ASSESSMENT ON ACCEPTANCE OF ASSESSMENT ON ACCEPTANCE OF TRADITIONAL & COMPLEMENTARY TRADITIONAL & COMPLEMENTARY

MEDICINE (T&CM) SERVICES MEDICINE (T&CM) SERVICES BY MEDICAL DOCTORS IN BY MEDICAL DOCTORS IN

KLANG VALLEY & PUTRAJAYAKLANG VALLEY & PUTRAJAYA

PrefacePreface

AcknowledgementAcknowledgement

IntroductionIntroduction

BackgroundBackground

• What is traditional medicine?What is traditional medicine?

• What is complementary medicine?What is complementary medicine?

• What is traditional and What is traditional and complementary medicine?complementary medicine?

T&CM Policy in T&CM Policy in MalaysiaMalaysia

Integration of Traditional Integration of Traditional & Complementary & Complementary

Medicine in Healthcare Medicine in Healthcare SystemSystem

Selected T&CM services Selected T&CM services provided in identified hospitals provided in identified hospitals include:include:• Acupuncture;Acupuncture;

• Traditional Malay massage; Traditional Malay massage;

• Herbal therapy as an adjunct Herbal therapy as an adjunct therapy to oncology treatment; andtherapy to oncology treatment; and

• Malay Postnatal care established in Malay Postnatal care established in July 2009 (Hospital Putrajaya)July 2009 (Hospital Putrajaya)

General ObjectiveGeneral Objective

• To assess the acceptance of T&CM To assess the acceptance of T&CM services amongst medical doctors in services amongst medical doctors in government hospitals at Klang Valley government hospitals at Klang Valley & Putrajaya.& Putrajaya.

Specific ObjectivesSpecific Objectives

• To determine the knowledge of medical doctors To determine the knowledge of medical doctors regarding T&CM services and associated socio regarding T&CM services and associated socio demographic characteristics.demographic characteristics.

• To determine the acceptance of medical To determine the acceptance of medical doctors regarding T&CM services and doctors regarding T&CM services and associated socio demographic characteristics.associated socio demographic characteristics.

• To determine the practise of T&CM services To determine the practise of T&CM services among medical doctors for Klang Valley and among medical doctors for Klang Valley and Putrajaya hospitals.Putrajaya hospitals.

• To explore the relationship between socio To explore the relationship between socio demographic characteristics of medical doctors demographic characteristics of medical doctors and their willingness to discuss/refer the and their willingness to discuss/refer the patients to T&CM services.patients to T&CM services.

Methodology:Methodology:

• A cross sectional study using a self-A cross sectional study using a self-administered questionnaire administered questionnaire conducted among medical doctors in conducted among medical doctors in all government hospitals within the all government hospitals within the Klang Valley and Putrajaya.Klang Valley and Putrajaya.

Non T&CMNon T&CM

1.1. Hospital KajangHospital Kajang

2.2. Hospital AmpangHospital Ampang

3.3. Hospital Sungai Hospital Sungai BulohBuloh

4.4. Hospital SerdangHospital Serdang

5.5. Hospital Tunku Hospital Tunku Ampuan Rahimah, Ampuan Rahimah, KlangKlang

6.6. Hospital Kuala Hospital Kuala LumpurLumpur

7.7. Hospital SelayangHospital Selayang

T&CMT&CM

8. Hospital Putrajaya8. Hospital Putrajaya

ResultsResults

• Respondent CharacteristicsRespondent Characteristics

No. Subject Item Frequency Percent (%)

1. Gender/sex Male 261 33.5

Female 517 66.5

2. Ethnicity Malay 444 57.3

Chinese 161 20.7

Indian 151 19.5

Others 19 2.5

3. Age <46 705 90.5

46+ 74 9.5

4. HQ Medical degree 516 66.5

Master/PhD 260 33.5

5. Hospital type With T&CM service 91 11.7

Without T&CM service

688 88.3

6. Position HO 180 23.2

MO 327 42.1

Specialist/Consultant 269 34.7

7. Services <10 503 64.6

10+ 276 35.4

8. Formal TCM education

Yes 57 7.3

No 720 92.7

9. Specificqualification

Yes 2 0.3

No 777 99.7

9a. Area of modality

acupuncture & herbal medicine

1 50.0

herbal medicine 1 50.0

9b. Duration of course

1 year 1 50.0

3 years 1 50.0

9c. Certification level

Masters 2 100.0

9d. Institution/ organization

Nanjing TCM 1 50.0

Napier University 1 50.0

10. Sources on T&CM

Friends & family 448 63.7

Self-reading 456 63.1

Others - Internet 13 30.2

Hospital CME 100 15.5

Seminar/ conference 72 11.2

11. Share knowledge

Yes 294 46.5

No 338 53.5

No. Subject Item Frequency Percent (%)

