Development of Community-Linked Continuum Care Model for New Tuberculosis Patients at Ban Thi Hospital, Ban Thi District, Lamphun Province.

Abstract

      This participatory action research, based on the Kemmis and McTaggart framework, aimed to examine the situation of care for new tuberculosis patients, to develop a community-linked continuum care model for new tuberculosis patients through the participation of a multidisciplinary team and network partners, and to evaluate the outcomes of the model. The study was conducted from January to September 2024, a total of 9 months, and the model was developed through three cycles of four weeks each. The samples comprised 30 purposively selected members of the multidisciplinary team and network partners and 31 new tuberculosis patients registered for treatment at Ban Thi Hospital in fiscal year 2025. Research instruments included a structured interview form, a focus group discussion guide, a participatory observation form, a general information questionnaire, a tuberculosis knowledge test, a self-care behavior assessment, a treatment outcome record form, and a satisfaction assessment. Quantitative data were analyzed using descriptive statistics, Paired t-test, Wilcoxon Signed-Rank Test, and Fisher’s exact test, while qualitative data were analyzed using content analysis and thematic analysis.

      The results showed that most new tuberculosis patients were older or middle-aged adults with low income, and 54.84% were underweight and 54.84% had comorbidities. The retrospective death rate in fiscal years 2022–2024 was 7.69%, exceeding the target of less than 5.00%. Patients had a low level of knowledge about treatment and medication, information referral between the hospital and sub-district health promoting hospitals was delayed, and stigma persisted in the community. The developed model comprised five components: 1) initial assessment and high-risk classification, 2) health education and service agreement, 3) a medication monitoring system by relatives and village health volunteers, 4) information referral to sub-district health promoting hospitals and the community within 24 hours, and 5) continuous symptom surveillance, with a nurse acting as case manager. The level of participation increased from low (1.22) to high (2.76). After implementation, the mean knowledge score increased from 19.31±5.54 to 25.31±3.63 (t = 8.23, p < .001), self-care behavior increased from a moderate level (3.44±0.48) to a high level (4.18±0.30) (t = 10.38, p < .001), and patient satisfaction increased from 3.34±0.36 to 4.16±0.43 (t = 12.60, p < .001). The treatment success rate was 93.55%, the death rate was 3.23%, below the target, no patients defaulted from treatment, and the mean medication adherence rate was 98.22±1.99%. Satisfaction of the multidisciplinary team and network partners was at a high level (4.11±0.39).