Primary traditional Chinese medicine (TCM) health service has been attracting continuously improving attention. However, primary TCM health service system still has problems, which have constrained the development of TCM in China.
To analyze the current situation of primary TCM health service system in China and explore the strategies to continuously improve the capacity of primary TCM health service.
In December 2022, data were retrieved from the China Health Statistics Yearbook, National Statistics of Traditional Chinese Medicine, the official websites of the National Bureau of Disease Control and Prevention and the National Center for Cardiovascular Diseases. The index system was constructed from the three levels of health input, service output and health needs, and the combination of rank-sum ratio method and the WHO health system performance module framework was used to comprehensively evaluate the current situation of primary TCM health service.
In terms of health input, from 2017 to 2021, the number of primary healthcare institutions providing TCM health services except for township health centers has increased, and the number of TCM clinical departments beds in community health service centers (stations), township health centers, and outpatient clinics has shown an increasing trend, but the proportion of TCM clinical departments beds in outpatient clinics to the total number of outpatient departments has decreased; the proportion of TCM practicing (assistant) physicians in community health service centers (stations), township health centers and clinics has increased significantly, while the proportion of TCM practicing (assistant) physicians in village clinics remained stable, and the proportion of TCM practicing (assistant) physicians in outpatient clinics decreased by years; in the past five years, the absolute value of financial input for primary healthcare institutions has steadily increased, while the financial allocation for TCM organizations has fluctuatingly decreased. In terms of service output, from 2017 to 2021, the proportion of TCM consultations to the total consultations in various institutions has steadily increased according to a certain increase (except for TCM outpatient clinics), while the proportion of TCM consultations in village clinics alone has always remained above 30.0%; in addition to township health centers, the per capita burden of consultations of TCM practicing (assistant) physicians in other primary healthcare institutions was generally on a downward trend. The comprehensive evaluation found that 2017, 2018 and 2021 were in a suitable state of resource allocation, while 2019 and 2020 were in an unbalanced state of resource allocation.
At present, the construction of primary TCM health service system in China has been effectively implemented, but there are still some problems in the process of orderly promotion. Problems such as insufficient resources for primary TCM, unbalanced service and utilization, insufficient advantages of TCM, imperfect personnel training mechanism and low financial input have constrained the development TCM. In order to promote the continuous improvement of the health service capacity of primary TCM health service institutions, it is necessary to consolidate the functions of government, further promote TCM culture, establish incentive mechanism to optimize the training mode of talents, strengthen the close integration of TCM health services with health insurance policies, and build a TCM medical association supported by "information integration".
Community health service institutions play an important role in the protection of people's health, the application of community traditional Chinese medicine services can significantly improve the quality of life for the patients, and alleviate the problems of the accessibility and affordability for the health care. The bliometric analysis on traditional Chinese medicine services in community health service institutions can provide a basis and direction for further improving the capacity of community traditional Chinese medicine services.
To explore the development process, research hotspots and frontiers of traditional Chinese medicine services provided by community health service institutions in China based on the bibliometric analysis and scientific knowledge mapping analysis.
On January 1, 2023, CNKI, Wanfang Data and VIP were searched for relevant literature from inception to 2022-12-31. Excel software was used for the statistical analysis of annual publication volume, source journals and source institutions, CiteSpace 6.1.R6 software was used for the research collaborative network of institutions, clustering analysis and burst analysis of keywords. Frequency analysis and co-occurrence network analysis of authors and keywords were carried out with VOSviewer software.
A total of 920 papers were included, as for their sources, 270 journals and 38 universities were involved, represented by Journal of Traditional Chinese Medicine (80 articles), Beijing University of Chinese Medicine and Guangzhou University of Chinese Medicine (14 articles) with the highest number of articles. A total of 449 research institutions were involved, and the institution with the highest number of articles was Beijing University of Chinese Medicine (23 articles). SHI Yongxing (27 articles) and BAO Yong (18 articles) were the top 2 authors. Twelve clusters could be formed by the co-occurrence analysis of authors, and there was close collaboration among authors within the same cluster, but a wide collaborative network had not been formed yet. A total of 1 252 keywords were involved in this study, forming 13 clusters labeled with "Traditional Chinese Medicine" and "Community", etc. Researches on "constitution of traditional Chinese medicine" and "diabetes mellitus" are expected to become frontiers in this field.
Traditional Chinese medicine services in community health service institutions in China is in a period of stable development, however, there are still deficiencies in the richness of research methods, formation of collaborative networks with greater influence and scale. It is necessary to strengthen cooperation among community health service institutions, as well as the cooperation between universities and community health service institutions, by combining multidisciplinary research methods.
Faced with the increasingly severe trend of population aging and the threat of non communicable chronic diseases, China actively guides and promotes the development of community embedded integrated medical and nursing care service with characteristics of traditional Chinese medicine (TCM). However, there are limited studies on performance evaluation in this field in the existing literature. The construction of a set of scientific and effective performance evaluation index system for community embedded integrated medical and nursing care service with characteristics of TCM has important theoretical significance and practical value.
To construct a performance evaluation index system for community embedded integrated medical and nursing care service with characteristics of TCM, determine the weights for indicators of each level, so as to provide reference for the formulation of relevant policies and the performance evaluation of community embedded integrated medical and nursing care service with characteristics of TCM.
From September to October 2022, a two-dimensional theoretical framework of "embedded-performance" for the community embedded integrated medical and nursing care service with characteristics of TCM was established through literature research and based on the embeddedness theory and the structure-process-outcome theoretical model. From October to November 2022, an index system was constructed based on the two-dimensional theoretical framework of "embedded-performance", with methods of literature research, Delphi method, and field investigation. In December 2022, the analytic hierarchy process was applied to determine the weight coefficients and test the logical consistency of indicators at all levels.
A performance evaluation index system for community embedded integrated medical and nursing care service with characteristics of TCM, containing 2 dimensions of embeddedness and embedded performance, 6 primary indicators, 19 secondary indicators, and 45 tertiary indicators was constructed. The primary indicators with the highest weight were A5 (service process) and A6 (service outcome), while the secondary and tertiary indicators with the highest combined weight were B17 (service output), B19 (service satisfaction), and C44 (elderly satisfaction). All judgment matrices have passed the consistency test with CR<0.1.
The two-dimensional theoretical framework of "embedded-performance" for community embedded integrated medical and nursing care with characteristics of TCM has strong applicability and feasibility. The performance evaluation index system constructed based on this theoretical framework has a high concentration of expert opinions, strong scientific, rationality, systematicness, hierarchy, and application value, which can provide reference for government departments to formulate relevant policies, and is an effective tool for conducting performance evaluation of community embedded integrated medical and nursing care service with characteristics of TCM.
Stroke prevention and treatment has been the focus of attention in the global medical community, and the unique advantages of acupuncture for stroke treatment are becoming increasingly prominent, Chinese guidelines for acute ischemic stroke 2018 recommend acupuncture for acute cerebral infarction patients (gradeⅡrecommendation, B-level evidence). Standardization and normalization of clinical research data can ensure the data quality of clinical research and provide assurance for data collation and mining. Case registration is a real-world study, and the consistency of data elements is one of the necessary elements to ensure plan implementation, efficient data quality, and credible clinical research evidence. Therefore, the research group developed the data elements and definitions of this project based on the national key research and development project case registration research of acupuncture and moxibustion for the treatment of stroke, in order to optimize the clinical research paradigm of acupuncture and moxibustion for the prevention and treatment of stroke.
