Assessment Study Of Impacts On Traditional Chinese Medicine Services Delivery And Needs

Background and ObjectiveThis study, with a view of global health, aims to comprehensively and systematically examine factors associated with delivery of traditional Chinese medicine (TCM) services based on Anderson health service use model and assess needs of TCM care based on epidemiological approach of health service need assessment for maximizing TCM priorities, meeting multiple needs of TCM care, and implementing "some suggestions for improving development of health service industry". Hubei Province as an example was analyzed.Resources and methodsResources include (1) National Population Census in2010of Hubei,(2) Hubei Provincial’Economic and Social Development Statistics Bulletin in2009,(3) National Health Services Survey in2008of Hubei,(4) National survey of TCM of Hubei.Samples include TCM hospitals (119), general hospitals (460), community health centers (230) and township health centers (1153).We describe indicators selected by inclusion of Anderson model, examine factors associated with delivery of TCM services, and assess needs of TCM care.Methods(1) Document analysis. Literatures and related materials from Medline, CNKI, VIP, websites of health and statistics department were analyzed for choosing independent variables of regression analysis.(2) Cross-sectional survey. The survey was conducted by the unit of each county/district. Collected data were double-checked and then reported by each administrative level.(3) Anderson health service use behavioral model study. In the Anderson model, factors include four dimensions:1) health care system,2) external environment (physical, political and economic components),3) predisposing characteristics,4) enabling resources,5) health service use. Database was built based on Anderson model.(4) Health services need assessment. The assessment includes prepare step and assessment step. In the prepare step, we choose epidemiological approach to assess health services need based on TCM theories and theory of need, demand and delivery. In the assessment step, we firstly collect information of Hubei, health status, what TCM services are available in Hubei, and what TCM services are worth doing. At last, we assess TCM care needs.(5) Data analysis. Excel and Stata10.0were used for data management and analysis. Descriptive and regression analysis were used to examine delivery of TCM services and its related factors. Health service need assessment was used to assess TCM service needs.ResultsDescriptive analysisHealth care systemThe average number of health personnel in TCM hospitals was smaller than that in general hospitals; the average numbers of health personnel were similar in community health centers and township health centers. The average number registered nurse in community health centers was larger than that in township health centers. The total income of general hospitals was2.5times of that of TCM hospitals, which was mostly derived from medical income. The total income of community health centers was smaller than that of township health centers with a high percentage of medical income. The total expenditure of each type of institute was more than the total income.The health administrative system was composed of three tiers: provincial, municipal, and county tier with full-time staff. In all106counties/districts,1/3county/district health departments had set a TCM department, in which2/3of them had full-time staff. External environmentHubei, with185.9thousand Kilometer square, is located in central China, comprised by17cities."Suggestion for supporting and improving TCM development" was released following the releasing of new health care reform. In2009, Hubei’s GDP was1256.6billion yuan, ranked11; GDP per capita was22050yuan, ranked13. Predisposing characteristicsThe number of total population was57.24million, family size was3.16, the number of urban population was28.46million, accounted for49.72%, ratio of male to female was1.09, aging rate (aged65years old and over) was9.09%, rate of illiteracy was4.58%. Urban income was14400yuan, rural income is5000yuan. Enabling resourcecs TCM resourcesThe number of TCM practitioners was22070, in which the number of TCM doctors accounted for49.79%. TCM hospitals had most of TCM doctors (44.39%) and TCM nurses (73.24%), township health centers had most of hebal parmacists (37.88%). The number of TCM beds was21487; TCM hospitals had four times of TCM beds of general hospitals. Most of TCM practitioners were with secondary education with an intermediate title. The percentage of TCM practitioners under25years old was higher in TCM hospitals (8.26%) than others. TCM administration and policies1/4of counties/districts had set TCM continuing training committee and1/2had set TCM continuing training centers;1/2of them had hired part-time or full-time staff.28types of TCM appropriate technologies had been promoted,631times of training to use TCM appropriate technologies were provided;2.37million yuan was invested in TCM development, in which more for TCM residents training than TCM continuing training. TCM items were included for reimbursement by new cooperative medical services at some extent.TCM service deliveryThe total number of TCM outpatient visits was16.76million per year; the total number of discharges was0.61million per year. TCM hospitals mainly provided TCM medical services including half of TCM outpatient services and79%of TCM discharges. Community health services provided TCM public health services (public health services including TCM contents) which were more variable than township health services provided. Primary health care settings provided21types of TCM therapies, in which the most frequent provisions were cupping, herbal medicine and massage. Appropriate TCM public health services were more in community health centers than township health centers. Regression analysisTCM hospitalsDelivery of TCM outpatient services was associated