Developing a Model for Chronic Kidney Disease Prevention in At-Risk Groups through the District Health Board, Health Region 9

Abstract

Diabetic and hypertensive patients are at risk of developing chronic kidney disease (CKD), which can affect the quality of life of the patients, their families, and communities, as well as impact the country's healthcare system and economy. This study is an Operational Research (OR) aimed at developing a model for preventing CKD in at-risk groups through the District Quality of Life Board (DQLB) in Health Region 9. The sample groups included: 1) Informants at the district, provincial, sub-district, and village levels, and 2) DQLB members, according to the Prime Minister's Office regulations of 2018, in pilot areas for the policy development of a CKD prevention model in communities through the DQLB in four models. The study was conducted between October 2022 and September 2023. The research was conducted in three phases: Phase 1 involved analyzing the problem situation, Phase 2 involved implementation (planning, action, observation, and reflection), and Phase 3 involved summarizing and evaluating outcomes. Secondary data was collected from the Health Data Center and analyzed using descriptive statistics and inferential statistics, comparing proportions using the Z-test with a statistical significance level set at 0.05.

Study results: The development and evaluation of the CKD prevention model in the four pilot areas led to the following nine proposals for CKD prevention in at-risk groups through the DQLDC mechanism in Health Region 9: 1) Policy declaration 2) Integration of surveillance data management for NCD and CKD 3) Setting common goals by integrating with the “Diabetes Remission” 4) Creation of public policies 5) Management of health-promoting environments 6) Strengthening community capacity to reduce risk factors for CKD 7) Providing knowledge and raising awareness about reducing salt and sodium intake through Digital Health Stations 8) Establishing proactive service systems in the community, and 9) Evaluating outcomes. The pilot DQLBs showed improvement in achieving the goal of better blood pressure control among hypertensive patients. However, areas requiring intensified efforts include slowing the decline in eGFR levels among diabetic and/or hypertensive patients with stage 3-4 eGFR. Only DQLB Khamsakaesaeng showed a statistically significant improvement of 17.39% in this area, with a p-value of 0.0026, due to the integration of the "Diabetes Remission " campaign. Recommendations: It is advisable to continuously monitor and support diabetic and hypertensive patients in controlling sodium intake to reduce blood pressure and to help achieve diabetes remission, in conjunction with slowing the decline in eGFR through a case-based monitoring system.

Keywords: CKD; Developing Model; District Quality of Life Board; Risk Group