Terminally ill patients' and their relatives' experiences and behaviors regarding complementary and alternative medicine utilization in hospice palliative inpatient care units: a cross-sectional, multicenter survey.

BACKGROUND: Terminally ill patients often experience exacerbations of diseases that render mainstream medicine ineffective in relieving symptoms, prompting attempts at complementary and alternative medicine (CAM). This study collected data from terminally ill patients and their relatives to determine differences between CAM use, behavioral patterns, and perceptions of health information about CAM. METHODS: A cross-sectional design using a self-administered questionnaire was adopted. Eight medical institutions in Taiwan with inpatient hospice palliative care units were chosen. Ninety-two terminally ill patients and 267 relatives met the inclusion criteria. The questions concerned the experience of CAM use, the kinds of products/services CAM provided, the purpose of CAM use, the source of CAM information, and the perceptions and attitudes toward CAM. RESULTS: Both terminally ill patients and their relatives have a high proportion of lifetime and one-year prevalence of CAM use (88.0% vs. 88.4%; p = 0.929). CAM use for musculoskeletal and neurological discomfort is higher among terminally ill patients than among their relatives. Relatives/friends are the most frequent sources of information on CAM (53.3% vs. 62.2%; p = 0.133). The percentage of terminally ill patients who discontinued mainstream medical treatment because of CAM use was higher than that of their relatives (18.5% vs. 9.3%; p = 0.026). More than half the terminally ill patients and their relatives had never been asked about CAM by medical staff (64.1% vs. 66.7%), nor had they informed medical professionals about the use of CAM products and services (63% vs. 66.9%). Random inquiries by medical professionals may be associated with increased disclosure of CAM use (terminally ill patients: odds ratio, 9.75; 95% confidence interval, 1.97-48.35 vs. relatives: odds ratio, 5.61; 95% confidence interval, 2.66-11.83). CONCLUSIONS: The high prevalence and concealment of CAM use in terminally ill patients should be considered. Medical professionals should establish a friendly and barrier-free communication model, encourage patients to share CAM experiences, and provide evidence-based information on the use of CAM products and services, to reduce the potential damage caused by harmful use.

Family Medicine Academic Workforce of Medical Schools in Taiwan: A Nationwide Survey.

Little is known about family medicine academic workforce in Taiwan, and basic data on this may aid healthcare decision-makers and contribute to the limited literature. We analyzed data from 13 medical schools in Taiwan collected by the Taiwan Association of Family Medicine from June to September 2019, regarding characteristics of medical schools, and total staff, gender, age, degree, working title (adjunct/full-time), academic level, and subspecialty of each current family medicine faculty member. Total 13 medical schools in Taiwan with an undergraduate education program in family medicine, but only nine of the 13 medical schools had family medicine departments, while four still do not. A total of 116 family medicine faculty members ranging from 33-69 years. Of these, most were male (n = 85, 73.3%), with a mean age of 43.3 years. Most faculty members possessed a master's degree (n = 49, 42.2%), were academic lecturers (n = 49, 42.2%), were located in northern Taiwan (n = 79, 68.1%), and subspecialize in gerontology and geriatrics (n = 55, 47.4%) and hospice palliative care (n = 53, 45.7%). Additionally, most family medicine faculty in medical schools were adjunct faculty (n = 90, 77.6%), with only about one-fourth (n = 26, 22.4%) working full-time. Our study provides the most holistic census to date on academic family medicine faculty from all medical schools in Taiwan. The novel information can provide educational leaders, health policy managers, and decision-makers about the current developments of the family medicine departments in Taiwan's medical schools. The basic data will help formulate an effective medical school family medicine education plan and improve the establishment and development of the family medicine faculty workforce to help medical education and national health policy development in the future in Taiwan.

Professionals' experiences and attitudes toward use of Traditional Chinese Medicine in hospice palliative inpatient care units: A multicenter survey in Taiwan.

