The Role of Traditional, Complementary, and Integrative Healthcare in Achieving the Goals of the Astana Declaration and Universal Health Coverage: The Development of the Traditional, Complementary, and Integrative Healthcare Declaration
... The Astana Declaration reaffirmed and redirected global efforts in primary healthcare [5]. This declaration sought to ensure equitable access to the highest attainable standard of health worldwide [15][16][17]. With a focus on achieving high performance in PHC, the WHO, during its 75th anniversary, collaborated with member countries to address the post-COVID-19 public health landscape. ...
Background
Performance measurement systems (PMS) are increasingly recognized as essential tools in healthcare services. However, there remains a significant gap in the literature regarding their development, implementation, and impact on primary health care (PHC). This study aims to systematically review peer-reviewed literature to identify and analyze existing constructs, methodologies, and challenges associated with PMS in primary care settings worldwide.
Methods
This systematic review follows the PRISMA guidelines regarded as the gold standard for evidence synthesis in scientific and grey literature. The quality of the selected studies was assessed using the Rosalind Franklin Qualitative Research Appraisal Instrument (RF-QRA), focusing on transferability, reliability, credibility, and confirmability.
Results
From an initial pool of 167 articles, 14 studies were selected for in-depth analysis. These studies highlighted several challenges, including difficulties in evaluating PMS post-implementation within primary care units, limited evidence on the longitudinal monitoring of performance indicators, and inconsistencies in methodological approaches. The findings also revealed that regional, operational, and cultural contexts influenced the most PMS adaptations.
Conclusions
This systematic review offers a comprehensive diagnosis of the best PMS models implemented globally over the past five years, emphasizing heterogeneity, diversification, and reliability. The findings underscore the potential for PMS to inform public policies to achieve high-performance primary healthcare systems and enhance decision-making processes at both operational and managerial levels.
Simple Summary
The demand for traditional and complementary medicine (T&CM), perceived as natural and safe, among cancer patients has been steadily increasing. However, this trend raises concerns about the potential risks of using these therapies concurrently with conventional treatments and whether patients are fully adhering to their prescribed treatments. In Asia, T&CM is particularly common due to cultural and historical influences. This systematic review and meta-analysis is the first study to investigate the prevalence of T&CM use among cancer patients in Asia, how often they disclose this use to their physicians, and the factors influencing their choices. Understanding these aspects may enhance communication between patients and physicians, ultimately leading to safer and more effective cancer care.
Abstract
Globally, cancer patients frequently use T&CM during their treatment for various reasons. The primary concerns regarding the use of T&CM among cancer patients are the potential risks associated with interactions between pharmaceuticals and T&CM, as well as the risk of noncompliance with conventional cancer treatments. Despite the higher prevalence of T&CM use in Asia, driven by cultural, historical, and resource-related factors, no prior review has tried to estimate the prevalence and influencing factors of T&CM use and disclosure among cancer patients in this region. This study aims to examine the prevalence and disclosure rates of T&CM use among cancer patients in Asia to assess various factors influencing its use across different cancer treatment settings in Asia. Systematic research on T&CM use was conducted using four databases (PubMed, EMBASE, Web of Science, and CINAHAL) from inception to January 2023. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS). A random effects model was used to estimate the pooled prevalence of T&CM use, and data analysis was performed using Stata Version 16.0. Among the 4849 records retrieved, 41 eligible studies conducted in 14 Asian countries were included, involving a total of 14,976 participants. The pooled prevalence of T&CM use was 49.3%, ranging from 24.0% to 94.8%, and the disclosure rate of T&CM use was 38.2% (11.9% to 82.5%). The most commonly used T&CM modalities were herbal medicines and traditional medicine. Females were 22.0% more likely to use T&CM than males. A subgroup analysis revealed the highest prevalence of T&CM use was found in studies conducted in East Asia (62.4%) and those covered by both national and private insurance (55.8%). The disclosure rate of T&CM use to physicians remains low. Moreover, the factors influencing this disclosure are still insufficiently explored. Since the disclosure of T&CM use is a crucial indicator of patient safety and the quality of cancer treatment prognosis, future research should focus on identifying the determinants of non-disclosure.
