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JKM > Volume 38(3); 2017 > Article
Kim and Han: E-mail survey on the current status of clinical practice and activation measures for Korean medicine in stroke care

Abstract

Objectives

The aim of this study was to investigate the current status of and seek for measures to activate Korean medicine in stroke care.

Methods

This is an e-mail survey targeting the members of Korean medical doctors registered at the association of Korean medicine. The project team of the society of stroke on Korean medicine for the development of clinical practice guideline for stroke has devised the items for the questionnaire. The survey was conducted for 15 days in November 2016.

Results

The percentage of the respondents who have treated patients with stroke for the past month was 11.2% in the acute phase, 20.5% in the convalescent phase, and 32.4% in the chronic phase. Approximately 80% of the respondents answered they had a decrease in the number of patients compared to 10 years ago, regardless of the stroke phase. Most of the respondents were using Western medicine together with traditional Korean medicine for physical examination. Acupuncture and herbal medicine were the main therapeutic interventions. The two measures chosen by the most respondents to activate the Korean medicine usage for stroke care were the expansion of the insurance coverage (34.9%) and the generation of evidence on the effectiveness of traditional Korean medicine (25.1%)

Conclusion

It is necessary to actively show the role of the Korean medicine through the establishment of the evidence on the effectiveness of Korean medicine and the promotion based on the evidence. In addition, optimal treatment methods should be derived based on the traditional knowledge and modern scientific research and the methods should be educated to every Korean medical clinics and hospitals so that they can be implemented in clinical practice. At the same time, the government should provide policy support to ensure that the optimal treatment can be timely and appropriately implemented.

Table 1
Characteristics of Responders (%)
Sex male female NR TR TRs
465 (78.8) 125 (21.2) 0 (0) 590 590

AG 20’s 30’s 40’s 50’s 60’s&over NR TR TRs
57 (9.7) 192 (32.5) 214 (36.3) 106 (18.0) 21 (3.6) 0 (0) 590 590

Yrs of CC < 10 11–20 21–30 31–40 ≥ 41 NR TR TRs
224 (38.0) 197 (33.4) 121 (20.5) 19 (3.2) 7 (1.2) 0 (0) 590 590

Yrs since LA ≤10 11–20 21–30 31–40 ≥ 41 NR TR TRs
224 (38.0) 197 (33.4) 121 (20.5) 19 (3.2) 7 (1.2) 22 (3.7) 590 568

Affiliation KMC KMH PMI or MH NH EduI ReI Etc. NR TR TRs
420 (71.2) 73 (12.4) 34 (5.8) 30 (5.1) 19 (3.2) 2 (0.3) 12 (2.0) 0 (0) 590 590

Employment Director or employer Employee Etc. NR TR TRs
363 (62.8) 185 (32.0) 30 (5.2) 12 (2.0) 590 578

Specialty GP SP NR TR TRs
435 (73.7) 155 (26.3) 0 (0) 590 590
- IM Acu RM OG SC NP E&D PD NR TR TRs
- 80 (51.6) 20 (12.9) 17 (11.0) 16 (10.3) 8 (5.2) 7 (4.5) 4 (2.6) 3 (1.9) 0 (0) 155 155

MFP (adr) MS IM NP OG E PD DM NR TR TRs
567 (96.1) 565 (95.8) 454 (76.9) 416 (70.5) 406 (68.8) 385 (65.3) 375 (63.6) 0 (0) 3,168 590

MAG (adr) < 10 11–19 20–39 40–59 ≥ 60 TR TRs
401 (68.0) 423 (71.7) 507 (85.9) 566 (95.9) 545 (92.4) 2,442 590

NR: no response, TR: total response, TRs: Total respondents, AG: age group, Yrs: years, CC: clinical career, LA: license acquisition, KMC: Korean Medicine clinic, KMH: Korean Medicine hospital, PMI: Public medical institution, MH: military hospital, NH: Nursing hospital, EduI: Educational institute, ResI Research institute, GP: general physician, SP: specialist, IM: internal medicine, Acu: Acupuncture & Moxibustion Medicine, RM: rehabilitation medicine, OG: obstetrics & gynegology, SC: Sasang constitutional medicine, NP: neuropsychiatry, E: Eye, ear, nose, and throat department, DM: dermatology, PD: pediatrics, MFP: main field of practice, MS: musculoskeletal diseases, Adr: allow duplicate responses, MAG: major age group of patients

