Improvement of care for Patients with Diabetes Mellitus at a Health Promoting Hospital in Phibun Rak District, Udon Thani Province

Abstract

This action research aims to investigate the caring situation and development in diabetic patients, in aSub-district Health Promoting Hospitals, Phibun Rak District, Udon Thani Province by using the conceptual framework of Expanded Chronic Care Model (ECCM). The main research informants and participants included  diabetic patients, caregivers, health service providers, health volunteers and community leaders. Data were collected by in-depth interview, focus group discussion and observation. The research process is comprised of 4 steps : 1) the situational study of diabetes care in the community; 2) action planning; 3) implementation, reflection and improvement; and 4) evaluation, quantitative analysis by using frequency and percentage, and qualitative analysis by using content analysis. The research was performed during August 2019 – April 2020.

The results in the stage of situational study revealed that diabetic patients, who were unable to control their blood sugar level, most of them got an inadequate perception about diabetes leading to improper eating behavior, exercise and drug use. Additionally, the caregivers provided less patient care and health volunteers got inadequate disease perception and confidence to give advice to diabetic patients. In the aspect of health service, the service access was delayed, the health education was not covered, the patient database was not updated, the home visit guidelines were lacked, the community leaders had not yet participated in planning and supporting diabetic patient care.  

Development stage of diabetic patient care with participation of people who involved in brainstorming, planning and proceeding 4 following elements included 1) personal skill development by providing workshop, visiting diabetic patients at home and caregivers; 2) service system development by improving diabetes care service at Sub-district Health Promoting Hospitals to give the diabetic patients a faster service, clarifying staff roles and recruiting health volunteers into diabetes clinic; 3) patient database development by updating the database and comprehensive linking the information from hospital to community; 4) decision support by making home visit guidelines for staffs and health volunteers, as well as potential development of health volunteers in knowledge informing and home visiting. The evaluation found that the patient behavior had been improved, resulting in decreasing hemoglobin A1c of 21 patients. The caregivers and health volunteers had enhanced their knowledge about diabetes and confidence in taking care of diabetic patients. The patient database had been updated and the home visit guidelines had been provided. The community leaders had paid more attention and participated in taking care of diabetic patients.