Abstract
This research aimed to 1) evaluate the situation of primary care provision in Northeast of Thailand 2) lessons learned for the role model of primary care, strengths, key success factors, problems, and obstacles for the area-based service 3) home care by the three doctors’ team and 4) to make a policy recommendation. A questionnaire and guideline for in dept-interview and brainstorming were used as a research tool. The subjects consisted of 468 primary care team members selected by a simple random sampling method. Most consisted of nursing professional and public health technical officer working in the health region 7, 8, 9 and 10. It was found that the attitude of respondents was at a good level. The most of unit passed in quality outcomes framework (QOF) with 80.7%. Half of total lacked doctor and less than half lacked health personnel. Most of them received a lesser budget than the expense from the Contracting Unit for Primary Care. With a full score of 3, the overall mean of service was 2.61 (SD 0.84). The lowest was 2.29 consisting of consultation and communication channels (SD 0.57), and service system (SD 0.39). The lowest scores consisted of service delivery 1.73 (SD 0.51), health workforce 1.92 (SD 0.68), and health information system 2.39 (SD 0.52). The registered teams showed the statistically significant completion in service more than those with the non-registers (p-value 0.018, Adjusted Odds Ratio 5.16 with 95% confident interval 1.33 to 20.12). The service of primary care unit among urban, semi-urban and rural model were not different. The urban, and semi-urban showed superior in ability of team, a holistic care and advice by family doctors. The community participation, supported by public health volunteers and network of rural model were closer and stronger than of the urban and semi-urban. Key factors for the patients regarding to primary care unit were in a good location, quick service, easy to access and the familiarity of. Most of patient accepted the three doctors. The urban team with more experienced showed completely in the service and activities better than in the rural. The policy and the registration help to link primary care team and support for the patient care. The problems were lack of the family doctors and health personnel. Instrument was broken, and the data results inputting was overload. The Human Papilloma Virus (HPV) screening and Antenatal care (ANC) were not covered. It was concluded that primary care in urban, semi-urban, areas was found to be outstanding in home health care by the family doctors consisting of multidisciplinary teams. The continuing service delivery to patients’ home was duly covered. The small primary care in rural areas proved significantly with a pass in the QOF more than the medium size. Lacking the family doctor and health team, it was supported by the network in the rural areas. Training and knowledge were required to update within the health professionals. The management of health information by technology and reference systems should be improved for the patients’ benefit more than the staff workload. The telemedicine needed to be an innovative for all areas.
