ASSESSMENT ON ACCEPTANCE OF TRADITIONAL & COMPLEMENTARY MEDICINE (T&CM) SERVICES BY MEDICAL DOCTORS IN KLANG VALLEY & PUTRAJAYA

Preface

Acknowledgement

Introduction

Background

• • •

What is traditional medicine?

What is complementary medicine?

What is traditional and complementary medicine?

T&CM Policy in Malaysia

Integration of Traditional & Complementary Medicine in Healthcare System

• • •

Selected T&CM services provided in identified hospitals include:

•

Acupuncture; Traditional Malay massage; Herbal therapy as an adjunct therapy to oncology treatment; and Malay Postnatal care established in July 2009 (Hospital Putrajaya)

General Objective

•

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

Specific Objectives

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

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

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

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

Methodology:

•

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

Non T&CM 1.

2.

3.

4.

5.

Hospital Kajang Hospital Ampang Hospital Sungai Buloh Hospital Serdang Hospital Tunku Ampuan Rahimah, Klang 6.

7.

Hospital Kuala Lumpur Hospital Selayang T&CM 8. Hospital Putrajaya

Results

•

Respondent Characteristics

No.

1.

2.

3.

4.

5.

6.

7.

8.

9.

9a.

Subject

Gender/sex Ethnicity Age HQ Hospital type Position Services Formal TCM education Specific qualification Area of modality

Item

Male

Female Malay

Chinese Indian Others

<46

46+ Medical degree

Master/PhD

With T&CM service

Without T&CM service

HO

MO

Specialist/Consultant

<10

10+ Yes

No Yes

No

acupuncture & herbal medicine herbal medicine Frequency

261

517 444

161 151 19

705

74 516

260

91

688

1 180

327

269

503

276 57

720 2

777 1

Percent (%)

33.5

66.5

57.3

20.7

19.5

2.5

90.5

9.5

66.5

33.5

11.7

88.3

23.2

42.1

34.7

64.6

35.4

7.3

92.7

0.3

99.7

50.0

50.0

7.

8.

9.

9a.

9b.

9c.

9d.

10.

6.

11.

Position Services Formal TCM education Specific qualification Area of modality Duration of course Certification level Institution/ organization HO MO Specialist/Consultant <10 10+ Yes No Yes No acupuncture & herbal medicine herbal medicine 1 year 3 years Masters Sources on Share T&CM knowledge

Nanjing TCM Napier University Friends & family

Self-reading Others - Internet Hospital CME Seminar/ conference

Yes

No 180 327 269 503 276 57 720 2 777 1 1 1 1 2 1 1

448

456 13 100 72

294

338 23.2

42.1

34.7

64.6

35.4

7.3

92.7

0.3

99.7

50.0

50.0

50.0

50.0

100.0

50.0

50.0

63.7

63.1

30.2

15.5

11.2

46.5

53.5

•

Respondent Knowledge on T&CM Services

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

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

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

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

TCM (n/%) 65(78.3) 59(71.1)

31(37.3) 35(38.5)

N 83 83

83 83

Non TCM (n/%) 482(74.7) N 645 429(66.9)

174(27.3) 202(32.1)

641

638 629

Questions 5. Indicate hospitals that had been selected for the T&CM pilot project:-



Hospital Kepala Batas, Pulau Pinang.



Hospital Putrajaya.



Hospital Sultan Ismail, Johor.

TCM (n/%) 5(7.2)

6. Indicate the T&CM modalities offered by the pilot hospitals:  Acupuncture.

 Malay traditional massage.

 Herbal treatment.

39(50.0)

N 69

78

Non TCM (n/%) 40(6.7) N 596

132(21.4) 617

•

Respondents’ Attitude on T&CM Services

Attitude

Positive Negative

TCM Hospital (n/%)

8(10) 72(90) 80

Non TCM Hospital (n/%)

53(8.4) 580(91.6) 633

Total (N/%)

61(8.6) 652(91.4) 713

Statement Integration

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

b.

T&CM services will reduce workload of conventional medicine.

the

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 recovery process.

speed up patients’

f.

Patients treatment.

have more choices for

Safety

g.

T&CM practitioners practise patient safety.

