transcending public-private boundaries. The central role of primary care is highly prominent in almost all the integration models. However, these models are associated with a variety of drawbacks in relation to capacity, perception, and operation that necessitate further scholarly and policy scrutiny, indicating the robustness and persistence of siloed healthcare practices.
Collapse
Affiliation(s)
- Alex Jingwei He
- Department of Asian and Policy Studies, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong Special Administrative Region.
| | - Vivien F Y Tang
- Department of Asian and Policy Studies, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong Special Administrative Region
| |
Collapse
|
7
|
Chen WS, Hsu HC, Chuang YW, Lee M, Lu KY, Chen YF, Chen CM. Predictors for the use of traditional Chinese medicine among inpatients with first-time stroke: a population-based study. BMC Complement Med Ther 2020; 20:244. [PMID: 32762664 PMCID: PMC7409405 DOI: 10.1186/s12906-020-03037-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 07/26/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Stroke is one of the major causes of death and disability. The treatments that are provided to patients during hospitalization after an acute stroke are very important in stabilizing their medical condition and enabling the recovery of their motor functions. However, limited information is available regarding the use of traditional Chinese medicine (TCM) during hospitalization for first-time stroke patients. The researchers aimed to investigate the factors affecting TCM use and to provide clinicians with comprehensive information on TCM use among first-time stroke inpatients in Taiwan. METHODS The researchers collected and analyzed data, including patient characteristics, TCM use, and TCM prescription patterns, from the National Health Insurance Research Database in Taiwan for first-time stroke inpatients between 2006 and 2012. RESULTS Among the 89,162 first-time stroke patients, 7455 were TCM users, and 81,707 were TCM nonusers. The predictors for TCM use were as follows: age, 45-64 or < 45 years; men; living in a level 2, 4, or 7 urbanized area; insured amount ≥ 576 USD per month; ischemic stroke; hospitalized for first-time stroke for 8-14 days, 15-28 days, or ≥ 29 days; stroke severity index score 0-9 or 10-19; Charlson-Deyo comorbidity index score 0 or 1-2; hospitalization in a regional or community hospital; receiving rehabilitation; and previous experience with outpatient TCM use. An increase in the number of TCM users was observed from 2006 to 2012. Furthermore, 68.8-79.7% of TCM users used acupuncture only, while 17.8-26.1% used both acupuncture and Chinese herbal medicine. CONCLUSIONS An increasing number of first-time stroke patients have been choosing TCM as a complementary treatment during hospitalization. Moreover, TCM use is associated with demographic, clinical, and socioeconomic characteristics. These findings may help clinicians comprehensively understand the trend and the important factors affecting TCM utilization among patients who are hospitalized due to first-time stroke.
Collapse
Affiliation(s)
- Wei-Sen Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,Department of Physical Medicine and Rehabilitation, Jing Mei Hospital, Taipei, Taiwan
| | - Hung-Chih Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.,Department of Natural Biotechnology, Nanhua University, Dalin, Chiayi, Taiwan.,Center for Musculoskeletal Regenerative Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Physical Medicine and Rehabilitation, Xiamen Chang Gung Hospital, Xiamen, China
| | - Yi-Wen Chuang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,Jinan Rehabilitation Clinic, Tainan, Taiwan
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuan-Yu Lu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan
| | - Yi-Fei Chen
- School of Traditional Chinese Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
8
|
Ye J, Xiao A, Yu L, Zhou L. Attitude toward and practice of using traditional Chinese medicine in psychiatry: A mixed study of forty-nine leading psychiatrists in China. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Chan KW, Lee PW, Leung CPS, Chan GCW, Yiu WH, Cheung HM, Li B, Lok SWY, Li H, Xue R, Chan LYY, Leung JCK, Lam TP, Lai KN, Tang SCW. Patients' and clinicians' expectations on integrative medicine Services for Diabetes: a focus group study. BMC Complement Med Ther 2020; 20:205. [PMID: 32615961 PMCID: PMC7331247 DOI: 10.1186/s12906-020-02994-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/16/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We observed an exceptionally low utilisation of IM and potential underreporting in diabetes. We aimed to explore the barriers and recommendations regarding service delivery and research of IM service among diabetes patients and physicians. METHODS A 10-group, 50-participant semi-structured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities and education levels; and 29 physicians (14 conventional medicine (ConM) and 15 Chinese medicine (CM)) with diverse clinical experience, academic background and affiliation were purposively sampled from private and public clinics. Their perspectives were qualitatively analysed by constant comparative method. RESULTS Seven subthemes regarding barriers towards IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology and access to medical records. Patients underreported the use of CM due to the concern over neutrality of medical advice among physicians. Inconvenience of service access, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, ConM physicians emphasised standardisation and reproducibility while CM physicians emphasised personalisation. Some CM-related outcome measurements were suggested as non-communicable. Both physicians acknowledged the discordance in epistemology should be addressed by pragmatic approach. CONCLUSION Key obstacles of CAM clinical utilisation are different between patients. Further assessment on IM should be pragmatic to balance between standardisation, reproducibility and real-world practice. Evidence-based IM programs and research should merge with existing infrastructure.