BACKGROUND: Medical staff may have difficulties in using conventional medicine to manage symptoms among terminally ill patients, including adverse effects of the treatment. Traditional Chinese medicine (TCM) is regarded as a complementary or alternative medicine, and has been increasingly used in the field of palliative medicine in recent years. This study aimed to investigate the experiences of and attitudes toward using TCM among palliative care professionals, and to provide preliminary information about its use in palliative care. METHODS: This was a cross-sectional survey study conducted in eight inpatient hospice wards in Taiwan between December 2014 and February 2016. The questionnaire was self-administered, and was analyzed with descriptive statistics including Pearson's Chi-square test and Fisher's exact test. RESULTS: A total of 251 palliative care professionals responded to the questionnaire, of whom 89.7% and 88.9% believed that the use of TCM could improve the physical symptoms and quality of life in terminally ill patients, respectively. Overall, 59.8%, of respondents suggested that TCM had rare side effects, and 58.2% were worried that TCM could affect the liver and kidney function of patients. In total, 89.7% and 88.0% of professionals agreed there were no suitable clinical practice guidelines and educational programs, respectively, for TCM use in palliative care. CONCLUSIONS: Most of the respondents agreed there was insufficient knowledge, skills-training, and continuing education on the use of TCM in terminally ill patients in Taiwan. These results show that to address patient safety considerations, guidelines about use of TCM in palliative care should be established.

Differences in do-not-resuscitate orders, hospice care utilization, and late referral to hospice care between cancer and non-cancer decedents in a tertiary Hospital in Taiwan between 2010 and 2015: a hospital-based observational study.

BACKGROUND: In 2009, the Taiwanese national health insurance system substantially expanded hospice coverage for terminal cancer patients to include patients with end-stage brain, dementia, heart, lung, liver, and kidney diseases. This study aimed to evaluate differences in do-not-resuscitate (DNR) status and hospice care utilization between terminal cancer patients and advanced non-cancer patients after the policy change. METHODS: Data were obtained from the Death and Hospice Palliative Care Database of Taipei Veterans General Hospital in Taiwan. The differences between cancer and non-cancer patients who died in this hospital between 2010 and 2015 were analyzed in terms of patient characteristics, rates of DNR orders, hospice care utilization, number of living days after DNR order, duration of survival (DOS) after hospice care enrollment, and the rate of late referral to hospice care. RESULTS: Data for 8459 patients who died of cancer and major non-cancer terminal diseases were included. DNR order rate, hospice care utilization rate, and DOS were significantly higher for cancer patients than for non-cancer patients (p < 0.001, p < 0.001, and p < 0.001, respectively). The number of living days after DNR order and the late referral rate were significantly higher for non-cancer decedents than for cancer decedents (p < 0.001 and p < 0.001, respectively). From 2010 to 2015, there were significantly increasing trends in the hospice utilization rate, number of living days after DNR order, and rate of late referral for the cancer group (p < 0.001, p = 0.001, and p < 0.001, respectively). For the non-cancer group, there were significantly increasing trends in the rate of DNR order, hospice utilization rate, and number of living days after DNR order (p < 0.001, p < 0.001, and p = 0.029, respectively). CONCLUSIONS: Further guidelines should be developed to help clinicians to promptly refer terminal cancer and non-cancer patients to hospice care. Considering the lower hospice utilization rate and the growing need for hospice care among terminal non-cancer patients, policymakers should consider how to improve the relevant levels of professional care to enhance the accessibility and availability of hospice care in Taiwan.

Doctor-Shopping Behaviors among Traditional Chinese Medicine Users in Taiwan.

