Zhong xi yi jie he lin chuang zheng ju de ying yong ji yan jiu

Echoing the recommendations from the World Health Organization (WHO) Traditional Medicine Strategy 2014-23, the concept of evidence-based healthcare (EBHC) was incorporated into the integration of traditional and complementary medicine (T&CM) with national health system.This thesis investigated how the use of EBHC approach guided the integration of T&CM with the national health system in Hong Kong context. As Chinese medicine (CM) is a major type of T&CM in Hong Kong, four studies were conducted to explore the integration from three perspectives related to CM service delivery, namely service standards, health information and health workforce, within the Hong Kong health system.Firstly, to improve the standard of CM service, consensus on recommending evidence-based CM interventions for cancer palliative care were built among twelve Hong Kong clinical experts via the GRADE-ADOLOPMENT approach. Three out of seven evidence-based interventions reached positive consensus as service recommendations. These recommendations were i) acupuncture and ii) acupressure for reducing fatigue among palliative cancer patients; and iii) moxibustion for reducing nausea and vomiting among patients receiving chemotherapy.Secondly, to guide future investment in the development of evidence-based health information, CM clinical research questions were prioritized by twelve international experts in cancer palliative care using a two-round Delphi survey. Eight research priorities reached positive consensus after the two-round survey. Six of them focused on acupuncture and related therapies for pain, fatigue, insomnia, anxiety, xerostomia, paresthesia and dysesthesia while two related to Chinese herbal medicine (CHM) for constipation and anemia.Thirdly, given the Chinese medicine practitioner (CMP) workforce play an important role in determining the use of evidence in clinical practice, individual qualitative face-to-face interviews were performed to explore their beliefs and attitudes of applying evidence-based synopses of systematic reviews (SRs) and randomized controlled trials (RCTs) in routine practice (n=15). Analysis of the interviews identified eleven constructs and sub-constructs within four Consolidated Framework for Implementation Research (CFIR) domains: intervention characteristics, outer setting, inner setting and characteristics of individuals. Facilitators which promoted the application of results from synopses of clinical evidence in CMPs’ routine practice included adaptability, external policy and incentives, and leadership engagement while barriers included complexity, culture, available resources, knowledge and beliefs about the intervention. The remaining four constructs acted as both barriers and facilitators.Fourthly, to address some of the barriers described above, an EBHC education workshop was tailored for Hong Kong CMPs. CMPs who completed the workshop (n=59) demonstrated significant improvements in the attitude and knowledge domains of the Evidence-based Practice Questionnaire (EPQ). Significant improvements were also observed in the attitude, perceived behavioural control, decision making, and intention and behaviour domains of the Evidence-based Practice Inventory (EPI).To conclude, this thesis suggests the following policy recommendations: i) to design theory-based customized implementation strategies for promoting the implementation of evidence-based CM service recommendations; ii) to invest in the identified clinical research priorities which helps reduce research waste; iii) to incorporate EBHC education into current CMP curricula, and iv) to disseminate synopses of existing clinical evidence via the public access website.為促進香港中醫藥的發展，香港特區政府遵循《世界衛生組織傳統醫學戰略2014至2023年》的重點方向，以「循證醫學」為本推動本地中西醫結合的政策和措施。本論文試利用概念框架，把中醫與香港醫療系統以「循證醫學」的方式結合，並從醫療服務標準、健康衛生資訊及人力資源規劃三方面，探討如何實踐中西醫結合臨床證據的應用及研究。本論文的第一部份邀請了12名香港專家，包括西醫、中醫和護士，進行Delphi專家問卷，透過GRADE-ADOLOPMENT方法制訂本地中醫在癌症紓緩治療的臨床建議，旨在提高中醫服務標準。結果顯示，達成專家共識的臨床建議如下: 使用針灸或穴位按摩改善疲勞症狀，以及艾灸改善化療引起的噁心和嘔吐。第二部份則邀請了12名國際專家，包括西醫、中醫、護士及臨床研究方法學家，參與Delphi專家問卷，確定中醫在癌症紓緩治療領域的優先臨床研究課題，旨在提供更多具實證的健康資訊。結果表明，在有限的研究資源下，我們應先進行臨床研究，探討針灸及相關療法能否改善正接受癌症紓緩治療患者的症狀。由於中醫師在應用臨床證據上扮演著重要的角色，因此第三部份邀請了15名香港中醫師，進行面對面訪談，以探討他們對在臨床上應用相關概要的看法。結果指出，應用概要之主要障礙為中醫師對「循證醫學」的認知不足，而且缺乏相關培訓，以致無法掌握其應用，甚至存在偏見。基於第三部份的結果，本論文的第四部份向59名香港中醫師提供「循證醫學」實踐證書課程。透過網上問卷評估發現，課程可有效改善他們對「循證醫學」的認知及態度。總的而言，本論文提供下列政策建議，從中醫方面推廣以「循證醫學」為本的中西醫結合發展:一. 研究實踐中醫臨床建議的利弊，再訂立合適的實施方案;二. 為減少研究浪費，未來的研究資源應著重分配在已確定的中醫優先臨床研究課題;三. 可考慮將「循證醫學」實踐證書課程納入目前的中醫常規培訓中;四. 以及，在網頁上發放基於現有中西醫結合臨床證據的概要，供公眾人士瀏覽。Wong, Hoi Lam Charlene."November 2019."Ph.D. Chinese University of Hong Kong 2020.Includes bibliographical references (leaves 146-162).Abstracts and appendix 4 also in Chinese.Title from PDF title page (viewed on September 6, 2022).Wong, Hoi Lam Charlene