Collapse
Affiliation(s)
- Kam Wa Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Pak Wing Lee
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Crystal Pui Sha Leung
- Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hospital Authority, Hong Kong, Hong Kong SAR
| | - Gary Chi Wang Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong SAR
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Hoi Man Cheung
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Bin Li
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Sarah Wing Yan Lok
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Hongyu Li
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Rui Xue
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Loretta Yuk Yee Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Joseph Chi Kam Leung
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Sydney Chi Wai Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR.
| |
Collapse
|
10
|
Wong CHL, Wu IXY, Adams J, Steel A, Wardle J, Wu JCY, Leung TH, Chung VCH. Development of Evidence-Based Chinese Medicine Clinical Service Recommendations for Cancer Palliative Care Using Delphi Approach Based on the Evidence to Decision Framework. Integr Cancer Ther 2020; 19:1534735420940418. [PMID: 32646246 PMCID: PMC7357016 DOI: 10.1177/1534735420940418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives: Existing evidence supports the use of certain Chinese medicine (CM) interventions for symptom management among palliative cancer patients. However, evidence-based service recommendations tailored to the local context are needed for CM planning and implementation. In response, we aimed to establish consensus on CM clinical service recommendations for cancer palliative care among Hong Kong experts. Methods: Seven CM interventions showing statistically significant favorable results in existing systematic reviews (SRs) and overviews of SRs were subjected to a GRADE-ADOLOPMENT-based 2-round Delphi survey. Twelve Hong Kong experts in cancer palliative care, including conventionally trained physicians, CM practitioners, and nurses (n = 4 from each category), were invited to participate. Use of the Evidence to Decision framework within the GRADE-ADOLOPMENT approach enabled experts to consider aspects of problem priority, benefits, harms, equity, acceptability, and feasibility when making CM recommendations in cancer palliative care. Results: Three evidence-based CM interventions reached positive consensus as service recommendations, namely: (1) acupuncture for reducing fatigue among palliative cancer patients; (2) acupressure for reducing fatigue among palliative cancer patients; and (3) moxibustion for reducing nausea and vomiting among patients receiving chemotherapy. Median rating of recommendation ranged from 2.5 to 3.0 (interquartile range = 0.00-1.00) on a 4-point Likert-type scale, and the percentage agreement ranged from 83.4% to 91.7%. Conclusions: The GRADE-ADOLOPMENT approach facilitates a consensus-based process of reaching 3 evidence-based CM recommendations for cancer palliative care. Future studies may develop tailored strategies to implement these recommendations in the Hong Kong health system.
Collapse
Affiliation(s)
- Charlene H. L. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Irene X. Y. Wu
- Xiang-Ya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Justin C. Y. Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting Hung Leung
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent C. H. Chung
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
11
|
Chan K, Tsang L. Public attitudes toward traditional Chinese medicine and how they affect medical treatment choices in Hong Kong. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2018. [DOI: 10.1108/ijphm-02-2017-0009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to test a conceptual model using public attitudes toward biomedicine and traditional Chinese medicine (TCM) to predict respondents’ medical treatment choice.
Design/methodology/approach
A quantitative online survey was conducted using quota sampling. Altogether 1,321 questionnaires from Hong Kong residents of age 15 years or above were collected.
Findings
Attitudes toward biomedicine in relation to TCM and perceived cost of TCM consultation were found to be significant variables in predicting respondents’ medical treatment choice of treatment. Perceived efficacy of TCM, however, was not a significant predictor. Older respondents, as well as respondents with higher education, were less likely to consult biomedicine first when ill. They were also less likely to consult biomedicine exclusively.
Research limitations/implications
This study uses a convenience sample recruited through personal networks. The findings cannot be generalized to the rest of the population.
Practical implications
Respondents in the study generally perceived TCM’s efficacy to be high, but not high enough to make it the medical treatment of choice. To promote TCM in Hong Kong, there is a need to enhance trust in it. This can be achieved through strengthening scientific research and development of TCM, enhancing professional standards of TCM practitioners and educating the public about the qualifications of TCM practitioners. Strategic channel planning to reach potential target and reducing the time cost of TCM medication should be examined.
