Abstract
Primary care is a crucial quality health care system in achieving health for all people. This study
aimed to evaluate the provisioning and supporting systems, and also compare the provisioning and
supporting systems to the district areas of primary care services for diabetic and hypertensive patients
in Khon Kaen province covering the pilot and non-pilot primary care clusters (PCCs), the non-communicable
disease (NCD) clinics of hospitals, and the health-promoting hospitals of Mueang, Nam Phong and
Ubolratana districts. A cross-sectional study was conducted with 170 health personnel via purposive
sampling. Data were collected by self-administered questionnaire with 0.84 Cronbach’s alpha coefficient.
Data were analyzed using descriptive statistics in terms of percentage, mean and standard deviation, and
inferential statistics in terms of ANOVA and least-significant difference. The findings showed that mean
score of the provisioning and supporting system of the primary care service of NCD clinics of the hospitals
was higher than the PCCs and health-promoting hospitals at both province and district levels. The mean
scores of the NCD clinics were higher than the others in all dimensions of the provisioning system, including
the relationship between clients and family medicine or family doctor, shared care plan for the
individual patient, health information system, and self-management supports of the patients. However,
the mean score of continuity of care and coordination provided by the pilot PCCs was higher than the
NCD clinic of the hospitals. In terms of the supporting process associated with the family care team and
multi-disciplinary team, and the understanding of primary care service principles, the mean score of the
NCD clinics was higher than the PCCs and health-promoting hospitals. However, regarding the aspect of
trust in time allocation of the team in providing care to patients, the mean score of the non-pilot PCCs
was the highest, while the another aspect of continuity of health care service development served by
the pilot and non-pilot PCCs and the NCD clinic had the same level of mean scores. When considering
the dimension of the provisioning system of all three districts, in particular, the pilot PCCs of Nam Phong
and Ubolratana districts had a higher mean score than the pilot PCCs of Mueang district. The pilot PCC
of Nam Phong district had the highest mean score in two aspects: relationship between clients and
family medicine or family doctor, and self-management supports of the patients. The pilot PCC of Ubol-ratana district had the highest mean score in two aspects: shared care plan for the individual patient,
and continuity of care and coordination. In addition, the remaining aspect linked to the health information
system provided by the pilot PCCs of Nam Phong and Ubolratana districts had the same mean.
There were significant differences in all aspects in all three districts, except the relationships between
clients and family medicine team (no significant difference in all districts). The present evaluation of the
primary care models was an early assessment set by the central national project that needed longer
time after implementation to learn more lessons for further improvement. Moreover, the present study
was biased on the opinions of health care providers and did not include the opinions of clients and
clinical outcomes of the service provision.
