Development of Clinical Practice Guidelines and Referral System for Pediatric Thalassemia in Community Hospitals, Loei Province

Abstract

        This action research aimed to explore the situation and problems, develop a service system, and evaluate the outcomes of a nursing care and referral system for pediatric patients with transfusion-dependent thalassemia (TDT) in Loei Province. The study was conducted using the action research process of Kemmis and McTaggart, consisting of four phases: planning, action, observation, and reflection. Participants were purposively selected, comprising 54 multidisciplinary team members, 109 pediatric TDT patients, and 109 family members. Research instruments included clinical practice guidelines, referral and coordination guidelines, treatment outcome reporting forms, and a satisfaction questionnaire. Content validity was verified by three experts, yielding a Content Validity Index (CVI) greater than 0.80 and an Index of Item-Objective Congruence (IOC) greater than 0.91. Quantitative data were analyzed using descriptive statistics and dependent t-test, while qualitative data were analyzed using content analysis.

        The results revealed that the developed service system comprised: 1) clinical practice guidelines for pediatric TDT treatment, 2) referral and coordination guidelines among network hospitals, 3) service system guidelines for community hospitals, and 4) a treatment outcome reporting system. After implementation, all 14 hospitals achieved 100% compliance with the system. The mean hemoglobin level significantly increased from 8.55 to 9.05 g/dl, and the mean ferritin level significantly decreased from 1,668.79 to 1,394.57 ng/ml (p < .01). Patient and family satisfaction significantly improved in all dimensions (p < .01).

        The findings demonstrated that the developed service system effectively improved clinical outcomes and enhanced patient and family satisfaction. This system should be disseminated to other regions with similar contexts.