Originality/value
The study is the first to relate attitudes to and perceptions of TCM with medical treatment choices in Hong Kong.
Collapse
|
12
|
Liem A, Rahmawati KD. The meaning of complementary, alternative and traditional medicine among the Indonesian psychology community: a pilot study. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2017; 15:288-294. [PMID: 28659233 DOI: 10.1016/s2095-4964(17)60336-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Complementary, alternative and traditional medicine (CATM) is a new field, as well as a promising area of study and practice in psychology. It is important to research the cultural context and meaning of CATM, including its definitions and examples, among different communities of psychology because CATM's use is dependent on how it is understood by the members. The aim of this pilot study is to provide an interpretation of the Indonesian psychology community's understanding of CATM through a qualitative approach. METHODS Online interviews with open-ended questions and purposive sampling were used. Participants were dominantly psychologists or lecturers in clinical psychology area. Ten males and 12 females with an average age of 28.0 ± 2.5 years voluntarily participated in this study. Interviews were audio-recorded, transcribed verbatim, and reviewed and analysed by the two authors to ensure accuracy of interpretation. RESULTS It was found that there was no single meaning of CATM among the Indonesian community of psychology. Participants were not familiar enough with the terms and tended to use them with overlap. It can be suggested that "complementary medicine" and "alternative medicine" or "complementary-alternative medicine" combined provides more suitable terminology for use among Indonesian psychology community when communicating with other health care professionals. CONCLUSION The understanding of the terms and examples of CATM were diverse and were often used interchangeably in the projects/interviews. It was also found that Indonesian psychologists required more education regarding CATM. In addition, future studies with more participants from various aspects of the psychology community should be conducted to capture a more representative sample.
Collapse
Affiliation(s)
- Andrian Liem
- School of Psychology, University of Queensland, Queensland 4072, Australia.,School of Psychology, University of Ciputra, Surabaya 60219, Indonesia
| | | |
Collapse
|
13
|
Liem A, Newcombe PA. Indonesian provisional clinical psychologists' knowledge, attitudes, and behaviours towards complementary-alternative medicine (CAM). Complement Ther Clin Pract 2017; 28:204-211. [PMID: 28779931 DOI: 10.1016/j.ctcp.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/07/2017] [Accepted: 06/29/2017] [Indexed: 01/30/2023]
Abstract
Sixty provisional clinical psychologists in Indonesia were emailed to seek their participation in an online-questionnaire that reflected: CAM knowledge, attitudes CAM, and CAM behaviours. Of the 60 participants approached, 44 with majority of female (95%) completed the questionnaire. The mean age of participants was 25 years. Overall, participants reported low knowledge of CAM and attitudes towards CAM were positive. While 73% reported having recommended CAM to their clients, only 39% had ever made referral. Most of the participants (98%) had used CAM personally but just over half (59%) had ever used it in clinical practice. It was found that knowledge and attitudes towards CAM did not predict CAM recommendation, personal use, nor professional use among the participants. However, CAM knowledge was found to predict CAM referrals. It is assumed that positive attitudes towards CAM integration among participants has been conflicted with their concern for CAM safety.
Collapse
Affiliation(s)
- Andrian Liem
- School of Psychology, University of Queensland, Australia.
| | | |
Collapse
|
14
|
Sheikh K, Josyula LK, Zhang X, Bigdeli M, Ahmed SM. Governing the mixed health workforce: learning from Asian experiences. BMJ Glob Health 2017; 2:e000267. [PMID: 28589031 PMCID: PMC5435263 DOI: 10.1136/bmjgh-2016-000267] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/05/2017] [Accepted: 02/07/2017] [Indexed: 01/28/2023] Open
Abstract
Examination of the composition of the health workforce in many low and middle-income countries (LMICs) reveals deep-seated heterogeneity that manifests in multiple ways: varying levels of official legitimacy and informality of practice; wide gradation in type of employment and behaviour (public to private) and diverse, sometimes overlapping, systems of knowledge and variably specialised cadres of providers. Coordinating this mixed workforce necessitates an approach to governance that is responsive to the opportunities and challenges presented by this diversity. This article discusses some of these opportunities and challenges for LMICs in general, and illustrates them through three case studies from different Asian country settings.