Doctor-shopping has caused an increase in medical expense, potential to receive duplicate medications, and suffer adverse drug reactions. We carried out a population-based retrospective study aimed at examining the user patterns of traditional Chinese medicine (TCM) ambulatory care in Taiwan. We retrieved complete TCM ambulatory visit datasets for the year 2007 from the National Health Insurance database in Taiwan. We defined the patients whose distribution of TCM physician numbers scored more than 97.5 percent (more than, or equal to, five TCM physicians) within one year as TCM doctor-shoppers. In total, 6,596,814 subjects (28.9%) paid TCM visits during that year. All 177,728 subjects (2.69%) who visited more than five (including) TCM physicians were classified as TCM shoppers. The most prevalent diagnostic grouping was upper respiratory infections (44.7%) and sprains and strains (44.0%). Men had a lower odds ratio (OR) among TCM shoppers than women (OR = 0.94, 95% confidence interval (CI) = 0.93-0.96). Younger people were less likely to be TCM shoppers than other people were. The ORs of TCM shoppers were higher among veterans and low-income patients (OR = 1.29 (1.23-1.35), and 1.33 (1.27-1.41)). In conclusion, health education on the potential of drug interactions and iatrogenic health risks incurred from doctor-shopping should be addressed to those high-risk patients.

Prevalence of Polyherbacy in Ambulatory Visits to Traditional Chinese Medicine Clinics in Taiwan.

Patients with a polyherbal prescription are more likely to receive duplicate medications and thus suffer from adverse drug reactions. We conducted a population-based retrospective study to examine the items of Chinese herbal medicine (CHM) per prescription in the ambulatory care of traditional Chinese medicine (TCM) in Taiwan. We retrieved complete TCM ambulatory visit datasets for 2010 from the National Health Insurance database in Taiwan. A total of 59,790 patients who received 313,482 CHM prescriptions were analyzed. Drug prescriptions containing more than five drugs were classified as polyherbal prescriptions; 41.6% of patients were given a polyherbal prescription. There were on average 5.2 ± 2.5 CHMs: 2.3 ± 1.1 compound herbal formula items, and 3.0 ± 2.5 single Chinese herb items in a single prescription. Approximately 4.6% of patients were prescribed 10 CHMs or more. Men had a lower odds ratio (OR) among polyherbal prescriptions (OR = 0.96, 95% confidence interval [CI] 0.92-0.99), and middle-aged patients (35-49 years) had the highest frequency of polyherbal prescription (OR = 1.19, 95% CI = 1.13-1.26). Patients with neoplasm, skin and subcutaneous tissue disease, or genitourinary system disease were more likely to have a polyherbal prescription; OR = 2.20 (1.81-2.67), 1.65 (1.50-1.80), and 1.52 (1.40-1.64), respectively. Polyherbal prescription is widespread in TCM in Taiwan. Potential herb interactions and iatrogenic risks associated with polyherbal prescriptions should be monitored.

Utilization and patterns of community healthcare services for senior residents in long-term care facilities in Taiwan: a nationwide study.

BACKGROUND: Community healthcare is one of the many important services used to care for the disabled elderly in aging societies. The aim of this study was to evaluate the utilization and patterns of community healthcare services used by senior residents in long-term care facilities (LTCFs) in Taiwan. METHODS: Secondary data analyses were conducted of the Taiwan National Health Insurance Research Database for 9338 LTCF senior residents receiving community healthcare services throughout the 2004 calendar year. The community healthcare services used by male and female LTCF senior residents were also compared by Chi-square testing. Descriptive statistics are used to present the patterns of professional visits and services by contracted healthcare facilities. RESULTS: About one-third of those senior residents living in LTCFs in Taiwan in 2004 received community healthcare services. Female residents received a higher percentage of community healthcare services than males in all age groups (p<0.001). Community home nursing care institutions provided 67% of healthcare visits and professional visits. Of those services provided to patients, the majority of the skilled nursing services were attributable to replacement of nasogastric tube (55%) and urinary catheter (38%). CONCLUSION: Whether or not the replacement of nasogastric tubes and urinary catheters among the LTCF senior resident population is an appropriate use of time and targeted medical resources needs further investigation. When addressing concerns about the community healthcare needs of senior residents of LTCFs, policymakers should carefully consider the current shortage of professional healthcare workers as they assess strategies to best meet the needs of the elderly in Taiwan.