Development of Access to Health Care for Type 2 Diabetes: a Case Study on Primary Care in Phra Phutthabat District, Saraburi Province - การพัฒนาการเข้าถึงบริการสุขภาพสำหรับ ผู้ป่วยเบาหวานชนิดที่ 2 : กรณีศึกษาบริการปฐมภูมิ อำเภอพระพุทธบาท จังหวัดสระบุรี

Abstract

The objective of this study was to develop a health service program for patients with type 2
diabetes in health promoting hospitals of Praputthabat District, Saraburi Province. The study, conducted
during June 2011 – September 2014, was comprised of 3 phases: (1) situational analysis, (2)
program development, and (3) evaluation. Data collected through discussion with health care providers,
diabetes patients, caregivers, health volunteers, and records on health services for the patients. In
the first phase, it was found that there were service gaps which needed to be addressed by developing
trust and increasing access to care. The program development phase comprised 3 steps which were (1)
identifying outcomes for new services, constructing trust, and finding new diabetes cases, (2) promoting
health volunteers to perform dextrostix blood glucose test for diabetes patients at home in the
morning before the follow up visit to the hospital, and (3) classifying health risk and conducting home
visits by nurse case manager for investigating cause of uncontrolled blood sugar. The outcomes of
evaluation phase indicated that diabetes patients gain more access to care; but they were unable to
control blood sugar. Barriers of self managements of blood sugar control were food consumption habits,
eating more fruits during sweet fruit season, culture, and gender. It was recommended that a nurse case
manager was required to provide primary care support to diabetes patients dealing with the obstacles in
order to prevent diabetes complications.
Key words: diabetes type 2, access to health care, primary care, action research