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

Total

390 (50.1) 225 (28.9)

424 (54.4)

580 (74.4)

242 (31.3)

570 (73.2) 419 (53.8) 481 (61.7)

T&CM n(%) 58 (65.9) 35 (40.2) 67 (76.1) 69 (78.4) 59 (67.8) 70 (81.4) Non-T&CM n(%) 332 (48.7) 190 (27.9) 357 (52.9) 511 (75.3) 34 (40.0) 59 (68.6) 208 (30.6) 511 (75.4) 360 (53.0) 411 (60.7)

Statement 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 conventional medical education.

in

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 treatment of certain diseases.

promise for Total 177 (22.7)

468 (60.0) 455 (58.4) 413 (53.0)

403 (51.7) 288 (36.9) 357 (45.8) T&CM n(%) 12 (14.0) 56 (65.1) 47 (54.0) 51 (58.6) 42 (48.2) 38 (43.6) 45 (51.7) Non-T&CM n(%) 71 (10.5) 412 (60.5) 408 (60.0) 362 (53.3) 361 (53.1) 250 (36.7) 312 (45.9)

Statement 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 “sham/quack” practices.

are definitely Total

437 (56.1) 596 (76.6) 16 (21.2)

192 (24.7) 327 (42.0) T&CM n(%) 48 (55.1) 61 (70.9) 389 (57.1) 535 (78.8) 17 (19.5) 16 (18.3) 30 (34.9) Non-T&CM n(%) 148 (21.7) 176 (25.9) 297 (44.2)

•

Respondent Practice on T&CM Services

Proportions of Practice among Respondents in Klang Valley Hospitals Statement

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

Yes 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?

Yes Yes 3.1. If no, why?

3.1a. Unethical 3.1b. Belief of ineffectiveness of T&CM

3.1c. Lack of evidence of effectiveness

3.1d. Competition

3.1e. Lack of legal recognition

3.1f. Costs 3.1g. Cost effectiveness

3.1h. Lack of training

3.1i. Distrust Philosophical differences 3.1j. Profit motive Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 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 No

Yes/No Frequency (%) (n=688)

603(87.6) 536(77.9) Yes 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 Hospital Putrajaya Statement

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

Yes/No Frequency (%)

Yes Yes

(n=91)

37(40.7) 34(37.4) 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 treatment

3.1b. Massage 3.1c. Acupuncture

Yes Yes Yes Yes 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 No 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)

•

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

>46 yrs Female Specialty Generalists Ever used positive acceptance have knowledge in T&CM services T&CM (n/%)

(2/5.7) (27/77.1) Rheumatologists (3/25) (24/68.6) (8/22.9) (6/20) (23/92)

Non T&CM (n/%)

(42/78) (375/70.1) O&G (24/82.8) (369/70.4) (263/49.1) (53/10.7) (410/93.2)

Discussion

• Based on literature reviews:  Demographic characteristics of doctors:  Age  Gender  Specialty  Self use • From the findings:  >46 yrs  Female  Generalists  Ever used

• Based on literature reviews:  Physicians’ knowledge of T&CM:  QoL • From the findings:  Wellness purposes  Fulfill needs

• Based on literature reviews:  Physicians’ attitude towards T&CM:  Integration  Competition  Acceptance • From the findings:  As part of hospital services  Future  Not to use  Regular basis & included in conventional medical education

• Based on literature reviews:  Physicians’ attitude towards T&CM:  skepticism • From the findings:  Need further testing  Reduce respect

• Based on literature reviews:  Physicians’ practice of T&CM:  referral • From the findings:  Referred patients  Massage & acupuncture

Conclusion

Limitation

Suggestion

References

• • • • • • • • • Ahmad Syukri Chew. 2008. Traditional/Complementary Medicine. Possible Ethical Dilemma. MMA News. April:18-22.

Annual Report, T&CM Division, MOH, 2007. Corbin, W. L. & Shapiro, H. 2002. Physicians want education about Complementary and Alternative Medicine to enhance communication with their patients. Archives International Medicine 162:1176-1181.

Deraf Penilaian Pertengahan Penggal Rancangan Malaysia Ke-9 Kementerian Kesihatan Malaysia Program: Penyelidikan Dan Sokongan Teknikal, Disember 2007.

Eisenberg, D.M., Kessler, RC., Foster, C. 1993. Unconventional medicine in the United States: prevalence, costs and patterns of use. New England Journal of Medicine 328:246-252.

