The Development of Continuing Care Guideline for Chronic Kidney Disease : Primary Care Network, Khon Kean Hospital

Abstract

This action research focused on develop a continuing care guideline for chronic kidney disease patients registered at Khon Kean Hospital and its Primary Care Network using chronic care model and continuing care as conceptual framework. 70 participants were recruited (consisted of patients and their caregivers, village health volunteers, community leaders, and health care providers). Data was collected through in-depth interviews, focus groups, observation and related clinical records survey. All data were analyzed using descriptive statistics and qualitative-data content analysis. The research results showed that the developed continuing care guideline expanded more holistic and continuity care for those chronic kidney disease patients. Families and community were reached out and encouraged to involved in supportive caring. Volunteers and health care providers were trained and connected systematically. Patients’ knowledge, and self care behaviors were improved. As a results, clinical signs evaluation changed up from Phase 4 to Phase 3 : 13.33 percent .