Table 2
Current Status of Stroke Patients in Korean Medical Clinics in Last One Month (%).
Question Answer Acute phase Convalescent phase Chronic phase
Have you treated any stroke patient for the last one month? Yes 66 (11.2) 121 (20.5) 399 (67.6)
No 524 (88.8) 469 (79.5) 191 (32.4)

What is the proportion of the patients with stroke in a single day? < 5% 59 (89.4) 73 (60.3) 272 (68.2)
5–10% 3 ( 4.5) 18 (14.9) 55 (13.8)
10–20% 2 ( 3.1) 15 (12.4) 21 ( 5.3)
20–50% 1 ( 1.5) 11 ( 9.1) 23 ( 5.8)
> 50% 1 ( 1.5) 4 ( 3.3) 28 ( 7.0)

What is the main motivation for a stroke patient to visit the clinic? Stroke was the only and main complaint of the patient. 45 (68.2) 58 (47.9) 119 (29.8)

The patient wanted to be mainly treated for other disease in parallel with stroke. 10 (15.2) 14 (11.6) 94 (23.6)

The patient wanted to be mainly treated for stroke in parallel with other disease. 11 (16.6) 49 (40.5) 186 (46.6)
Table 3
Main Methods of Examination for Stroke Patients (%).
Examination method/phase Acute Convalescent Chronic
Pattern identification 4 ( 6.1) 23 (19.0) 86 (21.6)
Sasang constitutional medicine 1 ( 1.5) 6 ( 4.9) 15 ( 3.8)
Examination and diagnosis according to the Western medicine 13 (19.7) 10 ( 8.3) 46 (11.5)
Combination of the examination method of traditional Korean medicine and the Western medicine 48 (72.7) 82 (67.8) 252 (63.2)
Number of respondents 66 121 399
Table 4
Main Methods of Treatment for Stroke Patients (%).
Treatment method/phase Acute Convalescent Chronic
Acupuncture 66 ( 100.0) 111 (91.7) 384 (96.2)
Herbal medicine 61 (92.4) 92 ( 76.0) 260 (65.2)
Moxibustion 41 (62.1) 68 (56.2) 217 (54.4)
Electro-acupuncture 32 (48.5) 71 (58.7) 220 (55.1)
Pharmaco-acupuncture 28 (42.4) 42 (34.7) 102 (25.6)
Blood-letting 26 (39.4) 42 (35.5) 143 (35.8)
Cupping 19 (28.8) 26 (21.5) 132 (33.1)
Needle-embedding 5 (7.6) 6 (5.0) 9 (2.3)
Qigong 0 (0.0) 4 (3.3) 3 (0.8)

Number of responds 278 463 1,470
Number of respondents 66 121 399

Allow duplication responses

Table 5
The Most Commonly Prescribed Type of Herbal Medicine
Type/phase Acute Convalescent Chronic
Decoction (individual preparation) 42 ( 95.5) 79 (85.9) 122 (79.7)
Pills or powder (individual preparation) 9 (20.5) 3 (3.3) 10 (6.5)
Marketed products (health insurance-covered) 1 (2.3) 5 (5.4) 13 (8.5)
Marketed products (health insurance-uncovoered) 4 (9.1) 4 (4.3) 8 (5.2)
Etc. 0 (0.0) 1 (1.1) 1 (0.7)