Collapse
Affiliation(s)
- Kabir Sheikh
- Public Health Foundation of India, New Delhi, India
| | - Lakshmi K Josyula
- Previous affiliation: Indian Institute of Public Health, Hyderabad, Public Health Foundation of India; Present affiliation: The George Institute for Global Health, Hyderabad, India
| | - Xiulan Zhang
- China Institute of Health, School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Maryam Bigdeli
- Past: Alliance for Health Policy and Systems Research, WHO; Present: Department of Health Systems Governance, Policy and Aid Effectiveness, World Health Organization (WHO), Geneva, Switzerland
| | - Syed Masud Ahmed
- Centre of Excellence for UHC, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
15
|
Wang SY, Lin LW, Chang YY, Huang YP. Health care professionals’ interactions with cancer patients who use complementary and alternative medicine in Taiwan. Collegian 2016. [DOI: 10.1016/j.colegn.2015.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
16
|
Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care. Sci Rep 2015; 5:18853. [PMID: 26686267 PMCID: PMC4685421 DOI: 10.1038/srep18853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/16/2015] [Indexed: 11/30/2022] Open
Abstract
Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care”, and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.
Collapse
|
17
|
Dong X, Bergren SM, Chang ES. Traditional Chinese Medicine Use and Health in Community-Dwelling Chinese-American Older Adults in Chicago. J Am Geriatr Soc 2015; 63:2588-2595. [PMID: 26662921 PMCID: PMC9869288 DOI: 10.1111/jgs.13828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Chinese people have practiced traditional Chinese medicine (TCM) for thousands of years, but there is a paucity of research regarding TCM use in Chinese older adult immigrants in the United States. This study aims to provide an overall estimate of TCM use for Chinese older adults in the United States and to examine associations between sociodemographic characteristics, health measures, and TCM use. Data were collected through the Population Study of Chinese Elderly in Chicago, a community-based participant research study that surveyed 3,158 Chinese older adults aged 60 and older. TCM use was measured using an eight-item scale that examined eight kinds of TCM. Seventy-six percent of participants reported any use of TCM within the past year. After adjusting for potential confounding factors, health status was associated with greater use of acupuncture (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.06-1.68) and massage therapy (OR = 1.53, 95% CI = 1.21-1.93), and quality of life was associated with less use of prescribed herbal products (OR 0.69, 95% CI = 0.55-0.87), tai chi (OR = 0.62, 95% CI = 0.50-0.78), and other traditional medicine (OR = 0.47, 95% CI = 0.40-0.56). These findings call for further investigation of TCM use by Chinese older adults, especially those with poor health and those with better quality of life. In the clinical setting, physicians should have awareness of TCM when treating Chinese older adults and look toward possible integration with Western medicine for more culturally appropriate, patient-centered care.
Collapse
Affiliation(s)
- XinQi Dong
- Chinese Health, Aging and Policy Program; Rush Institute for Healthy Aging; Rush University Medical Center; Chicago Illinois
| | - Stephanie M. Bergren
- Chinese Health, Aging and Policy Program; Rush Institute for Healthy Aging; Rush University Medical Center; Chicago Illinois
| | - E-Shien Chang
- Chinese Health, Aging and Policy Program; Rush Institute for Healthy Aging; Rush University Medical Center; Chicago Illinois
| |
Collapse
|
18
|
Nambiar D, Narayan VV, Josyula LK, Porter JDH, Sathyanarayana TN, Sheikh K. Experiences and meanings of integration of TCAM (Traditional, Complementary and Alternative Medical) providers in three Indian states: results from a cross-sectional, qualitative implementation research study. BMJ Open 2014; 4:e005203. [PMID: 25424993 PMCID: PMC4248091 DOI: 10.1136/bmjopen-2014-005203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Efforts to engage Traditional, Complementary and Alternative Medical (TCAM) practitioners in the public health workforce have growing relevance for India's path to universal health coverage. We used an action-centred framework to understand how policy prescriptions related to integration were being implemented in three distinct Indian states. SETTING Health departments and district-level primary care facilities in the states of Kerala, Meghalaya and Delhi. PARTICIPANTS In each state, two or three districts were chosen that represented a variation in accessibility and distribution across TCAM providers (eg, small or large proportions of local health practitioners, Homoeopaths, Ayurvedic and/or Unani practitioners). Per district, two blocks or geographical units were selected. TCAM and allopathic practitioners, administrators and representatives of the community at the district and state levels were chosen based on publicly available records from state and municipal authorities. A total of 196 interviews were carried out: 74 in Kerala, and 61 each in Delhi and Meghalaya. PRIMARY AND SECONDARY OUTCOME MEASURES We sought to understand experiences and meanings associated with integration across stakeholders, as well as barriers and facilitators to implementing policies related to integration of Traditional, Complementary and Alternative (TCA) providers at the systems level. RESULTS We found that individual and interpersonal attributes tended to facilitate integration, while system features and processes tended to hinder it. Collegiality, recognition of stature, as well as exercise of individual personal initiative among TCA practitioners and of personal experience of TCAM among allopaths enabled integration. The system, on the other hand, was characterised by the fragmentation of jurisdiction and facilities, intersystem isolation, lack of trust in and awareness of TCA systems, and inadequate infrastructure and resources for TCA service delivery. CONCLUSIONS State-tailored strategies that routinise interaction, reward individual and system-level individual integrative efforts, and are fostered by high-level political will are recommended.
