Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong

Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong's TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster both increased understanding and safe referrals.     

Prevalence and determinants of the use of traditional Chinese medicine in Hong Kong

We studied 2,822 subjects above 18 years of age in Hong Kong by random telephone interview to assess the role of traditional Chinese medicine in health care. During their most recent illness, 73% consulted Western doctors, 17% self-medicated while 9% consulted herbalists. Age and education were important determinants of their health care choice. The most common reason given for their choice was faith in the practitioners they consulted. When they needed further consultation for the same illness, 42% consulted herbalists, illustrating that herbalists played an important supplementary role when Western medicine failed to provide relief. Compared with previous findings, there appeared to be little decline in the popularity of traditional Chinese medicine in Hong Kong.     

Age, chronic non-communicable disease and choice of traditional Chinese and western medicine outpatient services in a Chinese population

Background  

In 1997 Hong Kong reunified with China and the development of traditional Chinese medicine (TCM) started with this change in national identity. However, the two latest discussion papers on Hong Kong's healthcare reform have failed to mention the role of TCM in primary healthcare, despite TCM's public popularity and its potential in tackling the chronic non-communicable disease (NCD) challenge in the ageing population. This study aims to describe the interrelationship between age, non-communicable disease (NCD) status, and the choice of TCM and western medicine (WM) services in the Hong Kong population.     

Identifying barriers to the adoption of evidence-based medicine practice in clinical clerks: a longitudinal focus group study

OBJECTIVE: To identify and explore common barriers to the adoption of evidence-based medicine (EBM) practice in the undergraduate setting. DESIGN: Nested longitudinal, focus group-based, qualitative study. Setting The University of Hong Kong Medical School, Hong Kong, China. PARTICIPANTS: A group of 39 Year 4 medical undergraduates who participated in an EBM intervention cluster randomised crossover trial. MAIN OUTCOME MEASURES: Students' attitudes, opinions and perceptions of barriers to EBM use. RESULTS: General attitudes towards EBM and the teaching intervention were positive. Four sets of barriers to greater EBM use were identified as follows. (1) Learning environment including prevailing norms for student learning involving examination-oriented, textbook learning, prior availability of clinical practice guidelines, lack of encouragement from teachers and economy of time by utilising teacher expertise. (2) Limitations of evidence consisting of poor point-of-care access to medical literature, difficulty in locating evidence and the perceived low relevance of overseas evidence to Chinese patients. (3) Lack of opportunity to practise EBM due to lack of continuity of care and anxieties about negative teacher attitudes towards EBM use at the point-of-care. (4) Time constraints such as competing study demands and long evidence search time. CONCLUSIONS: Significant barriers to the successful implementation of EBM learning in the clinical clerkship setting were identified. These can be specifically targeted to ameliorate any inhibition of clinical learning they may impose.     

Hong Kong Chinese parental attitudes towards vaccination and associated socio-demographic disparities

BackgroundMost previous studies on parental attitudes towards vaccination focused on a disease-specific vaccine. In this study we describe general attitudes towards vaccination in Chinese parents and associated socio-demographic disparities.MethodsData were collected from a random sample of 1996 Hong Kong Chinese parents by telephone interviews (response rate 60%). Multiple linear regression analysis was performed.ResultsMost parents believed vaccination to be effective (91.6%) and beneficial (78.7%), though many considered optional vaccines unimportant (39.5%) and unnecessary (62.1%). Demographic characteristics associated with parental negative attitudes to vaccination included being female, born in Hong Kong, married, having fewer children, and children ever experienced vaccination side effects. Lower personal income and religious affiliation were associated with more hesitant attitudes towards optional vaccines.ConclusionSegments of the population hold significantly negative attitudes towards vaccination and optional vaccines, suggesting a need for targeted efforts on vaccination communication in these groups.     

Attitudes to traditional Chinese medicine amongst Western trained doctors in the People's Republic of China

This study analyses the attitudes of Western trained doctors to traditional Chinese medicine (TCM) in Shenyang, Northern China. Research methodology involved a series of structured interviews as well as developing a questionnaire. Two hundred and fifty questionnaires were distributed in four centres, 177 were returned. Ninety-eight percent of respondents had some theoretical and practical TCM training; the older doctors having significantly more than their recently qualified colleagues. There was clear consensus that TCM (mainly herbal medicine) was useful and safe in treating patients with chronic or intractable illness. Doctors were influenced in their choice of treatment by their training, clinical experience and the available published research. TCM was not practiced in isolation, but in conjunction with Western medicine; 76% treating their patients with TCM, 90% treating their friends or family and 82% referring patients to TCM specialists.     