1. Gender/sex Male 261 33.5

Female 517 66.5

2. Ethnicity Malay 444 57.3

Chinese 161 20.7

Indian 151 19.5

Others 19 2.5

3. Age <46 705 90.5

46+ 74 9.5

4. HQ Medical degree 516 66.5

Master/PhD 260 33.5

5. Hospital type With T&CM service 91 11.7

Without T&CM service 688 88.3

6. Position HO 180 23.2

MO 327 42.1

Specialist/Consultant 269 34.7

7. Services <10 503 64.6

10+ 276 35.4

8. Formal TCM education

Yes 57 7.3

No 720 92.7

9. Specificqualification

Yes 2 0.3

No 777 99.7

9a. Area of modality

acupuncture & herbal medicine

1 50.0

herbal medicine 1 50.0

9b. Duration of course

1 year 1 50.0

3 years 1 50.0

9c. Certification level

Masters 2 100.0

9d. Institution/organization

Nanjing TCM 1 50.0

Napier University 1 50.0

10. Sources on T&CM

Friends & family 448 63.7

Self-reading 456 63.1

Others - Internet 13 30.2

Hospital CME 100 15.5

Seminar/ conference 72 11.2

11. Shareknowledge

Yes 294 46.5

No 338 53.5

• Respondent Knowledge on T&CM Respondent Knowledge on T&CM ServicesServices

Questions TCM (n/%) N Non TCM (n/%)

N

1. Traditional & Complementary Medicine Division is established to ensure safe practices of T&CM.

65(78.3) 83 482(74.7) 645

2. T&CM services offered in the pilot hospitals are for wellness purposes.

59(71.1) 83 429(66.9) 641

3. Traditional and Complementary Healthcare Practices Act has been passed by the Parliament.

31(37.3) 83 174(27.3) 638

4. The National T&CM policy (2001) states that the T&CM therapy shall be incorporated into Malaysia health care system.

35(38.5) 83 202(32.1) 629

Questions TCM (n/%) N Non TCM (n/%)

N

5. Indicate hospitals that had been selected for the T&CM pilot project:-Hospital Kepala Batas, Pulau Pinang.Hospital Putrajaya.Hospital Sultan Ismail, Johor.

5(7.2) 69 40(6.7) 596

6. Indicate the T&CM modalities offered by the pilot hospitals:-Acupuncture.Malay traditional massage.Herbal treatment.

39(50.0) 78 132(21.4) 617

Questions TCM (n/%) N Non TCM (n/%)

N

5. Indicate hospitals that had been selected for the T&CM pilot project:-Hospital Kepala Batas, Pulau Pinang.Hospital Putrajaya.Hospital Sultan Ismail, Johor.

5(7.2) 69 40(6.7) 596

6. Indicate the T&CM modalities offered by the pilot hospitals:-Acupuncture.Malay traditional massage.Herbal treatment.

39(50.0) 78 132(21.4) 617

• Respondents’ Attitude on T&CM Respondents’ Attitude on T&CM ServicesServices

Attitude TCM Hospital

(n/%)

Non TCM Hospital

(n/%)

Total (N/%)

Positive 8(10) 53(8.4) 61(8.6)

Negative 72(90) 580(91.6) 652(91.4)

80 633 713

Statement Total T&CMn(%)

Non-T&CMn(%)

Integration

a. T&CM services should be integrated as part of hospital services.

b. T&CM services will reduce the workload of conventional medicine.

c. T&CM services will increase the quality of life of the patients.

d. T&CM services will prevent patients from seeking unregulated T&CM practices.

Benefits

e. T&CM services speed up patients’ recovery process.

f. Patients have more choices for treatment.

Safety

g. T&CM practitioners in hospitals practise patient safety.

h. T&CM services are carried out in a safe and accountable environment in the hospital.