Collapse
Affiliation(s)
- D Nambiar
- Public Health Foundation of India, New Delhi, India
| | - V V Narayan
- All India Institute of Medical Sciences, New Delhi, India
| | - L K Josyula
- Indian Institute of Public Health, Hyderabad, India
| | - J D H Porter
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - K Sheikh
- Public Health Foundation of India, New Delhi, India
| |
Collapse
|
19
|
Lakshmi JK, Nambiar D, Narayan V, Sathyanarayana TN, Porter J, Sheikh K. Cultural consonance, constructions of science and co-existence: a review of the integration of traditional, complementary and alternative medicine in low- and middle-income countries. Health Policy Plan 2014; 30:1067-77. [PMID: 25171821 DOI: 10.1093/heapol/czu096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 11/15/2022] Open
Abstract
This review examined the determinants, patterns and imports of official recognition, and incorporation of different traditional, complementary and alternative systems of medicine (TCAM) in the public health establishment of low- and middle-income countries, with a particular focus on India. Public health systems in most countries have tended to establish health facilities centred on allopathy, and then to recognize or derecognize different TCAM based on evidence or judgement, to arrive at health-care configurations that include several systems of medicine with disparate levels of authority, jurisdiction and government support. The rationale for the inclusion of TCAM providers in the public health workforce ranges from the need for personnel to address the disease burden borne by the public health system, to the desirability of providing patients with a choice of therapeutic modalities, and the nurturing of local culture. Integration, mostly described as a juxtaposition of different systems of medical practice, is often implemented as a system of establishing personnel with certification in different medical systems, in predominantly allopathic health-care facilities, to practise allopathic medicine. A hierarchy of systems of medicine, often unacknowledged, is exercised in most societies, with allopathy at the top, certain TCAM systems next and local healing traditions last. The tools employed by TCAM practitioners in diagnosis, research, pharmacy, marketing and education and training, which are seen to increasingly emulate those of allopathy, are sometimes inappropriate for use in therapeutic systems with widely divergent epistemologies, which call for distinct research paradigms. The coexistence of numerous systems of medicine, while offering the population greater choice, and presumably enhancing geographical access to health care as well, is often fraught with tensions related to the coexistence of philosophically disparate, even opposed, disciplines, with distinct and unaligned notions of evidence and efficacy, and ethical and operational challenges of the administration of a plural workforce.
Collapse
Affiliation(s)
- Josyula K Lakshmi
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Devaki Nambiar
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Venkatesh Narayan
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Tamysetty N Sathyanarayana
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - John Porter
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Kabir Sheikh
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Plot 1, ANV Arcade, Amar Co-Operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India, Public Health Foundation of India, New Delhi, India and London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| |
Collapse
|
20
|
Lin HW, Tsai HH, Yu IW, Kumar A, Wu MP. Would It Matter to Expose Elderly Patients Who Took Digoxin to Chinese Medications? Value Health Reg Issues 2014; 3:211-221. [PMID: 29702930 DOI: 10.1016/j.vhri.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Elderly patients seem vulnerable to digoxin toxicity because of their diminished organ functions and tendency to encounter drug interactions. The aim of this research was to explore the extent of the concurrent use of digoxin with Chinese medications (CMs), its contributing factors, and the relevant consequences. METHODS A retrospective population-based cohort study was conducted using Longitudinal Health Insurance databases in Taiwan. Those elderly patients being prescribed with digoxin in outpatient settings in 2006 were evaluated for the incidence, prevalence, and duration of concurrent use with concentrated CMs in 2006. After 1:1 random matching to select the corresponding digoxin-only elderly users, univariate and multivariate logistic regression analyses were performed to explore factors associated with concomitant incident digoxin-CM use and incident digoxin-specific CM use. The relevant clinical and economic outcomes for a 3-month follow-up period from the initial exposure of incident digoxin-CM use were compared. RESULTS Of 185,076 elderly, 6,374 were prescribed with digoxin and 789 were CM-digoxin users in 2006. The prevalence and incidence of concomitant CM use among digoxin elderly users were 0.43% and 0.22%, respectively. Although the other factors were not statistically significantly associated with incident CM-digoxin use, patients with heart diseases and with benign prostate hypertrophy had an increased likelihood of incident CM-digoxin use of 115% and 102%, respectively. Almost all the concerned clinical and economic outcomes were not statistically significantly different between incident exposure or not, except for the use of potassium-sparing and nonsteroidal anti-inflammatory drugs. CONCLUSIONS There was a relatively low incidence of digoxin-CM use among the elderly in Taiwan. Although no significant effects on clinical and economic outcomes occurred, it is necessary to monitor potential side effects of digoxin more aggressively for those vulnerable elderly using digoxin with CMs, especially for those who tended to expose to incident digoxin-CM use elderly patients.