Eisenberg D.M., Davis, R.B., Ettner, S.L., Appel, S., Wilkey, S., & Van Rompay, M. 1998. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 280:1569 1575.

Eirnarson,A., Lawrimore T., Brand, P., Gallo, M., Rotatone,C & Koren, G. 2000. Attitudes and Practices of Physicians and Naturopaths Toward Herbal Products, Including Use During Pregnancy and Lactation. Can J Clin Pharmacol. 7: 45-49.

Furnham, A. & Kirkcaldy, B. 1996. The health beliefs and behaviors of orthodox and complementary medicine clients. British Journal of Clinical Psychology 35: 49-61.

• • • • • • • • • • Furnham, A. & Forey, J. 1994.The attitudes, behaviors and beliefs of patients of conventional vs complementary (alternative) medicine. Journal of Clinical Psychology. 50: 458-469 Kurtz, M.E., Nolan, R.B. & Rittinger, W.J. 2003 Primary care physicians’ attitudes and practices regarding Complementary and Alternative Medicine. Journal of the American Ostheopathic Association 103(12): 597-602.

Levine,M.A.& Levine, M.L.W. & Mayberry, R.M. 2003. Complementary and Alternative Medical Practices: Training, Experience, and Attitudes of a Primary Care Medical School Faculty. The Journal of the American Board of Family Medicine. 16(4):318-326.

Lie, D.A & Boker, J. 2006. Comparative survey of Complementary and Alternative Medicine (CAM) attitudes, use, and information-seeking behaviour among medical students, residents & faculty. BMC Medical Education 6:58.

Majeed, K., Mahmud, H., Khawaja, H.R., mansoor, S., Masood, S & Khimani, F. 2007. Complementary and Alternative Medicine: Percetions of Medical Students From Pakistan. Med Educ Online 12:11.

Micozzi, M.S. 1996. The Need To Teach Alternative Medicine. The Chronicle of. Higher Education Aug (A48). Murray, J & Shepherd,S. 1993. Alternative or Additional Medicine? An Exploratory Study in General Practice. Soc Sci Med, 37:983-988.

National Policy of Traditional & Complementary Medicine, T&CM Division, MOH, 2nd ed. 2007).

Oberbaum, M., Notzer, N., Abramowitz, R & Branski, D. 2003. Attitude of Medical Students to the Introduction of Complementary Medicine into the Medical Curriculum in Israel. IMAJ 5: 139 – 141.

• • • • • • • • • Poynton,L., Dowell, A., Dew, K. & Egan, T. 2006. General practitioners’ attitudes toward (and use of) complementary and alternative medicine: a New Zealand nationwide survey. http://www.nzma.org.nz/journal/119-1247/2358.html [6 Februari 2008]. Sikand, A. & Laken, M. 1998. Pediatricians’ experience with and attitudes toward Complementary/Alternative Medicine. Archives of Pediatrics & Adolescent Medicine 152:1059-1064.

Tiralongo, E. & Wallis, M. 2008. Attitudes and perceptions of Australian pharmacy students towards Complementary and Alternative Medicine - A pilot study. http://www.biomedcentral.com/1472-6882/8/2.html [6 February 2008].

Traditional & Complementary Medicine Division. Standard Operating Procedures for T&CM Unit in Hospital, Revised Edition, July 2009.

Verhoef,M.J & Sutherland, L.R.1995. General Practitioners’ Assessment of and Interest in Alternative Medicine in Canada. Soc Sci Med 41:511-515.

Wahner-Roedler, D.L., Vincent, A., Elkin, P.L., Loehrer,L.L, Stephen S. Cha & Bauer, B.A. 2006. Physicians’ attitudes toward Complementary and Alternative Medicine and their knowledge of specific therapies: A survey at an academic medical center. eCAM 3(4): 495–501.

Wetzek, M.S., Eisenberg, D.M. & Kaptchuk, T.J. 1998. Courses involving complementary and U.S. medical schools. JAMA 280: 784-787.

alternative medicine at Zwicky, J.F., Hafner, A.W. & Barrett, S. 1993. Reader’s Guide to Alternative Health Methods: Scientific Perspective. Chicago, Ill: American Medical Association 3-13.

Wilkinson, Leland; APA Task Force on Statistical Inference (1999). "Statistical methods in psychology journals: Guidelines and explanations". American Psychologist 54: 594–604. doi:10.1037/0003-066X.54.8.594