Preferences for the Use of Appropriate TCM Techniques among Primary Health Workers: a Discrete-choice Experiment-based Study

Abstract

Background The promotion of appropriate traditional Chinese medicine (TCM) techniques in primary care institutions is an important measure emphasizing the co-development of Chinese and western medicine, and enhancing the inheritance and development of TCM. Objective To analyze primary health workers'preferences for the use of appropriate TCM techniques, providing policy recommendations for the promotion and use of such techniques in primary healthcare institutions. Methods This questionnaire survey was conducted between July and August 2021. A discrete choice model with seven attributes and 18 choice sets obtained through the use of an efficient orthogonal design were used to develop the questionnaire used in the survey, and the questionnaire has three versions each version with evenly allocated six choice sets (including an opt-out option). Additionally, the three versions have a common general demographic part (sex, age, education level, professional title, etc.) and one common consistency test question. A randomized multistage stratified cluster sampling was used to select 319 health workers on duty on the survey day from a total of 23 primary healthcare institutions in three counties in eastern, central and western China (one county was extracted from each region), and each worker was required to complete one version of the questionnaire extracted sequentially by themselves. Two hundred and ninety-five cases who returned a questionnaire passing a consistency test were included for analysis, resulting in a response rate of 92.5%. Primary health workers' preferences for appropriate TCM techniques were analyzed using conditional Logit models and latent class models. Furthermore, the changes in utility of primary health workers due to attribute level changes were monetized using willingness to pay and presented accordingly. Results The conditional Logit analysis showed that medical insurance, the average duration of each operation with the TCM technique, the influence of operation with the TCM technique on income, work burden, the promotion of professional title, and patient healthcare cost, as well as effectiveness of the TCM technique were associated with primary health workers' preferences for the use of appropriate TCM techniques (P<0.05). The latent class model revealed that the opt-out option coefficient for those holding a wait-and-see attitude toward the use of TCM techniques (16.2%) was -3.660 (P<0.001), while that for those supporting the use of TCM techniques (83.8%) was 2.189 (P<0.001). Moreover, those holding a wait-and-see attitude toward the use of techniques exhibited a stronger preference for appropriate TCM techniques that have been proven to be more efficacious (β=1.275), and those supporting the use of TCM techniques showed no significant preference for those with unchangeable effectiveness (β=0.054) . Conclusion Primary health workers prefer to use appropriate TCM techniques that can increase their income without workload increase, facilitate their professional title promotion, retain or reduce patient costs, and are covered by health insurance and have good efficacy. To effectively promote primary health workers' enthusiasm in the use of appropriate TCM techniques, it is suggested to add these techniques to the medical insurance reimbursement list, and make a connection between the use of these techniques and title promotion. In addition, different incentive strategies should be adopted for different types of primary health workers.

Keywords

• traditional chinese medicine therapy|community health services|community health workers|preference|discrete choice experiment|conditional logistic regression analysis|latent class analysis