Traditional Korean Medicine Home Care for the Older Adults during the COVID-19 Pandemic in South Korea

Objectives: The aim of this study was to examine the status of community care services regarding traditional Korean medicine (TKM) for older adults and raise awareness on current opinions and services of TKM institutions. Methods: The National Development Institute of Korean Medicine conducted a survey of 16 local governments by sending official letters through an electronic document system from October 2020 to November 2020. The survey items included basic demographic information and information about TKM service. Results: Eleven (68.8%) of the 16 local governments provided TKM home care services. A total of 136 TKM clinics provided home care services for 598 older adults with musculoskeletal disorders. The number of TKM services provided in five or more local governments were cupping 11 (100.0%), acupuncture 11 (100.0%), education and consulting 10 (90.9%), and moxibustion 9 (81.8%). Moreover, pain (recorded on visual analogue scale) and quality of life significantly improved following TKM services (p < 0.001). Conclusions: Covered under medical policy, TKM homecare services could function as a viable alternative for continued medical care disrupted during the coronavirus disease 19 pandemic. In addition, standardisation and legalisation of these services could ensure and improve their efficiency.

Analysis of the Efficiency of China’s Medical Service Resources under the Background of Hierarchical Medical Policy

Background: Hierarchical medical system (HMS) is a good policy to promote the fairness of medical services for residents. Given the importance of HMS, it is necessary to know the implementation effect of the policy. Therefore, we aimed to analyze the efficiency of medical service resources in China under the background of hierarchical medical policy. Methods: Based on the panel data of China's medical resources in 2015-2019, we used DEA model to calculate the technical efficiency (TE), pure technical efficiency (PTE) and scale efficiency (SE) of medical resources from both lateral and longitudinal aspects. We used Malmquist index to evaluate the change trend of efficiency, and further we compared the efficiency differences of regions and medical institutions. Results: In lateral evaluation results, TE was relatively stable, while total factor productivity (TFP) was on the rise. In longitudinal evaluation results, TE and TFP showed a downward trend. Conclusion: The government should consider the differences in development between regions and make health plans by regions. Medical institutions should strive to break down the constraints and make use of their advantages, which is conducive to improving efficiency.

Clinical impact of medical policy supporting universal germline testing for patients with colorectal cancer.

10514 Background: Colorectal cancer (CRC) affects approximately 104,000 patients (pts) annually in the United States, up to 45% of which are estimated to be genetic and/or familial. Aligned with clinical guidelines, in 2020, a large U.S. insurer established Medical Policy allowing for and reimbursing germline genetic testing (GGT) for all CRC pts. This study reports overall uptake of GGT in CRC pts under this inclusive policy, actionable findings and treatment implications for pts tested, stratified by self-reported ancestry/ethnicity. Methods: Two independent de-identified datasets were reviewed, including administrative claims data of commercially insured and Medicare Advantage enrollees, aged 18+ with CRC (≥1 claim with ICD10 C18, C19 or C20 in the first position) who were continuously enrolled (CE) in the health plan from 1/2019-10/2020. Evidence of genetic testing based on CPT codes, was examined during 2020. A second de-identified dataset of CRC pts whose GGT was billed to the insurer under the Medical Policy, was also reviewed. Patient demographics, clinical information and GGT results were descriptively analyzed. Results: Of the >18,000,000 CE enrollees, 55,595 were identified as CRC pts, of whom 1,675 (3%) received GGT. From the GGT dataset, 788 pts had test results available for review. 143 (18%) pts had pathogenic/likely pathogenic (P/LP) variants in genes including MSH2, MLH1, PMS2, MSH6, CHEK2, APC, BRCA2, ATM, MUTYH (biallelic). Of pts with P/LP variants, 96 (67%) were potentially eligible for precision therapy and/or clinical treatment trials. Overall, 133 (93%) had P/LP variants in genes with precision therapy, clinical trial and/or published management implications. In a subset of pts (n=674) with ethnicity data; Asian, Black/African-American and Hispanic pts showed lower relative uptake of germline testing than Caucasians (Table). Conclusions: Despite Medical Policy allowing for GGT for all pts with CRC, only 3% of eligible pts received testing. If all CRC pts had been tested, these data suggest up to 6,705 pts with P/LP variants conferring potential eligibility for precision therapy (PD-1/PD-L1 inhibitors) or clinical treatment trials (PARP inhibitors), and an additional 2,602 pts with mutations in genes with published management recommendations, could have been identified, but were missed. Additional research is needed to identify obstacles to systematic implementation of this Medical Policy, the best timing of GGT to prevent CRC and improve access to underrepresented populations. CRC patients with germline genetic testing.[Table: see text]

