基层卫生技术人员中医药适宜技术使用偏好研究：基于离散选择实验

BackgroundThe promotion of appropriate traditional Chinese medicineTCMtechniques in primary care institutions is an important measure emphasizing the co-development of Chinese and western medicineand enhancing the inheritance and development of TCM. Objective To analyze primary health workerspreferences for the use of appropriate TCM techniquesproviding 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 surveyand the questionnaire has three versionseach version with evenly allocated six choice setsincluding an opt-out option. Additionallythe three versions have a common general demographic partsexageeducation levelprofessional titleetc.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 easterncentral and western Chinaone county was extracted from each regionand 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 analysisresulting 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. Furthermorethe 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 insurancethe average duration of each operation with the TCM techniquethe influence of operation with the TCM technique on incomework burdenthe promotion of professional titleand patient healthcare costas 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 techniques16.2%was -3.660 P<0.001while that for those supporting the use of TCM techniques83.8%was 2.189 P<0.001. Moreoverthose 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 efficacious =1.275and those supporting the use of TCM techniques showed no significant preference for those with unchangeable effectiveness =0.054. Conclusion Primary health workers prefer to use appropriate TCM techniques that can increase their income without workload increasefacilitate their professional title promotionretain or reduce patient costsand are covered by health insurance and have good efficacy. To effectively promote primary health workers enthusiasm in the use of appropriate TCM techniquesit is suggested to add these techniques to the medical insurance reimbursement listand make a connection between the use of these techniques and title promotion. In additiondifferent incentive strategies should be adopted for different types of primary health workers.