Effectiveness of Chronic Obstructive Pulmonary Disease Control after Service System Development in Buriram Hospital

Abstract

This study aimed to develop a caring service system for chronic obstructive pulmonary disease (COPD) patients; and to assess the effectiveness of the system. It was conducted in Buriram from  1 October 2012 to 30 September 2015. The study samples were COPD patients with at least four follow-up visits per year at the COPD clinics of all 23 hospitals in Buriram province. The study began with situation assessment, followed by development of the service system, the implementation and outcome evaluation. The study tools included clinical practice guideline for COPD, physician order sheet, and referral guideline for COPD patients. Data were collected from all the treatment and management records within the network; and were analyzed by using percentage and Chi–square test. The care system was operated by a multidisciplinary team with the clear roles and rersponsibility of the team members, close coordination of patient care, development hospital network, set clinical practice guideline, and utilization of physician order sheet and referral guideline for COPD patients. As for the results, there were 988, 1,095 and 1,162 cases of COPD in 2013-2015, respectively. With the implementation of the system, various favorable outcomes were observed. The admission and re-admission rates of the patients were significantly reduced (p=0.001). As well, there was an increasing percentage of smoking COPD patients who quit smoking after receiving service from smoking clinic. However, the dead rate was not significantly reduced due to the delay in seeking medical services among the patients. Based on the study results, it should be concluded that the COPD service system with the devlopment of hospital network in the province and clear management guidelines could be effective in treating patients with COPD. Such network should be expanded to cover all levels of care, from primary facilities to tertiary hospitals. Programs to increase awareness among the patients for smoking cessation and seeking early treatment should be promoted. In this regard, close collaboration among health personnel and patients we all as their family members is essential in order to increase effectiveness of care for the patients with COPD.