ASSESSMENT ON ACCEPTANCE OF TRADITIONAL

1
ASSESSMENT ON ACCEPTANCE OF TRADITIONAL
COMPLEMENTARY MEDICINE (TCM) SERVICES BY
MEDICAL DOCTORS IN KLANG VALLEY PUTRAJAYA
2
Preface
3
Acknowledgement
4
Introduction
5
Background

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

6
TCM Policy in Malaysia
7
(No Transcript)
8
Integration of Traditional Complementary
Medicine in Healthcare System
9
Selected TCM 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)

10
General Objective

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

11
Specific Objectives

• To determine the knowledge of medical doctors
  regarding TCM services and associated socio
  demographic characteristics.
• To determine the acceptance of medical doctors
  regarding TCM services and associated socio
  demographic characteristics.
• To determine the practise of TCM 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 TCM services.

12
Methodology

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

13

• Non TCM
• Hospital Kajang
• Hospital Ampang
• Hospital Sungai Buloh
• Hospital Serdang
• Hospital Tunku Ampuan Rahimah, Klang
• Hospital Kuala Lumpur
• Hospital Selayang

• TCM
• 8. Hospital Putrajaya

14
(No Transcript)
15
Results

• Respondent Characteristics

16
No. Subject Item Frequency Percent ()
1. Gender/sex Male 261 33.5
1. Gender/sex Female 517 66.5
2. Ethnicity Malay 444 57.3
2. Ethnicity Chinese 161 20.7
2. Ethnicity Indian 151 19.5
2. Ethnicity Others 19 2.5
3. Age lt46 705 90.5
3. Age 46 74 9.5
4. HQ Medical degree 516 66.5
4. HQ Master/PhD 260 33.5
5. Hospital type With TCM service 91 11.7
5. Hospital type Without TCM service 688 88.3
6. Position HO 180 23.2
6. Position MO 327 42.1
6. Position Specialist/Consultant 269 34.7
7. Services lt10 503 64.6
7. Services 10 276 35.4
8. Formal TCM education Yes 57 7.3
8. Formal TCM education No 720 92.7
9. Specific qualification Yes 2 0.3
9. Specific qualification No 777 99.7
9a. Area of modality acupuncture herbal medicine 1 50.0
9a. Area of modality herbal medicine 1 50.0
9b. Duration of course 1 year 1 50.0
9b. Duration of course 3 years 1 50.0
9c. Certification level Masters 2 100.0
9d. Institution/ organization Nanjing TCM 1 50.0
9d. Institution/ organization Napier University 1 50.0
10. Sources on TCM Friends family 448 63.7
10. Sources on TCM Self-reading 456 63.1
10. Sources on TCM Others - Internet 13 30.2
10. Sources on TCM Hospital CME 100 15.5
10. Sources on TCM Seminar/ conference 72 11.2
11. Share knowledge Yes 294 46.5
11. Share knowledge No 338 53.5
17
No. Subject Item Frequency Percent ()
1. Gender/sex Male 261 33.5
1. Gender/sex Female 517 66.5
2. Ethnicity Malay 444 57.3
2. Ethnicity Chinese 161 20.7
2. Ethnicity Indian 151 19.5
2. Ethnicity Others 19 2.5
3. Age lt46 705 90.5
3. Age 46 74 9.5
4. HQ Medical degree 516 66.5
4. HQ Master/PhD 260 33.5
5. Hospital type With TCM service 91 11.7
5. Hospital type Without TCM service 688 88.3
6. Position HO 180 23.2
6. Position MO 327 42.1
6. Position Specialist/Consultant 269 34.7
7. Services lt10 503 64.6
7. Services 10 276 35.4
8. Formal TCM education Yes 57 7.3
8. Formal TCM education No 720 92.7
9. Specific qualification Yes 2 0.3
9. Specific qualification No 777 99.7
9a. Area of modality acupuncture herbal medicine 1 50.0
9a. Area of modality herbal medicine 1 50.0
9b. Duration of course 1 year 1 50.0
9b. Duration of course 3 years 1 50.0
9c. Certification level Masters 2 100.0
9d. Institution/ organization Nanjing TCM 1 50.0
9d. Institution/ organization Napier University 1 50.0
10. Sources on TCM Friends family 448 63.7
10. Sources on TCM Self-reading 456 63.1
10. Sources on TCM Others - Internet 13 30.2
10. Sources on TCM Hospital CME 100 15.5
10. Sources on TCM Seminar/ conference 72 11.2
11. Share knowledge Yes 294 46.5
11. Share knowledge No 338 53.5
18

