Utilization and stakeholder perspectives on traditional Chinese medicine in Taiwan's integrated home-based medical care: a mixed-methods study
Pin-Shuan Chen, Chung Hua Hsu, Yu-Hwei Tseng
Abstract
BACKGROUND: In 2019, traditional Chinese medicine (TCM) was incorporated into Taiwan's Integrated Home-Based Medical Care program (iHBMC). This study examines the implementation and challenges of this initiative. METHODS: This sequential mixed-methods study included a retrospective analysis of medical records from 116 patients who received TCM home visits at Taipei City Hospital between 2019 and 2022. Descriptive statistics were used to summarize patient characteristics, TCM modalities, and visit frequencies. For the qualitative component, shadowing observations and in-depth interviews were conducted with 20 patients, caregivers, and healthcare providers. Qualitative data were analyzed using the constant comparison method and content analysis to identify perceived benefits and challenges of home-based TCM. Quantitative and qualitative findings were integrated to provide a comprehensive understanding of service implementation and experiences. RESULTS: Of 116 patients receiving home-based TCM, most were aged 81+ and diagnosed with circulatory, musculoskeletal, or psychiatric conditions. Acupuncture and herbal medicine were the main modalities. TCM physicians provided more frequent visits than other home care professionals, especially in long-term cases, facilitating close monitoring and timely adjustments. Patients and caregivers reported symptom relief, improved function, and psychosocial support from regular TCM visits. Key challenges included limited interdisciplinary collaboration, high workload, suboptimal home settings, and concerns about polypharmacy and herb-drug interactions. Participants emphasized the need for improved team communication and clear guidelines for integrated care. CONCLUSION: Integrating TCM into the iHBMC program offers benefits for older adults with chronic or complex conditions. However, maximizing these benefits will require policies that foster interprofessional collaboration, address practical challenges, and strengthen guidelines for safe integration. Enhancing communication among stakeholders is essential to optimizing patient outcomes and service quality within home-based care.