The Effectiveness of Diabetes Clinic Service at Sub-District Health Promoting Hospitals after The Transfer of Mission to Khon Kaen Provincial Administrative Organization

Abstract

Objective: To evaluate the effectiveness of diabetic patient services and study problems, obstacles, and recommendations for diabetic patient services at the Subdistrict Health Promotion Hospital under the Khon Kaen Provincial Administrative Organization (PAO). Methods: This is an evaluation research using the CIPP Model, conducted between April and December 2024. Qualitative research using in-depth interviews and focus group discussions. Sample group 1) Non-communicable Disease Control Committee, Khon Kaen Provincial Administrative Organization, 8 people 2) Professional nurses responsible for the diabetes clinic and providing care to patients in the diabetes clinic of the Subdistrict Health Promotion Hospital under the Khon Kaen Provincial Administrative Organization, totaling 30 people. 3) Type 2 diabetes patients who were referred to receive services at the Subdistrict Health Promotion Hospital under the Khon Kaen Provincial Administrative Organization, totaling 30 people. Specific selection, quantitative research using questionnaires, sample group 1) Diabetic patients, sample size 322 people, stratified random sampling. 2) Professional nurses, sample size of 145 people, by simple random sampling, calculated sample size by estimating the population proportion in the case where the population size is known, using Daniel's (2010) formula. Results: 1) In terms of context, the service model in the diabetes clinic still operates according to the original guidelines before the transfer of duties, namely: It is the Chronic Care Model by the Khon Kaen Provincial Administrative Organization. It has established strategies for promoting, preventing and controlling diseases and health threats to be used as guidelines for operations. 2) Import factors There is a shortage of personnel working in diabetes clinics. This is resolved by hiring more and recruiting personnel to fill vacant positions. In terms of budget, the Subdistrict Health Promoting Hospital (Sor.PH) has received an increased budget allocation, resulting in a better financial situation than before the transfer of duties. Materials, equipment, tools, medicines, and medical supplies continue to be supported by the hospital as usual. If supplies are insufficient, they can be purchased from the Subdistrict Health Promoting Hospital budget. In terms of management systems, coordination with local hospitals is being carried out through the CUP BOARD, with a joint service plan being developed as before. 3) In terms of process, services are provided in diabetes clinics according to the Chronic Care Model and NCD Clinic Plus criteria, with hospitals serving as the main service network and sub-district health promotion hospitals as the operational network. 4) In terms of results, the service quality of the diabetes clinic before and after the transfer of duties was not significantly different (t= 2.51, p-value = 0.20). Health outcomes showed that the blood sugar levels of type 2 diabetic patients before and after the mission transfer, the majority had HbA1C levels less than 7.0, 52.00% and 70.50%, respectively. The health behaviors of type 2 diabetes patients, when compared before and after the mission transfer, were significantly different (t = 4.27, p-value < 0.05). Conclusion: The Diabetes Clinic continues to operate according to the Chronic Care Model under the disease control strategy of the Khon Kaen Provincial Administrative Organization. Although the number of personnel is insufficient, additional recruitment has been made, while the budget of the subdistrict health promotion hospital has increased, resulting in a more stable financial situation. Equipment and materials are still supported by the hospital and can be purchased additionally. There is also a coordination system through CUP BOARD to provide services according to the Chronic Care Model and NCD Clinic Plus standards, with the hospital acting as the host and the Subdistrict Health Promotion Hospital is a network operator, resulting in no significant difference in service quality, patients' HbA1C levels improving, and patients' health behaviors improving significantly.