Abstract
The purpose of this action research was to develop a primary care model for a healthy community in the eastern region of Thailand. The research process consisted of 5 stages: 1) exploration of primary care delivery in selected settings, 2) improved understanding of the concept of primary care unit management, 3) build community health participation, 4) maintain development of primary, and 5) evaluate and recommend. Selected settings for the study were a community health center and municipal health center in urban area of Chonburi province. Informants included administrative committees, health care providers, village health volunteers, community leaders, and people in the community, Data were collected from documents and reports by in-depth interviews, focus group discussions, brain-storming, questionnaires, and observations. Content analysis was validated by informants and experts in the community. The results were as follows:The Primary Care Model is designed by developing and modifying structures of the previous health centers as the primary care units (PCU). The PCU activities focused on four dimensions of health care including health promotion, prevention, primary medical care and rehabilitation. The main health care providers working at the PCU were professional nurses and technical nurses. The physician worded regularly at the PCU for a half day per week. There was a health referral network. The health care networking committee was set from four alliances in order to create changes, monitor, and evaluate the development of the PCU.The process to establish effective primary care units emphasized personnel development, health service system improvement, and community potential enhancement. The keys for success included shaping ideas and enhancing knowledge as well as building community participation in the health system development. The educational institutes in the community mentored and supervised the development.The outcomes of the development process included providing four dimensions of health care services that were congruent with the health care providers’ experiences and background. Applied the concepts from anthropology to understand the potential of the community. Health care providers and community members started working together by creating sa vision and mission; building community participation in health care; setting a strategic plan, and establishing a health care networking committee. Establishing a health partnership in the community was a key for success for the primary care model. The communities were satisfied with convenient services that easily accessed, and provided service with care. Educational institutes and community agencies took responsibility to develop services. The professional nurses are the main personnel and demonstrated competencies in working at PCU.The main element to improve the quality of services included having focused health policy and qualified personnel. The qualified nurses should be Masters prepared in the field of community or family nursing. An effective budget management, quality control health networking, community data base are needed. In addition, modification of the role of community agencies and people in the communities in the communities in order to take responsibility for their own communities by establishing community health partnership.Recommendations for primary care model development are to prepare and improve the structure, the main personnel should be a professional nurse and allocate personnel based on their potential and ratio between health personnel and clients. Development of the ability of personnel and the administrator. Improvement the home health care, the holistic care. Development the budget management, the quality control and the net working. Establishing the health learning center and community volunteers in the community, And modification of the role of community agencies in the communities in order to take responsibility.Suggestions for health policy should be built by agreement of government, professional agencies, and educational intakes. Future research should study the development of a primary care model focusing on service cost analysis, decentralization and role of satisfied primary care model, and a health learning center.
