Evaluation of Chronic Non-Communicable Disease Patients Transferring for Treatment at Sub-district Health Promoting Hospitals, Thailand - การประเมินผลการส่งต่อผู้ป่วยโรคไม่ติดต่อเรื้อรัง ไปรักษาทีโรงพยาบาลส่งเสริมสุขภาพตำบล ประเทศไทย

Abstract

           The objective of this study was to evaluate the context, input, process, and health outcomes, compare health behavior and satisfaction with health care services before and after referring at hospital and sub-district health promoting hospitals (SHPH) in Thailand; and to evaluate advantages and disadvantages in the receiving treatment of chronic non-communicable diseases at the SHPHs. It was conducted as a formative evaluation research with both quantitative and qualitative studies; and the study period was from
October 2013 - March 2014. The samples for the quantitative study consisted of (1) 453 care giving staff, one person from each of the SHPHs randomly selected through a multi-stage sampling to ensure a balance in regional distribution; and (2) 1,580 diabetes mellitus (DM) patients and 1,580 hypertension (HT) patients receiving care service at the selected SHPHs. For the qualitative study, data were collected from a group of 100 persons who were administrators, practitioners (doctors, nurses and stakeholders),
and patients with diabetes mellitus or hypertension from 5 selected provinces in different regions. Tools for evaluation were questionnaire, medical treatment records, and guideline for in-depth interview; and analyses were conducted by using descriptive statistics and paired t-test (for quantitative data) and content analysis (for qualitative data). It was found that the majority (85.0%) SHPH's care givers agreed with the policy on referring non-communicable disease patients from high level hospitals to SHPHs because the patients were able to received medical services close to their home which would reduce traveling expense and avoid long-waiting time at congested hospitals. However, only 54.7% of DM patients and 52.5% of HT patients
had confidence in the medical treatment capacity of the SHPHs. The average number of patients registered at each SHPH was 40.6, 131.4 and 42.5 for DM, HT and dual diseases, respectively. Most SHPHs were well equipped with medical care resources in which 77.9% had well-prepared drugs, equipment and treatment tools, 82.1% had nurses and 92.8% had and utilized treatment guideline. However, 45.9 and 57.4 percent of care givers had low level of knowledge in the treatment of DM and HT, respectively. For the process evaluation, it was found that 79.7% of patient transfers were made by using the patienttransferring forms; 81.5% of SHPH provided high level of care services, and 57.2% had obtained participation from a higher level hospital in the care process. Majority of the care givers were moderately satisfied with the provision of care to the patients (56.5%). There were differences in health behaviors in which 67.8% and 66.6% of patients with DM and HT had medium level health behavior before attending the SHPHs, respectively; and the percentages changed to 79.7 and 80.2 respectively during receiving treatment in the SHPHs (p<0.05). However, there was a decline in the percentages of patients with controlled level of blood sugar and blood pressure (from 63.8% to 54.0% for DM and 53.7% to 46.1% for HT).
Comparison of patients' satisfaction on the services revealed that 47.7% of DM patients and 45.5% of HT patients had medium level of satisfaction when receiving services at a higher level hospital; and the percentage was increased to 76.8 and 75.3 percent respectively for the services at SHPHs (p<0.05). Based on the opinions of the patients, it was advantageous receiving services at SHPHs because it was more convenient (94.5% of patients), cost saving (85.2%), and closer care (78.1%). However, 20.8% of SHPH staff expressed their concern about the increase of their workload.

Key words: process evaluation, diabetes mellitus, hypertension, sub-district health promoting hospital