Development of Management Models for Individuals at Risk of Harms Related to Steroids in Si Chomphu District, Khon Kaen Province

Abstract

Objectives: 1) To study the prevalence of the use of inappropriate drugs and health products in Chomphu district. Khon Kaen Province, 2) to develop a management models for individuals with risk of harms related to steroids (RHRS) for community network (the Model) and 3) to evaluate the implementation of such model. Methods: The study was an action research during 2018-2022. The subjects were patients with chronic diseases with a history of using steroid-adulterated drugs and health products. The study was divided into 3 phases. Phase 1 was the study the prevalence of the use of inappropriate drugs and health products identified during home visits of patients in 7 groups of chronic diseases and inspections of groceries within the community. Phase 2 involved the development of the Model, identification of those with RHRS by community network, screening of harms in those with RHRS by personnel in sub-district health promotion hospitals and referral of those with suspected harm for treatment at Si Chomphu Hospital. Phase 3 was the evaluation of the implementation of such model. Results: The Model consisted of 6 activities including 1) public education on relevant knowledge; 2) identification of those with RHRS; 3) screening those with DPRS for potential harms; 4) referral of patients from the community to hospitals according to guidelines; 5) treatment of patients with Cushing’s syndrome or harms related to steroids and 6) outcome evaluation of the treatment using the ECHO Model. Implementation of the Model identified 353 patients with RHRS. 240 of patients underwent the screening and were referred to Si Chomphu Hospital. There were nine cases with symptoms meeting the criteria for Cushing's syndrome, accounting for 3.75% of the patients at risk. Assessment of clinical outcomes after treatment revealed that nine patients recovered from Cushing's syndrome. Humanistic outcomes assessment found that patients and their relatives were satisfied with the treatment at the highest level. Evaluation of economic outcomes revealed that the cost of treatment for patients was ≥ 3,908 baht per case and indirect cost was ≥ 10,500 baht per case. Conclusions: The model for identification, screening, and referral of patients at risk of harms from steroids with the help of community network led to timely medical treatment. If the patients at risk could be identified early on, prevention of potential diseases and complications is feasible and the burden of related medical expenses could be reduced.