| Objective1.All randomized controlled trials(RCTs)of Oral Chinese Patent Medicine(OCPMs)combined with Conventional Western Medicine in the treatment of psoriasis vulgaris were included to work out the systematic review and Bayesian network meta-analysis,to provide scientific and reliable evidence for the effectiveness and safety.2.Chinese medicine practitioners,Western medicine doctors and patients with psoriasis were invited to participate in individual interviews and focus groups.This qualitative study aimed to summarize the experiences of using chinses medicine and western medicine and to investigate the perceptions of Chinese medicine practitioners,Western medicine doctors and patients towards the Integrated Chinese-Western medicine treatment of psoriasis in Hong Kong.Also,to provide substantive suggestions for the development of Chinese Medicine Hospital under the integrated Chinese-Western medicine service model in Hong Kong.Methods1.Night databases including PubMed,EMBASE,AMED,Cochrane Library,Cochrane Central Register of Controlled Trials(CENTRAL),China National Knowledge Infrastructure(CNKI),Wanfang Data,Chinses Biomedical Literature Database(CBM)and Weipu(VIP)databases will be searched systematically until March 31,2022.Data will be analyzed by using RevMan 5.4,STATA 16.0 and ADDDS 1.16.7.2.Using the purposive sampling method to invite Chinese medicine practitioners,Western medicine doctors and patients with psoriasis who had previously used Chinese medicine,and to conduct the individual,semi-structured interviews.In addition,using the purposive sampling method to invite Chinese medicine practitioners with experience in cooperation with western medicine doctors or scientific research,and to conduct the focus groups discussion.The interviews were audio-recorded,transcribed verbatim.The transcripts were imported to ATLAS.ti 22 software and thematically analyzed by Framework Analysis.ResultsA total of 48 RCTs were eventually included,involving 4144 patients,and 8 kinds of oral Chinese patent medicines.The results of network meta-analysis showed that,compared with the control group(Conventional Western Medicine),OCPMs combined with Conventional Western Medicine in the treatment of psoriasis vulgaris could increase severity index(PASI)90 and 60 response rate.In addition,some of the OCPMs could reduce the incidence of adverse events.The efficacy ranking(PASI 90 response rate)based on NMA was as follows:Compound Qingdai Capsule/Pill>Runzao Zhiyang Capsule>Xiaoyin Granule/Capsule/Tablets>Zidan Yinxie Capsule>Yujin Yinxie Tablets>Keyin Pill>Kuda Pill>Yinxie Capsulc>Conventional Western Medicine.(All OCPMs were combined with Conventional Western Medicine).Compound Qingdai Capsule/Pill combined with Conventional Western Medicine may be the best choice to achieve an improvement in PASI 90.The efficacy ranking(PASI 60 response rate)based on NMA was as follows:Runzao Zhiyang Capsule>Compound Qingdai Capsule/Pill>Keyin Pill>Yinxie Capsule>Xiaoyin Granule/Capsule/Tablets>Zidan Yinxie Capsule>Kuda Pill>Yujin Yinxie Tablets>Conventional Western Medicine.(All OCPMs were combined with Conventional Western Medicine).Runzao Zhiyang Capsule combined with Conventional Western Medicine may be the best choice to achieve an improvement in PASI 60.The efficacy ranking(PASI 90 response rate)based on NMA subgroup analysis of different intervention types,Xiaoyin Granule/Capsule/Tablets combined with phototherapy or Acitretin or the combination of using Acitretin and topical therapy may be the best choice to achieve an improvement in PASI 90.OCPMs combined with Conventional Western Medicine in the treatment of psoriasis vulgaris do not appear to pose any additional risk.In addition,some of the OCPMs could reduce the incidence of adverse events.Yinxie Capsule may reduce the chance of developing the skin adverse reactions,the presence of elevated transaminases and Hyperlipidemia.Runzao Zhiyang Capsule may reduce the chance of developing dry eyes and dry mouth,however Runzao Zhiyang Capsule may increase the incidence of gastrointestinal reactions.This study finally conducted 51 interviews when the theoretical saturation was achieved on themes.20 patients with psoriasis and 20 doctors(16 Chinese medicine practitioners and 4 Western medicine doctors)were participated in individual interviews.11 Chinese medicine practitioners were participated in 2 focus groups.The results from qualitative interview with the experiences of psoriasis patients using Chinese medicine and western medicine:Psoriasis patients believe that Western medicine is effective in treating psoriasis,however,it is common to experience some side effects and relapse after stopping the medicine.Moreover,some patients are willing to continue using Chinese medicine treatment because the specialist outpatient clinics of public hospitals are always full,and the waiting time is too long.Also,they are worried about the side effects of Western