Psychometric properties of the Chinese quality of life instrument (HK version) in Chinese and Western medicine primary care settings

Background

The Chinese Quality of Life Measure (ChQOL) had only been validated on a small number of selected subjects in Hong Kong and had never been tested in the Western medicine (WM) primary care setting.

Aims and objectives

To test the psychometrics properties of ChQOL(HK version) in both TCM and WM general outpatient clinics.

Methods

Three samples of Chinese adult patients [(1) 569 consulting TCM clinics for episodic illnesses; (2) 524 consulting WM clinics for episodic illnesses; (3) 205 consulting WM clinics for chronic disease follow-up] in Hong Kong were invited to complete the ChQOL(HK version) and the SF-36 Health Survey during their consultations and 2 weeks after consultations. The scaling assumptions, factor structure, convergent construct validity, reliability, responsiveness, and discriminatory power of the ChQOL were evaluated.

Results

Majority of items satisfied the scaling assumptions. A two instead of 3-factor structure was found with physical form and emotion facets loading on one factor. Convergent construct validity was confirmed with moderate correlations with SF-36 scores. Internal consistency and test?Cretest reliability were satisfactory. The ChQOL(HK version) was able to detect significant improvements 2?weeks after consultations, and it was able to discriminate between groups with different illness severity, age, and sex.

Conclusion

The ChQOL(HK version) was shown to have satisfactory validity, reliability, discriminatory power, and responsiveness in both TCM and Western medicine primary care settings. The validity of the 3-domain scaling structure needs further evaluation.     

Evaluating traditional Chinese medicine using modern clinical trial design and statistical methodology: application to a randomized controlled acupuncture trial

Traditional Chinese medicine (TCM), used in China and other Asian counties for thousands of years, is increasingly utilized in Western countries. However, due to inherent differences in how Western medicine and this ancient modality are practiced, employing the so-called Western medicine-based gold standard research methods to evaluate TCM is challenging. This paper is a discussion of the obstacles inherent in the design and statistical analysis of clinical trials of TCM. It is based on our experience in designing and conducting a randomized controlled clinical trial of acupuncture for post-operative dental pain control in which acupuncture was shown to be statistically and significantly better than placebo in lengthening the median survival time to rescue drug. We demonstrate here that PH assumptions in the common Cox model did not hold in that trial and that TCM trials warrant more thoughtful modeling and more sophisticated models of statistical analysis. TCM study design entails all the challenges encountered in trials of drugs, devices, and surgical procedures in the Western medicine. We present possible solutions to some but leave many issues unresolved.     

中西医结合治疗支原体肺炎

目的探索中西医结合治疗支原体肺炎的疗效。方法５２例病人随机分为两组：中西医结合治疗组３３例,以丁胺卡那霉素加中药治疗;对照组１９例,以红霉素治疗,综合治疗相同。结果中西医结合治疗组总体疗程优于对照组,疗效显著,Ｐ＜０．０１。结论中西医结合治疗支原体肺炎是值得推广的方法。     

Hong Kong Chinese daughters' intergenerational caregiving obligations: a cultural model approach

This paper, based on a study carried out in Hong Kong, outlines the caregiving obligations of Hong Kong Chinese daughters towards their frail elderly parents. A cultural model approach drawn from cognitive anthropology is taken to focus on how Chinese caregiving daughters develop a sense of what is right and emotionally fulfilling and acquire the motivation to care for their parents. An ethnographic approach was used in the study and techniques included guided and open-ended interviews and non-participatory observations. A total of 20 co-residential caregiving daughters were interviewed in their homes on average twice over the course of one year. All interviews were conducted in Cantonese. Although the sample was small, daughters' accounts are structured by reference to cultural models and this structure provides the common basis for generalisability of results. Concepts of Confucian antecedents, reciprocity and personhood and other modern ideas of filial duty are explored. Conclusions are drawn about the shifting rights and obligations of Chinese caregiving daughters within the contemporary urban realities of Hong Kong. The findings of this study have relevance for the development of welfare policy for older Chinese persons and the chronically ill, and to all services involving women. The findings will also serve to inform family caregiver education programs.     