Collapse
Affiliation(s)
- Hsiang-Wen Lin
- School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan, ROC; Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan, ROC.
| | - Hsin-Hui Tsai
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan, ROC; Department of Cosmetic Science, Providence University, Taichung, Taiwan, ROC
| | - I-Wen Yu
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Arun Kumar
- School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan, ROC
| | - Man-Pin Wu
- School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan, ROC
| |
Collapse
|
21
|
Perspectives on Medical Services Integration among Conventional Western, Traditional Korean, and Dual-Licensed Medical Doctors in Korea. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:105413. [PMID: 24382975 PMCID: PMC3870632 DOI: 10.1155/2013/105413] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/04/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine the perspectives on the options for the integration of western and traditional Korean medical services among three types of medical doctors with different disciplines in Korea. We surveyed and analyzed responses from 167 conventional Western medicine (WM), 135 traditional Korean medicine (KM), and 103 dual-licensed (DL) doctors who can practice both. All three kinds of doctors shared similar attitude toward license unitarization. KM doctors most strongly agreed on the need of the cooperative practice (CP) between KM and WM and on the possibility of license unitarization among three groups. DL doctors believed that CP is currently impracticable and copractice is more efficient than CP. WM doctors presented the lowest agreement on the need of CP and showed lower expectation for DL doctors as mediators between WM and KM than others. This study showed the difference of perspectives on the options for the integrative medical services among three different doctor groups in Korea. More studies are required to explore the underlying reasons for these discrepancies among WM, KM, and DL doctors.
Collapse
|
22
|
Liu CH, Tang WR, Wang HM, Lee KC. How cancer patients build trust in traditional Chinese medicine. Eur J Integr Med 2013. [DOI: 10.1016/j.eujim.2013.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Kim JH, Kwong EMS, Chung VCH, Lee JCO, Wong T, Goggins WB. Acute adverse events from over-the-counter Chinese herbal medicines: a population-based survey of Hong Kong Chinese. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:336. [PMID: 24279604 PMCID: PMC4222756 DOI: 10.1186/1472-6882-13-336] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 10/30/2013] [Indexed: 12/02/2022]
Abstract
Background Although over-the-counter traditional Chinese herbal medicine (COTC) is commonly used to treat everyday illness in many parts of the world, no population-based study has been done to examine the prevalence and factors associated with COTC-related adverse events. Methods A cross-sectional telephone survey was conducted among Hong Kong Chinese adults in 2011 (n = 1100) with informed verbal consent. Stepwise logistic regression of demographic, attitudinal and behavioral variables was used to determine factors associated with past-year adverse events. Results Of study respondents, 71.7% (789/1100) reported past-year COTC use and 2.3% (25/1100) reported at least one COTC-related adverse event in the past year. Of the 27 adverse events cases reported among COTC users, the most common were allergic reactions (n = 11) dizziness (n = 5), and gastro-intestinal problems (n = 4). Pills/capsules were the dosage form that caused the highest proportion of adverse events (n = 10), followed by plasters (n = 7), creams/ointments (n = 5), and ingestible powders (n = 2). Although COTC users reporting adverse events were more likely to report greater practices to avoid adverse events (OR = 6.47; 95% CI: 1.38-30.3); they were also more likely to possess lower education levels (OR = 9.64, 95% CI: 2.20-42.3) and to have received COTC information from non-reliable, mass-media information sources such as magazines (OR = 3.32; 95% CI: 1.01-8.50) or television (OR = 2.93; 95% CI: 1.03-10.7). Package labels were also felt to be unclear by 42.9% of COTC users. A large proportion of COTC users demonstrated low levels of COTC-related knowledge, while the main impediment to greater information-seeking was the belief that reliable COTC information is not obtainable from Western health professionals. Conclusions Despite global movements toward more stringent complementary medicine regulation, the limited accessibility of reliable information and widespread misperceptions among consumers present major challenges for the safe use of complementary medicine.
