| Objective:Objective to understand the behavior of psoriasis patients in the outpatient department of Dermatology of Jiangsu Provincial Hospital of traditional Chinese medicine in choosing diagnosis and treatment institutions,visiting doctors,different treatment methods of traditional Chinese and Western medicine,dosage forms of traditional Chinese medicine,traditional treatment methods of traditional Chinese medicine,and analyze the influence of TCM cultivation,economic ability,education level,disease-related factors,and medical insurance policy on their different choices of diagnosis and treatment,In order to guide the rational and standardized choice of Chinese and Western medicine treatment for psoriasis patients in our country,doctors can effectively manage patients,improve the clinical diagnosis and treatment effect,improve the quality of medical service,and provide reference for improving the current health development plan and strategy of Integrated Chinese and Western medicine.Methods:In this study,275 patients with psoriasis who were treated in dermatology clinic from April 2018 to October 2020 were randomly selected as the research objects,and the professionals provided on-site guidance to fill in the questionnaire,so as to ensure the accuracy of the content of the questionnaire.The items were added and deleted according to the pre survey results,and the reliability and validity of the questionnaire were tested;In this study,EpiData was used for data entry,and IBM SPSS 25.0 was used for data collation and analysis.Descriptive analysis was used for classification data,chi square test was used for classification data comparison,and Spearman correlation coefficient was used for correlation comparison between measurement data,P=0.05 as the statistical benchmark.Results:(1)There were statistically significant differences in the proportion of drug reimbursement that psoriasis patients were willing to bear in terms of family debt,medical insurance and related policies,and disease severity(P<0.05).Patients without debt were more willing to accept full self funded treatment drugs,and patients with lighter condition were more likely to accept drugs with lower reimbursement proportion.The more disposable income patients had,the higher they were willing to pay for the treatment of psoriasis(P<0.05).(2)Some of the patients were not aware of the severity of their own diseases.(3)The main flow of patients with psoriasis is from low-level hospitals to high-level hospitals,and from specialized hospitals to general hospitals.There were statistically significant differences in the type of first hospital and medical history(P<0.05).The proportion of patients with first hospital referral≥4 hospitals in prefecture level city and below hospitals was higher than that in provincial or specialized hospitals.The number of patients with medical history>20 years referred≥4 hospitals was the largest,accounting for the largest proportion.The top three reasons for patients to choose current hospitals were "high level of diagnosis and treatment","reliable doctors","standard hospital management and good treatment environment",with 55.7%,42.4%and 22.5%of patients choosing hospitals respectively.(4)There was a significant difference between Chinese medicine and Western medicine in the stage of disease development and the most effective treatment(P<0.05).In the acute stage,the proportion of patients choosing pure Chinese medicine treatment was higher than that in the remission stage and the regression stage.The proportion of patients who thought the most effective treatment was the highest,accounting for 88.5%.The patients chose traditional Chinese medicine treatment mainly for oral and external use,less traditional Chinese medicine treatment(including acupuncture,medicine bath,etc.)and intravenous drip of traditional Chinese medicine.The difference in the age of patients was statistically significant(P<0.001).The patients who chose traditional Chinese medicine treatment were mostly 40-60 years old,The patients who choose intravenous injection of traditional Chinese medicine are mainly between 21 and 40 years old.(5)55.4%of patients chose doctors from the hospital official website,accounting for the largest proportion;The proportion of TCM doctors in traditional Chinese medicine hospital was the highest,accounting for 59.0%.The background of doctors was also considered by some patients.The patients who chose "well-known dermatology experts" were the most,accounting for 46.3%.There was less demand for doctors who carried out traditional treatment(such as acupuncture and cupping),only 11 patients.154 patients(71.0%)paid more attention to doctors who visited carefully.(6)The most commonly used oral dosage forms of TCM were Decoction and granule,accounting for 56.3%and 39.7%respectively;The difference of oral dosage form in age,education level,whether to deal with chronic diseases in outpatient department,and treatment mode was statistically significant(P<0.05).The choice of pills was mostly in 41-60 years old patients,and the choice of Chinese patent medicine granules and tablets was mostly in 21-40 years old patients;Compared with junior high school or technical secondary school,the proportion of pills and semi-solid agents chosen by patients with education level of junior college or undergraduate is higher;The proportion of patients with slow process is higher than that of patients without process;The proportion of patients who choose pure Chinese medicine treatment is higher than other treatment methods,and no one chooses pills.Most patients chose ointment and lotion for external use,accounting for 62.0%and 43.9%respectively.There were statistically significant differences in age,education level,family debt,chronic disease,disease development stage and treatment choice(P<0.05).The most patients who chose oil were 41-60 years old,and the proportion of oil and ointment in this age group was higher than other preparations,accounting for 22.4%and 33.9%respectively;The patients in junior high school or technical secondary school chose ointment more than other dosage forms,accounting for 45.1%,which was higher than other cultural levels.The patients who chose ointment and medical moisturizing milk mostly concentrated in college or undergraduate level,with 35 and 49 respectively;The patients without foreign debt chose lotion,oil and ointment more than those with foreign debt;The proportion of the patients without chronic diseases in choosing lotion,ointment and medical moisturizer was higher than that of the patients with chronic diseases.The application of medical moisturizing milk in acute stage was higher than that in other stages,accounting for 19.9%.Most patients choose aerosol in remission period.The choice of pure Chinese medicine treatment of patients,choose medical moisturizing milk more than other treatment,choose oil most of the patients choose the combination of traditional Chinese and Western medicine treatment.(7)In addition to external application of traditional Chinese medicine,56.9%of the patients had tried external treatment of traditional Chinese medicine,followed by traditional Chinese medicine bath,accounting for 19.7%.There were differences in the effective rate of different treatment methods(P<0.001),and the effective rate of traditional Chinese medicine was the highest.Only 6.5%of the patients had used acupuncture to treat psoriasis.Moxibustion,pricking and cupping,and surrounding needling were the top three treatment methods that patients were willing to try.4.7%of the patients had self blood therapy for psoriasis.The main reasons for patients not willing to try self blood therapy were "easily infected with blood borne diseases","not carried out in hospital","not knowing","no time","high price".4.0%of the patients had used cupping therapy,and 88.7%of the patients did not know about it.Conclusion:(1)The disposable income of patients with psoriasis is positively correlated with the acceptable amount of medical expenditure.(2)Patients’ correct cognition of their own condition plays an important role in their behavior in the process of medical treatment.Medical institutions and community services should strengthen the publicity of psoriasis related knowledge,promote reasonable and scientific medical treatment,and avoid excessive medical treatment.(3)From the perspective of long-term treatment,patients tend to have better medical resources,higher level and more authoritative medical experts in the region.(4)The patients’ choice of Chinese and Western medicine was influenced by the disease development stage,past efficacy,personal views and age.(5)The compliance of patients to take traditional Chinese medicine varies from person to person.Patients have more choices for decoction and granules.The choice of oral dosage form gives priority to the side effects and efficacy of drugs.The choice of age,education level,medical insurance policy and treatment mode affects the choice of oral dosage form.The texture and sense of use were given priority in patients’ choice of external dosage forms,and more patients chose lotion and ointment.The patients’ choice of topical preparation is affected by the disease development stage,age,education level,debt and chronic disease.(6)Due to the lack of understanding of traditional Chinese medicine,the neglect of characteristic diagnosis and treatment specialty construction,the imperfect compensation mechanism and other factors,patients rarely choose traditional Chinese medicine treatment to alleviate the condition of psoriasis.It is suggested that the government,hospitals,doctors and individuals should work together to establish a correct medical behavior. |
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