The Development of the District Health System and Outcomes of Care for Patients with Diabetes at Phan District, Chiang Rai Province During 2011-13

Abstract

This research had the objective to study the model and outcomes of care for
diabetes patients in Phan District of Chiang Rai Province during 2011-13. This study used a
retrospective research design and collected electronically-stored data on 147 diabetes
patients in Phan District Hospital who then received follow-up care at the Muang Kham
Primary care unit (PCU). These data were supplemented by in-depth interviews with ten
doctors, nurses and staff of the PCU. The quantitative data were analyzed by descriptive
statistics and Chi-square test.
In the past, the system of care for diabetes patients in Phan District was mostly
passive, in that most cases came for treatment at the district hospital. The total number of
registered diabetes cases is increasing over time and reached 5,361 in 2013 (an increase of
918 over 2011). The large and growing caseload is straining the hospital facilities and is
causing over-crowding and rushed service, with no increase in clinicians or staff. This is
eroding the quality of care, and patients do not always receive comprehensive evaluations,
determination of related health problems, or complete health information about their
condition. The decline in quality of care is also discouraging some cases from going for drug
resupply at the hospital, which can result in blood-sugar imbalance, chronic foot sores,
impaired vision, or even stroke. To address the current and future challenges of health
care, Phan District has started to implement a District Health System (DHS) which consists
of a network of linked facilities throughout the district. The DHS ensures that the
population will be seen before illness develops and during illness for management of
complications and post-complication care. The DHS uses a pro-active, population-based
approach and attempts to identify all persons in the district who have chronic illness,
especially those in the early, pre-complication stage of illness. In this way, the condition
can be managed and complications can be prevented. This study found that the DHS
improved referral for diabetes patients to the Muang Kham PCU, and thereby reduced
travel time for the patients, instead of requiring them to go to the Phan District Hospital.
There was an increase in clients who received blood tests and other health screening in
2013 when compared with 2011. However, there need to be improvements in the services
and data system for comprehensive health promotion, prevention and care for diabetes
patients that is complete and accurate. There need to be links among the Muang Kham
PCU and Phan District Hospital. There needs to be more involvement of the community
(i.e., Tambon administrative organizations, village health volunteers and staff of the
Tambon Health Promotion Hospital) in the design of services, especially in documenting
existing cases and finding new cases at the earliest stages of the disease cycle to reduce
complications of diabetes.