Collapse
|
24
|
Lam TP, Sun KS. Dilemma of integration with Western medicine - views of Traditional Chinese Medicine practitioners in a predominant Western medical setting. Complement Ther Med 2013; 21:300-5. [PMID: 23876560 DOI: 10.1016/j.ctim.2013.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/19/2013] [Accepted: 04/26/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to explore the in-depth views of the Traditional Chinese Medicine (TCM) practitioners towards Western and Chinese medicine, and the possible ways of integration under a predominant Western medical setting. DESIGN AND SETTING Purposive, qualitative design based on focus group interviews of TCM practitioners in Hong Kong. PARTICIPANTS Information-rich participants were recruited from a Western medicine training course for TCM practitioners. Two focus groups comprising 13 TCM practitioners were held before the course, and two others with 10 TCM practitioners after the course. RESULTS The TCM practitioners were adapted to act in a supportive role to Western doctors although they recognized their own strengths. They highlighted the prejudice from the Western doctors on their diagnostic approach. The TCM practitioners felt that they were actually more open-minded than the Western doctors, who often discouraged the patients to see them. Regarding integration with Western medicine, they considered it as a complicated issue due to the different concepts and forms of integration, as well as the balance between the two types of medicine. While there was a concern that learning Western medicine might overshadow their TCM mindset, they thought that TCM had always welcomed new elements to be added into it over the centuries, Western medicine being no exception. CONCLUSIONS The TCM practitioners are adapted to a supportive role to Western doctors under a predominant Western medical setting. Despite the uncertainties for collaboration, the TCM practitioners tend to support the trend of integration.
Collapse
Affiliation(s)
- Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
| | | |
Collapse
|
25
|
An investigation of the use of traditional chinese medicine in stroke patients in taiwan. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:387164. [PMID: 23304199 PMCID: PMC3530233 DOI: 10.1155/2012/387164] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/14/2012] [Accepted: 11/19/2012] [Indexed: 11/18/2022]
Abstract
Background. The use of complementary and alternative medicine in critical illness is increasing worldwide. This study investigates how traditional Chinese medicine (TCM) is used in stroke patients. Methods. Using Taiwan National Health Insurance reimbursement claims, we compared the annual use of TCM between stroke patients and general population, identifying 15,330 patients with a new onset of stroke in 2000–2009. The sociodemographic status and medical comorbidities between stroke patients receiving TCM services and those without using the service were compared. Results. The use of TCM was higher in stroke patients than in the general population, 27.9% versus 25.4% in 2000 and 32.7% versus 27.8% in 2009, respectively, and grew consistently from 2000 to 2009. Among stroke patients, women, younger patients, white-collar employees, higher-income residents, and those living in areas with more TCM physicians were more likely to use TCM. Stroke patients using rehabilitation services were more likely to have more TCM visits (OR = 2.28, 95% CI = 1.96–2.66) and higher expenditure on TCM (OR = 2.67, 95% CI = 2.29–3.12) compared with stroke patients without rehabilitation. Conclusion. TCM is popular and well accepted in Taiwan. Patients with stroke have a higher TCM utilization rate than people without stroke.
Collapse
|
26
|
Chung VCH, Ma PHX, Lau CH, Wong SYS, Yeoh EK, Griffiths SM. Views on traditional Chinese medicine amongst Chinese population: a systematic review of qualitative and quantitative studies. Health Expect 2012; 17:622-36. [PMID: 22647085 DOI: 10.1111/j.1369-7625.2012.00794.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Health-care professionals worldwide have started to appreciate patients' perspectives on the use of complementary and alternative medicine (CAM) particularly given its popularity. However, cultural perspectives may vary and it may not be possible to apply research findings on the use of CAM from the west to the east. OBJECTIVE This systematic review aims to synthesize usage patterns of traditional Chinese medicine (TCM) amongst Chinese populations in different parts of the world and explore potential geographical variations. SEARCH STRATEGY Six international and four Chinese databases were searched, and manual searches of relevant monographs and government publications were carried out. INCLUSION CRITERIA Quantitative, qualitative or mixed-method research that aimed to investigate Chinese patients' perception of, and perspectives on, TCM was included. DATA EXTRACTION AND SYNTHESIS For each study included, texts under the headings of 'results' or 'findings' were extracted and subjected to analysis. A thematic synthesis approach was adopted for synthesizing qualitative and quantitative studies. MAIN RESULTS Amongst the 28 studies included, twenty were quantitative surveys, six were qualitative studies and two were mixed-method studies. The overall methodological quality was mediocre. Data synthesis suggested that patients from all regions share a common cultural affinity to TCM and consider it to be an effective complement to western medicine (WM) for treating chronic or serious diseases. However, heterogeneous views on (i) disclosing TCM use to WM doctors and (ii) the potential harm of herbs emerged across different study locations. DISCUSSION AND CONCLUSIONS Future research should explore how variation in health systems may influence patients' perception of CAM in different countries.
