Result of a Pulmonary Tuberculosis Patients Care Process in the Outpatient Department : A Case Study of Phrompiram Hospital, Phitsanulok Province

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Abstract

Background: Tuberculosis remains a major global public health problem. Lack of adherence to medication, the occurrence of adverse drug reactions, lack of home visits, and limitations in coordination among multidisciplinary teams all affect the success rate of tuberculosis treatment and the quality of life of patients. Appropriate care guidelines for the local context will lead to increased treatment success rates, reduced drug discontinuation, and improved quality of life for tuberculosis patients.

Aims: This research study has the main objective to develop the pulmonary tuberculosis care process in the outpatient department of Phromphiram Hospital, Phitsanulok Province, and the sub-objectives are: 1) To study the situation, problems, and concepts of care for pulmonary tuberculosis patients in the outpatient department of Phromphiram Hospital. 2) To create and examine the components of the process for caring for pulmonary tuberculosis patients in the outpatient department of Phromphiram Hospital. 3) To experiment and study the results of the trial of the process for caring for pulmonary tuberculosis patients in the outpatient department of Phromphiram Hospital, and 4) to assess the cost and satisfaction of stakeholders towards the care process for pulmonary tuberculosis patients in the outpatient department of Phromphiram Hospital.

Methods: It is a research and development consisting of 4 steps: (1) study of the situation, problems, and concepts of care for pulmonary tuberculosis patients in the outpatient department of Phromphiram Hospital. (2) Creation and examination of the components of the care process for pulmonary tuberculosis patients in the outpatient department of Phromphiram Hospital using survey factor analysis statistics. (3) Trial and study of the results of the trial of the care process for pulmonary tuberculosis patients in the outpatient department of Phromphiram Hospital, and (4) Assessment of stakeholder satisfaction with the care process for pulmonary tuberculosis patients in the outpatient department of Phromphiram Hospital. Step 1: Study of data from 240 new and recurrent pulmonary tuberculosis patients over a 3-year period. Step 2: Survey study by collecting data from a sample group of 67 related personnel and 5 experts. The tools used were factor analysis form and opinion assessment form according to process components. Step 3: The sample group used in the experimental phase of the research was 6 new pulmonary tuberculosis patients who received services at the tuberculosis clinic of Phromphiram Hospital. Purposive sampling was used to organize activities according to the care process for the experimental group as follows: 1) Before the experiment, there was a preparation meeting. 2) During the experiment, the experimental group activities began with a program for the care process for 6 patients with pulmonary tuberculosis, for a total of 6 months. Received self-management care process by nurses with the outpatient department's pulmonary tuberculosis patient care process, which the researcher created with 5 steps, including: (1) Data collection, (2) Data processing and evaluation, (3) Persuasion/relationship building/decision making. (4) Goal setting/implementation, in terms of action or practice (Action), patients take action, self-management skills, health education (Health education), in terms of self-management behavior in patients with pulmonary tuberculosis, and (5) reflection of results. 3) After the experiment, summarize the results of the experiment and analyze the data. Step 4: Sample group of 6 pulmonary tuberculosis patients and 6 staff members who work in the care of tuberculosis clinic patients. The research instruments used in steps 1-4 were: (1) data recording form, (2) process evaluation form, (3) process component analysis questionnaire, and (4) satisfaction evaluation form. The experimental tool was a manual for the outpatient care process for pulmonary tuberculosis patients. Data were analyzed in steps 1-4 using content analysis, documents, percentages, means, standard deviations, and exploratory factor analysis (EFA).

Results: The results of the trial and study of the process for caring for pulmonary tuberculosis patients in the outpatient department of Phromphiram Hospital found that 1) Knowledge in patients, the mean score of knowledge about pulmonary tuberculosis (93.33%) was significantly higher than before the intervention (54.44%) and above the standard criteria (80%), with a statistically significant p-value of 0.0031. 2) Behavior After the experiment, the mean percentage of self-care behavior scores was significantly higher than before the experiment (84.37%) and above the standard criteria (80%). 3) Efficacy of pulmonary tuberculosis treatment. After the trial, the experimental group had a 100% success rate of treatment with negative sputum smears at least twice during the treatment period. Sputum smear results must be negative in the last month of treatment 100%, patients received the medication for the prescribed period of 6-8 months 83.33%, Come for regular follow-up treatment appointments 100%, take medication continuously and correctly 100%, cough reduced or disappeared 100%, no fever 100%, weight gain 100%, fatigue improved 100%, chest radiographic changes improved 100%. 4) Satisfaction assessment results found that, it was at the highest level. And the evaluation results of the satisfaction assessment of stakeholders towards the process of caring for pulmonary tuberculosis patients in the outpatient department: a case study of Phromphiram Hospital, Phitsanulok Province, from the patient care team, 6 people, had the highest level of satisfaction.

Conclusion: The research results show that the developed outpatient pulmonary tuberculosis patient care process is appropriate in terms of content and process and can be used as a guideline. (CPG), A care plan can be applied effectively in the care of pulmonary tuberculosis patients to achieve successful treatment of the patients.