medicine.They believe that using Chinese medicine not only improves skin conditions but also improves the physical fitness.However,some patients choose to stop using Chinese medicine treatment due to various factors such as inconvenient medication,expensive fees,and difficulty in seeking Chinese medicine practitioners who are good at treating psoriasis.The results from qualitative interview with the perceptions of Chinese medicine practitioners,Western medicine doctors and patients towards the Integrated Chinese-Western medicine treatment of psoriasis in Hong Kong:Psoriasis patients have positive are concerned in the effectiveness and the fees of the integrated Chinese-Western medicine service model.Doctors in Hong Kong believe that the collaboration of Chinese and Western medicine can complement each other’s strengths and compensate for each other’s weaknesses.In addition,they are concerned in the effectiveness and the framework for the operation of the integrated Chinese-Western medicine service model.The purpose of this service model is to enhance clinical effectiveness and improve the quality of life of patients.Efforts should be made to develop the advantages of Chinese and Western medicine combined treatment.Doctors in Hong Kong believe that Chinese medicine can play a role in conditioning the body and improving physical fitness,thereby reducing the side effects of Western medicine,control the symptoms and the long-term relapse.Here are some suggestions for the implementation integrated Chinese-Western medicine service model by doctors in Hong Kong.First,medical staffs need to strengthen their training on the understanding of Chinese and Western medicine in treating psoriasis.Establishing a platform for the collaboration of Chinese and Western medicine with quality communications and implementing of patient record sharing pilot project are required.Moreover,it is suggested to accelerate the development of standard treatment guideline of integrated traditional Chinese and Western medicine for psoriasis and to develop quantitative and scientific research on the effectiveness and safety of integrated ChineseWestern medicine in the treatment of psoriasis.ConclusionCompared OCPM with Chinese herbal medicines,OCPM are convenient to use,easy to import,which are highly acceptable to patients.The purpose of conducting network meta-analysis is to facilitate the management and application of OCPMs for psoriasis and provide reliable reference for further clinical application and research of the Integrated Chinese and Western Medicine treatment of psoriasis vulgarisThe results of network meta-analysis showed that,OCPMs combined with Conventional Western Medicine in the treatment of psoriasis vulgaris could achieve an improvement in PASI 90 or PASI 60.In addition,some of the OCPMs could reduce the incidence of adverse events.This study conducted a qualitative study to summarize and analyze the advantages and disadvantages of Chinese and Western medicine in the treatment of psoriasis;the perceptions of Chinese medicine practitioners,Western medicine doctors and patients towards the Integrated Chinese-Western medicine treatment of psoriasis in Hong Kong.According to the results from the qualitative interview of patients with psoriasis,this study found that in addition to efficacy and medication safety,the patients’ cognition of traditional Chinese medicine,the experiences of using Chinese medicine,economic status,and social resource allocation may also be the factors that can affect their acceptance towards Chinese medicine.According to the results from the qualitative interview of doctors in Hong Kong,they are concerned in the effectiveness of the integrated Chinese-Western medicine service model.Doctors in Hong Kong believe that Chinese medicine practitioners can play an important role in the Integrated Chinese-Western medicine treatment.However,the current restrictions and rules on Chinese medicine practitioners may hinder the development of the integrated Chinese-Western medicine service model.This study suggests that it is necessary to increase the effectiveness of integrated Chinese and Western medicine in the treatment of psoriasis by developing of the medium-term priority of the Integrated Chinese-Western medicine treatment and strengthening the related training.Some suggestions for the implementation integrated Chinese-Western medicine service model were summarized and analyzed.In response to the issue of integrated Chinese and western medicine in the treatment of psoriasis,this study conducted a qualitative interview research to answer the related questions in the first time.As an exploratory investigation,this study hopes to provide reliable support and evidence-based knowledge which to inform policymaking and practice of the Chinese Medicine Hospital under the integrated Chinese-Western medicine service model in Hong Kong. |
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