Survey of Clinical Practice Patterns of Korean Medicine Doctors for Anorexia in Children: A Preliminary Study for Clinical Practice Guidelines
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Questionnaire Development
2.3. Distribution and Collection of Questionnaires
2.4. Statistical Analyses
3. Results
3.1. Demographic Characteristics of the Respondents
3.2. Diagnosis Used for Children with Anorexia
3.3. KM Treatments for Children with Anorexia (Intervention)
3.4. Perception
3.5. Safety and Effectiveness
3.6. Information to Be Included in the CPGs
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Factors | N (%) | |
---|---|---|
Age (years) | 20–29 | 27 (7) |
30–39 | 138 (35.9) | |
40–49 | 136 (35.4) | |
50–59 | 66 (17.2) | |
≥60 | 17 (4.4) | |
Sex | Male | 278 (72.4) |
Female | 106 (27.6) | |
Clinical experience (years) | ≤4 | 57 (14.8) |
5–9 | 109 (28.4) | |
10–19 | 118 (30.7) | |
20–29 | 76 (19.8) | |
≥30 | 24 (6.3) | |
Place of work | Seoul | 129 (33.6) |
Gyeonggi | 91 (23.7) | |
Busan | 20 (5.2) | |
Daegu | 18 (4.7) | |
Special training | No | 266 (69.3) |
Yes | 118 (30.7) | |
Name of the academic society for specialist training (if applicable) | The Society of Internal Korean Medicine | 37 (31.4) |
Korean Acupuncture and Moxibustion Medicine Society | 23 (19.5) | |
The Society of Korean Medicine Obstetrics and Gynecology | 18 (15.3) | |
The Society of Korean Medicine Pediatrics | 10 (8.5) | |
The Society of Korean Medicine Rehabilitation | 10 (8.5) | |
The Society of Korean Medicine Ophthalmology, Otolaryngology & Dermatology | 9 (7.6) | |
The Society of Sasang Constitutional Medicine | 6 (5.1) | |
The Society of Korean Medicine Neuropsychiatry | 5 (4.2) | |
Affiliated medical institution | Primary KM clinic | 254 (66.1) |
University-affiliated KM hospital | 36 (9.4) | |
KM hospital (not a university affiliated hospital) | 36 (9.4) | |
Specialized KM clinic (KM clinic providing specialized treatment for specific diseases) | 28 (7.3) | |
Monthly average number of first-time pediatric patients with anorexia that were encountered in the last month | ≤5 | 309 (80.5) |
6–10 | 53 (13.8) | |
11–20 | 13 (3.4) | |
21–30 | 4 (1.0) | |
31–40 | 1 (0.3) | |
≥41 | 4 (1.0) | |
Average treatment period for children with anorexia in the last year | <1 month | 120 (31.3) |
≥1 month to <3 months | 201 (52.3) | |
≥3 months to <6 months | 36 (9.4) | |
≥6 months to <1 year | 21 (5.5) | |
≥1 year to <3 years | 4 (1.0) | |
≥3 years | 2 (0.5) | |
Average treatment cost per treatment for children with anorexia in the last year (copay) (Won) (If an herbal decoction is included, it is calculated by dividing the total dose by the number of treatment days) | <5000 | 9 (2.3) |
≥5000 to <10,000 | 45 (11.7) | |
≥10,000 to <20,000 | 180 (46.9) | |
≥20,000 to <50,000 | 72 (18.8) | |
≥50,000 to <100,000 | 21 (5.5) | |
≥100,000 | 57 (14.8) | |
Age range of the children with anorexia that were being treated (multiple responses allowed) | Infants (≥1 month to <1 year) | 17 (2.4) |
Preschool children (≥1 year to <7 years) | 267 (38.2) | |
Children in early elementary school (7–9 years) | 245 (35.1) | |
Children in the upper grade of elementary school (10–12 years) | 104 (14.9) | |
Middle school students (13–15 years) | 40 (5.7) | |