Collapse
Affiliation(s)
- Vincent C H Chung
- School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | | | | | | |
Collapse
|
27
|
Developing policy for integrating biomedicine and traditional chinese medical practice using focus groups and the delphi technique. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:149512. [PMID: 22649469 PMCID: PMC3358044 DOI: 10.1155/2012/149512] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/28/2012] [Accepted: 03/01/2012] [Indexed: 11/18/2022]
Abstract
In Hong Kong, statutory regulation for traditional Chinese medicine (TCM) practitioners has been implemented in the past decade. Increasing use of TCM on top of biomedicine (BM) services by the population has been followed; but corresponding policy development to integrate their practices has not yet been discussed. Using focus group methodology, we explore policy ideas for integration by collating views from frontline BM (n = 50) and TCM clinicians (n = 50). Qualitative data were analyzed under the guidance of structuration model of collaboration, a theoretical model for understanding interprofessional collaboration. From focus group findings we generated 28 possible approaches, and subsequently their acceptability was assessed by a two round Delphi survey amongst BM and TCM policy stakeholders (n = 12). Consensus was reached only on 13 statements. Stakeholders agreed that clinicians from both paradigms should share common goals of providing patient-centered care, promoting the development of protocols for shared care and information exchange, as well as strengthening interprofessional connectivity and leadership for integration. On the other hand, attitudes amongst policy stakeholders were split on the possibility of fostering trust and mutual learning, as well as on enhancing innovation and governmental support. Future policy initiatives should focus on these controversial areas.
Collapse
|
28
|
Wong W, Lam LKC, Li R, Ho SH, Fai LK, Li Z. A comparison of the effectiveness between Western medicine and Chinese medicine outpatient consultations in primary care. Complement Ther Med 2011; 19:264-75. [PMID: 21944656 DOI: 10.1016/j.ctim.2011.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 05/19/2011] [Accepted: 07/07/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Traditional Chinese medicine (TCM) plays an important role in the primary care system in many places, but research evidence on its effectiveness is largely lacking. The aim of the present study was to compare the effectiveness between TCM and Western medicine (WM) consultations in primary care. OBJECTIVES To evaluate whether medical consultations could improve the quality of life and health condition of patients in primary care and to find out whether there was any difference in the effectiveness bewteen TCM and WM. DESIGN, SETTING AND SUBJECTS This was a prospective, longitudinal study on 290 patients of one TCM public and 841 patients of two WM general outpatient clinics (GOPC) in Hong Kong when they consulted for an episodic illness. METHODS All patients attending a TCM GOPC in TWH, and the two WM GOPC (TWH and ALC), who fullfilled the inclusion criteria were invited to participate. Each patient answered a structured questionnaire on the presenting complaint, socio-demography, chronic morbidity and service utilization, the Chinese Quality of Life instrument (ChQOL) and the SF-36V2 Health Survey immediately before and two weeks after the doctor consultation. The Global Rating on change Scale (GRS) was also administered in the week 2 assessment. OUTCOME MEASURES The primary outcomes were changes in the ChQOL and SF-36V2 HRQOL scores. Secondary outcomes included the GRS score. The significance of the change within individual were tested by paired t-tests. The differences in change in scores between WM and TCM were tested by independent sample-t-tests or chi-square, as appropriate. Multivariate regresions were used to determine the independent effect of type of medicine on the change in HRQOL scores. RESULTS Mean ChQOL and SF-36V2 scores of subjects improved significantly two weeks after TCM or WM consultations in all domains except for the Physical form domain of ChQOL. The greatest improvements were found in the SF-36V2 physical-health related domains. 78% TCM clinics and 71% of subjects WM clinics reported an improvement in GRS. The proportion of subjects who had improvement in HRQOL scores were lower among subjects consulting the WM clinic (72.3%) than those consulting TCM clinics (100%) but the difference was not significant after correction for baseline scores. CONCLUSIONS Both TCM and WM consultations were associated with significant improvement in HRQOL in over 90% of patients. There was no singificant difference between the effectiveness of TCM and WM consultations. The results support the role of TCM as an alternative primary care service in Hong Kong.
Collapse
Affiliation(s)
- Wendy Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
| | | | | | | | | | | |
Collapse
|