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What Percent of Chinese Medicine Is Supported by Peer Reviewed Studies

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one Introduction

Recently at that place has been an increasing tendency in utilization of complementary and alternative medicine (CAM).[1] Herbs are being used by 75% of the people in the globe for their basic healthcare needs. [2] Medical doctors should know virtually patients' use of CAM concurrently when taking their medical history, because the frequency of CAM use has greatly increased.[iii] This increase is due to both the interest of patients in CAM for seeking help likewise equally exploration of the effectiveness of diverse therapies and interventions by researchers.[4]

Traditional Chinese medicine (TCM), an important category of CAM, is famous for Chinese herbal medicine (CHM) and acupuncture, and is increasing in popularity in many countries.[5] Some pharmaceutical drugs composed of a grade derived from CHM like artemisinin and 3-n-butylphthalide are as well popular globally and successfully marketed.[6–viii] People go to TCM clinics to seek treatment of diseases or to augment or supersede other treatments or Western medicine (WM).[9] People use TCM not only considering of searching for handling of disease or regarding every bit adjunct to WM, but as well considering of the few side effects of TCM, need of tonic care or health promotion, and expectation of removing the root of diseases.[9,10]

The utilization of TCM is mutual among Asian immigrants in Western countries and in Asian, including China, Hong Kong, Singapore, Korean, Nippon, and Taiwan.[11] Usage of TCM is extensive in Taiwan not only because TCM is a office of Chinese culture left from ancient Chinese, but too considering TCM is an important function of the medical system in Taiwan.[12]

The National Wellness Insurance (NHI) program, a milestone of the medical system, was implemented in 1995 in Taiwan.[13,14] All residents with a registered dwelling in Taiwan are mandated to join the universal wellness insurance program.[13] More than 99% of residents in Taiwan were enrolled in the NHI program by the end of 2010.[fourteen,15] The NHI program covers both WM and TCM, just there is different insurance coverage betwixt them under the program.[sixteen] NHI covers both inpatient and ambulatory care of WM, and convalescent care of TCM, but excludes inpatient TCM care.[13] The enrollees nether the NHI program can seek medical care from either WM or TCM or both, and from public or private medical facilities or both.[xiii,17]

The information of the NHI program are an administrative dataset.[18] All the claims data and file of registry in the NHI program are collected in the National Health Insurance Research Database (NHIRD), which is maintained past the National Health Research Institutes (NHRI), and which provides an optimal platform for inquiry.[v,fifteen] The NHIRD has been used by researchers to explore some issues and publish manufactures in Taiwan.[xviii]

TCM utilization has been discussed in several articles, but the trends of TCM utilization have seldom been explored. TCM usage by children betwixt ii cross-exclusive cohorts has been published recently.[xix] Nevertheless, no study has investigated the trend of TCM utilization by the whole population among 3 cohorts. This issue is important, because TCM utilization of the whole population can provide a much more than extensive film of TCM utilization than can data only on children.[13]

The objective of this report was to investigate the trends of TCM utilization from 2000 to 2010. We compared the mean TCM visits among iii cohorts of 2000, 2005, and 2010, and derived 3 randomly sampled cohorts of most 1 1000000 representative beneficiaries in 2000, 2005, and 2010 from NHIRD for this research. The results of this study may serve as a reference for medical providers to improve preparedness and inform the health policies of authorities.

2 Method

2.1 Data source

This study was a cross-exclusive analysis of TCM utilization over time. All data of the NHI plan used in this study were derived from the NHIRD, which is maintained by the NHRI of Taiwan.[eighteen] The NHIRD contains patient sex, date of birth, all records of clinical visits and hospitalizations, drugs prescribed, and their dosages and diagnosis codes, which are encoded with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).[xv] For the sake of confidentiality and ethical considerations, the identification numbers of all individuals and facilities of the dataset, which we obtained from NHIRD, were encrypted and transformed with a random alphanumeric string.[15]

2.2 Report samples

For this enquiry, we derived the dataset of randomly sampled groups totaling almost 1 1000000 insured beneficiaries from NHIRD in each of 3 cohorts: 2000, 2005, and 2010. All ambulatory TCM visits used by these representative beneficiaries in the 3 cohorts were analyzed for trends of TCM utilization. Diagnosis of medical records in the NHIRD was coded according the ICD-nine-CM. The distribution of ambulatory visits in different affliction categories was grouped by the chief diagnosis. In society to compare the mean TCM visits to WM visits among different disease categories, nosotros also derived the mean WM visits for the three cohorts from NHIRD. In each cohort, the representative beneficiaries who had at least i convalescent TCM visit were divers as TCM users, whereas the representative beneficiaries who had no ambulatory TCM visits were defined equally not-TCM users.