Background: Performance measurements are increasingly used in health services, however, there is a lack of these types of applications in the literature, especially for performance measurement systems in primary health care. The concepts of a performance measurement system (SMD) constitute a limitation in the literature for what has been implemented to date in primary health care services. This article constructs a systematic review of peer-reviewed literature to demonstrate current constructs used in performance measurement systems in different areas of primary care.
Methods: The document uses the PRISMA approach, considered the gold standard for synthesis of evidence and studies reported as scientific or dark literature. To evaluate the quality of the selected studies, the four categories of The Rosalind Franklin Qualitative Research Appraisal Instrument - RF-QRA were used.
Results: Of the 167 articles extracted, fourteen studies were selected and showed that there is a difficulty in evaluating the post-implementation of performance measurement systems directly in primary care units, which brings a study limitation and the lack of evidence of monitoring indicators throughout over time.
Conclusions: The development of the systematic review process that emphasizes heterogeneity, diversification, reliability and originality reflected a diagnosis based on the last five years of the best MDS models implemented around the world. This may reflect the implementation of public policies focusing on high-performance primary health care.
The primary contentious issues surrounding non-pharmacological intervention, such as the use of traditional and complementary medicine (T&CM) by cancer patients, are noncompliance with treatment and potential hazards arising from drug-T&CM interactions. The aim of this review was to determine the prevalence and disclosure rate of T&CM use among cancer patients in Asia. Systematic research was performed on the four databases inception to January 2023. The pooled prevalence estimate of T&CM use was pooled using random-effects models. Among the 4,849 records retrieved, 41 eligible studies conducted in 14 Asian countries were included, involving a total of 14,976 participants. The pooled prevalence estimate of T&CM use was 49.3%, ranging from 24.0% to 94.8%, and the disclosure rate of T&CM use was 38.2% (11.9% to 82.5%). Females were 22.0% more likely to use T&CM than males. Subgroup analysis revealed the highest prevalence of T&CM use was found in studies conducted in East Asia (62.4%), those covered by both national and private insurance (55.8%), and studies before 2011 (53.4%). The prevalence of T&CM use among cancer patients is high; however, the disclosure rate of T&CM use to physicians is still less. Disclosure of T&CM use is among the key indicators of patient safety and prognosis quality in cancer treatment. Therefore, future studies in the field should include influencing factors of non-disclosure of T&CM use.
Yu-Tong Fei and colleagues examine the problems with designing and implementing trials of acupuncture
Background
There has been a considerable increase in the number of traditional and complementary medicine (T&CM) practitioners over the past 20 years and in some jurisdictions are estimated to outnumber general practitioners. Despite this globally significant role, it is apparent that worldwide not all T&CM professions operate under adequate accountability and regulatory oversight for maintaining public protection. To date there has been no published systematic examination of stakeholder opinions regarding regulated and unregulated T&CM occupations. In response, this review aims to investigate, describe, and analyse attitudes held by a range of stakeholder groups towards the regulation of T&CM professions.
Methods
A database search of AMED, CINAHL, Embase, Ovid MEDLINE, ProQuest, PsycINFO, PubMed, Scopus, and Google Scholar was conducted for original research published between 2000 and 2020 on stakeholder opinions regarding the regulation of T&CM professions.
Results
Sixty studies across 15 countries reported on the views of six health care stakeholder groups: consumers, T&CM practitioners, conventional medicine practitioners, professional associations, education providers, and policy-makers. Across all stakeholder groups there was between 15% and 95% (median 61%) support for, and 1% to 57% (median 14%) opposition to the regulation of various T&CM professions. The main reasons for supporting regulation included providing greater public protection, raising training and practice standards, establishing title protection, and gaining acceptance from conventional medicine providers. Concerns regarding regulation included potential restrictions to practice, misappropriation of practice, and medical oversight of T&CM practitioners. Few studies canvassed the views of professional associations ( n = 6), education providers ( n = 2), and policy-makers ( n = 2).
