Development of Integrated Care Model for Poor Control Type 2 Diabetes Patients Health Network Kalasin Province

Abstract

     This study was action research aimed to study the situation, develop a model, and the effect of an integrated care model. for patients with poorly controlled diabetes of the health network of Yang Talat District, Kalasin Province Research co-author was 31 multidisciplinary team in the hospital and health network of Yang Talat District. Sample size were 2,482 type 2 diabetic patients with cumulative average sugar greater than 7 who came to receive services at the Diabetes Clinic, Yang Talad Hospital. and sub-district health promotion hospitals from October 2020 to September 2022. research tools from the deployment of life traffic table tennis policy into practice, together with document review, research and brainstorming sessions with multidisciplinary teams Developed a model of care using the Chemmis and Magtagad PAOR process. Data collection tools consisted of individual patient records, and a record form of cumulative average glucose examination results Data was collected by interviewing, brainstorming and cumulative average sugar examination. Data were analyzed by content analysis, percentage, mean, standard deviation and paired t - test.

     The results showed that The situation of poorly controlled diabetic care showed that 79% of type 2 diabetic patients had an average cumulative sugar of more than equal to 7 after the integrated care model for poorly controlled diabetic patients. The percentage of patients with poorly controlled diabetes decreased from 79 to 61, the mean cumulative glucose level decreased from 10.14% to 8.96% and decreased significantly (p – value < .000) compared to before operation.