Kim and Han: E-mail survey on the current status of clinical practice and activation measures for Korean medicine in stroke care

Abstract

Objectives

The aim of this study was to investigate the current status of and seek for measures to activate Korean medicine in stroke care.

Methods

This is an e-mail survey targeting the members of Korean medical doctors registered at the association of Korean medicine. The project team of the society of stroke on Korean medicine for the development of clinical practice guideline for stroke has devised the items for the questionnaire. The survey was conducted for 15 days in November 2016.

Results

The percentage of the respondents who have treated patients with stroke for the past month was 11.2% in the acute phase, 20.5% in the convalescent phase, and 32.4% in the chronic phase. Approximately 80% of the respondents answered they had a decrease in the number of patients compared to 10 years ago, regardless of the stroke phase. Most of the respondents were using Western medicine together with traditional Korean medicine for physical examination. Acupuncture and herbal medicine were the main therapeutic interventions. The two measures chosen by the most respondents to activate the Korean medicine usage for stroke care were the expansion of the insurance coverage (34.9%) and the generation of evidence on the effectiveness of traditional Korean medicine (25.1%)

Conclusion

It is necessary to actively show the role of the Korean medicine through the establishment of the evidence on the effectiveness of Korean medicine and the promotion based on the evidence. In addition, optimal treatment methods should be derived based on the traditional knowledge and modern scientific research and the methods should be educated to every Korean medical clinics and hospitals so that they can be implemented in clinical practice. At the same time, the government should provide policy support to ensure that the optimal treatment can be timely and appropriately implemented.

Table 1
Characteristics of Responders (%)
Sex male female NR TR TRs
465 (78.8) 125 (21.2) 0 (0) 590 590

AG 20’s 30’s 40’s 50’s 60’s&over NR TR TRs
57 (9.7) 192 (32.5) 214 (36.3) 106 (18.0) 21 (3.6) 0 (0) 590 590

Yrs of CC < 10 11–20 21–30 31–40 ≥ 41 NR TR TRs
224 (38.0) 197 (33.4) 121 (20.5) 19 (3.2) 7 (1.2) 0 (0) 590 590

Yrs since LA ≤10 11–20 21–30 31–40 ≥ 41 NR TR TRs
224 (38.0) 197 (33.4) 121 (20.5) 19 (3.2) 7 (1.2) 22 (3.7) 590 568

Affiliation KMC KMH PMI or MH NH EduI ReI Etc. NR TR TRs
420 (71.2) 73 (12.4) 34 (5.8) 30 (5.1) 19 (3.2) 2 (0.3) 12 (2.0) 0 (0) 590 590

Employment Director or employer Employee Etc. NR TR TRs
363 (62.8) 185 (32.0) 30 (5.2) 12 (2.0) 590 578

Specialty GP SP NR TR TRs
435 (73.7) 155 (26.3) 0 (0) 590 590
- IM Acu RM OG SC NP E&D PD NR TR TRs
- 80 (51.6) 20 (12.9) 17 (11.0) 16 (10.3) 8 (5.2) 7 (4.5) 4 (2.6) 3 (1.9) 0 (0) 155 155

MFP (adr) MS IM NP OG E PD DM NR TR TRs
567 (96.1) 565 (95.8) 454 (76.9) 416 (70.5) 406 (68.8) 385 (65.3) 375 (63.6) 0 (0) 3,168 590

MAG (adr) < 10 11–19 20–39 40–59 ≥ 60 TR TRs
401 (68.0) 423 (71.7) 507 (85.9) 566 (95.9) 545 (92.4) 2,442 590

NR: no response, TR: total response, TRs: Total respondents, AG: age group, Yrs: years, CC: clinical career, LA: license acquisition, KMC: Korean Medicine clinic, KMH: Korean Medicine hospital, PMI: Public medical institution, MH: military hospital, NH: Nursing hospital, EduI: Educational institute, ResI Research institute, GP: general physician, SP: specialist, IM: internal medicine, Acu: Acupuncture & Moxibustion Medicine, RM: rehabilitation medicine, OG: obstetrics & gynegology, SC: Sasang constitutional medicine, NP: neuropsychiatry, E: Eye, ear, nose, and throat department, DM: dermatology, PD: pediatrics, MFP: main field of practice, MS: musculoskeletal diseases, Adr: allow duplicate responses, MAG: major age group of patients

Table 2
Current Status of Stroke Patients in Korean Medical Clinics in Last One Month (%).
Question Answer Acute phase Convalescent phase Chronic phase
Have you treated any stroke patient for the last one month? Yes 66 (11.2) 121 (20.5) 399 (67.6)
No 524 (88.8) 469 (79.5) 191 (32.4)

What is the proportion of the patients with stroke in a single day? < 5% 59 (89.4) 73 (60.3) 272 (68.2)
5–10% 3 ( 4.5) 18 (14.9) 55 (13.8)
10–20% 2 ( 3.1) 15 (12.4) 21 ( 5.3)
20–50% 1 ( 1.5) 11 ( 9.1) 23 ( 5.8)
> 50% 1 ( 1.5) 4 ( 3.3) 28 ( 7.0)

What is the main motivation for a stroke patient to visit the clinic? Stroke was the only and main complaint of the patient. 45 (68.2) 58 (47.9) 119 (29.8)

The patient wanted to be mainly treated for other disease in parallel with stroke. 10 (15.2) 14 (11.6) 94 (23.6)

