Sociodemographic characteristics of participants
Of the 25,574 registered KMDs, 931 initiated the survey. A total of 830 (3.25%) survey responses were analysed after excluding two individuals who did not consent to participate in the study, four who were not currently practising, and 95 who did not complete the survey. The demographics and practice characteristics of the survey respondents are presented in Table 1. A total of 363 (43.73%) KMDs responded that they currently use BTs, while 467 (56.27%) responded that they do not. The 830 respondents were most likely to be 30–39 years old (36.14%) and self-employed (60.0%). Of the 830, 629 (75.78%) were general practitioners (GPs), and 201 (24.22%) were specialists. The 76 specialities of the KM clinics included skin diseases (30.26%), obesity (28.95%), paediatric growth (19.74%), women’s diseases (18.42%), digestive diseases (18.42%), rhinitis (11.84%), autoimmune diseases (11.84%), cancer (7.89%), psychiatric diseases (6.58%), and neurological diseases (3.95%) (including duplicates). The percentage of BT users was higher in KMDs who mainly treat middle-aged (30–49 years old) patients (38.57%, p < 0.0001), who were specialists (31.68%, p < 0.0001), held a PhD (27.55%) or Master’s degree (26.45%) (p < 0.0001), worked in a KM hospital (27.27%, p < 0.0001), worked in city (commercial areas) (27%, p < 0.0001), were interns or residents (10.19%) and clinical faculty (6.34%) (p < 0.0001). There were no differences in the current use of BTs according to sex, age, years of medical experience after licensure, employment region, or KM area of speciality (Table 1).
Perception on BTs
When asked whether BTs were actively used in KM clinical practice, 76.63% disagreed. The percentage of negative responses was higher among BT non-users (p < 0.0001), those who work in KM clinics (p < 0.0001), and GPs (p = 0.0296). Most BT users (98.9%) and non-users (93.58%) believed that BT is essential in their clinical practices. There were 622 (74.94%) who were aware that BT can be used to monitor the progress of KM treatment, with a significantly high proportion of BT users (62.59%) that “strongly agree” with this statement (p < 0.0001; Table 2).
BT frequency and indications in KM practice
Among the 363 users, BTs were predominantly ordered 1–9 times (41.32%) in the past month. Most BT users in KM hospitals (98.10%) were referred by KMDs to a medical doctor (MD), whereas 87.7% in KM clinics were not. Peripheral fingerstick (55.92%) and venipuncture (53.44%) were the most common blood sampling methods and were predominantly performed by nurses or nursing assistants (77.84%). BT analysis was more likely to be performed using an automated analyser (76.31%) than by transferring to a specialised laboratory (35.54%). Centrifuges were more likely to be used in KM hospitals (64.76%) than in KM clinics (25.5%) or other institutions (14.29%; p < 0.0001) (Table 3).
Most BT users (96.69%) ordered LFTs, followed by kidney function tests (KFTs; 64.74%), diabetes tests (51.79%), lipid panels (51.52%), and complete blood counts (CBCs; 51.24%). Other parameters suggested by respondents were prothrombin time, hepatitis tests (amylase, lipase, IgE, live blood tests), and anti-Müllerian hormone, D-dimer, procalcitonin, and uric acid levels. The main purposes of BTs were to determine the basic health condition (67.22%), monitor HILI (58.68%), follow up after KM treatment (55.10%), decide whether or not to prescribe HM (42.98%), and rule out severe or acute diseases (32.78%). In total, 80.95% of BT users in KM hospitals ordered blood testing as a basic examination upon admission. Other purposes included checking BT levels before prescribing HM to avoid “the misunderstanding of existing illnesses as being caused by HM,” diagnosing and treating “precocious puberty,” and participating in a government “infertility support program.” Most BT users (93.67%) replied that BTs are important in their practice (Table 3). According to the survey, the average percentage of patients undergoing blood testing was 24.29% (± 30.02%) (median 10%, mode 10%) (Supplementary Table S1).
BTs were ordered by 51.52% of BT users regardless of the patient’s chief complaint or disease, while 36.09% ordered when patients complained of fatigue or decreased stamina. Among the International Classification of Diseases − 10 categories, ‘Endocrine, nutritional, and metabolic diseases (Chapter IV)’ (25.90%), ‘Diseases of the digestive system (Chapter XI)’ (21.76%), and ‘Diseases of the circulatory system (Chapter IX)’ (15.43%) were the most common disease factors that determined BT use. The medical history of patients receiving BTs included liver disease (51.79%), diabetes (33.61%), and kidney disease (31.13%), whereas 50.41% underwent blood testing regardless of their medical history (Table 4).
Among the different treatment modalities in KM, BTs were ordered by 75.21% considering the use of HM, and 28.93% used BTs regardless of treatment. When to use and how often to follow up with BTs varied by type of medical institution (p < 0.0001). The rate of “patient’s first visit (except for prescription of HM) (45,71%),” and “before and after prescription of HM” (43.75%) were relatively high among BT users inKM hospitals and specialised KM clinic, respectively. The follow-up periods for BT were 3 to < 8 weeks (43.53%), less than 3 weeks (18.18%), and 12 weeks to < 6 months (8.82%). A total of 20.11% of patients had no specific follow-up period. More than 80% of BT users in specialised KM clinics retested BT after more than three weeks, while BT users in KM hospitals had a relatively high rate of retesting within three weeks (33.33%; Table 4). Of the 363 BT users, 11 (3.03%) experienced patient safety incidents related to BTs, including bleeding, bruising, hematoma, angioedema, pain, delayed haemostasis after blood sampling, hypotension, and dizziness after fasting (Supplementary Table S1).
Requirements for BT implementation
BT users identified the “cost of a BT” (65.56%), “lack of legal and institutional safeguards” (57.02%), and “cost of a blood tester” (40.50%) as the primary difficulties in using BTs in KM institutions. Meanwhile, BT non-users most commonly cited the “cost of a blood tester” (61.46%) as a reason for not using BT. Moreover, synthesising the responses of BT users and non-users, “burden in manpower expansion in charge of BT” (n = 274), “patients’ lack of awareness about BT in KM clinics” (n = 216), “difficulties in using referral laboratories” (n = 189), and “time charge in collecting blood and check the results” (n = 133) were identified as barriers to using BT (Fig. 1). The most popular opinion was that “BT should be covered by NHI” to promote the use of BTs in KM institutions. “Education on the interpretation of the BT results” was valued more by BT non-users (41.54%), while “improving awareness of the legitimacy of BTs by KMDs” was valued by BT users (43.53%; Fig. 2). Most BT non-users (n = 453, 97.0%) hoped to use BTs in their future care, with demands for BT coverage by NHI (89.85%) and cost support for BTs (57.62%; Fig. 3).
Barriers to blood tests (BT) use in Korean Medicine (KM) practice among BT users and non-users (multiple responses). Data are presented as frequency (%).
Methods to promote blood tests (BTs) in Korean Medicine (KM) practice among BT users and non-users (multiple responses). Data are presented as frequency (%). KMD, Korean Medicine doctor.
Demands of blood test (BT) non-users to use BT in the future (multiple responses). KM, Korean Medicine; KMD, Korean Medicine doctor.
A total of 419 (50.48%) KMDs were aware of the campaign to use BT in KM clinics; 118 (14.22%) individuals have participated in the campaign. Overall, 98.31% of campaign participants reported that the campaign was important, and 73.73% were satisfied with it.
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