การพัฒนาระบบบริการผู้ป่วยติดเตียงที่ยากไร้ พื้นที่กรุงเทพมหานคร

Phitchayuth Kritrattanachot; Sriparinya  Toopgrajank; Nalinee  Suradinkura; Tippawan  Chakphet; Vichit  Suradinkura

Authors

Phitchayuth Kritrattanachot Suan Sunandha Rajabhat University
Sriparinya Toopgrajank Suan Sunandha Rajabhat University
Nalinee Suradinkura Suan Sunandha Rajabhat University
Tippawan Chakphet Suan Sunandha Rajabhat University
Vichit Suradinkura Suan Sunandha Rajabhat University

Keywords:

healthcare service system, bedbound patients, impoverished patients

Abstract

This mixed-methods study aimed to: 1) assess the development level of service systems for impoverished bedridden patients, service innovations, standards of care, service policies, and stakeholder participation; 2) examine the influence of service innovations, standards of care, service policies, and stakeholder participation on the development of these service systems; and 3) propose strategic guidelines for service system improvement. The quantitative phase involved 350 bedridden patients selected through multistage random sampling. Data were analyzed using descriptive statistics, structural equation modeling (SEM), and path analysis. The qualitative phase consisted of in-depth interviews with 15 informants selected through purposive selection, with data analyzed through content analysis.

The results revealed that: 1) The highest mean score was for the development of service systems for impoverished bedridden patients, followed by standards of care, service policy, service innovation, and stakeholder participation, respectively. 2) The SEM model showed good fit with the empirical data (Chi-square = 70.9, df = 44, p = .06, GFI = .99, AGFI = .99, CFI = .99, RMR = .043, RMSEA = .042). Standards of care had the greatest total influence on service system development for impoverished bedridden patients, followed by stakeholder participation, service policy, and service innovation. 3) The proposed development guidelines included: 3.1) expanding service accessibility through mobile health units and centralized data systems; 3.2) applying digital and Internet of Things (IoT) technologies aligned with local community contexts; 3.3) developing and implementing practical, standardized care protocols; 3.4) ensuring sustained policy and budgetary integration; and 3.5) fostering multisectoral and community-wide engagement to build equitable, inclusive, and sustainable care systems.

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