• Respondent Knowledge on TCM Services

19
Questions TCM (n/) N Non TCM (n/) N
1. Traditional Complementary Medicine Division is established to ensure safe practices of TCM. 65(78.3) 83 482(74.7) 645
2. TCM 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 TCM policy (2001) states that the TCM 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 TCM pilot project- Hospital Kepala Batas, Pulau Pinang. Hospital Putrajaya. Hospital Sultan Ismail, Johor. 5(7.2) 69 40(6.7) 596
6. Indicate the TCM modalities offered by the pilot hospitals- Acupuncture. Malay traditional massage. Herbal treatment. 39(50.0) 78 132(21.4) 617
20
Questions TCM (n/) N Non TCM (n/) N
5. Indicate hospitals that had been selected for the TCM pilot project- Hospital Kepala Batas, Pulau Pinang. Hospital Putrajaya. Hospital Sultan Ismail, Johor. 5(7.2) 69 40(6.7) 596
6. Indicate the TCM modalities offered by the pilot hospitals- Acupuncture. Malay traditional massage. Herbal treatment. 39(50.0) 78 132(21.4) 617
21

• Respondents Attitude on TCM Services

22
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
23
Statement Total TCM n() Non-TCM n()
Integration a. TCM services should be integrated as part of hospital services. b. TCM services will reduce the workload of conventional medicine. c. TCM services will increase the quality of life of the patients. d. TCM services will prevent patients from seeking unregulated TCM practices. Benefits e. TCM services speed up patients recovery process. f. Patients have more choices for treatment. Safety g. TCM practitioners in hospitals practise patient safety. h. TCM services are carried out in a safe and accountable environment in the hospital. Competition in service i. TCM will become the preferred treatment in comparison to conventional treatment by patients in the future. j. TCM has a future in the Malaysian healthcare system. Acceptance k.  CME on TCM services should be given to healthcare professionals on regular basis. l. TCM should be included in conventional medical education. m.  A medical doctor should not refer patients to TCM services provided in government hospitals. n. A medical doctor should consider using TCM for him/herself. o. TCM therapies hold promise for treatment of certain diseases. Skepticism p.  Accepting TCM services will reduce the respect of my peers. q. TCM therapies need further scientific testing before being used with conventional medicine. r. The results from TCM therapies are mainly due to a placebo effect. s. TCM therapies provide temporarily relief without long-term gains. t. TCM 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)
24
Statement Total TCM n() Non-TCM n()
Competition in service i. TCM will become the preferred treatment in comparison to conventional treatment by patients in the future. j. TCM has a future in the Malaysian healthcare system. Acceptance k.  CME on TCM services should be given to healthcare professionals on regular basis. l. TCM should be included in conventional medical education. m.  A medical doctor should not refer patients to TCM services provided in government hospitals. n. A medical doctor should consider using TCM for him/herself. o. TCM therapies hold promise for treatment of certain diseases. Skepticism p.  Accepting TCM services will reduce the respect of my peers. q. TCM therapies need further scientific testing before being used with conventional medicine. r. The results from TCM therapies are mainly due to a placebo effect. s. TCM therapies provide temporarily relief without long-term gains. t. TCM 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)
25
Statement Total TCM n() Non-TCM n()
Skepticism p.  Accepting TCM services will reduce the respect of my peers. q. TCM therapies need further scientific testing before being used with conventional medicine. r. The results from TCM therapies are mainly due to a placebo effect. s. TCM therapies provide temporarily relief without long-term gains. t. TCM 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)
26

