Management and performance of home health care services for chronic patients of Chao Praya Yommarat Hospital in urban community, Suphanburi Province

Abstract

Currently, demand for home health care (HHC) services is increasing to reduce complications and severity of chronic illness, number of hospital services, and health expenditures. The purpose of this qualitative research was to identify the problems and provide suggestions to develop the patterns of HHC management of executives and performance of responsible HHC service providers for chronic disease patients in the urban community of Chao Praya Yommarat Hospital in Suphanburi Province. The study sample includes five managers from a HHC center, primary care unit (PCU), and three community health centers (CHC), and 16 service practitioners, consisting of nurse practitioners or professional nurses from a social medicine unit. The data were collected by in-depth interviews. Qualitative data were analyzed and synthesized for content analysis.

The results of this study revealed that the main problem of HHC management was the lack of some multi-disciplinary team members, especially doctors, due to their excessive workload. Also, performance problems of HHC were attributed to lack of nurse practitioners. Village health volunteers (VHVs) and care givers lacked adequate knowledge of HHC. Following up elderly patients was difficult because of a change of address.

The research findings demonstrated that the multi-disciplinary teams have an important role in HHC for chronically ill patients, with assistance from VHVs, family health leaders, and care givers. The Ministry of Public Health (MoPH) should have a policy to support a proactive approach of the multi-disciplinary team and increase compensation for team members. There should be support for the training of nurses to become nurse practitioners. There should be more capacity development of VHVs, family health leaders and caregivers on a regular basis.