Development of pulmonary tuberculosis patient care services through the participation of multidisciplinary teams and community networks in Yangsisurach district, Mahasarakham province.

Abstract

     This action research aimed to develop the provision of pulmonary tuberculosis care services with the participation of a multidisciplinary team and community networks in Yangsisurach District. The research was conducted from September 2020 to August 2021. There were 2 groups of participants: `1) The group that jointly developed the guidelines for pulmonary tuberculosis care, including the multidisciplinary team in the hospital, public health officers at the sub-district health promotion hospital, village health volunteers, elderly care volunteers, and community leaders. 2) 35 patients and their families with pulmonary tuberculosis. The research instruments included a tuberculosis severity classification form, a DOTS medication record form, a tuberculosis patient screening form in household contacts/close contacts, a home visit record form, an INHOME-SSS patient assessment form, an observation form, and a satisfaction assessment form. Qualitative data were analyzed using content analysis, and quantitative data by number, mean, and percentage.
     The results of the study found that the provision of pulmonary tuberculosis care services with the participation of a multidisciplinary team and community networks at Yangsisurach Hospital consisted of: 1) Developing a participatory management system with supervision and monitoring of the network. Resulting from participation and pushing for the project plan supported by the local administrative organization and the provincial community. 2) Developing and providing care services in clinics and community for pulmonary tuberculosis patients, including developing the potential of multidisciplinary teams in hospitals, sub-district health promotion hospitals and community network partners, developing CNPG for case management of pulmonary tuberculosis patients with comorbidities / those with problems in caregivers and taking tuberculosis drugs, including developing CPG, developing one-stop service, creating a guideline manual for managing drug complications for patients and families, developing a referral system, developing a continuous care system in the community. 3) Developing an information system and information referral. Including a consultation system for sub-district hospitals/communities 4) Develop a community network to take care of the DOT system at home. The evaluation found that patients who missed appointments decreased from 2.25 to 0, the percentage of self-drug withdrawal decreased from 1.58 to 0, the percentage of malnutrition decreased from 3.47 to 1.32, the percentage of readmissions within 1 month increased from 3.67 to 0, the treatment coverage rate increased from 79.63 to 91.33, the mortality rate decreased from 15.63 to 3.52, and the treatment success rate increased from 78.22 to 88.05. The results of the service development resulted in patients being able to access treatment, reducing death, and achieving treatment within the specified time frame, reducing treatment costs.