P1045misaligned Expectations on Integrative Medical Service for Diabetes and Diabetic Kidney Disease: A Comparative Focus Group Series of Patients and Physicians

Abstract

Background and Aims Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We sought to explore the barriers and recommendations regarding IM service among diabetes and diabetic kidney disease (DKD) patients and physicians. Method A 10-group, 50-participant semi-structured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities and education levels; and 29 physicians (14 western medicine (WM) and 15 Chinese medicine (CM)) with diverse clinical experience, academic background and affiliation were purposively sampled from private and public clinics. The perspectives were qualitatively analysed by constant comparative method with grounded theory approach. Results Seven subthemes regarding barriers towards IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology and access to medical records. Patients underreported the use of CM due to the concern over neutrality of medical advice among physicians. Practical issues including inconvenience of access to service, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, WM physicians emphasized standardization and reproducibility while CM physicians emphasized personalization. Some CM-related outcome measurements were suggested as abstract and non-communicable. Both WM and CM physicians acknowledged the discordance in epistemology should be addressed by pragmatic approach. Conclusion Further assessment on IM should be pragmatic to balance between standardisation, reproducibility and real-world practice. Evidence-based IM programs and research should merge with existing infrastructure.