Adolescent cough medicine abuse in Hong Kong: implications for the design of positive youth development programs in Hong Kong

This study examines the phenomenon of adolescent cough medicine abuse in Hong Kong. Quantitative data obtained from questionnaire survey with 225 adolescents showed that there were personal, peer, family and community factors influencing adolescent cough medicine abuse. Part 2 of the study obtained qualitative data from focus group interviews with cough medicine abusers (N = 8), their family members (N = 5) and service providers (N = 6). The accounts of the participants revealed that the primary factors accounting for adolescent cough medicine abuse were social pressure (peer and environmental influences), family (difficult relationships or harmful incidents), availability (ease of access), and ignorance (unaware of the consequence of cough medicine use and belief that cough medicine was non-addictive). The present findings provide useful pointers for the development of the positive youth development program supported by the Hong Kong Jockey Club Charities Trust.     

Decolonization and the movement for institutionalization of Chinese medicine in Hong Kong: a political process perspective

This paper focuses on the question of why the social and political acceptance of Chinese medicine has grown in the former British colony of Hong Kong since the late 1980s. To supplement the conventional explanations for the institutionalization of alternative medicines, we propose a political process perspective that highlights the effects of political changes amidst the decolonization process in Hong Kong. During the late 1980s and early 1990s, the weakening of the political position of the established elite, the opening up of political space for previously excluded groups, and the competition for support among the new political elite, all stimulated the indigenous Chinese medicine organizations to mobilize for the institutionalization of Chinese medicine. By the mid-1990s academics from leading tertiary institutions began to take over the leadership of the movement and in doing so carried it to a higher level. In the conclusion, we briefly consider the implications of this movement for the future development of alternative medicine in Hong Kong and other societies.     

中西医结合治疗冠心病的临床体会

目的分析冠心病的中西医结合治疗方法的临床效果。方法回顾性分析该院68例冠心病患者临床资料。随机分为治疗组和对照组,各34例。治疗组采用中西医结合治疗方法;对照组仅采用西医常规治疗方法。结果通过治疗,治疗组的临床症状疗效总有效率为93.02%,心电图疗效的总有效率为93.02%和95.35%,而对照组的临床症状疗效总有效率为79.07%,心电图疗效的总有效率为81.39%,两组总有效率比较差异有统计学意义(P<0.05)。结论通过临床观察我们认为中西医药的联合应用具有协同作用,对心绞痛的控制及其他症状的减轻和消除、心功能的改变都优于单纯的西药或者中药的治疗,值得临床推广应用。     

Self-perceived quality of life of Chinese elderly people in Hong Kong

Central to the philosophy of occupational therapy is a commitment to the improvement of clients' quality of life (QOL). There has been a growing interest in the QOL of elderly people in Hong Kong. Social and cultural differences may preclude the application of QOL findings for elderly people in Western countries to their Hong Kong counterparts. This study, which is the preliminary phase of a larger study, explored the QOL of Chinese elderly people in Hong Kong from their own perspective. Focus group interviews were conducted with six Chinese community-residing elderly people who identified the following domains and component elements as being important to their QOL: physical and functional well-being (good health, leisure), psychological well-being (life satisfaction, happiness), social well-being (social interaction, social network/support) and economic well-being (money, housing). Further investigation of factors including self-concept, self-pride, personal autonomy, role fulfilment, and coping ability is required to determine if these are QOL elements for this population. Participants' culturally related philosophical beliefs were found to influence their QOL. Copyright © 1998 Whurr Publishers Ltd.     

对中西医结合治疗慢性肾衰的几点思考

中西医结合是治疗慢性肾衰比较理想的模式,值得临床和科研多方面深入研究和探讨,首先要统一认识,形成系统,中医病名归属范畴应有所扩大.临床治疗慢性肾衰要把握中医辨别病机本虚标实特点,难点在于处理好中医分型论治与西医分期治疗的对应关系,重点是中西药物的有机结合,即在现代药理的基础上辨证使用中药和中西药物临床有机结合运用.     