Competition in servicei. T&CM will become the preferred treatment in comparison to conventional treatment by patients in the future.j. T&CM has a future in the Malaysian healthcare system.Acceptancek.  CME on T&CM services should be given to healthcare professionals on regular basis.l. T&CM should be included in conventional medical education. m.  A medical doctor should not refer patients to T&CM services provided in government hospitals.n. A medical doctor should consider using T&CM for him/herself.o. T&CM therapies hold promise for treatment of certain diseases. Skepticismp.  Accepting T&CM services will reduce the respect of my peers.q. T&CM therapies need further scientific testing before being used with conventional medicine. r. The results from T&CM therapies are mainly due to a placebo effect.s. T&CM therapies provide temporarily relief without long-term gains.t. T&CM services are definitely “sham/quack” practices.

390 (50.1)

225 (28.9)

424 (54.4)

580 (74.4)

242 (31.3)

570 (73.2)

419 (53.8)

481 (61.7)

177 (22.7)468 (60.0)455 (58.4)413 (53.0)403 (51.7)288 (36.9)357 (45.8)437 (56.1)596 (76.6)16 (21.2)

192 (24.7)327 (42.0)

58 (65.9)

35 (40.2)

67 (76.1)

69 (78.4)

34 (40.0)

59 (68.6)

59 (67.8)

70 (81.4)

12 (14.0)56 (65.1)47 (54.0)51 (58.6)42 (48.2)38 (43.6)45 (51.7)48 (55.1)61 (70.9)17 (19.5)16 (18.3)30 (34.9)

332 (48.7)

190 (27.9)

357 (52.9)

511 (75.3)

208 (30.6)

511 (75.4)

360 (53.0)

411 (60.7)

71 (10.5)412 (60.5)408 (60.0)362 (53.3)361 (53.1)250 (36.7)312 (45.9)389 (57.1)535 (78.8)148 (21.7)176 (25.9)297 (44.2)

Statement Total T&CMn(%)

Non-T&CMn(%)

Competition in service

i. T&CM will become the preferred treatment in comparison to conventional treatment by patients in the future.

j. T&CM has a future in the Malaysian healthcare system.

Acceptance

k.  CME on T&CM services should be given to healthcare professionals on regular basis.

l. T&CM should be included in conventional medical education.

m.  A medical doctor should not refer patients to T&CM services provided in government hospitals.

n. A medical doctor should consider using T&CM for him/herself.

o. T&CM therapies hold promise for treatment of certain diseases.

Skepticismp.  Accepting T&CM services will reduce the respect of my peers.q. T&CM therapies need further scientific testing before being used with conventional medicine. r. The results from T&CM therapies are mainly due to a placebo effect.s. T&CM therapies provide temporarily relief without long-term gains.t. T&CM services are definitely “sham/quack” practices.

177 (22.7)

468 (60.0)

455 (58.4)

413 (53.0)

403 (51.7)

288 (36.9)

357 (45.8)

12 (14.0)

56 (65.1)

47 (54.0)

51 (58.6)

42 (48.2)

38 (43.6)

45 (51.7)

71 (10.5)

412 (60.5)

408 (60.0)

362 (53.3)

361 (53.1)

250 (36.7)

312 (45.9)

Statement Total T&CMn(%)

Non-T&CMn(%)

Skepticism

p.  Accepting T&CM services will reduce the respect of my peers.

q. T&CM therapies need further scientific testing before being used with conventional medicine.

r. The results from T&CM therapies are mainly due to a placebo effect.

s. T&CM therapies provide temporarily relief without long-term gains.

t. T&CM services are definitely “sham/quack” practices.

437 (56.1)

596 (76.6)

16 (21.2)

192 (24.7)

327 (42.0)

48 (55.1)

61 (70.9)

17 (19.5)

16 (18.3)

30 (34.9)

389 (57.1)

535 (78.8)

148 (21.7)

176 (25.9)

297 (44.2)

• Respondent Practice on T&CM Respondent Practice on T&CM ServicesServices

Statement Yes/No Frequency (%)

