The Development of a Seamless Geriatric Clinic Service Model in Tertiary Hospitals in Ubon Ratchathani Province

Abstract

This research and development research aimed to study the situation, problems and needs of geriatric clinics, develop a geriatric clinic service model, and evaluate the developed model at Sunpasitthiprasong Hospital. The research was divided into 3 phases as follows: Phase 1: Study of the problem situation and needs of elderly clinics by analyzing external factors (Six Building Blocks); Phase 2: Development of a model for elderly clinics; Phase 3: Evaluation of the results of the development. The concept of systems theory and the PDCA development model were applied. The sample group was a group of health care professionals who work with outpatients, the elderly, and their caregivers, totaling 12 people. The research tools included 1) a semi-structured questionnaire, 2) staff and service recipients satisfaction assessment forms, 3) activities of daily living (ADL) assessment forms, and 4) an appointment attendance record form. All four research tools were tested for their content validity index (CVI) and reliability. Results demonstrated CVIs .80, .81, .81, and .80, respectively, and reliabilities (Cronbach's alpha coefficients) ​​of .88, .80, .80, and .81, respectively. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis.

Results: The situation analysis of the elderly clinic service at the hospital found there was no established specialized elderly clinic, no personnel responsible for an elderly clinic, and no holistic elderly assessment. Moreover, services for the elderly were incorporated within the setting for the adult and elderly group. The newly-developed holistic geriatric clinic service model included three aspects: 1) Prehospital, a care model provided based on CGA; 2) Intra-hospital, a care model based on geriatric syndrome and discharge planning for the elderly with complex problems, especially, those having hip fractures; and 3) Posthospital care to provide a continuum of elderly care, such as information and geriatric assessment data being transferred back to the relevant hospital. The evaluation of the developed model found that the staff and the elderly were very satisfied, the elderly received discharge planning and care transfer, and, at home, the ability to perform ADLs generally increased, with patients reporting no new injuries and regaining their prior normal levels of ADLs. The adherence rate with follow-up appointments was 80%. Therefore, the service model for an elderly clinic that provides continuous holistic care from hospital to home had positive outcomes on the elderly. Therefore, the newly-developed care model should be applied to providing care for the elderly in geriatric clinics.