Conclusions
There appears to be broad support for the regulation of T&CM professions, although there was wide variation in attitudes as to how this should be applied. Further research, with a particular focus on policy-makers, education providers, and professional associations, is critical to inform appropriate health policy and practice recommendations relating to T&CM professional regulation across jurisdictions. Systematic review registration: the a priori protocol for this systematic review was registered in PROSPERO and is available at: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42020198767 .
Introduction
We evaluate the effectiveness and safety of transdermal acupuncture
by needles for smoking cessation.
Methods
A literature search for randomized controlled trials (RCTs) was performed
in seven electronic databases from inception to February 2017. Meta-analysis was
conducted using Revman 5.3.0 software. We used either a random effects model
(REM) or a fixed effects model (FEM) for pooling data according to the result of
a heterogeneity test (defined as significant if I2>75%). Trial sequential analysis
(TSA) was applied by TSA 0.9.5.10 Beta software.
Results
Twenty-four trials involving 3984 participants were included. The
methodological quality was generally low. With regard to smoking abstinence,
meta-analysis showed acupuncture was more effective compared to no
intervention/waiting list for short-term (4 weeks) cessation (1 trial, RR=2.37, 95%
CI: 1.41, 3.97) and long-term (longer than 6 months) (2 trials, RR=2.66, 95% CI:
1.50, 4.70). Compared to acupuncture/auricular acupressure alone, acupuncture
plus auricular acupressure showed more benefit for short-term cessation (3 trials,
RR=1.52, 95% CI: 1.03, 2.25). Acupuncture plus auricular acupressure was
more effective compared to sham acupuncture plus sham auricular acupressure
for short-term cessation (3 trials, RR=2.50, 95% CI: 1.44, 4.33) and long-term
(2 trials, RR=3.61, 95% CI: 1.37, 9.48). Acupuncture in combination with
counseling, educational smoking cessation program or moxibustion had more
benefit compared to acupuncture for short-term cessation (3 trials, RR=0.75, 95%
CI: 0.63, 0.91) and long-term (2 trials, RR=0.77, 95% CI: 0.56, 1.05), and TSA
illustrated the cumulative Z-curve of this comparison for long-term across the
traditional boundary of 5% significance and monitoring boundaries. No serious
adverse events occurred.
Conclusions
Acupuncture combined with counseling, educational smoking cessation
program or moxibustion was more effective than acupuncture as monotherapy
with regard to long-term smoking cessation. Further, high quality trials are needed
to confirm the result.
Aim:
The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use.
Methods:
We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence.
Conclusions:
CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.
Background The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region.
Methods We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken.
Results Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers.
Conclusion TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.
Objective
To determine differences in antibiotic prescription rates between conventional General Practice (GP) surgeries and GP surgeries employing general practitioners (GPs) additionally trained in integrative medicine (IM) or complementary and alternative medicine (CAM) (referred to as IM GPs) working within National Health Service (NHS) England.
Design
Retrospective study on antibiotic prescription rates per STAR-PU (Specific Therapeutic group Age–sex weighting Related Prescribing Unit) using NHS Digital data over 2016. Publicly available data were used on prevalence of relevant comorbidities, demographics of patient populations and deprivation scores.
Setting
Primary Care.
Participants
7283 NHS GP surgeries in England.
Primary outcome measure
The association between IM GPs and antibiotic prescribing rates per STAR-PU with the number of antibiotic prescriptions (total, and for respiratory tract infection (RTI) and urinary tract infection (UTI) separately) as outcome.
Results
IM GP surgeries (n=9) were comparable to conventional GP surgeries in terms of list sizes, demographics, deprivation scores and comorbidity prevalence. Negative binomial regression models showed that statistically significant fewer total antibiotics (relative risk (RR) 0.78, 95% CI 0.64 to 0.97) and RTI antibiotics (RR 0.74, 95% CI 0.59 to 0.94) were prescribed at NHS IM GP surgeries compared with conventional NHS GP surgeries. In contrast, the number of antibiotics prescribed for UTI were similar between both practices.
Conclusion
NHS England GP surgeries employing GPs additionally trained in IM/CAM have lower antibiotic prescribing rates. Accessibility of IM/CAM within NHS England primary care is limited. Main study limitation is the lack of consultation data. Future research should include the differences in consultation behaviour of patients self-selecting to consult an IM GP or conventional surgery, and its effect on antibiotic prescription. Additional treatment strategies for common primary care infections used by IM GPs should be explored to see if they could be used to assist in the fight against antimicrobial resistance.
