Development of a long-term patients service system for the elderly in the community Primary care unit Nakhon Phanom hospital network

Abstract

BACKGROUND: Nakhon Phanom Hospital is a 345-bed general hospital responsible for the population in Mueang Nakhon Phanom District. It found that the statistics of the elderly and elderly with chronic diseases were increasing.

In 2021-2022, the data showed the homebound elderly was 2.71 and 4.62%, the bedridden elderly was 0.38, 0.56%, the dependent elderly receiving care as long term care plan was 85.02, 88.59%, the elderly with having the problem in the transitional period not being able to access long-term services in the community was 12.46 and 23.28%, respectively. These causing might result in delayed rehabilitation, increased disability, and increased dependence.

OBJECTIVE: To 1) development of a long-term patient service system for the elderly in the community, 2) study the results of developing a long-term patient service system for the elderly in the community, primary care units, Nakhon Phanom Hospital Network.

METHODS: This is an action research. The sample group includes dependent elderly people, primary caregivers (Family caregivers: FCG), caregivers (CG), and case managers (CM) in Mueang Nakhon Phanom District, Nakhon Phanom Hospital Service Network. The development process uses the 4 steps of Kemmis & McTaggart as follows: 1) Planning-P 2) Action -A 3) Observation-O and 4) Reflection-R. When the cycle is complete, the plan will be improved and implemented. Data collection was conducted between October 2022 and January 2024. Data was analyzed using descriptive statistics and inferential statistics with paired sample t-test.

RESULTS:  The long-term elderly service system for the elderly in the community in the context of the primary care unit of Nakhon Phanom Hospital Network was developed. The results of this developing service system showed that 1) The elderly part: After using the developed service system, ADL score increased and it showed no significant difference in the bedridden elderly, but it was significantly different in the homebound elderly. The overall quality of life of the elderly, both the bedridden elderly and homebound elderly group was significantly higher than before the development of the service system (p<0.001). 2) The family caregiver (FCG) found that the average score of stress and burden in caring for long-term patients for caregivers was significantly lower than before using the service system (p<0.001). 3) The service provider found that the knowledge test after training in long-term care skills for caregivers (CG) was significantly higher than before training (p<0.001) and the satisfaction of caregivers managing the elderly (CM) was found to be at the very best level with an average of 4.47 (SD=0.41).

CONCLUSION AND RECOMMENDATIONS: Developing a long-term patient service system for the elderly in the community showed the better result than before service. This developed service allows the elderly to receive health problem resolution quickly and in time, receive rehabilitation, prevent complications, and delay dependency with a networked work process and continuous supervision and monitoring of long-term patients. Ultimately, they have a good quality of life according to their potential. The long-term patient service system should be expanded to all disease groups and all age groups, using the participation of networks in the community.