| ObjectiveThe current situation in China is characterized by a severe and rapidly growing aging population,with home-based care being the primary form of elderly care.Traditional Chinese medicine(TCM)is expected to play a great significant role in the future healthcare and elderly care system.This study uses Actor Network Theory,Stakeholder Theory,Andersen’s Health Service Utilization Model,etc.as the theoretical analysis framework to comprehensively review and summarize the roles and issues in the supply and demand of TCM services for home-based elderly care in Zhejiang Province.The research analyzes the criteria and pathways for establishing and sustaining TCM service organization for homebased elderly care and for promoting their effectiveness.It aims to construct a comprehensive,continuous,coordinated,and standardized TCM service model for home-based elderly care in Zhejiang Province,which can be widely replicated and implemented.Our goal is to provide a"Zhejiang model" that could serve as a unique contribution in addressing the challenges of an aging society in China.Methods1.Literature reviewIn this study,the Citespace bibliometric software is employed to conduct a systematic and visual analysis of domestic and international literature on home-based elderly care,the integration of medical and nursing,and care the service capabilities of traditional Chinese medicine.This analysis establishes the theoretical and literature foundation for the research.2.Policy text analysisThis study draws on Roswell and Zegfeld’s classification method of policy tools to conduct a quantitative study on 90 TCM health care policy texts issued at the national and Zhejiang provincial levels between January 2012 and August 2023.This analysis aims to identify the characteristics and issues within these policies.3.Questionnaire survey methodThis study adopts a multi-stage stratified cluster random sampling method,and selects Hangzhou,Taizhou,and Jinhua as sample cities according to the per capita GDP stratification of cities in Zhejiang Province in 2021.Field surveys was conducted with 1762 elderly individuals receiving home-based care and 24 medical institutions,including TCM hospitals and community health service centers.The surveys aim to understand the utilization and supply of traditional Chinese medicine services for home care in Zhejiang Province and possible problems.4.In-depth interview methodThis study conducted in-depth interviews with relevant stakeholders,such as the recipients of home-based care(the elderly)and service providers(healthcare institutions,social organizations,and research institutions).These interview seek to gain insights into the current issues and challenges of TCM services for home care and to gather suggestions.5.Expert consultation methodTwo rounds of expert consultation was conducted,by using stakeholder theory analysis,and surveyed experts in different fields such as traditional Chinese medicine and management,as well as staff from different departments such as health,civil affairs,and traditional Chinese medicine management,to identify the multiple stakeholders of home-based elderly care traditional Chinese medicine services.This information serves as a foundation for building the model for traditional Chinese medicine services in home-based elderly care in Zhejiang Province6.Statistical analysis methodBased on the data characteristics and research needs,ArcGIS software was used to conduct geospatial analysis.Through spatial autocorrelation analysis and Gaussian two-step moving search method,the geospatial distribution of medical resources and the spatial accessibility of public traditional Chinese medicine hospitals in Zhejiang Province were analyzed and create visual maps.AMOS 21.0 software was used to construct a structural equation model and analyze Factors affecting the demand for traditional Chinese medicine services in home-based elderly care.SAS 9.4 software was used for Logistic regression to analyze the influencing factors that influence the utilization of traditional Chinese medicine services in home-based elderly population.Results1.The quantitative analysis of policy text at both the national and provincial level shows a significant focus on traditional Chinese medicine and elderly care.The policies are issued in a timely manner,service measures are solid,and incentives and guarantees are in place.However,there is room for further improvement in three aspects.Firstly,the policy tool structure Sexual disorders are mainly concentrated in the supply-type and environmental-type,and demand-based policy tools such as insurance support and tax incentives are insufficiently used.Secondly,the policy system is unbalanced,and the traditional Chinese medicine health and elderly care policy affects the service objects and the service methods adopted.Thirdly,the policy tools are unbalanced in the social elderly care service system,and there are few demand-oriented service methods and service contents.2.Research on the Utilization of Traditional Chinese medicine Service in Home-Based Elderly Care.The research results on the demand and utilization of home-based elderly care Chinese medicine services show that:(1)there is a large objective demand for home-based elderly care Chinese medicine services in Zhejiang Province,but the demand is still insufficient,and the utilization level needs to be further improved.The data shows that the prevalence of chronic diseases among the elderly is 61.58%,the average demand score for traditional Chinese medicine services is 10(6,13),and the utilization rate of traditional Chinese medicine services is 36.55%.