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Traditional Chinese Medicine in Hong Kong: Utilization Patterns and its Role in the Future Healthcare System

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Traditional Chinese Medicine in Hong Kong: Utilization Patterns and its Role in the Future Healthcare System

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    1. Traditional Chinese Medicine in Hong Kong: Utilization Patterns and its Role in the Future Healthcare System The RGC Public Policy Research Funding Scheme (Round 2) Principal Investigator: Prof. Sian Griffiths Director, School of Public Health and Primary Care Faculty of Medicine The Chinese University of Hong Kong Postgraduate student trained: Vincent Chung BCM BSc PhD, Registered Chinese Medicine Practitioner

    2. Developing Traditional, Complementary and Alternative Medicine (TCAM) International Perspective from the World Health Organization (WHO): Two major milestones: The WHO Traditional Medicine Strategy 2002-5 The WHO Congress of Traditional Medicine 2008

    3. WHO and TCAM Development (1) The WHO Traditional Medicine Strategy 2002-5 specified the goals of 1) increasing governmental support for TCAM amongst member states; 2) promoting the integration of TCAM into member states national healthcare systems In a WHO survey published in 2005: 51 out of 96 responding member states were planning a national policy for TM/CAM, while the remaining states have already formulated policies

    4. The Beijing Declaration for Developing TCAM, 2008

    7. Traditional Chinese Medicine (TCM) in Hong Kong: Policy Development since 1997 Basic Law of Hong Kong SAR, Article 138 The Government of the Hong Kong Special Administrative Region shall, on its own, formulate policies to develop Western and traditional Chinese medicine and to improve medical and health services.

    8. TCM in Hong Kong: Overview

    9. Policy Address 1997 Policy Address 2001 Policy Address 2005 Policy Address 2009 3 Major Achievements

    11. An understanding of who, how and why patients are choosing TCM may offer valuable insights for policy making. Data on the characteristics of TCM users in the population may be used to answer policy questions in all three domains of public health health services, health protection, and health promotion (Griffiths, Jewell, & Donnelly, 2005). Choice for TCM and integrative TCM-WM in the HK population

    12. How do Chinese populations perceive TCMs role in contemporary healthcare? Who uses TCM in Hong Kong? How do patients perceive the quality of communication in their outpatient encounters with TCM and WM professionals? Does TCM have a role in tackling the challenges of increasing NCD prevalence in our aging population? 5) What are the policy implications of these findings?

    13. VIEWS ON TRADITIONAL CHINESE MEDICINE AMONGST CHINESE POPULATIONS: A SYSTEMATIC REVIEW OF QUALITATIVE AND QUANTITATIVE STUDIES Question 1: How do Chinese populations perceive TCMs role in contemporary healthcare?

    14. We searched 5 electronic databases (MEDLINE, EMBASE, AMED, PsychINFO, and British Nursing Index) Since their inception till Jan 2009 for qualitative studies and quantitative surveys that investigated Chinese peoples views on TCM No Limit on the location of the study populations (China, Taiwan, Hong Kong, Macao or overseas)

    15. The methodological quality of all included studies was assessed independently by two reviewers (VCH Chung and CH Lau) using the criteria proposed by Mills et al (Mills, E.J. 2006). Findings of all included studies were extracted independently by two investigators. We employed a qualitative approach for data synthesis, which involved three main steps of: (1) classifying studies, (2) comparing and contrasting findings, and (3) thematic analysis (Harden, A. 2004; Lucas, P. 2007; Garcia, J. 2002). Analysis of the extracted data generated 4 major themes: (1) cultural grounding, faith and lay construction of TCM knowledge; (2) perceived strength and weakness of TCM; (3) perceived complementarity of TCM and WM; (4) choice for integrated TCM-WM treatment.