High school students and above (≥16 years) | 26 (3.7) |
Factors | N (%) | |
---|---|---|
Diagnostic methods used for children with anorexia 1 | Diagnosis based on the clinical features | 288 (36.4) |
Pattern identification—Qi, Blood, Fluid, Humor, and Organ system diagnosis based on KM textbooks | 260 (32.8) | |
Pattern identification—Sasang constitutional diagnosis | 101 (12.8) | |
Pattern identification—Six-Meridian pattern identification based on “Cold Damage Medicine” | 30 (3.8) | |
KM diagnostic device | 29 (3.7) | |
Pattern identification—Hyungsang Constitutional medicine | 26 (3.3) | |
Korean Children’s Eating Behavior Questionnaire | 24 (3.0) | |
Blood and urine test | 19 (2.4) | |
Pattern identification—Eight Constitution medicine | 11 (1.4) | |
Title of frequently used pattern identification 1 | Spleen-stomach qi deficiency | 244 (38.6) |
Spleen failure in transportation | 147 (23.3) | |
Stomach yin deficiency | 98 (15.5) | |
Liver depression | 90 (14.2) | |
Milk and food damage | 43 (6.8) | |
Others | 10 (1.6) | |
Diagnostic equipment used for children with anorexia 1 | Height and weight measurement | 281 (43.6) |
Bioelectrical impedance analysis (InBody) | 133 (20.7) | |
None | 73 (11.3) | |
KM diagnostic device—Heart Rate Variability | 59 (9.2) | |
Blood and Urine Test | 22 (3.4) | |
KM diagnostic device—Electro Pulse Graph | 19 (3.0) | |
KM diagnostic device—Yangdorak Diagnosis | 18 (2.8) | |
Digital Infrared Thermal Imaging | 15 (2.3) | |
KM diagnostic device—Tongue Diagnosis | 9 (1.4) | |
KM diagnostic device—Constitutional Diagnosis | 5 (0.8) | |
KM diagnostic device—Iris Diagnosis | 4 (0.6) | |
Others | 6 (0.9) | |
Do you agree that the diagnostic criteria of anorexia for children aged 0–3 years should be applicable to all children (0–19 years)? | Yes | 297 (77.3) |
No | 54 (14.1) | |
I do not know | 33 (8.6) |
Factors | N (%) | |
---|---|---|
Treatment 1 | Herbal medicine | 375 (38.1) |
Acupuncture | 211 (21.5) | |
Moxibustion | 153 (15.6) | |
Dietetic therapy | 96 (9.8) | |
Cupping therapy | 58 (5.9) | |
Electroacupuncture | 39 (4.0) | |
Manipulation/Exercise therapy | 37 (3.8) | |
Pharmacopuncture | 13 (1.3) | |
Type of herbal medicine formulation 1,2 | Compound herbal decoction | 363 (57.1) |
Soft extract covered by insurance | 57 (9.0) | |
Mixture of soluble granules covered by insurance | 56 (8.8) | |
Soft extract not covered by insurance | 43 (6.8) | |
Mixture of soluble granules not covered by insurance | 34 (5.3) | |
Distillate of compound herbal decoction | 32 (5.0) | |
Powder preparation | 25 (3.9) | |
Pill preparation | 24 (3.8) | |
Name of herbal medicine 1,2 | Sogunjung-tang | 223 (16.5) |
Hyangsayukgunja-tang | 214 (15.9) | |
Bojungikgi-tang | 187 (13.9) | |
Samchulgeonbi-tang | 161 (11.9) | |
Hyangsayangwi-tang | 130 (9.6) | |
Insamyangwi-tang | 90 (6.7) | |
Jeonssiigong-san | 84 (6.2) | |
Samryeongbaekchul-san | 81 (6.0) | |
Bihwa-eum | 37 (2.7) | |
Bohwa-hwan | 36 (2.7) | |
Haeulgeonbi-tang | 12 (0.9) | |
Sosik-hwan | 12 (0.9) | |
Single herb 1,2 | Atractylodis Rhizoma Alba | 321 (18.5) |
Citri Pericarpium | 228 (13.1) | |
Crataegii Fructus | 210 (12.1) | |
Hordei Fructus Germiniatus | 201 (11.6) | |
Massa Medicata Fermentata | 199 (11.4) | |