Registered nurses integrate traditional Chinese medicine into the triage process

People in the United States often consult registered nurses (nurses) for advice when they want to explore alternatives to Western medicine, such as traditional Chinese medicine (TCM). Nurses find themselves confronting dilemmas when they are caught between these radically different worlds of medical cultures and thinking. Twenty Minnesota nurses were interviewed to learn how they integrate TCM into their triage process. Symbolic interactionism was the research framework used, and mixed coding methods facilitated data analysis. Several sociological theories explain the findings. The major finding is that nurses use a four-step triage process that begins from the Western medical perspective and includes consideration of TCM use. Nurses' recommendations are influenced by their situational roles and relationships, and by the cues they read from the person who is asking their advice. The results point to nurses being natural disseminators of TCM information and education in their resource role for others making health care decisions.     

从卫生服务供方意向调查的变迁看中医发展危机

为了进一步了解中医的发展状况，通过对2008年与2000年样本地区卫生服务供方的意向调查数据的比较，分析卫生服务供方对中医信仰的变迁。研究发现，卫生服务供方对中医信仰进一步降低，中医成为西医的简单补充。在这种情况下，如何把握中医特色，创新诊疗手段，总结推广中医特效治疗种类和范围，推广适宜技术等尤为重要，逐步提高卫生服务供方对于中医的支持和认可。     

中西医结合治疗小儿内科疾病与单一西药治疗效果对比分析

目的探究中西医结合治疗小儿内科疾病的临床疗效。方法选择2016年4月至2017年4月本院就医的98例内科疾病患儿随机分为两组,其中对照组49例,采用单一西药治疗,观察组49例,采用中西医结合治疗方式,比较两组患儿临床治疗效果。结果采用中西医结合治疗的观察组患儿治疗总有效率为95.92%,不良反应发生率为4.08%,而进行单一西医治疗的对照组患儿,治疗总有效率为87.75%,不良反应发生率为14.28%。结论中西医结合治疗小儿内科疾病不但可以提升临床治疗效果,还可以控制不良反应发生率,因此在小儿内科疾病治疗过程中,要注重中西医结合治疗方式的临床推广应用。     

Implementing inclusive education in an early childhood setting: a case study of a Hong Kong kindergarten

Inclusive education has been promoted in primary and secondary schools in Hong Kong since the 1990s, and it has now spread to pre-primary education. Without qualified teachers and sufficient resources, however, it is difficult to implement inclusion in early childhood settings. This case study investigated how inclusive education was practised in an ordinary kindergarten in Hong Kong with a focus on its benefits and challenges. Two children with special educational needs, their teachers and parents, the learning support team members, and the school principal were involved in the study, which included the triangulation of observations, interviews, and documentation analysis. The results indicated that (1) the chosen kindergarten demonstrated a variety of inclusive practices and (2) although there were some problems and difficulties, all of the participants interviewed showed positive attitudes towards the inclusive programme. The implications and challenges of implementing inclusion in Hong Kong early childhood settings are discussed.     

Graduates' evaluation of a postgraduate diploma course in family medicine

BACKGROUND: Postgraduate programmes offer an opportunity to learn family medicine for physicians in practice who were unable to obtain formal training in the immediate postgraduate phase of their career. Since 1985, the Chinese University of Hong Kong has provided a part-time 1-year diploma course at hours convenient for private practitioners. The curriculum has evolved, reducing public health components and increasing family medicine concepts. Between six and 16 students took the course each year until 1999, when formal recognition led to increased popularity. OBJECTIVE: The aim of this study was to evaluate the components and outcomes of the course as a prelude to further development. METHODS: Evaluation comprised a structured telephone interview conducted with two enrollees from each year of the course (total 28), selected randomly from class lists. RESULTS: Participants were mostly young doctors, with an average of 5 years in general practice. Many graduates are now prominent in training and development of family medicine in Hong Kong. Graduates rated most components favourably, but found the original research components too demanding, and not useful subsequently for most. Counselling, family dynamics, consultation and practice organization skills were valued. Conventional continuing education components, such as lectures by specialists, were evaluated poorly. CONCLUSIONS: This course has proved useful in the Hong Kong context, being practical for physicians, and allowing them to study ideas they would not otherwise encounter. Critical appraisal and evidence-based medicine exercises now replace the former research components.