Number of responds 56 92 154
Number of respondents 44 92 153
Table 6
The Most Commonly Prescribed Herbal Medicine Top 5
Rank/phase Acute Convalescent Chronic
1 Seonghyangjeonggi-san (星香正氣散) Mangeum-tang (萬金湯), Bojungikgi-tang (補中益氣湯) Mangeum-tang (萬金湯),
2 Uhwangcheongsim-won (牛黃淸心元), Uhwangcheongsim-hwan (牛黃淸心丸) Gamidaebo-tang (加味大補湯)
3 Sipjeondaebo-tang (十全大補湯) Individually prescribed decoction
4 Cheongpyesagan-tang (淸肺瀉肝湯) Ganghwaryupung-tang (羌活愈風湯), Boyanghwano-tang (補陽還五湯) Bojungikgi-tang (補中益氣湯)
5 Yanggyeoksanhwatang (凉膈散火湯) Sipjeondaebo-tang (十全大補湯)
Table 7
Changes in Visits of Stroke Patients Compared to 10 Years Ago (%, n=364)
Change of stroke patients visit frequency/phase Acute Convalescent Chronic
No Change 65 ( 17.9) 68 (18.7) 69 (19.0)
Decreased by less than 50% 60 (16.5) 91 (25.0) 110 (30.2)
Decreased by more than 50% 234 (64.3) 200 (54.9) 179 (49.2)
Increased by less than 50% 1 (0.3) 4 (1.1) 5 (1.4)
Increased by more than 50% 4 (1.1) 1 (0.3) 1 (0.3)
Table 8
The Pros and Cons of the Korean Medicine and the Measures to Promote the Use of Korean Medicine for Stroke (%).
What do you think is the merit of Korean traditional medicine in treating stroke?
 There are relatively few adverse events. 87 (14.7)
 The cure rate is higher. 99 (16.8)
 The patients are highly responsive to the treatment. 89 (15.1)
 It improves the overall health status. 307 (52.0)
 Etc. 8 ( 1.4)
What do you think is the disadvantage of Korean traditional medicine in treating stroke?
 The interventions not covered by insurance cost high. 275 (46.6)
 There is a lack of trust in the treatment of Korean traditional medicine. 110 (18.6)
 It is used as an adjuvant therapy for Western medical treatment. 119 (20.2)
 The effect is unclear compared to Western medical treatment. 49 ( 8.3)
 It is inconvenient for patients to frequently visit clinics. 24 ( 4.1)
 Etc. 13 ( 2.2)
What do you think is the most necessary to promote the use of traditional korea medicine for stroke?
 The coverage of the national health insurance should be expanded to more interventions of traditional Korean medicine. 206 (34.9)
 The effect of traditional Korean medicine in treating the stroke should be more actively publicized. 81 (13.7)
 The evidences on the effectiveness of traditional Korean medicine in treating the stroke needs to be created. 148 (25.1)
 Clinical practice guidelines of traditional Korean medicine for stroke should be developed. 52 ( 8.8)
 Establishment of the policy of traditional Korean medicine for managing severe diseases including stroke is required. 81 (13.7)
 It is essential to develop new formulations to make the herbal medicine easy-to-take. 17 ( 2.9)
Etc. 5 ( 0.8)

참고문헌

1. Association of Korean medicine professors for cardiovascular and neurological medicine. Cardiovascular and Neurological Medicine in Korean Medicine. Seoul. Wooripub;(2016). p. 243


2. Feigin VL, Forouzanfar MH, & Krishnamurthi R, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. The Lancet;(2014). 383(9913):245-55.
crossref

3. Statistics Korea. Cause-of-death statistics 2015 (summary). 2016. Sep. 27. [cited 2016 Dec 27]. Available at: URL:https://kostat.go.kr/portal/korea/kor_nw/2/6/2/index.board?bmode=read&bSeq=&aSeq=356345&pageNo=1&rowNum=10&navCount=10&currPg=&sTarget=title&sTxt=


4. World Health Organization. The Top 10 Causes of Death. 2014. May. [cited 2016 Dec 27]. Available at: URL:http://www.who.int/mediacentre/factsheets/fs310/en/


5. Clinical research center for stroke. Korean Clinical Practice Guidelines for Stroke (revised edition). 2013. Feb. [cited 2016 Dec 27]. Available at: URL: http://www.stroke-crc.or.kr/%EB%87%8C%EC%A1%B8%EC%A4%91%EC%A7%84%EB%A3%8C%EC%A7%80%EC%B9%A8%2020130322.pdf


6. Health insurance review & assessment service. National health insurance statistics index 2006. 2015. July. [cited 2016 Dec 27]. Available at: URL:http://opendata.hira.or.kr/op/opc/selectStcPblc.do?sno=10437&odPblcTpCd=001&searchCnd=&searchWrd=&pageIndex=1