Glycyrrhizae Radix | 167 (9.6) | |
Poria | 161 (9.3) | |
Atractylodis Rhizoma | 123 (7.1) | |
Galli Stomachichum Corium | 48 (2.8) | |
Other—Ginseng Radix | 11 (0.6) | |
Other—Cervi Pantotrichum Cornu | 9 (0.5) | |
Herbal medicine treatment duration 2 | <1 month | 70 (18.7) |
≥1 month to <3 months | 218 (58.1) | |
≥3 months to <6 months | 73 (19.5) | |
≥6 months to <1 year | 10 (2.7) | |
≥1 year to <3 years | 3 (0.8) | |
≥3 years | 1 (0.3) | |
Style of acupuncture 1,2 | Meridian points acupuncture | 169 (45.7) |
Dermal needle | 48 (13.0) | |
Intradermal needle | 47 (12.7) | |
Sa-am acupuncture therapy | 43 (11.6) | |
Acupoints used for acupuncture 1,2 | ST36 | 172 (25.0) |
CV12 | 144 (20.9) | |
PC6 | 96 (13.9) | |
ST25 | 54 (7.8) | |
SP6 | 43 (6.2) | |
CV4 | 42 (6.1) | |
Acupoints used for moxibustion 1,2 | CV12 | 120 (54.5) |
CV4 | 29 (13.2) | |
ST36 | 21 (9.5) | |
ST25 | 11 (5.0) | |
Type of dietetic therapy 1,2 | Dietetic therapy based on KM theory | 62 (51.7) |
Dietetic therapy based on nutritional science | 55 (45.8) |
Clinical Experience | ||||||
---|---|---|---|---|---|---|
Treatment | ≤4 Years (n = 57) (n (%)) | 5–9 Years (n = 109) (n (%)) | 10–19 Years (n = 118) (n (%)) | 20–29 Years (n = 76) (n (%)) | ≥30 Years (n = 24) (n (%)) | p-Value (Χ2 Test) |
Herbal medicine | 54 (94.7) | 106 (97.2) | 115 (97.5) | 76 (100) | 24 (100) | 0.016 |
Acupuncture | 37 (64.9) | 71 (65.1) | 65 (55.1) | 20 (26.3) | 18 (75) | <0.001 |
Moxibustion | 26 (45.6) | 52 (47.7) | 50 (42.4) | 9 (11.8) | 16 (66.7) | 0.068 |
Statements | N (%) | |
---|---|---|
1. From your treatment experience, what is the overall effect of KM treatment on anorexia in children? | Mostly effective | 209 (54.4) |
Very effective | 125 (32.6) | |
Moderate | 47 (12.2) | |
Mostly not effective | 2 (0.5) | |
Not at all effective | 1 (0.3) | |
2. What are the advantages of KM in the treatment of anorexia in children? 1 | Effective | 305 (32.3) |
Fundamental treatment to strengthen the digestive function | 255 (27.0) | |
Fewer side effects | 246 (26.1) | |
More helpful than other treatment methods | 112 (11.9) | |
Economical | 24 (2.5) | |
3. What needs to be supplemented in KM for treating anorexia in children? 1 | Treatment cost | 265 (34.6) |
Treatment information (promotion and awareness) | 227 (29.7) | |
Convenience of treatment (herbal medicine and acupuncture) | 207 (27.1) | |
Duration of treatment | 39 (5.1) |
Factors | N (%) | |
---|---|---|
Evaluation period of effectiveness in the treatment of anorexia in children | 1 month | 164 (42.7) |
3 months | 149 (38.8) | |
6 months | 54 (14.1) | |
1 year | 11 (2.9) | |
Others—2 weeks | 5 (1.3) | |
Effectiveness evaluation index in the treatment of anorexia in children 1 | Amount of food | 340 (28.8) |
Weight | 257 (21.8) | |
Improvement in general condition of the child | 242 (20.5) | |
Height | 165 (14.0) | |
Body mass index | 89 (7.5) | |
Numeric rating scale | 85 (7.2) | |
Safety evaluation period in the treatment of anorexia in children | 1 month | 196 (51.0) |
3 months | 118 (30.7) | |
6 months | 53 (13.8) | |
1 year | 7 (1.8) | |
Others—2 weeks | 5 (1.3) | |
Safety evaluation index in the treatment of anorexia in children 1 | Changes in the child’s general condition | 296 (37.6) |
