Evaluation of Primary Care Service System Models for Diabetic and Hypertensive Patients in Khon Kaen Province

Abstract

Primary care is a crucial quality health care system in achieving health for all people. This study aimed to evaluate the provisioning and supporting systems, and also compare the provisioning and supporting systems to the district areas of primary care services for diabetic and hypertensive patients in Khon Kaen province covering the pilot and non-pilot primary care clusters (PCCs), the non-communi­cable disease (NCD) clinics of hospitals, and the health-promoting hospitals of Mueang, Nam Phong and Ubolratana districts. A cross-sectional study was conducted with 170 health personnel via purposive sampling. Data were collected by self-administered questionnaire with 0.84 Cronbach’s alpha coefficient. Data were analyzed using descriptive statistics in terms of percentage, mean and standard deviation, and inferential statistics in terms of ANOVA and least-significant difference. The findings showed that mean score of the provisioning and supporting system of the primary care service of NCD clinics of the hospitals was higher than the PCCs and health-promoting hospitals at both province and district levels. The mean scores of the NCD clinics were higher than the others in all dimensions of the provisioning system, in­cluding the relationship between clients and family medicine or family doctor, shared care plan for the individual patient, health information system, and self-management supports of the patients. However, the mean score of continuity of care and coordination provided by the pilot PCCs was higher than the NCD clinic of the hospitals. In terms of the supporting process associated with the family care team and multi-disciplinary team, and the understanding of primary care service principles, the mean score of the NCD clinics was higher than the PCCs and health-promoting hospitals. However, regarding the aspect of trust in time allocation of the team in providing care to patients, the mean score of the non-pilot PCCs was the highest, while the another aspect of continuity of health care service development served by the pilot and non-pilot PCCs and the NCD clinic had the same level of mean scores. When considering the dimension of the provisioning system of all three districts, in particular, the pilot PCCs of Nam Phong and Ubolratana districts had a higher mean score than the pilot PCCs of Mueang district. The pilot PCC of Nam Phong district had the highest mean score in two aspects: relationship between clients and family medicine or family doctor, and self-management supports of the patients. The pilot PCC of Ubol­ratana district had the highest mean score in two aspects: shared care plan for the individual patient, and continuity of care and coordination. In addition, the remaining aspect linked to the health informa­tion system provided by the pilot PCCs of Nam Phong and Ubolratana districts had the same mean. There were significant differences in all aspects in all three districts, except the relationships between clients and family medicine team (no significant difference in all districts). The present evaluation of the primary care models was an early assessment set by the central national project that needed longer time after implementation to learn more lessons for further improvement. Moreover, the present study was biased on the opinions of health care providers and did not include the opinions of clients and clinical outcomes of the service provision.