7. Health insurance review & assessment service. Medical expenses statistics index 2011. 2015. July. [cited 2016 Dec 27]. Available at: URL: http://opendata.hira.or.kr/op/opc/selectStcPblc.do?sno=10408&odPblcTpCd=001&searchCnd=&searchWrd=&pageIndex=1


8. Health insurance review & assessment service. Medical expenses statistics index 2015. 2016. Feb. [cited 2016 Dec 27]. Available at: URL: http://opendata.hira.or.kr/op/opc/selectStcPblc.do?sno=10900&odPblcTpCd=001&searchCnd=&searchWrd=&pageIndex=1


9. Korea health industry development institution. Healthcare workforce-number of licensed Korean medical doctors. 2015. Dec. 23. [cited 2016 Dec 27]. Available at: URL: https://www.khiss.go.kr/khidi/themestat/sublistThemeSubjectstat.jsp?htxt_code=12599056317038554276471450314736&uplist_id=358_E&list_id=358_EB


10. Ministry of Health and Welfare. Survey on Korean medicine use and consumption 2014. 2011. Dec. 7. [cited 2016 Dec 27]. Available at: URL:http://www.prism.go.kr/homepage/theme/retrieveThemeDetail.do;jsessionid=8C0E78708F3DAB1DD75E9C6186430BE8.node02?cond_research_name=&cond_organ_id=&cond_research_year_start=&cond_research_year_end=&cond_brm_super_id=NB000120061201100060495&research_id=1351000-201100127&pageIndex=6&leftMenuLevel=110


11. Bak YH, Huang DS, & Shin HK. A Survey of the Medical Treatment Environment in Traditional Korean Medicine Clinics. Journal of Korean Oriental Medicine;(2011). 32(4):25-36.


12. Korea health industry development institution. Health industry white paper 2014. 2015. Sep. 21. [cited 2016 Dec 27]. Available at: URL: http://khiss.go.kr/board/bbs_read.jsp?tname=MINBOARD358&bbsid=B301&cat_bbsid=B307&bbs_seq=420&jkey=&jword=&pg=1&htxt_code=13789506829741518083358661986895&wj_vcs=&reverseNum=19&forwardNum=1


13. Shin HK. Clinical study on CVA patients in Hospital attached to college of oriental medicine and NMC department oriental medicine. Korean Journal of Oriental Medicine;(1995). 1(1):1-14.


14. Zhou L, Chen Y, & Liu J, et al. Evaluating the implementation of evidence-based TCM Clinical Practice Guidelines for Cerebral Infarction. European Journal of Integrative Medicine;(2014). 6(2):147-55.
crossref

15. Ko MM, Lee JA, & Cha MH, et al. Stroke in Traditional Korean Medicine: A Nine-Year Multicentre Community-Based Study in South Korea. Scientific Reports;(2016). 628286
crossref

16. Chang CC, Lee YC, & Lin CC, et al. Characteristics of traditional Chinese medicine usage in patients with stroke in Taiwan: a nationwide population-based study. Journal of ethnopharmacology;(2016). 186311-21.
crossref

17. Yam W, & Wilkinson JM. Is acupuncture an acceptable option in stroke rehabilitation? A survey of stroke patients. Complementary therapies in medicine;(2010). 18(3):143-9.
crossref

18. Liao CC, Lin JG, & Tsai CC, et al. An investigation of the use of traditional Chinese medicine in stroke patients in Taiwan. Evidence-Based Complementary and Alternative Medicine;(2012). 2012387164
crossref

19. Chang CC, Chen TL, & Chiu HE, et al. Outcomes after stroke in patients receiving adjuvant therapy with traditional Chinese medicine: A nationwide matched interventional cohort study. Journal of ethnopharmacology;(2016). 17746-52.
crossref

20. Chen L, Fang J, & Ma R, et al. Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: a multicenter randomized controlled trial. BMC Complementary and Alternative Medicine;(2016). 16(1):226
crossref

21. Fang J, Chen L, & Ma R, et al. Comprehensive rehabilitation with integrative medicine for subacute stroke: A multicenter randomized controlled trial. Scientific Reports;(2016). 625850
crossref

