In patient involvement, patients are transforming from mere recipients to collaborators in medical services by integrating their experiences and needs throughout the entire healthcare process into medical practice. This aims to enhance the effectiveness, efficiency, and quality of healthcare services. However, the implementation of proven patient-centered strategies for patient involvement in the quality improvement among chronic obstructive pulmonary disease (COPD) in our country remains to be explored.
This scoping review systematically reviews and analyzes the existing strategies for patient involvement among patients with COPD to provide a reference for implementation that in China.
Employing the scoping review guidelines of Joanna Briggs Institute in Australia as the methodological framework, the relevant studies on patient involvement among patient with COPD were searched by computer on PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, China Biology Medicine disc, from the establishment of the database to November 29, 2022. A thematic analysis was methodically applied to distill and synthesize findings.
A total of 37 articles were included in this review. The categorization of patient involvement was divided into three types: direct involvement in medical care, organizational-level, and clinical research. Based on the intensity of involvement, categories were further classified into three levels: consultation, engagement, and collaborative leadership. A nine-category matrix of patient involvement behaviors was constructed through intensity and type. The implementation of COPD patient engagement was primarily reflected in five categories encompassing eight behaviors, including: integration in direct medical care (patients expressing their preferences and wishes regarding treatment plans) ; consultation at the organizational management level (assessing patient treatment experiences and organizing discussions around patients' concerns) ; as well as involvement in clinical research, including consultation (listening to patient needs) and engagement (expressing preferences and wishes for interventions, involved in the development of assessment tools, and in discussions about research design and implementation). Assessing patient treatment experiences (10 articles, 27.03%) and expressing patient preferences and wishes regarding interventions (10 articles, 27.03%) were the two most frequently implemented behaviors of patient involvement in COPD.
There are numerous measures for patient involvement in the improvement of medical quality, but there is still limited practice in the field of COPD. Very few studies have assessed the impact of patient involvement on clinical outcomes and quality of life, indicating that the practice of patient involvement in China requires further exploration.
As China's Traditional medicine is included in the ICD-11 code, the rational allocation of basic TCM medical resources is the guarantee to promote the integration of traditional Chinese medicine and western medicine and the universal coverage of high-quality medical resources. The uneven layout and service capabilities of grassroots medical institutions have led to a widespread imbalance in the supply and demand of medical resources in urban and rural areas.
Understand the development status of traditional Chinese medicine services in rural areas of China, scientifically evaluate the coverage and accessibility of grassroots traditional Chinese medicine diagnosis and treatment, provide new ideas for optimizing the spatial resource allocation of grassroots traditional Chinese medicine services, and propose optimization strategies accordingly.
Based on the seventh national population census data and path planning data, the concept of medical service radius is introduced to calculate the diagnosis and treatment scope of different levels of traditional Chinese medicine medical institutions under walking mode. Using methods such as spatial kernel density index and spatial standard deviation ellipse to reveal the spatial fairness of the supply and demand capacity of traditional Chinese medicine medical services. Based on the above results, propose types and measures for optimizing the layout of traditional Chinese medicine medical resources.
As of 2022, there are a total of 699 medical institutions in Zengcheng District, including 18 traditional Chinese medicine medical institutions with beds. There were significant differences in the distribution of beds in traditional Chinese medicine medical institutions in different townships and streets. Meanwhile, the number of beds per thousand population in Zhongtan Town was 14.31, ranking first among all streets. The number of beds per thousand people in Yongning Street ranks last, with only 0.89 beds. Traditional Chinese medicine medical institutions in Zengcheng District had shown a clear dual center pattern, with weak accessibility to traditional Chinese medicine services for residents in the central part of Zhongxin Town, the northern part of Paitan Town, and the southwestern part of Shitan Town. The supply capacity of traditional Chinese medicine services varies greatly among different townships. There was still a certain degree of inconsistency between the spatial distribution of traditional Chinese medicine medical institutions and the overall spatial clustering of urban residents. There were differences in the radius of traditional Chinese medicine services between different townships.
Since the implementation of the development strategy of traditional Chinese medicine, China's Traditional medicine has been protected and developed. We should adopt a more scientific strategy to closely integrate traditional Chinese medicine services with the development of the city and the needs of residents. We should actively adopt a differentiated strategy of increasing facility points, combining resource transfer and sinking, and integrating traditional Chinese medicine information technology for diagnosis and treatment across regions, gradually achieving a true strategy of full coverage and equal emphasis on traditional Chinese and Western medicine.