Yoga, a popular mind-body practice, may produce changes in cardiovascular disease (CVD) and metabolic syndrome risk factors.
This was a systematic review and random-effects meta-analysis of randomized controlled trials (RCTs).
Electronic searches of MEDLINE, EMBASE, CINAHL, PsycINFO, and The Cochrane Central Register of Controlled Trials were performed for systematic reviews and RCTs through December 2013. Studies were included if they were English, peer-reviewed, focused on asana-based yoga in adults, and reported relevant outcomes. Two reviewers independently selected articles and assessed quality using Cochrane's Risk of Bias tool.
Out of 1404 records, 37 RCTs were included in the systematic review and 32 in the meta-analysis. Compared to non-exercise controls, yoga showed significant improvement for body mass index (-0.77 kg/m(2) (95% confidence interval -1.09 to -0.44)), systolic blood pressure (-5.21 mmHg (-8.01 to -2.42)), low-density lipoprotein cholesterol (-12.14 mg/dl (-21.80 to -2.48)), and high-density lipoprotein cholesterol (3.20 mg/dl (1.86 to 4.54)). Significant changes were seen in body weight (-2.32 kg (-4.33 to -0.37)), diastolic blood pressure (-4.98 mmHg (-7.17 to -2.80)), total cholesterol (-18.48 mg/dl (-29.16 to -7.80)), triglycerides (-25.89 mg/dl (-36.19 to -15.60), and heart rate (-5.27 beats/min (-9.55 to -1.00)), but not fasting blood glucose (-5.91 mg/dl (-16.32 to 4.50)) nor glycosylated hemoglobin (-0.06% Hb (-0.24 to 0.11)). No significant difference was found between yoga and exercise. One study found an impact on smoking abstinence.
There is promising evidence of yoga on improving cardio-metabolic health. Findings are limited by small trial sample sizes, heterogeneity, and moderate quality of RCTs.
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Complementary medicine (CM) holds an established place of value for health care consumers around the world. Consumers seek CM specifically for the type of clinical care provided by CM practitioners, which is perceived as holistic and individualized. The holistic approach of CM has been described as patient-centered and there are indeed many parallels between the philosophy of holism and the paradigm of patient-centered care (PCC). In light of the contemporary movement toward PCC as a means of improving health care delivery, it is worth exploring CM as a potential existing resource of PCC. This is of particular interest with consideration to the growing burden of chronic disease, the emphasis of PCC in chronic disease management, and the high representation of chronic disease sufferers among CM users. However, there has been minimal investigation into the question of whether the holistic philosophies of CM are translated by CM practitioners into practical, clinical application. The changing landscape of CM practice necessitates a deeper understanding of the nature of CM clinical care to assess the role of CM in the contemporary health care environment.
Medicinal plants and traditional medicines have been used worldwide since ancient times. Currently, there is neither a globally consented terminology nor a harmonized regulatory approach. Nevertheless, it is common sense that quality, efficacy and safety should be assessed following scientific standards, addressing particulars and considering an adequate level of risk management. A global market for traditional medicines is emerging, if not already existing. Therefore, a constructive communication about regulatory systems for herbal and traditional medicinal products should be enforced. Best practice standards might be developed according to current scientific knowledge in order to improve mutual acceptance of data, sets of monographs and assessments. Overall, a convergence of the diverse regulatory systems might save resources and lead to an adequate availability of herbal and traditional medicinal products to the patients without neglecting public health.
People might be attracted to and use complementary and alternative medicines (CAM) because they hold beliefs that are congruent with CAM. This article collates, examines and synthesizes the evidence surrounding this hypothesis. Most studies are cross-sectional and focus on a limited number of beliefs. Multivariate studies suggest that beliefs related to control and participation, perceptions of illness, holism and natural treatments, and general philosophies of life predict CAM use when controlling for demographic and clinical factors. Further research should examine the robustness of these relationships in different illness groups and the prospective relationships among beliefs and CAM use over time.