22. Liu AJ, Li JH, & Li HQ, et al. Electroacupuncture for acute ischemic stroke: a meta-analysis of randomized controlled trials. The American journal of Chinese medicine;(2015). 43(08):1541-66.
crossref

23. Zhang T, Zhang L, & Zhang HM, et al. Systematic review of acupuncture therapy for acute ischemic stroke. China Journal of Traditional Chinese Medicine and Pharmacy;(2009). 24(1):101-4.
crossref

24. Vados L, Ferreira A, & Zhao S, et al. Effectiveness of acupuncture combined with rehabilitation for treatment of acute or subacute stroke: a systematic review. Acupuncture in Medicine;(2015). 33(3):180-7.
crossref

25. Zhang X, Liu XT, & Kang DY. GRADE in Systematic Reviews of Acupuncture for Stroke Rehabilitation: Recommendations based on High-Quality Evidence. Scientific Reports;(2015). 516582
crossref

26. Yang A, Wu HM, & Tnag JL, et al. Acupuncture for stroke rehabilitation, Cochrane Database of Systematic Reviews. Cochrane Database of Systematic Reviews;(2016). 26(8):CD004131


27. Zhang JH, Wang D, & Liu M. Overview of systematic reviews and meta-analyses of acupuncture for stroke. Neuroepidemiology;(2013). 42(1):50-8.
crossref

28. Zhang S, Liu M, & Asplund K, et al. Acupuncture for acute stroke. Cochrane Database of Systematic Reviews;(2005). 18(2):CD003317


29. Zhang S, Wu B, & Liu M, et al. Acupuncture efficacy on ischemic stroke recovery multicenter randomized controlled trial in China. Stroke;(2015). 46(5):1301-6.
crossref

30. Shih CC, Liao CC, & Sun MF, et al. A retrospective cohort study comparing stroke recurrence rate in ischemic stroke patients with and without acupuncture treatment. Medicine;(2015). 94(39):e1572
crossref

31. Chuang SF, Shih CC, & Yeh CC, et al. Decreased risk of acute myocardial infarction in stroke patients receiving acupuncture treatment: a nationwide matched retrospective cohort study. BMC complementary and alternative medicine;(2015). 15318
crossref

32. Wei YX, Zhao X, & Zhang BC. Synergistic effect of moxibustion and rehabilitation training in functional recovery of post-stroke spastic hemiplegia. Complementary therapies in medicine;(2016). 2655-60.
crossref

33. Kuang AK, Wang CX, & Zhao GS, et al. Long-term observation on qigong in prevention of stroke--follow-up of 244 hypertensive patients for 18–22 years. Journal of traditional Chinese medicine;(1986). 6(4):235-8.


34. Han CH. Clinical Practice Guideline of Korean Medicine for Stroke: Preliminary Guideline and Recommendation. Korean Journal of Oriental Internal Medicine;(2012). 33(4):347-66.


35. Lee MS, Shin BC, & Kim JI, et al. Moxibustion for stroke rehabilitation systematic review. Stroke;(2010). 41(4):817-20.
crossref

36. Lee MS, Choi TY, & Shin BC, et al. Cupping for stroke rehabilitation: a systematic review. Journal of the neurological sciences;(2010). 294(1):70-3.
crossref

37. Blunt SB, & Lee HP. Can traditional “cupping” treatment cause a stroke? Medical hypotheses;(2010). 74(5):945-9.
crossref

38. Leung K, Yan T, & Li L. Intracerebral haemorrhage and Qigong. Hong Kong medical journal;(2001). 7(3):315-8.


39. Liu CH, Hsieh YT, & Tseng HP, et al. Acupuncture for a first episode of acute ischaemic stroke: an observer-blinded randomised controlled pilot study. Acupuncture in Medicine;(2016). 34(5):349-55.
crossref

40. Wang C, Wu Z, & Li N, et al. Clinical curative effect of electric acupuncture on acute cerebral infarction: a randomized controlled multicenter trial. Journal of Traditional Chinese Medicine;(2014). 34(6):635-40.
crossref

41. González-Fraile E, Martín-Carrasco M, & Ballesteros J. Efficacy of MLC601 on functional recovery after stroke: A systematic review and meta-analysis of randomized controlled trials. Brain injury;(2016). 30(3):267-70.
crossref

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