Abstract
BackgroundDifference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We observed an exceptionally low utilisation of IM and potential underreporting in diabetes. We aimed to explore the barriers and recommendations regarding service delivery and research of IM service among diabetes patients and physicians.MethodsA 10-group, 50-participant semi-structured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities and education levels; and 29 physicians (14 conventional medicine (ConM) and 15 Chinese medicine (CM)) with diverse clinical experience, academic background and affiliation were purposively sampled from private and public clinics. Their perspectives were qualitatively analysed by constant comparative method.ResultsSeven subthemes regarding barriers towards IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology and access to medical records. Patients underreported the use of CM due to the concern over neutrality of medical advice among physicians. Inconvenience of service access, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, ConM physicians emphasised standardisation and reproducibility while CM physicians emphasised personalisation. Some CM-related outcome measurements were suggested as non-communicable. Both physicians acknowledged the discordance in epistemology should be addressed by pragmatic approach.ConclusionKey obstacles of CAM clinical utilisation are different between patients. Further assessment on IM should be pragmatic to balance between standardisation, reproducibility and real-world practice. Evidence-based IM programs and research should merge with existing infrastructure.
Highlights
Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide
Data on consultation mode is presented below. This is the first focus group study comparing the expectation of patients and physicians regarding the use of IM service for diabetes, with the participation of family medicine, internal medicine and complementary and alternative medicine (CAM) physicians in addition to patients
We demonstrated that there was an Perspectives of patients, conventional medicine (ConM) physicians and Chinese medicine (CM) physicians were compared Themes generally agreed by patients in yellow, by Chinese medicine (CM) physicians in blue, by conventional medicine (ConM) physicians in red, by both patients and CM physicians in green, by both patients and WM physicians in orange, by all parties in black expectation mismatch between patients, CAM physicians and physicians of conventional medicine
Summary
Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We aimed to explore the barriers and recommendations regarding service delivery and research of IM service among diabetes patients and physicians. Controversies on incorporating complementary and alternative medicine (CAM) into integrative medical (IM) care continue amid increasing utilisation and volume of evidence worldwide [1,2,3,4,5]. Research on the comparison of the perspectives among patients and physicians, especially between physicians from CAM and conventional medicine (ConM) of different specialties is limited amid the global call on addressing misaligned expectations between stakeholders prior to the design of interventions [16,17,18,19]
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