Abstract
The policy of Ministry of Public Health states that all hospitals under MOPH should establish Chronic Kidney Disease Clinics (CKD clinics). This study aims to evaluate the implementation of CKD clinics using mixed method research and the CIPP model. Results from 140 hospitals in 12 regional service providers showed that 70.71% of established CKD clinics in line with MOPH policy, while 22.14% already had CKD clinics prior to the MOPH policy statement, and the remaining 7.14% hospitals had not developed CKD clinic citing limitations due to area, personnel or budget. In total, 82.31% established sole purpose CKD clinics providing at least one day per week, but occupied the space used by other clinics. Whereas 17.69% did not separate CKD clinic from other health clinic and ran CKD services in parallel to other clinics. For example, some centers had a ‘CKD corner’ as part of their regular DM/HT clinic. In terms of the hospitals that had implemented CKD clinics, 44.62% of centers used both consultative meetings and two ways communication about policy, goals, future plans of CKD clinics to all health personnel and other stakeholders. Whereas, 27.69% used only two ways communication to realize policy, goals and planning of CKD clinic to among interested parties. The remaining 3.08% hospital used no clear consultative process in developing their clinics. Almost all hospitals reported that the supporting budget for CKD clinic was insufficient. Most hospitals (63.21%) funded the establishment of their CKD clinics from their own operating budgets and some fund support from National Health Security Office (NHSO). In terms of human resource, 58.46% have professional team (full) including physician, nurse, pharmacist physical therapist, and nutritionist or Dietitians. However, we found that 20.77% of hospital did not have funded position for nutritionists and in this cases, the advice about nutrition was provided by nurses. All hospitals with professional nutritionists funded this position of their own accord with temporary employee’s position. In addition, 95.38% of all hospital had implemented and maintained CKD patient databases, but only 42.31% of these contained all recommended clinical measures such as Serum Cr and eGFR, blood pressure, blood sugar, take ACE-I or ARB drug, and urine protein. For the most part, patient data were not utilized to track patient disease progression. Most personnel reported the reason for not using routine CKD patient data to gauge patient disease progression and outcomes was excessive workload. In general, CKD patient data was mainly used to report CKD’s KPI to the Ministry of Public Health.
