Collaboration between Western medicine and Korean medicine is a clinical practice based on sharing patients’ medical information and discussing cases, which can improve treatment effects by taking advantage of each type of medicine [1]. In Korea, the first project to demonstrate collaboration between Korean and Western medicine started in 2016. Medical fee structures, identifying diseases for collaborative treatment, and the institution of consultation have been further developed since then. The third project of collaboration started in October 2019, and grades the institution by evaluating its performance with respect to medical collaboration, and a differential medical fee is applied according to grade [2]. Previous research has reported on the perception, satisfaction, and process of medical collaboration [3].

Peripheral facial palsy (PFP) is a disease that is included as a good candidate project for collaboration between Korean and Western medicine; it is a common disease for medical consultation [4]. Although several studies have reported on quality of life, treatment effects, and the medical fees of consultations for PFP patients, there are few reports on consultation timing or duration [4–10].

In this study, we examined the records of PFP outpatients who were treated by way of collaboration between Korean and Western medicine at Kyung Hee University hospital from January 1^st, 2018 to December 31^st, 2018. We investigated the timing, department, treatment period and interval of medical consultation. The aim of this study was to determine the direction of PFP treatment by comparing with guidelines and providing basic data for research on models for PFP medical collaboration.

The number of patients visiting hospital in 2017 due to facial nerve disorders (G51) was 81,203, according to data from the National Health Insurance Service [11]. Bell’s palsy affects 20–30 people per 100,000 annually [12].

The Western medicine treatment for PFP is focused on medicine including steroids and antiviral agents, and an electromyogram is performed to check the degree of facial nerve damage [13]. The prognosis of PFP varies, but most patients show some recovery 2 to 3 weeks after onset of symptoms, and completely recover within 3 to 4 months. However, about 30% of patients do not completely recover [14], and patients with severe symptoms do not recover to the same extent as patients with mild symptoms [15]. PFP is accompanied by psychological symptoms, such as anxiety and decreased self-esteem, due to changes in appearance caused by the affected facial muscles. For this reason, patients with PFP may seek to be treated with both Korean and Western medicine, as described in studies on the effects of the collaborative treatment, medical expenses and quality of life [4–10]. However, there have been few studies on the time taken until the initial consultation and treatment intervals.

This study examined the records of 195 patients with PFP who received combined Korean and Western medicine treatment in Kyung Hee University hospital from January 1^st, 2018 to December 31^st, 2018. There were no significant differences in the treatment groups gender (97 males and 98 females) and the mean age was 53.61 ± 16.19 years.

In the pathway of the initial medical consultation, 109 cases were referred from Western medicine departments to the Korean medicine center, which was a greater number than were referred from the Korean medicine center to Western medicine departments. Previous research has reported that PFP patients visit Korean medicine centers more than patients with other diseases, similar to this study [9]. In the case of consultation in Western medicine departments with a referral to Korean medicine departments, the average time taken until the first consultation was 14.9 days from onset of symptoms. Consultation from within Kyung Hee University hospital took place earlier than from other hospitals, because both Western medicine and Korean medicine treatments are available in that hospital. Although there is no clear recommendation for the initial time of treatment by Korean medicine, Li et al [16] reported that starting acupuncture treatment during the acute stage and stationary stage (1 to 3 weeks from onset of symptoms) was more effective than any other treatment timing to improve PFP symptoms. This was a similar finding to this current study.

In the first consultation in a Korean medicine department, acupuncture treatment was performed for all patients, with conventional acupuncture most frequently used, followed by pharmacoacupuncture and electroacupuncture. In the Idiopathic Facial Paralysis Korean Medicine Clinical Practice Guideline [17], conventional acupuncture is strongly recommended, and pharmacoacupuncture and electroacupuncture are recommended. The results of this study were consistent with the guideline.

Treatment in Korean medicine departments involved 23.0 sessions on average, with an interval of 3.6 days, while the interval for acute stage patients was shorter, at 1.6 days. Park et al [4] reported that collaborative treatment between Western and Korean medicine departments involved 32.5 sessions on average, with only 9.3 sessions accounting for Korean medicine. The results of this current study are different, because recovery time for PFP is different depending on the severity of symptoms.

In the case of referral from Korean to Western medicine departments, the average time taken until the first consultation was 8.5 days from onset of symptoms, with majority of patients initially being referred to the neurology department. A previous study also reported that most patients with PFP were referred to the neurology department [9].

The most common Western medicine treatment was steroid medicine which was observed in 62 cases, and it took on average 3.1 days from onset of symptoms. This figure is longer than the guideline, and steroid treatment is generally recommended to start within 48 to 72 hours from the onset of symptoms [14,15]. Among the clinical tests, an electromyogram was performed most frequently, on average 20.5 days from the onset of symptoms. That is longer than the guideline, considering that an electromyogram test is typically recommended to be performed within 1 to 2 weeks from the onset of symptoms [13]. Physical therapy was carried out for 2 patients, on average 132 days from the onset of symptoms, which was longer than other treatments. In the design of this study, the data was collected for up to 5 consultations, and the results reflect the low number of patients sent for physical therapy. There were 2.8 Western medicine treatment sessions on average, with an interval of 5 days.

The Ministry of Health and Welfare started the demonstration project for the collaboration between Korean and Western medicine in 2016, and related studies include systems or manuals suggesting how to complement collaborative medical treatment. Medical consultation between Western and Korean medicine department is unfamiliar to patients. Jeong et al [18] surveyed patients’ perceptions and reported that most patients did not receive collaborative Western and Korean medical treatment as it was not common practise in hospitals. In addition, there is a lack of the communication and understanding between staff of Western medicine and Korean medicine centers. Some Western medicine staff thought it was difficult to confirm the effects of Korean treatments, or there was little shared knowledge between staff in Western medicine departments to Korean medicine departments. Some Korean and Western medicine departments thought that treatments were excessive because they did not appreciate the medical goals of each type of treatment [19]. Finally, there was a lack of an effective referral process. Lee et al [1] reported that unitary electronic medical records, continuous medical consultation, and a simplified process for patients were needed in the collaborations between medical staff of Western and Korean medicine departments. These issues make an active collaberative consultation difficult, and seem to cause differences in the initial treatment timing in the guidelines and what was observed in this current study.

This study investigated the timing of the initial consultation, medical treatments and departments accessed, and the treatment period, number of sessions and interval between treatments. The study provides meaningful insights into the timing of initial consultations, and it is expected to help in developing models and clinical guidelines for PFP treatment though collaboration between Korean and Western medicine departments. It may help medical staff understand the purpose of collaboration and lead to a more active involvement in initiating combined Korean and Western medicine treatment through collaboration.

There are limitations to this study. A treatment period and intervals between sessions were not detailed for medical treatments and each patient’s condition. There was a deviation in treatment sessions because PFP severity grade was not classified. In physical therapy, the initial treatment timing could be inaccurate because data collected for Western medicine treatment was limited in the design of this study. Moreover, we investigated Western medicine physical therapy, not Korean medicine physical therapy, due to its focusing on the active treatment like massage or exercise. Further studies will be required to compensate for these limitations.

In conclusion this study determined the timings and intervals of medicine collaboration for the treatment of PFP, and may provide the basis for further studies to determine improvements in collaborative treatments between Western and Korean medicine departments.