with higher medical income (b=0.00001, P=0.046), more health personnel (b=0.00377, P=0.008), less registered nurses (b=-0.00454, P=0.017), higher urban income (b=4.36006, P=0.000), TCM practitioners without doctoral degree (b=-0.13230, P=0.001), inavailability of TCM resident training (b=-0.00305, P=0.030), institution registered by medical insurance (b=1.14595, P=0.004). Delivery of TCM inpatient services was associated with more health personnel (b=0.00512, P=0.000), less registered nurses (b=-0.00484, P=0.009), more TCM beds (b=0.00441, P=0.000), less TCM doctors (b=-0.01795, P=0.000), TCM practitioners without doctoral degree (b=-0.16841, P=0.000), and TCM practitioners older than60years old (b=0.03516, P=0.000). General hospitalsDelivery of TCM outpatient services was associated with more doctors (b=0.01495, P=0.009), lower GDP at county level (b=-2.15007, P=0.017), more TCM doctors (b=0.00470, P=0.000), county health department with TCM administrative department (b=0.33310, P=0.045) but without full-time staff (b=-0.54819, P=0.043). Delivery of TCM inpatient services was associated with lower GDP at county level (b=-2.21007, P=0.026), higher rural income (b=0.00028, P=0.000), more TCM beds (b=0.00373, P=0.001) in a TCM ward (b=0.00785, P=0.000), more TCM doctors (b=0.00785, P=0.002), availability of TCM resident training (b=0.01675, P=0.002). Community health centersDelivery of TCM outpatient services was associated with more registered nurses (b=0.05246, P=0.001), provision of TCM rehabilitation (b=1.60162, P=0.000), smaller served population size (b=-3.41006, P=0.014), higher urban income (b=0.00006, P=0.004). Provision of TCM prevention was associated with more TCM outpatient services (b=0.00010, P=0.038), smaller served population size (b=-9.90006, P=0.042), county health department without TCM administrative department (b=-1.16455, P=0.032). Building of TCM health files was associated with more TCM outpatient services (b=0.00016, P=0.003), higher GDP at county level (b=3.25007, P=0.027), TCM administrative department with full-time staff (b=1.71594, P=0.013). Provision of TCM care was associated with more TCM outpatient services (b=0.00011, P=0.024), higher GDP at county level (b=3.68007, P=0.015), smaller served population size (b=-0.00001, P=0.028). Provision of TCM rehabilitation was associated with more TCM outpatient services (b=0.00075, P=0.002), higher GDP at county level (b=5.71007, P=0.031), smaller served population size (b=-0.00002, P=0.045), TCM administrative department (b=-1.60150, P=0.036) with full-time staff (b=2.22267, P=0.022). Provision of TCM health education was associated with more TCM outpatient services (b=0.00017, P=0.025), having TCM nurses (b=1.57425, P=0.042), county health department without TCM administrative department (b=-1.23046, P=0.032). Provision of TCM maternal and child care was associated with having TCM nurses (b=1.06896, P=0.008) and county health department with TCM administrative department (b=1.28620, P=0.044).Township health centers Delivery of TCM outpatient services was associated with more health personnel (b=0.00979, P=0.000), lower urban (b=-7.33006, P=0.005) and rural income (b=0.00018, P=0.000), more TCM doctors (b=0.70739, P=0.000). Provision of TCM care was associated with more TCM outpatient services (b=0.00007, P=0.000), more TCM doctors (b=1.35369, P=0.000), having TCM nurses (b=0.07164, P=0.017). Provision of TCM rehabilitation was associated with more health personnel (b=0.01133, P=0.014), more TCM outpatient services (b=0.00007, P=0.001), more TCM doctors (b=1.50301, P=0.000), having TCM nurses (b=0.11429, P=0.008). Provision of TCM health education was associated with more TCM outpatient services (b=0.00006, P=0.001), lower rural income (b=-0.00015, P=0.019), more TCM doctors (b=1.24376, P=0.000), having TCM nurses (b=0.12304, P=0.007). Provision of TCM maternal and child care was associated with TCM outpatient services (b=0.00006, P=0.000), smaller served population size (b=4.10006, P=0.043), lower rural income (b=-0.00019, P=0.002), more TCM doctors (b=1.51581, P=0.000), having TCM nurses (b=0.09475, P=0.002). TCM Service Need Assessment of Epidemiological ApproachCollected information of TCM medical services included acupuncture for treating rheumatoid arthritis, disc diseases and cerebrovascular diseases, oral herbal medicine for treating diabetes, gallstone and cholecystitis, TCM orthopedic reset for treating dislocation injury and strain which are worth doing. Moreover, TCM rehabilitation is worth doing as well.TCM services need was assessed. Total number of TCM medical services needs for treating the six types of diseases above was167.87million. Average burden of a TCM doctor per day was6times per patient. For each type of disases, percentages of TCM services needs were24.36%for rheumatoid arthritis,21.79%for disc diseases,19.23%for diabetes,18.59%for cerebrovascular diseases,8.97%for gallstone and cholecystitis, and7.05%for dislocation injury and strain. Current amount of available TCM services can meet1/10of the total need. Based on the criterion of World Health Organization set that one community nurse serves500commuity residents, we lack19654TCM nurses.Conclusions1) TCM resources were lacked in primary care settings, and delivery of TCM care preferred medical care to prevention.2) Comprehensive TCM services delivery in primary care settings had shown priorities.3) Better economical exteral environment improved appropriate delivery of TCM services.4) Impacts of urban and rural resident income on delivery of TCM services were different:urban resident income improved the delivery; however, rural resident income did not.5) Primary change is to increase quantity of TCM human resource. The policies of TCM continuing education and training should be based on needs of TCM services.6) Needs of TCM services are more than delivery of TCM services, so we should focus on the delivery of certainly effective TCM care and TCM rehabilitation.