• Respondent Practice on TCM Services

27
Proportions of Practice among Respondents in
Klang Valley Hospitals
Statement Yes/No Frequency ()
1. Would you let your patients know about the TCM therapies in hospitals with TCM services? 2. Would you refer your patients to TCM unit in hospitals with TCM services? 3. Would you support the initiation of TCM unit in your hospital? 3.1. If no, why? 3.1a. Unethical 3.1b. Belief of ineffectiveness of TCM 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 4. Have you ever used TCM for yourself? 5. Have any of your family members used any TCM therapies? 6. Have you documented any TCM use by your patients in their records? 7. Have you documented any adverse effects of TCM experienced by your patients? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No (n688) 603(87.6) 536(77.9) 525(76.3) (n163) 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) (n688) 303(44.0) 457(66.4) 323(46.9) 362(52.6)
28
Proportions of Practice among Respondents in
Hospital Putrajaya
Statement Yes/No Frequency ()
1. Have you offered your patients on TCM options? 2.  Have you sought the opinions of others regarding TCM options? 3.  Have you referred patients to TCM services? 3.1. If yes, which services do you refer to? 3.1a. Herbal treatment 3.1b. Massage 3.1c. Acupuncture 4. Have you ever used TCM for yourself? 5. Have any of your family members used any TCM therapies? 6. Have you documented any TCM use by your patients in their records? 7. Have you documented any adverse effects of TCM experienced by your patients? Yes Yes Yes Yes Yes Yes Yes Yes Yes No (n91) 37(40.7) 34(37.4) 35(38.5) (n35) 5(14.3) 27(77.1) 22(62.9) (n91) 28(30.8) 39(42.9) 26(28.6) 75(82.4)
29

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

30
  TCM (n/) Non TCM (n/)
gt46 yrs (2/5.7) (42/78)
Female (27/77.1) (375/70.1)
Specialty Rheumatologists OG
  (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 TCM services (23/92) (410/93.2)
31
Discussion
32

• Based on literature reviews
• Demographic characteristics of doctors
• Age
• Gender
• Specialty
• Self use

• From the findings
• gt46 yrs
• Female
• Generalists
• Ever used

33

• Based on literature reviews
• Physicians knowledge of TCM
• QoL

• From the findings
• Wellness purposes
• Fulfill needs

34

• Based on literature reviews
• Physicians attitude towards TCM
• Integration
• Competition
• Acceptance

• From the findings
• As part of hospital services
• Future
• Not to use
• Regular basis included in conventional medical
  education

35

• Based on literature reviews
• Physicians attitude towards TCM
• skepticism

• From the findings
• Need further testing
• Reduce respect

36

• Based on literature reviews
• Physicians practice of TCM
• referral

• From the findings
• Referred patients
• Massage acupuncture

37
Conclusion
38
Limitation
39
Suggestion
40
References

• Ahmad Syukri Chew. 2008. Traditional/Complementary
  Medicine. Possible Ethical Dilemma. MMA News.
  April18-22.
• Annual Report, TCM 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 1621176-1181.
• 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 328246-252.
• 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 2801569-1575.
• 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.

41

• 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 658.
• 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 1211.
• 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, 37983-988.
• National Policy of Traditional Complementary
  Medicine, TCM 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.

42

• 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 1521059-1064.
• Tiralongo, E. Wallis, M. 2008. Attitudes and
  perceptions of Australian pharmacy students
  towards Complementary and Alternative Medicine -
  A pilot study. http//www.biomedcentral.com/1472-6
  882/8/2.html 6 February 2008.
• Traditional Complementary Medicine Division.
  Standard Operating Procedures for TCM 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
  41511-515.
• 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) 495501.
• Wetzek, M.S., Eisenberg, D.M. Kaptchuk, T.J.
  1998. Courses involving complementary and
  alternative medicine at U.S. medical schools.
  JAMA 280 784-787.
• Zwicky, J.F., Hafner, A.W. Barrett, S. 1993.
  Readers 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
  594604. doi10.1037/0003-066X.54.8.594