1. Would you let your patients know about the T&CM therapies in hospitals with T&CM services?

2. Would you refer your patients to T&CM unit in hospitals with T&CM services?

3. Would you support the initiation of T&CM unit in your hospital?

3.1. If no, why?

3.1a. Unethical 3.1b. Belief of ineffectiveness of T&CM3.1c. Lack of evidence of effectiveness3.1d. Competition3.1e. Lack of legal recognition3.1f. Costs 3.1g. Cost effectiveness3.1h. Lack of training3.1i. Distrust Philosophical differences3.1j. Profit motive

4. Have you ever used T&CM for yourself?

5. Have any of your family members used any T&CM therapies?

6. Have you documented any T&CM use by your patients in their records?

7. Have you documented any adverse effects of T&CM experienced by your patients?

Yes

Yes

Yes

YesYesYesYesYesYesYesYesYesYes

Yes

Yes

Yes

No

(n=688)603(87.6)

536(77.9)

525(76.3)

(n=163)

59(36.2)92(56.4)133(81.6)31(19.0)121(74.2)49(30.1)68(42.3)118(72.4)75(46.0)46(28.2)

(n=688)303(44.0)

457(66.4)

323(46.9)

362(52.6)

Proportions of Practice among Respondents in Klang Valley HospitalsProportions of Practice among Respondents in Klang Valley Hospitals

Statement Yes/No Frequency (%)

1. Have you offered your patients on T&CM options?

2.  Have you sought the opinions of others regarding T&CM options?

3.  Have you referred patients to T&CM services?

3.1. If yes, which services do you refer to?

3.1a. Herbal treatment3.1b. Massage3.1c. Acupuncture

4. Have you ever used T&CM for yourself?

5. Have any of your family members used any T&CM therapies?

6. Have you documented any T&CM use by your patients in their records?

7. Have you documented any adverse effects of T&CM experienced by your patients?

Yes

Yes

Yes

YesYesYes

Yes

Yes

Yes

No

(n=91)37(40.7)

34(37.4)

35(38.5)

(n=35)

5(14.3)27(77.1)22(62.9)

(n=91)28(30.8)

39(42.9)

26(28.6)

75(82.4)

Proportions of Practice among Respondents in Hospital PutrajayaProportions of Practice among Respondents in Hospital Putrajaya

• Relationship between Socio Relationship between Socio Demographic Characteristics of Demographic Characteristics of Medical Doctors and Their Medical Doctors and Their Willingness to Discuss/ Refer the Willingness to Discuss/ Refer the Patients to T&CM Services Patients to T&CM Services

  T&CM (n/%)Non T&CM

(n/%)

>46 yrs (2/5.7) (42/78)

Female (27/77.1) (375/70.1)

SpecialtyRheumatologis

ts O&G

  (3/25) (24/82.8)

Generalists (24/68.6) (369/70.4)

Ever used (8/22.9) (263/49.1)

positive acceptance (6/20) (53/10.7)

have knowledge in T&CM services (23/92) (410/93.2)

DiscussionDiscussion

• Based on literature Based on literature reviews:reviews:

Demographic Demographic characteristics of characteristics of doctors:doctors:

AgeAgeGenderGenderSpecialtySpecialtySelf useSelf use

• From the findings:From the findings:

>46 yrs>46 yrsFemaleFemaleGeneralistsGeneralistsEver usedEver used

• Based on literature Based on literature reviews:reviews:

Physicians’ Physicians’ knowledge of knowledge of T&CM:T&CM:

QoLQoL

• From the findings:From the findings:

Wellness purposesWellness purposesFulfill needsFulfill needs

• Based on literature Based on literature reviews:reviews:

Physicians’ attitude Physicians’ attitude towards T&CM:towards T&CM:

IntegrationIntegration

CompetitionCompetitionAcceptanceAcceptance

• From the findings:From the findings:

As part of hospital As part of hospital servicesservices

FutureFutureNot to useNot to useRegular basis & Regular basis &

included in included in conventional conventional medical educationmedical education

• Based on literature Based on literature reviews:reviews:

Physicians’ attitude Physicians’ attitude towards T&CM:towards T&CM:

skepticismskepticism

• From the findings:From the findings:

Need further Need further testingtesting

Reduce respectReduce respect

• Based on literature Based on literature reviews:reviews:

Physicians’ Physicians’ practice of T&CM:practice of T&CM:

referralreferral

• From the findings:From the findings:

Referred patientsReferred patientsMassage & Massage &

acupunctureacupuncture

ConclusionConclusion

Limitation Limitation

Suggestion Suggestion

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