A Community Health and Healthcare Service System for Stroke Patients: Development and Effectiveness Evaluation

Abstract

The objective of this study was to develop and evaluate the effectiveness of the community health system to health care service system for stroke patients. The participatory action research was used to develop the model. Four provinces were selected: Chiang Rai, Nong Bua Lamphu, Samut Prakan, and Trang. The process consisted of 4 phases: (1) planning and development, (2) action period, (3) monitoring, and (4) effectiveness evaluation. The planning phase utilized mixed methods (quantitative surveys and qualitative focus groups) alongside brainstorming sessions with stakeholders at the community and health service system levels. The effectiveness evaluation was used to compare stroke knowledge achievement before and after the implementation. The samples were 1,134 elderly people aged 60 years and over. Data collected by a survey with questionnaires. The quantitative data were analyzed using descriptive statistics and paired t-test samples. Access to emergency medical services and results of hospital services by analyzing secondary data. The results of the study found that the community developed selfmanagement measures for promotion, prevention, risk control, emergency management, and follow-up. For the health service system, service systems both outside and inside the hospital were developed via a fast track for stroke patients. The elderly’s knowledge of stroke test scores were higher than the pretest at the significance level of 0.05 (Max score 12; pre/post: Chiang Rai 5.8/7.2, Nong Bua Lamphu 8.7/9.5, Samut Prakan 8.4/11.5, and Trang 8.0/10.4). Regarding access to the emergency medical service, it was found that stroke patients who came with the emergency medical service were 15.3%, 35.28%, 17.1%, and 52.1% in Chiang Rai, Nong Bua Lamphu, Samut Prakan, and Trang, respectively. The proportion of ischemic stroke patients arriving within the 4.5-hour window was 29.1%, 44.0%, 42.5%, and 52.6%, respectively (exceeding the 25% target). The rate of recombinant tissue plasminogen activator (rt-PA) administration within 1 hour was 87.7%, 60.0%, 81.9%, and 93.3% (exceeding the ≥60% target). Stroke mortality rates were 6.7%, 5.3%, 13.2%, and 4.9% (below the <7% target, except Samut Prakan). The findings of this study can be used as a guideline for promoting stroke patient care by utilizing a mechanism that seamlessly links the community health system with the health service system.