2.three Study variable

Gender, historic period, region, and income were called as contained variables to explore their effects on TCM utilization. Historic period was grouped into 5 groups: <twenty, xx to 34, 35 to 49, 50 to 64, and ≧65 years. Region was divided into six geographic regions: Taipei, Northern, Central, Southern, Kao-ping, and Eastern regions. Income was used every bit an indicator of socioeconomic condition (SES) and classified into 4 levels. We classified sampled beneficiaries with well-divers monthly income into iii categories: low, middle, and high levels of SES. The ranges of income betwixt low to middle levels of SES and between middle to high levels of SES were the same. Those without defined income were regarded every bit "other" level of SES.

2.4 Statistical analysis

SAS software, version ix.3 (SAS Institute Inc, Cary, North Carolina) was used to integrate, manage, and analyze the data. The data assay comprised descriptive statistics, including the demographic characteristics of TCM users and non-TCM users. A chi-square test (χ2) was used to examine the relationships between the categorical variables and the differences between TCM users and non-TCM users. The relative human relationship of ratio of TCM users in different demographic factors was calculated by multivariate logistic regression and expressed past adjusted odds ratio (AOR). Mean visits of all sampled enrollees (or TCM users) was the value derived from the number of all visits divided by all sampled enrollees (or TCM users). The percentage modify (% alter) in hateful TCM visits between 2000 and 2005 (2010) was calculated by dividing the deviation in hateful TCM visits betwixt 2000 and 2005 (2010) by hateful TCM visits in 2000.

ii.v Ethic consideration

All the names and identification numbers of enrollees and names of medical facilities in the dataset from NHIRD in our study were encrypted every bit a random alphanumeric series to protect the privacy of written report subjects and fulfill ethical considerations. So no one can identify whatsoever enrollee or facility from the dataset; therefore, the approval of Institutional Review Lath is exempted.

3 Results

3.1 Ratios of TCM users among different Cohorts of 2000, 2005, and 2010

The terminal samples contained 922,176 beneficiaries in 2000, 999,398 in 2005, and 998,432 in 2010 after removing incomplete information. Table 1 shows that the ratio of TCM users increased from 26.59% in 2000 to 28.29% in 2005 and farther to 28.66% in 2010. The ratio of TCM users amongst women was more than that among men in all 3 cohorts. This difference between genders in the number of TCM users increased gradually from 2000 to 2010 (AOR = 1.47 in 2000; 1.52 in 2005; 1.62 in 2010).

T1-60
Table 1:

Ratios of TCM users of selected enrollees nether NHI in 3 cohorts of 2000, 2005, and 2010.

The ratio of TCM users in all age groups increased consistently from 2000 to 2005 and further to 2010, except the 2 groups aged 35 to 49 years and 50 to 64 years, which both increased from 2000 to 2005 and decreased slightly in 2010. Compared with the group aged <20 years, the group aged 35 to 49 years had the highest ratio of TCM users in 2000 and 2005. (AOR = 1.68; 1.61); the group anile twenty to 34 years had the highest ratio of TCM users in 2010 (AOR = 1.sixty).

The ratio of TCM users in all SES groups except the other SES group increased constantly from 2000 to 2010. Compared with the other SES group, the eye SES grouping had the highest ratio of TCM users in 2000 and 2005 (AOR = 1.37; 1.32); the middle and loftier SES groups had the highest ratio of TCM users in 2010 (AOR = 1.forty).

The ratio of TCM users in all regions increased from 2000 to 2005 and farther to 2010 except for those in the central and southern regions, which increased from 2000 to 2005, simply decreased past 2010. Compared with the northern region, the cardinal region had highest ratio of TCM users in all three cohorts (AOR = 1.75; 1.71; i.63). This indicates that the ratio of TCM users in the fundamental region decreased gradually from 2000 to 2010.