(2)Factors influencing the demand for TCM services include knowledge of Chinese medicine culture,belief in Chinese medicine,average monthly household income,and health status.Factors affecting the utilization of traditional Chinese medicine services in home-based elderly care include gender,urban or rural residence,preretirement occupation,chronic illness,health insurance,belief in Chinese medicine,and attendance of Chinese medicine knowledge seminars(all P<0.05).(3)In-depth interviews with the home-based elderly care population revealed that there are still problems in the utilization of traditional Chinese medicine services in home-based elderly care,such as insufficient grassroots Chinese medicine diagnosis and treatment capabilities,doubts about the efficacy and safety of traditional Chinese medicine,and the insufficient role of the community in traditional Chinese medicine elderly care.3.Research on the Supply of TCM services in Home-Based Elderly care.The research results on the supply of traditional Chinese medicine services for home-based elderly care show that:(1)the allocation of traditional Chinese medicine resources in Zhejiang Province is generally improving.From 2018 to 2020,the number of TCM hospitals and grassroots medical institutions,the number of TCM hospitals and grassroots medical institutions and the total number of beds increased steadily;the proportion of TCM practitioners and pharmacists decreased;the number of diagnosis and treatment patients showed a trend of first increasing and then decreasing,but the use of TCM hospitals The proportion of traditional Chinese medicine practitioners continues to rise,and the proportion of traditional Chinese medicine practitioners in primary medical institutions remains stable;the proportion of financial allocations is small,but it is on an upward trend.(2)The area with better medical resources of various medical institutions in Zhejiang Province is Hangzhou City,and the worse area is Taizhou City;there is global spatial correlation and local autocorrelation,high-high agglomeration areas are mainly concentrated in Hangzhou City,and low-low aggregation areas Mainly concentrated in Wenzhou City;the areas with better medical resources for public TCM hospitals in Zhejiang Province are Hangzhou and Huzhou,and the public TCM hospitals in Quzhou and Jinhua have higher geographical accessibility.(3)The current status of traditional Chinese medicine services is relatively good.The survey of institutions in the sample areas shows that community health service centers(township health centers)provide rich types of traditional Chinese medicine services in various forms;the availability rate of basic traditional Chinese medicine equipment is relatively high.(4)In-depth interviews with medical institution personnel revealed that there are still problems such as a lack of supportive policies and incentive guarantee systems,insufficient human resources at the grassroots level,and insufficient government investment.4.Based on the analysis framework of Actor Network Theory and Stakeholder Theory,this study sorted out 8 categories of human actors and 3 categories of non-human actors in home care traditional Chinese medicine services and clarified that government departments are the most critical core actors.Based on this analysis,a model of the actor network for home-based elderly care with traditional Chinese medicine services is constructed.This model summarizes the functional roles,interests,actions,and issues of each actor in the network,both as service providers and recipients.The relationships of each subject in the network are mainly allocated under the organization of the core actor(the government),so as to form a stable TCM service actor network for home-based elderly care.ConclusionThe traditional Chinese medicine and elderly care policies formulated at the national and Zhejiang provincial levels are relatively comprehensive,but policy tools are mainly concentrated in supply-based and environmental-based policies,and demand-based policy tools are rarely used.There is a large objective demand for home-based elderly care TCM services in Zhejiang Province,but the demand is still insufficient and the utilization level needs to be further improved.The allocation of traditional Chinese medicine resources in Zhejiang Province is generally good,but there are problems such as insufficient growth in traditional Chinese medicine personnel,a small proportion of financial investment,and uneven distribution of medical resources.This study is based on the analysis framework of actor network theory and stakeholder theory,combined with the role and existing problems of both supply and demand sides of home care traditional Chinese medicine services in Zhejiang Province,and based on the principles of model construction,realistic constraints and basic requirements,and proposes a comprehensive and continuous approach to give full play to the role of multiple subjects and establish and improve a multiple co-governance mechanism.,standardized and coordinated "1616" Zhejiang Province home-based elderly care traditional Chinese medicine service model. |
PDF Full Text Request