The patient wanted to be mainly treated for stroke in parallel with other disease. 11 (16.6) 49 (40.5) 186 (46.6)
Table 3
Main Methods of Examination for Stroke Patients (%).
Examination method/phase Acute Convalescent Chronic
Pattern identification 4 ( 6.1) 23 (19.0) 86 (21.6)
Sasang constitutional medicine 1 ( 1.5) 6 ( 4.9) 15 ( 3.8)
Examination and diagnosis according to the Western medicine 13 (19.7) 10 ( 8.3) 46 (11.5)
Combination of the examination method of traditional Korean medicine and the Western medicine 48 (72.7) 82 (67.8) 252 (63.2)
Number of respondents 66 121 399
Table 4
Main Methods of Treatment for Stroke Patients (%).
Treatment method/phase Acute Convalescent Chronic
Acupuncture 66 ( 100.0) 111 (91.7) 384 (96.2)
Herbal medicine 61 (92.4) 92 ( 76.0) 260 (65.2)
Moxibustion 41 (62.1) 68 (56.2) 217 (54.4)
Electro-acupuncture 32 (48.5) 71 (58.7) 220 (55.1)
Pharmaco-acupuncture 28 (42.4) 42 (34.7) 102 (25.6)
Blood-letting 26 (39.4) 42 (35.5) 143 (35.8)
Cupping 19 (28.8) 26 (21.5) 132 (33.1)
Needle-embedding 5 (7.6) 6 (5.0) 9 (2.3)
Qigong 0 (0.0) 4 (3.3) 3 (0.8)

Number of responds 278 463 1,470
Number of respondents 66 121 399

Allow duplication responses

Table 5
The Most Commonly Prescribed Type of Herbal Medicine
Type/phase Acute Convalescent Chronic
Decoction (individual preparation) 42 ( 95.5) 79 (85.9) 122 (79.7)
Pills or powder (individual preparation) 9 (20.5) 3 (3.3) 10 (6.5)
Marketed products (health insurance-covered) 1 (2.3) 5 (5.4) 13 (8.5)
Marketed products (health insurance-uncovoered) 4 (9.1) 4 (4.3) 8 (5.2)
Etc. 0 (0.0) 1 (1.1) 1 (0.7)

Number of responds 56 92 154
Number of respondents 44 92 153
Table 6
The Most Commonly Prescribed Herbal Medicine Top 5
Rank/phase Acute Convalescent Chronic
1 Seonghyangjeonggi-san (星香正氣散) Mangeum-tang (萬金湯), Bojungikgi-tang (補中益氣湯) Mangeum-tang (萬金湯),
2 Uhwangcheongsim-won (牛黃淸心元), Uhwangcheongsim-hwan (牛黃淸心丸) Gamidaebo-tang (加味大補湯)
3 Sipjeondaebo-tang (十全大補湯) Individually prescribed decoction
4 Cheongpyesagan-tang (淸肺瀉肝湯) Ganghwaryupung-tang (羌活愈風湯), Boyanghwano-tang (補陽還五湯) Bojungikgi-tang (補中益氣湯)
5 Yanggyeoksanhwatang (凉膈散火湯) Sipjeondaebo-tang (十全大補湯)
Table 7
Changes in Visits of Stroke Patients Compared to 10 Years Ago (%, n=364)
Change of stroke patients visit frequency/phase Acute Convalescent Chronic
No Change 65 ( 17.9) 68 (18.7) 69 (19.0)
Decreased by less than 50% 60 (16.5) 91 (25.0) 110 (30.2)
Decreased by more than 50% 234 (64.3) 200 (54.9) 179 (49.2)
Increased by less than 50% 1 (0.3) 4 (1.1) 5 (1.4)
Increased by more than 50% 4 (1.1) 1 (0.3) 1 (0.3)
Table 8
The Pros and Cons of the Korean Medicine and the Measures to Promote the Use of Korean Medicine for Stroke (%).
What do you think is the merit of Korean traditional medicine in treating stroke?
 There are relatively few adverse events. 87 (14.7)
 The cure rate is higher. 99 (16.8)
 The patients are highly responsive to the treatment. 89 (15.1)
 It improves the overall health status. 307 (52.0)
 Etc. 8 ( 1.4)
What do you think is the disadvantage of Korean traditional medicine in treating stroke?
 The interventions not covered by insurance cost high. 275 (46.6)
 There is a lack of trust in the treatment of Korean traditional medicine. 110 (18.6)
 It is used as an adjuvant therapy for Western medical treatment. 119 (20.2)
 The effect is unclear compared to Western medical treatment. 49 ( 8.3)
 It is inconvenient for patients to frequently visit clinics. 24 ( 4.1)
 Etc. 13 ( 2.2)
What do you think is the most necessary to promote the use of traditional korea medicine for stroke?
 The coverage of the national health insurance should be expanded to more interventions of traditional Korean medicine. 206 (34.9)
 The effect of traditional Korean medicine in treating the stroke should be more actively publicized. 81 (13.7)
 The evidences on the effectiveness of traditional Korean medicine in treating the stroke needs to be created. 148 (25.1)
 Clinical practice guidelines of traditional Korean medicine for stroke should be developed. 52 ( 8.8)
 Establishment of the policy of traditional Korean medicine for managing severe diseases including stroke is required. 81 (13.7)
 It is essential to develop new formulations to make the herbal medicine easy-to-take. 17 ( 2.9)
Etc. 5 ( 0.8)

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