3.two The trend of mean TCM visits from 2000 to 2010

Tabular array 2 displays the percentage change in mean TCM visits from 2000 to 2005 (2010). The hateful TCM visits per enrollee was 1.22 in 2000 and then increased to 1.46 in 2005, and 1.56 in 2010. The percentage change in mean TCM visits was 19.seven% and 27.ix%, respectively, from 2000 to 2005 (2010). The pct change in mean TCM visits from 2000 to 2005 was larger than that from 2005 to 2010. Information technology could exist seen that the increasing trend of mean TCM visits was less steep from 2005 to 2010.

T2-60
Tabular array 2:

Trend of hateful TCM visits among 3 cohorts of 2000, 2005, and 2010.

Mean TCM visits among both women and men increased over time. The hateful TCM visits among women increased more that of men from 2000 to 2005 (2010). The mean TCM visits in all age groups increased through cohorts. The group aged less than xx years had the least percentage change in visits to TCM from 2000 to 2005 (2010), while the group aged xx to 34 years had the most. The percentage alter in mean TCM visits of all SES groups increased from 2000 to 2005 (2010). The middle SES group had the greatest percentage change in mean TCM visits from 2000 to 2005; withal, the high SES group had the largest percentage change from 2000 to 2010. The percent modify in mean TCM visits in all regions increased over time. The central region had the least percentage change in mean TCM visits from 2000 to 2005 (2010), while the Taipei region had the near.

3.iii The comparison of mean TCM visits among unlike disease categories

Tabular array iii exhibits the mean TCM visits per thousand enrollees in dissimilar disease categories. The elevation 5 illness categories of mean visits for TCM were diseases of the respiratory arrangement (302.three, 287.6, and 274.1); diseases of the musculoskeletal system and connective tissue (198.8, 220.8, and 204.6); injury and poisoning (187.5, 232.8, and 215.ix); diseases of the digestive system (134.ii, 165.6, and 190.three); and symptoms, signs, and sick-defined weather condition (171.ii, 284.4, and 332.2) in 2000, 2005, and 2010. The summit disease category in terms of virtually hateful TCM visits was diseases of the respiratory system in 2000 and 2005 (302.iii and 287.6) and symptoms, signs, and ill-defined conditions (332.2) in 2010.

T3-60
Tabular array three:

Hateful TCM and WM visits per chiliad enrollees and % alter in unlike disease categories from 2000 to 2010.

The 5 disease categories behind the everyman numbers of TCM visits in 2000, 2005, and 2010 were infectious and parasitic diseases (v.half-dozen, 6.3, and 5.2); diseases of the blood and blood-forming organs (2.iv, 3.4, and 4.1); complications of pregnancy, childbirth, and the puerperium (one.0, two.7, and 2.1); congenital anomalies (0.7, 1.7, and ii.1); and neoplasms (2.half dozen, six.5, and 11.five). The 3 disease categories with most upwardly pct alter of mean visits for TCM from 2000 to 2005 and from 2000 to 2010 were neoplasms (152.iv and 243.7); built anomalies (157.2 and 216.6); and complications of pregnancy, childbirth, and the puerperium (175.3 and 109.1). Above all, the affliction category of neoplasms had greatest up percentage change in mean TCM visits from 2000 to 2010 (343.7); still, the affliction category of respiratory system had the greatest downward per centum change in mean TCM visits from 2000 to 2005 and 2000 to 2010 (−4.ix, −ix.3).

4 Give-and-take

By studies have investigated changes in TCM utilization between several years in i cohort. Our written report explored TCM utilization among 3 cohorts of 2000, 2005, and 2010. This enquiry method makes the sample more than representative of the population. To the best of our knowledge, this is the beginning report to explore the tendency of TCM utilization amongst 3 unlike cohorts with a large-scale sample.