Changes in Chinese Patients' Trust in Doctor:a Systematic Review and Meta-Analysis

Background: To understand how patient’s trust has changed over time in China and explore the influencing factors of the changes.Methods: Databases were systematically searched from inception to Jan 1, 2020 for studies of patient’s trust in China investigating the change of the patient’s trust over time and the factors which influence the trust.Results: The cross-temporal meta-analysis results showed that the total trust, benevolence trust and technical competence trust of Chinese patients decreased rapidly across the year of data collection. The related meta-analysis results showed that trust and patient demographic variables have a weak but significant correlation (gender: r = 0·032; 95% CI 0·012, 0·052; p = 0·002; age: r = 0·079; 95% CI 0·047, 0·111; p < 0·001; education: r = 0·092; 95% CI 0·054, 0·131; p < 0·001). The medical policy stage and patient type had a significant influence on changes of trust.Conclusion: Patients’ trust in doctors have declined with increasing years, and farmer-friendly policy, conflicts and individuals’ characteristics influence patients’ trust.Practice implication: Chinese government should attach importance to the public welfare-oriented policies. Medical institutions need pay more attention to the diverse trust levels of different patient groups and strengthen the training of doctors’ benevolence skills.

Vietnam: Marshalling State and Non-State Actors

This chapter examines Vietnam’s campaign against Covid-19. When the coronavirus outbreak emerged in the Chinese city of Wuhan, the government of Vietnam considered it a highly contagious disease and immediately implemented all necessary measures to protect people from the emerging pandemic, even if these strict measures resulted in massive economic losses. The chapter then introduces the regulatory framework which enabled the government and other non-state actors in Vietnam to fight the epidemic effectively. It also discusses how Vietnam contained the spread of the virus in practice from the perspectives of health and medical policy, information and technology, economic policy, and international cooperation. Ultimately, Vietnam’s unique response derives from four factors: (1) the policy that prioritized public health over economic considerations; (2) Vietnam’s having been well prepared for dealing with contagious diseases since the SARS outbreak in 2003 and the government immediately introducing strict measures to prevent the spread of Covid-19 when it emerged in China; (3) the legal framework specifying the roles of the central and local governments to avoid any bureaucratic delays in making decisions in an epidemic; and (4) the government flexibly combining coercive means with deliberate action, public education, effective governance, and effective coordination with the community and the private sector.

Strategies for Effective Home Modification in Older Adults

There are various barriers to home modifications to prevent falls among the older population. Several strategies may be necessary to overcome these barriers and implement effective home modifications. The need for home modification should be assessed, which requires a home evaluation by a specialist. In Japan, welfare housing environment coordinators have been trained to provide advice on home modifications suitable for people with disabilities. In addition, in Japan, home assessment and advice on home modification before discharge from acute care hospitals for older people is allowed as a medical reimbursement, and a system for effective home modification is well established. Human resource training and medical policy arrangements on home modifications could improve the cost-effectiveness. In Japan, a system has been established to support the costs of home modification and environmental maintenance. Financial support has reduced the barrier to home modification. Fixed grab bars or shower chairs can be rented, which may be more cost-effective than purchasing them and may shorten the time required for installation. There may be psychological barriers to home modification for older population. Since many older people do not recognize the importance of home modification, promotion to convey the value of home modification may be necessary. Training of staff to engage in home modification, public financial support for modification, and ideas for reducing psychological hesitation may help to reduce the barriers for home modification and to enable effective home modification.

Trans Revolutionaries

Photo essay, and accompanying article, exploring the historical and cultural landscape of the Trans community in Havana, Cuba. Models, captured in their domestic setting, allow photographer Olga Chagaoutdinova and writer, Morag Shackerley-Bennett, an intimate insight into an unseen world. The juxtaposition of progressive medical policy and poor legal structure in Cuba has left many of its Trans population unsure not only of their future, but that of Cuban LGBTQ2I+ rights also.