Development of a community-based tuberculosis care model by the health network of Chiangrai Prachanukroh hospital
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Abstract
BACKGROUND: Tuberculosis patients have treatment success rates below the standard, with high rates of treatment default and mortality due to delayed treatment, lack of awareness, and limited community participation.
OBJECTIVE: To develop a community-based tuberculosis care model through the health network of Chiangrai Prachanukroh Hospital and evaluate its outcomes using the holistic care concept and evidence-based practice.
METHODS: The study consisted of four phases: 1) focus group discussions to analyze data, 2) development of the tuberculosis care model, 3) capacity building of the network and implementation of the model, and 4) outcome evaluation. Purposive sampling was used, included 20 health network members and 103 tuberculosis patients in each group registered for treatment at Chiangrai Prachanukroh Hospital before and after the model development. The study was conducted from December 2023 to October 2024. Data were collected using problem-solving summaries from focus groups, patient record forms, care outcomes, household contact screenings, socioeconomic support, and health network satisfaction surveys. Data were analyzed using descriptive statistics, Chi-square tests, and t-tests.
RESULTS: The community-based tuberculosis care model consists of home visits, screening of household contacts, and social and financial support. Implementation of the model led to increased treatment success rates, decreased mortality rates, and no treatment defaults; however, these differences were not statistically significant (p=0.082, 0.530, and 0.121). The network demonstrated increased satisfaction in terms of knowledge, referral processes, information coverage, and consultation (p<0.001). Home visits were conducted according to the model, with 100% timeliness and 89.36% coverage, which was lower due to patient deaths before treatment completion. Screening of household contacts and provision of social and financial support also increased.
CONCLUSIONS AND RECOMMENDATIONS: The developed community-based tuberculosis care model is appropriate for managing tuberculosis patients in the community. It enhances the quality of nursing care and leads to improved patient treatment outcomes. It is recommended that tuberculosis screening be further strengthened in high-risk chronic disease groups to ensure comprehensive coverage, as mortality remains high among patients with severe symptoms who enter tuberculosis treatment late.
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