The increase over fourth dimension in ratio of TCM users has been reported in previous studies.[thirteen,xix] The tendency of increasing TCM utilization was similar to the trend of TCM or CAM utilization reported in previous studies in Taiwan, the United States, and Europe.[13,20,21] Increase of ratio of TCM users and mean TCM visits may be related to the following reasons. Offset, the NHI coverage for TCM makes medical service of TCM cheaper and hands accessed for enrollees under the NHI program.[15] Second, evolution of TCM began more than 2000 years ago, and it is part of the culture and daily life.9 3rd, people regard TCM equally a substitute for or adjunct to WM treatment, and believe that TCM can treat the root of diseases.[22,23]

TCM users among women were more than those amidst men, and this difference between genders increased every bit time went on. This effect of this study that the increase of percentage change in mean TCM visits was higher for women than that for men was consistent with studies in the United States and in Taiwan.[11,xiii,24,25] Women seemed to prefer TCM more than men did.[11] There is no doubt that the ratio of TCM users amongst women will be more than that among men in the future.

TCM users were mainly the enrollees in the centre groups by age, 35 to 49 and 50 to 64 in this report, like to findings in by studies.[13,15,26,27] By 2010, TCM users increased faster among younger adults (age 20–34) than other age groups, which might exist related to a positive mental attitude toward TCM among the younger generation.[28] The percent change of hateful TCM visits increased most in the group aged 20 to 34 years from 2000 to 2010, and this is comparable to the issue shown in Tabular array 1 that the grouping anile 20 to 34 years had the highest within-group ratio of TCM users in 2010.

Consequent with the result of previous studies, the within-group ratio of TCM users was lowest in the group anile less than 20 years in all 3 cohorts.[13] Because the mean TCM visits and the percentage alter in hateful TCM visits were both least in the group anile less than 20 years, it is expected that the grouping aged less than twenty years volition be the age group with the least TCM utilization in the future. This result indicates that young people preferred WM over TCM when seeking medical service. A similar phenomenon has been reported amongst residents in Hong Kong.[29] This issue might exist influenced past parents, and indicates that pediatric TCM should be farther developed and popularized in the hereafter.

The highest TCM utilization in the grouping aged ≧ 65 years of TCM users might be caused by greater susceptibility to infectious diseases and aging with chronic conditions.[30] Physicians of TCM should make efforts to take care of the related diseases of the aged to fulfill their need for TCM treatment.

In the by, CAM was used mainly by people with heart or high SES, as they were the just ones who could afford it.[3,24,31] However, as enrollees under NHI, more than 99% of residents in Taiwan can afford TCM treatment at present.[14] The preference for TCM by people with high SES has been increasing recently. The reasons for TCM usage by people with loftier SES may exist the same in the by every bit at present—belief in TCM and using TCM as an adjunct to WM.[22,23]

The preference for TCM by people with high SES reflects the increasing ratio of TCM users in the group with high SES in 2010. Children with high SES as well had the highest TCM utilization, and this may be considering the behavior of seeking medical service and the SES of children are both related to their parents.[32] Recently, the rising in TCM utilization by people with high SES could result from belief in TCM and using TCM as an offshoot to WM as well as expectation of ameliorate quality of life and comeback of constitution through supplementary TCM treatment.[10,22,23]

In that location are vi regional divisions nether National Health Insurance in accuse of regional affairs. They are the Taipei, Northern, Cardinal, Southern, Kao-ping, and Eastern divisions.[33] The medical sources, public transportation, lifestyles, and configuration of the population are different in these six regions.[34] It is reasonable to discuss differences in TCM utilization by region every bit the outcomes of different regional responses to the TCM needs there, which may be used as a reference for policy making by the National Health Insurance Administration (NHIA).

The ratio of TCM users in the fundamental region was nonetheless the highest amid the half dozen regions in 2010, which could exist due to the presence there of the earliest professional person TCM physician training school, China Medical University. Institution of Cathay Medical University, resulting in a greater number of TCM physicians and more TCM clinics and TCM departments in hospitals in the central region. This may have given rise to more than TCM users in the region.

