臨床環境對針灸執業型態的影響：醫學中心與中醫醫院、診所之比較

How does Clinical Setting Affect Acupuncture Practice in Taiwan: a comparison between Chinese Medicine Physicians Practicing in General Hospitals and in Chinese Medicine hospitals and Clinics

目的：瞭解執業環境（醫院，中醫醫院與中醫診所）對於針刺使用的影響。材料與方法：採用自填式問卷進行橫斷面調查，內容包括醫師個人資料、針刺及其他療法使用範圍，及下背痛的診斷方式與針刺治療；共發送867 名中醫師。結果：本研究發出403 份問卷給醫院與中醫醫院執業針灸之中醫師，回收177 份，回覆率40.2%；發出464 份問卷給中醫診所執業針灸之中醫師，回收206 份，回覆率40.3%。在醫院職業者女性比例較高，年紀較輕，臨床經驗較少，但更多地參與教學和投稿文章。大部分醫師畢業於中國醫藥大學中醫學系（45%）或學士後中醫學系（50%）。中醫特考中醫師在診所執業（39%）的比醫院多（5%）。醫院與診所在使用治療方法的頻率，針刺治療的疾病類別，診斷技術、工具及留針時間和治療頻率出現顯著差異；針刺技術和針灸穴位的選擇無明顯差異。結論：臨床環境可以較明顯的影響針刺的使用，如治療疾病類別、留針時間和治療頻率；中醫師性別、教育與訓練以及臨床經驗年數等因素也有影響。

 

Objectives: To understand how clinical environment affects acupuncture practice in general hospitals, Chinese medicine (CM) clinics and hospitals. Design and Outcome Measures: A self-reported questionnaire comprising questions of demographic data, general use of acupuncture and other CM therapeutic methods, and diagnosis/treatment of low back pain, was adopted in this cross-sectional survey and sent to 867 CM physicians. Results: 403 questionnaires were sent to general hospitals and Chinese medicine hospitals and 464 to the Chinese medicine clinics. In the first group177 questionnaires were returned (we excluded 15 incomplete questionnaires), and the response rate was 40.2%. In the second group, 206 questionnaires were returned (we excluded 19 incomplete questionnaires), and the response rate was 40.3%. The respondent physicians practicing in general hospitals were more often female, younger and had less clinical experience but were more involved in teaching and publishing articles. A majority of them graduated from a School of Chinese Medicine (45%); or the School of Post-baccalaureate Chinese Medicine (50%). The proportion of doctors certified by the Special License Qualification Examination was higher (39%) in clinics than in hospitals (5%). Significant differences appeared between general hospitals versus CM clinics and hospitals regarding the frequency of use of therapeutic methods, the categories of disease treated by acupuncture, the chosen diagnostic techniques, as well as the needle retention time, and the frequency of treatment per patient. There were no substantial differences with regards to needle techniques and the choice of acupuncture points. Conclusion: This study suggests that the clinical setting can considerably influence the use of acupuncture such as the categories of disease treated, the retention time of the needles, and frequency of treatment. Factors such as gender, training, and the number of years of clinical experience of the physician also played a part.