Abstract
The impact of the COVID-19 epidemic as a result to change the service patterns at all levels of hospitals. The elderly has limited perception of the health care system. The situation of the outbreak of COVID-19 making access to health services more restrictive. This mixed method research aimed 1) to study the situation of accessibility to healthcare services among the elderly, 2) examine the factors predicting access to health services among the elderly with internal factors, interpersonal factor, and organizational factor. By using the quantitative method, the data were collected from 422 elderly persons aged 60 years and over who living in Pathum Thani Province. The data were collected from June to July, 2022 by using interview forms. The results were analyzed using descriptive statistics and Stepwise multiple regression. Aimed 3) to study the guidelines for improving accessibility to health services for the elderly in the context of the Covid-19 epidemic situation and in the next 10 years to support the emergence of new diseases, 4) to suggest policies for improving accessibility to health services for the elderly in the context of the COVID-19 epidemic situation and in the next 10 years to support emerging diseases. By using the qualitative method, the data were collected from 45 people of public health personnel and person who involved in access to health services of the elderly. The data were collected from August to September, 2022 by focus group interview. Qualitative data were analyzed by content analysis method. The results of the quantitative study revealed that the majority of the sample groups were female, 73.7%, with mean aged 68.94+6.51 years. The most service facility used by the elderly when they were sick or feeling unwell was pharmacy, accounting for 55.9%, followed by the sub-district health promoting hospital, 23.7%. As for the services that the elderly used the most to see a doctor or receiving medication by appointment was at the sub-district health promoting hospitals at 33.2%, followed by the district hospital at 28.2%. Overall accessibility to health services for the elderly was at a moderate level (19.4 percent), followed by a high level (17.8 percent). The results of Stepwise Multiple Regression statistic was found that the factors predicting the elderly's access to health services with statistical significance (p-value<0.05) were satisfaction to the health care service, perceived health status, age and income. These variables accounted for 34 percent of the elderly's variation in access to health services (R2=0.34). The results of the qualitative study on the approach to improve accessibility to health services for the elderly in the context of the COVID-19 epidemic situation and in the next 10 years to support emerging/re-emerging diseases revealed that there must be sufficient preparation in the service system which consists of personnel with potential in knowledge and skills in caring for the elderly. The location is convenient for access to services and adequate support for clients. Tools, equipment and medical supplies are always adequate and the arrangement of long-distance service systems (Telemedicine). It is also necessary to prepare the elderly to have health knowledge and technological literacy to access health information including the development of a service system that coordinates operations with local government organizations. Policy recommendations from the study consisted of 4 aspects: 1) Service aspect by developing a long-distance health service system, develop a proactive service system, applying technology to service, develop a service unit for the elderly, developing case management, develop hospital beds at home and coordinate operations with local authorities 2) Academics aspect by developing curriculum, arrange academic services, determine learning outcome according to the National Higher Education Qualifications Framework, develop curriculum identities and develop a network in educational management 3) Research aspect by researching drug and vaccine, development research and innovation toward enhancing health literacy and technology literacy; and 4) administrative policies of public health agencies and local administrative organizations to allocate budgets for producing and developing personnel, procurement of tools, medical supplies, building and expanding service units to care for the elderly.
