Chinese medicine usage in respiratory disorders: a health service research of teaching clinic patients

摘要

This research project aimed to: (a) determine the demographic profile and common conditions of patients in a Teaching Clinic; (b) describe the adverse events from Chinese medicine treatment; (c) examine the overall treatment outcomes and treatment interventions of Chinese medicine in patients with respiratory disorders; and (d) assess the level of knowledge and compliance with Chinese medicine in patients with respiratory disorders. The first component of this research is a systematic literature review on studies that assessed the quality of care based on medical records within outpatient practice. The second component is examining the medical records in the Chinese Medicine Teaching Clinic at RMIT University. The last component is a postal survey focusing on a subgroup of the patients (with respiratory disorders) attending the clinic. The RMIT University’s Human Research Ethics Committee reviewed and approved the project. For the medical record study, medical records in the Teaching Clinic dated 1 January 2010 to 31 December 2011 were reviewed and extracted. During the study period, 1,677 patients had made 11,529 visits to the Teaching Clinic. Patients mean age was 42.1±18.1 years and majority were female (65.7%) and Australian-born (66.2%). Patients generally had Chinese medicine for musculoskeletal and pain disorders, emotional disorders, obstetrics and gynaecological disorders, respiratory disorders and gastrointestinal disorders. The most common respiratory disorders were coryza, cough, allergic rhinitis, sinus problems and asthma. Acupuncture was given at almost all visits (96.7%). 153 adverse events were documented; most were gastrointestinal effects such as diarrhoea, nausea, heartburn. For the survey study, a questionnaire was developed and mailed to all (n=299) eligible potential respondents identified from the medical record study described above. In brief, the survey asked about the respondents’ use of health services, adverse events, compliance with Chinese medicine, knowledge of Chinese medicine and their demographic. A total of 63 surveys were returned, a 16.7% response rate. The survey provided additional demographic data compared with the medical records, including: 26.7% of health insured respondents were covered for Chinese medicine; and over half of the respondents earned more than $60,000 annually and had tertiary education. Survey respondents largely reported positive overall treatment outcomes. More respondents disclosed their other treatment to Chinese medicine practitioners (88.5%) than disclosing their Chinese medicine use to general practitioners (62.9%). Almost half of the respondents had moderately complied (44.3%) with Chinese medicine. In terms of knowledge, over a third of the respondents had good knowledge (34.9%) of Chinese medicine. Of 63 respondents, only five reported adverse events; Chinese medicine practitioners verified two events and were informed about three events. In summary, this study was the first to provide insight on quality of care and treatment practice in the Chinese Medicine Teaching Clinic, RMIT University. Additionally, this thesis reported treatment outcomes and communication on health service from the patients’ point of view. Several study limitations were identified, and accordingly, strategies for improving documentation, study design and clinic practices were recommended. Implementing these suggestions can improve health service and quality of care in the Teaching Clinic.