Patient Assessment of Chronic Illness Care among Type 2 Diabetic Patients in Dok Khamtai District, Phayao Province

Abstract

Thailand implemented Chronic Care Model (CCM) for chronically ill patients in district
health system. However, limited investigations have examined on assessment of patients with
chronic diseases using PACIC instrument. This study aimed to assess patient’s perspective on
receipt healthcare and to compare the quality of treatment received between diabetic clinic at
community hospital (DC-CH) and diabetic clinic at sub-district health promoting hospital (DCSDHPH)
which is a network under community hospital supervision.
The cross sectional study was carried out. A sample of 130 type 2 diabetic patients
was selected by stratified random sampling. The instrument using Patient Assessment of Chronic
Illness Care questionnaire (PACIC) consisted of 20 items which developed based on CCM. The
content validity was examined by three experts, yield IOC of 1. The value of Cronbach’s alpha
coefficient was 0.90. Data were analyzed by descriptive statistics and inferential statistics including
chi-square test and independent t-test at the significant level p<0.05.
The overall of PACIC had moderate score (Mean=3.11, S.D.=0.64). There was
significant difference between PACIC score of DC-SDHPH (Mean=3.30, S.D.=0.63) and DC-CH
(Mean=2.99, S.D.=0.62) (t=2.809, p-value=0.006). When consideration on subscale, the result
revealed that there were no significant difference of problem solving between PACIC score
of DC-CH (Mean=2.87, S.D.=0.78) and DC-SDHPH (Mean=2.98, S.D.=0.64). Whereas patient
activation, delivery/system design, goal setting and follow/coordination had differed significantly
of the mean score between DC-CH and DC-SDHPH.
There is considerable variation in diabetes management in different primary care
setting. Health service delivery network and sharing resource in district health system resulted in
achieving quality of caring in type 2 diabetes mellitus patients at SDHPH.