Efficacy of Development of the System and Process in Helping and Treating Schizophrenic Patients in Klongluang Hospital under District Health System, Klongluang District, Pathumthani Province - ผลการพัฒนาระบบและกระบวนการช่วยเหลือดูแลรักษา ผู้ป่วยจิตเภทในโรงพยาบาลคลองหลวง โดยใช้ระบบสุขภาพอําเภอของอําเภอคลองหลวง จังหวัดปทุมธาน

บทคัดย่อ

              Schizophrenia is the most chronic and disabling of the major mental illnesses. Department of Mental Health reported in 2015 that schizophrenia was the number one illness found in all of the mental disorders. Schizophrenia patients in Klongluang Hospital are a group of individuals who have chronic symptoms and complex problems which often lead to long-stay hospital admission and daily-life problems when discharged and return back home. The purpose of this study was to develop an effective system, as well as study results on the treatment outcomes by using the concept of district health system in caring for the patients. It was conducted as a 1-year-retrospective design (May 2016 - May 2017) among patients in Klongluang Hospital, Klongluang district, Pathumthani province. The participants were 40 patients aged 20 years old or more with schizophrenia diagnosed by psychiatrists (DSM-IV), and were referred to Klongluang Hospital for continued treatment. They were recruited by purposive sampling. The study was conducted in three steps: (1) developing a system and process in helping and treating Schizophrenic patients in Klongluang Hospital under district health system (DHS); (2) all participants were asked to undergo pre-examination by using an assessment form for serious mental illness with high risk to violence (SMI-V form), they were taken care by the DHS and were asked to received 5 monthly-assessment-sessions in order to evaluate the relapsed symptoms (at the 1st, 3rd, 6th, 9th, and 12th months), (3) all clinical data of the patients were analyzed. Descriptive statistics were used to analyze demographic data. Friedman’s test was used to compare pre-post mean scores of all five sessions. Wilcoxon-signed rank test was used to compare each time of pre-post mean scores of chronic psychotic patients. It was found that there was statistically significant reduction of mean scores of schizophrenia patients using serious mental illness with high risk to violence: SMI-V form within 1 year of treatment and intervention (p-value <0.001). Moreover, there was marked reduction of relapsed symptoms in 8 of 10 severe patients, from 11 episodes to 2 at 6 months of the program. At 1 year after they were enrolled in the program, none of the patients had relapsed symptoms. In conclusion, the present study demonstrated that the district health system in Klongluang District was effective in the treatment and care for the patients with schizophrenia who were aboe to receive more integrated course of treatments and better  care plan. In addtition, the patients were closely supported by the multidisciplinary team at the hospital and in their community. Through this coordinated care under the district health system, the patients had gained ability to manage their daily activities, had more productive and independent lives with a significant improvement in the quality of life of themselves and their caregivers.

Key words:  schizophrenia, psychotic disorder, district health system (DHS)