    16. Summary of Findings Lay applications of ancient Chinese philosophies and TCM theories like Yin-Yang and Qi-Blood are commonly used to explain aetiology, interpret symptoms and to provide rationale for self care practices. It is perceived that TCM is a lay form of healthcare in which recommendations from family and friends, instead of healthcare professionals, are of crucial value. The perceived advantage of integrating TCM and WM is mainly confined to the improvement of physical health outcomes and holism would be achieved when the side effects of WM are minimized whilst the tonic effects of TCM is maximized.

    17. Analysis of the thematic household survey datasets 2002 and 2005

    18. Thematic Household Survey 2002 & 2005 Commissioned by the Census and Statistic Department, Hong Kong SAR Government Conducted between May July, 2002 and Nov 2005 Mar 2006 Covered the entire land based population of HK, including both non-institutional and institutional residents Survey data were collected through the use of structured questionnaire via face to face interviews during personal visit by trained enumerator Covering BOTH non-institutional and institutional residents, 29,561 non-institutional (response rate: 97.2%, 2002) 2,111 institutional (response rate: 78.4%, 2002) 33,263 non-institutional (response rate: 79.2%, 2005) 3,461 institutional (response rate: 93.7%, 2005) Representing 6,504,255 (2002)/ 6,750,652 (2005) persons after applying population weight

    19. Have you EVER consulted a Chinese Medicine (CM) practitioner?

    20. Question 2: Who uses TCM in Hong Kong? DEMOGRAPHIC AND HEALTH RELATED CHARACTERISTICS OF TRADITIONAL CHINESE MEDICINE USERS IN HONG KONG

    21. Who are using TCM in Hong Kong?

    22. Summary Points Compared to the pre-1997 studies, three novel findings were noted. Firstly, respondents from the higher socioeconomic class emerged as a new class of TCM users. Secondly, there was low TCM utilization rate among the institutionalized elderly. Lastly, older respondents were less like to be covered by TCM insurance. Policy Implications: Better understanding of 1. TCM accessibility among the elderly and 2. Possible financing opportunities for community TCM services warrant further research.

    23. Question 3: How do patients perceive the quality of communication in their outpatient encounters with TCM and WM professionals? COMPARING THE OUTPATIENT CONSULTATION EXPERINCES AMONGST WM AND TCM USERS

    24. CAHPS 2.0 core component

    25. Are patients satisfied with communication quality in outpaients encounters? Patients are generally satisfied?

    27. Summary Points Users of WM public services were more likely to be dissatisfied with all evaluated aspects. The observed differences highlight the dissatisfaction with public WM services, which are mainly accessed by less affluent patients. Compared to users of private WM services, multivariate analysis showed that TCM patients were more likely to rate their clinicians highly for listening skills but low for respect. Further studies to better understand the reasons for dissatisfaction and the possible policy and organizational solutions are warranted. The need in improving communication skill training in TCM higher education, especially in privacy protection, should be further studied.

    28. Question 4: Does TCM have a role in tackling the challenges of increasing NCD prevalence in our aging population? INTERRELATIONSHIP BETWEEN AGE, CHRONIC DISEASE STATUS AND CHOICE FOR TCM AND WM

    29. (1) Double consulting of WM and TCM professionals is popular

    30. Probability of health service utilization type by age and NCD status

    31. Summary Points

    32. Findings from previous parts of presentation showed that government initiative in TCM development have led to increasing patient choice for integrative TCM-WM care. However, corresponding inter-professional care between WM Doctors (WMD) and TCM Practitioners (TCMP) has not been facilitated.

    33. Patient Choice and Need for Inter-professional Collaborations The preservation of continuity, coordination and comprehensiveness in a pluralistic primary care system poses a challenge to policy makers. Fostering inter-professional collaboration between TCMP and WMD may improve quality of care, but the current segregation of TCM and WM provisions in the Hong Kong health system implies that significant financial investments on education and service re-organization will be a prerequisite for better joint up working (e.g. sharing of electronic health records).

    35. Developing a policy framework for integration of traditional Chinese and allopathic medicine in Hong Kong using Delphi technique Supported by RGC Public Policy Research Funding Scheme (Round 4) In Progress

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