Medical Rehabilitation Services and Outcome Evaluation Process: A Situation Analysis in Thailand - สถานการณ์การดำเนินงานและการประเมินผลลัพธ์ของบริการฟื้นฟูสมรรถภาพทางการแพทย์ในประเทศไทย

Abstract

       This research was aimed at studying the service situation and outcome evaluation of medical rehabilitation for people with physical and mobility disability in fiscal year 2004-2006. It was a cross-sectional postal questionnaire survey conducted during April-May 2007, with telephone follow- up. There were 522 hospitals recruited in this study including public community, provincial, regional, university and rehabilitation hospitals. Some private hospitals were also included. For outcome evaluation process, the key informants were 324 rehabilitation doctors, 522 physiotherapists, and 236 occupational therapists. Response rates of hospital and rehabilitation professional were 60.9 and 57.8 percent respectively. Descriptive statistics was used for data analysis.

       The result showed that the average number of the physiotherapist working in each hospital was 3.3 while average occupational therapist was 0.7. There was 0.8 rehabilitation doctor per hospital except community hospital. Most prosthetist-othotist in Thailand worked in public, regional, university, and rehabilitation hospitals, only some worked in provincial hospitals. Rehabilitation hospitals provided the highest number of outpatient and inpatient rehabilitation services per year (30,000) and medical school hospitals provided for the highest number of inpatients (15,000 per year). Community hospitals provided fewer services annually (700-2,700 for outpatients and 122-242 for inpatients). The rehabilitation services provided at the out-patient department accounted for only 2.8 percent of total out-patients or 5 percent of total inpatients. The most common service was physiotherapy (89.3%) followed by occupational therapy (10.4%), and prosthetic services (0.4%). The outcome evaluation on ability to perform activity of daily living was done 90 percent of the times by rehabilitation professionals which Barthel Index was the most common used tools. The evaluation on cognitive function was also conducted 37.3-40.8 percent of cases of which the Mini-Mental State Examination was the most common used tool (33.0%).

      It was recommended that the policy makers on health system development should reconsider the investment in rehabilitation services delivery system responsive to the needs of people with all types of disability. More attention should be paid to rehabilitation manpower development in term of production, distribution and the incentive system. In addition, the functional outcome measurement is very important in demonstrating the effectiveness of service and would be the important mean for appropriate resource allocation. So, the standardization of functional outcome measure should be strengthened.

Key words: medical rehabilitation, functional assessment, sub-acute and non-acute care