Evaluation of adverse reactions | 283 (35.9) | |
Changes in vital signs | 158 (20.1) | |
Blood test | 39 (4.9) | |
Urine test | 12 (1.5) | |
Are there cases of adverse reactions during herbal medicine treatment for anorexia in children? | No | 346 (90.1) |
Yes | 27 (7.0) | |
No herbal medicine treatment administered for children with anorexia | 11 (2.9) | |
Are there cases of adverse reactions during acupuncture treatment for anorexia in children? | No | 265 (69.0) |
Yes | 6 (1.6) | |
No acupuncture treatment administered for children with anorexia | 113 (29.4) | |
Are there cases of adverse reactions during moxibustion treatment for anorexia in children? | No | 205 (53.4) |
Yes | 6 (1.6) | |
No moxibustion treatment administered for children with anorexia | 173 (45.1) |
Factors | N (%) | |
---|---|---|
What information would you like to know more about treating anorexia in children? (up to three multiple responses allowed) | Evaluation method | 257 (22.3) |
Diagnostic criteria | 231 (20.1) | |
Differential diagnosis | 196 (17) | |
Management | 174 (15.1) | |
Western medical treatments | 157 (13.6) | |
Treatment with Korean medicine | 137 (11.9) | |
Diagnostic criteria that should be included in the development of CPGs 1 | Diagnostic criteria for Korean medicine (pattern identification) | 329 (54.2) |
Diagnostic criteria for Western medicine | 277 (45.6) | |
Other—Evaluation tool for objectively assessing amount of food/defecation | 1 (0.2) | |
Evaluation method that should be included in the development of CPGs 1 | Questionnaire used to assess symptom severity | 284 (39.7) |
Questionnaire for pattern identification | 236 (33) | |
Food/symptom diary | 196 (27.4) | |
Western medical treatment that should be included in the development of CPGs 1 | Common adverse events and remedies | 316 (53) |
Efficacy/mechanism of individual Western medicines | 277 (46.5) | |
Korean medicine treatment methods that should be included in the development of CPGs 1 | Herbal medicine | 366 (27.2) |
Acupuncture | 243 (18) | |
Dietetic therapy | 203 (15.1) | |
Moxibustion | 189 (14) | |
Manipulation/Exercise therapy | 136 (10.1) | |
Differential diagnosis that should be included in the development of CPGs 1 | Specific information on similar diseases | 288 (50.6) |
Information on the types of similar diseases | 280 (49.2) |
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Lee, J.; Lee, S.H.; Kim, J.H.; Park, Y.S.; Park, S.; Chang, G.T. Survey of Clinical Practice Patterns of Korean Medicine Doctors for Anorexia in Children: A Preliminary Study for Clinical Practice Guidelines. Children 2022, 9, 1409. https://doi.org/10.3390/children9091409
Lee J, Lee SH, Kim JH, Park YS, Park S, Chang GT. Survey of Clinical Practice Patterns of Korean Medicine Doctors for Anorexia in Children: A Preliminary Study for Clinical Practice Guidelines. Children. 2022; 9(9):1409. https://doi.org/10.3390/children9091409
Chicago/Turabian StyleLee, Jihong, Sun Haeng Lee, Jae Hyun Kim, Yong Seok Park, Sulgi Park, and Gyu Tae Chang. 2022. "Survey of Clinical Practice Patterns of Korean Medicine Doctors for Anorexia in Children: A Preliminary Study for Clinical Practice Guidelines" Children 9, no. 9: 1409. https://doi.org/10.3390/children9091409