The Effects of the Home Ward Process on Changes in HbA1c Levels among Diabetic Patients at Phana Hospital, Amnat Charoen Province.

Abstract

             This study aimed to evaluate the effectiveness of the Home Ward process on HbA1c changes in type 2 diabetes patients and analyze factors affecting these changes. This was a retrospective analytical study using a single-group pre-posttest design that analyzed medical records of type 2 diabetes patients who participated in the Home Ward process at Phana Hospital, Amnat Charoen Province, between February and September 2024, totaling 64 patients. Electronic data recording forms were used to collect data from the HOS XP system, gathering HbA1c values before and after program participation (3-4 months), baseline patient data, and Home Ward activities. Data were analyzed using a paired t-test, a McNemar-Bowker test, and multiple logistic regression.

            The results showed that the mean HbA1c significantly decreased from 11.93% to 9.77% (p < 0.001), representing a 2.16% reduction. Hemoglobin A1c improved in 90.6% of patients. The proportion of patients achieving acceptable glycemic control targets (HbA1c ≤8%) increased 4.8-fold from 4.7% to 23.4%. A total of 73.4% of patients showed good treatment response (HbA1c reduction ≥1.0%). Significant predictive factors included baseline HbA1c levels, with patients having baseline HbA1c of 10-12.9% and ≥13% being 4.33 times more likely to respond well compared to patients with HbA1c <10% (p<0.05), and diabetes duration, with patients having diabetes for 11-14 years being less likely to respond well compared to those with 2-5 years duration (OR=0.17, p=0.040). The Home Ward process demonstrated high effectiveness in glycemic control for patients with type 2 diabetes, particularly those with poor initial control. The 2.16% HbA1c reduction exceeded the clinically significant difference threshold, demonstrating the program's potential to reduce diabetic complications. The study supports implementing the Home Ward process as a primary care model for diabetes management, with priority given to patients with high HbA1c levels and diabetes duration less than 10 years for optimal effectiveness.