The analysis of disease spectrum of traditional Chinese medicine of outpatient visitor to the contracted family doctor in Shenzhen community health centers

Background: The development plan of traditional Chinese medicine (TCM) has been integrated into the national development strategy, with a focus on significantly enhancing the TCM service capabilities of primary care facilities. However, researches on the disease spectrum of TCM diagnosis and treatment in community health centers is lacking. Objective: To understand the TCM diagnosis and treatment capabilities of Shenzhen's community health centers by analyzing the disease spectrum of TCM diagnosis and treatment among outpatients signed with family doctors at these centers. Methods: From May to June 2022, records of family doctor-signed residents who visited the outpatient departments of community health centers in 10 districts of Shenzhen from January 1, 2021, to June 30, 2021, and incurred diagnosis and treatment costs were extracted from the “Hangchuang Community Health Service Center Business System,” a unified information platform of the Shenzhen Health Commission. Records for which TCM was the purpose for the visit, which had corresponding diagnosis and treatment costs, as well as a primary diagnosis coded according to the “Classification and codes of diseases and patterns of traditional Chinese medicine” (TCD) were included in the study (n=385,138). The disease spectrum was analyzed based on the TCD, mainly involving specialty category, sub-specialty system classification and TCM term of disease and pattern. Results: Among the 385,138 records included, there were 170,077 male visits (44.16 %) with an average age of 37.5 ± 8.2 years; and 215,061 female visits (55.84 %), with an average age of 36.7 ± 9.4 years. The disease spectrum covered all seven specialty categories of TCD: internal medicine (219,445, 56.98 %), pediatrics (79,201, 20.56 %), otorhinolaryngology (47,965, 12.45 %), gynecology (30,620, 7.95 %), surgery (5,797, 1.51 %), orthopedics (1,407, 0.37 %), and ophthalmology (703, 0.18 %). The spectrum covered all sub-specialty system classifications under the seven specialty categories except for tumor diseases, cancer diseases in each specialty category, and certain eye disease classes such as diseases of the canthus, diseases of the cornea, pupil diseases, and traumatic eye diseases. In each specialty category, several diseases accounted for ≥90.00 % of the total diagnostic and treatment volume for that specialty category. The top five system diseases were respiratory system diseases (208,701, 54.19 %), musculoskeletal system diseases (73,369, 19.05 %), gynecological system diseases (30,620, 7.95 %), cardiovascular and cerebrovascular system diseases (27,539, 7.15 %), and digestive system diseases (19,162, 4.98 %). Patients under 15 and those aged 15 to 24 primarily had diseases related to the respiratory system and digestive systems. As age increased, the number of patients with paralysis, dizziness, headache, insomnia, and fatigue gradually increased; before the age of 45, the leading disease was the common cold, and after 45, it was muscle and joint pain caused by paralysis. Conclusion: The TCM diagnosis and treatment disease spectrum at Shenzhen's community health centers is broad but concentrated and singular, predominantly involving internal medicine. The disease spectrum is mainly concentrated in five major systems: respiratory, musculoskeletal, gynecological, cardiovascular and cerebrovascular, and digestive systems. There is a need to further enhance and expand the TCM diagnosis and treatment capabilities of community health centers to better meet the diverse health needs of residents

Traditional Chinese Medicine Disease Spectrum Analysis in Outpatient Clinics of Contracted Residents by Family Doctors in Shenzhen Community Health Service Centers

Background The development of traditional Chinese medicine (TCM) has been listed as a national development strategy with vigorous improvement of TCM service capacity in primary care institutions as the important elements, however, there are few studies on the disease spectrum of TCM in community health service institutions. Objective To analysis the TCM disease spectrum in outpatient clinics of contracted residents by family doctors in Shenzhen community health service centers (abbreviated as CHSC) and understand the capability of TCM in Shenzhen health centers, thus providing a theoretical basis for promoting the development of TCM in primary care in China. Methods From May to June 2022, the records of outpatient consultations with treatment cost of 10 Shenzhen CHSCs from 2021-01-01 to 2021-06-30 were extracted by the unified information platform of the Health Commission of Shenzhen Municipality (Hangchuang Community Health Service Center Business System) . The 385 138 records with purpose of TCM treatment, matching diagnosis and treatment costs, first diagnosis can be coded in Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine (TCD) were collected. The disease spectrum was analyzed based on the classification of disease in TCD, mainly involving department categories, specialty system classifications, and TCM disease terms. Results A total of 385 138 records of TCM diagnosis and treatment were selected in this study, including 170 077 (44.16%) male cases and 215 061 (55.84%) female cases, with an average age of (36.7±9.4) years. All of the 7 TCD categories of disease spectrum were involved, including internal medicine accounting for 56.98% (219 445 cases) , pediatrics accounting for 20.56% (79 201 cases) , otolaryngology accounting for 12.45% (47 965 cases) , gynecology accounting for 7.95% (30 620 cases) , surgery accounting for 1.51% (5 797 cases) , orthopedics accounting for 0.37% (1 407 cases) and ophthalmology accounting for 0.18% (703 cases) . Apart from the specialty system classifications of tumor diseases, cancer diseases in each category, classifications of middle canthal disease, black eye disease, pupillary disease, traumatic eye disease in Ophthalmology, the disease spectrum involves all specialty system classifications in 7 categories. The cumulative diagnosis and treatment volume of several disease spectrums accounted for 90.00% of the total diagnosis and treatment in each category. The top 5 system diseases in the spectrum included respiratory system diseases accounting for 54.19% (208 701 cases) , musculoskeletal system diseases accounting for 19.05% (73 369 cases) , gynecological system diseases accounting for 7.95% (30 620 cases) , cardiovascular and cerebrovascular system diseases accounting for 7.15% (27 539 cases) , and the digestive system diseases accounting for 4.98% (19 162 cases) . Patients aged <15 years and 15-24 years mainly suffered from diseases related to the respiratory and digestive systems, and the incidence of diseases such as paralysis, dizziness, headache, insomnia, fatigue were increased with the increase of age; cold ranked the first for patients aged below 45 years, the paralysis of muscle and joint pain ranked the first for patients aged above 45 years. Conclusion The TCM diseases spectrum in Shenzhen CHSCs is wide, but the categories are relatively concentrated and single, mainly involving internal medicine, concentrating on respiratory system diseases, musculoskeletal system diseases, gynecological system diseases, cardiovascular and cerebrovascular system diseases, and digestive system diseases. It is necessary to strengthen and expand the TCM diagnosis and treatment capabilities in CHSCs to better meet diverse health needs of the residents