The central region had the weakest increasing trend of percentage change in mean TCM visits, which implies that the get-go priority for selection of workplace for TCM physicians should be to avoid the fundamental region. The Taipei region had the highest increment of percentage change in hateful TCM visits, which may have resulted from the convenience of transportation, loftier accessibility of TCM service, and high population density around Taipei and New Taipei cities.[34]

The disease categories with the meridian 5 mean TCM visits were all the same in 2000, 2005, and 2010 in this study, similar to the results of related studies.[13,xv,xix,35] As a previous study stated, respiratory tract infection was the most common cause of convalescent visits by children.[36] On the basis of the reduction in per centum alter of mean visits in both TCM and WM ambulatory visits for diseases of the respiratory system from 2000 to 2010, nosotros deduced that the reduction in ambulatory TCM visits for diseases of the respiratory system resulted from a subtract in medical need due to diseases of the respiratory organization, non the transfer of medical care from TCM to WM. The reduction of ambulatory visits for diseases of the respiratory organisation might be due to climate change or advertisements fostering disease prevention.

Symptoms, signs, and ill-divers conditions surpassed diseases of the respiratory system in the mean TCM visits by 2010 and became the well-nigh common disease category in TCM usage.[13,15,19,35] Utilization of WM for symptoms, signs, and sick-defined atmospheric condition also increased by 2010. Information technology will be worth exploring the increase of medical requirements by affliction type inside the disease category of symptoms, signs, and ill-divers weather condition.

The 5 disease categories with the fewest mean TCM visits were similar to those found by a previous written report.[xv] The increase of 343.70% in TCM utilization for neoplasms from 2000 to 2010 may accept resulted from the implementation of screening for iv major cancers by the authorities to notice potential cancer patients. TCM may have become an alternative option or adjunct to WM for cancer treatment, consequently pushing up TCM utilization for neoplasms.[37] However, it would be worthwhile to explore the kinds of cancer patients who seek TCM handling. Such information could be useful for policymaking and arrangement of medical resources.

The mean TCM visits for diseases of the skin and subcutaneous tissue; diseases of the blood and claret-forming organs; and diseases of the genitourinary organization vastly surpassed hateful WM visits from 2000 to 2010. Many diseases in these 3 disease categories are related to chronic atmospheric condition or degenerative organ function.[38] TCM are considered to have the following characteristics: tonic care, wellness promotion, suitability to different health needs, clearing the root of the affliction, and few side furnishings.[x] These characteristics of TCM encourage patients with diseases in these iii affliction categories to use TCM. Therefore, TCM utilization for these iii illness categories rose more than WM utilization did.

Even though this population-based investigation tin can minimize the bias due to sufficiently large national representative samples from population. There were yet several limitations in this written report. Outset, visits to medical facilities, which were not contracted with the NHIA were not included in the claims data from NHIRD in this written report. 2nd, people who went to visit medical facilities contracted with NHIA and took CHM (yin-pian) rather than scientific granules or powder were not recorded in the claim data we analyzed. Tertiary, the claims data from NHIRD we analyzed did not include the visits to traditional Chinese pharmacies, from which people bought CHM to add together to their diet for the purpose of tonic supplement for stiff constitution, health intendance, and taste of nutrient.[22]

v Conclusions

Both the ratio of TCM users and mean TCM visits increased consistently from 2000 to 2005 and continued ascension, albeit less steeply, through 2010. It can exist predicted that women volition have higher TCM utilization than men in the futurity. Preference for TCM increased among those with loftier SES during the report time period. The primal region had the largest mean TCM visits, but the least increase of percentage change in mean TCM visits; therefore, the Taipei region had the greatest increment of per centum modify in mean TCM visits from 2000 to 2010. Diseases of the respiratory system had the highest mean TCM visits in 2000, and this decreased over fourth dimension. Among all disease categories explored in this study, neoplasms had the highest percentage change in mean TCM visits from 2000 to 2010.

Acknowledgments

Nosotros admit the assistance and support of the Institute of Public Wellness, School of Medicine, National Yang-Ming University. The data used in this research were derived from the NHIRD provided by the NHIA and managed by the NHRI of Taiwan. The interpretations and conclusions herein do not correspond those of the NHIA or NHRI. The authors declare no funding and disharmonize of interests regarding the publication of this commodity.

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Keywords:

Chinese herbal medicine; affliction categories; national health insurance; traditional Chinese medicine; utilization of traditional Chinese medicine

Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Source: https://journals.lww.com/md-journal/fulltext/2016/07050/the_trends_of_utilization_in_traditional_chinese.60.aspx

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