Abstract
This study was conducted to evaluate 1. diabetes and hypertension service delivery, including both curative and preventive approaches, and 2. human resources in health management and coordination between hospitals and other stakeholders in the community using a mixed method study. 8 and 16 high-performance district and sub-district hospitals across four provinces in Thailand were chosen for the study. Quantitative data from questionnaires were analyzed using descriptive analysis where categorical data were reported as number (percent), and numeric data were reported as mean (SD). For qualitative analysis, content analysis was used to identify and summarize three domains as follows
1. The similarities and uniqueness of service deliveries between each health providers
2. The comparison of the job descriptions in district and sub-district hospitals by occupation
3. Human resources in health management focused on the adequateness of the human workforce and methods used for retaining health personnel. All hospitals included in this study were selected appropriately. In 2021, all hospitals recruited in the study received better scores than the country average in multiple diabetes and hypertensive indicators in preventive and curative domains proposed by the Ministry of Public Health. In order to achieve high quality of care. In addition, this study evaluated diabetes and hypertensive services using the framework from the handbook of integrated, people-centered health services in new normal diabetic and hypertensive clinics, a guideline endorsed by the Department of Medical Services, Ministry of Public Health. All hospitals provide almost comprehensive care according to the recommended guideline. Varieties of health professionals performed specific tasks to increase patients' health literacy, stratify patients based on their clinical risks, register patients in the database for continuity of care, reorient the care model according to patient health status, and assess patients when there were changes in blood pressure or blood sugar control. However, most hospitals could not achieve the self-monitoring domain due to insufficient equipment compared to patients' demands. Due to the limited amount and types of health professionals working in sub-district hospitals compared to district hospitals, health professionals working in sub-district hospitals need to be more flexible and perform multiple roles outside their trained professions. In contrast, health professionals in district hospitals only worked on specific tasks they excelled. Therefore, multiple sub-district hospitals asked for temporary pharmacists and dieticians' support from district hospitals which were crucial for operating non-communicable disease clinics but were not regularly stationed in sub-district hospitals. The support could improve the quality of care where patients receive services from trained professionals, and additional support could relieve partial workloads from health professionals in sub-district hospitals. Moreover, village health volunteers were one of the significant human resource components in providing quality diabetes and hypertensive preventive and curative care, especially in sub-district hospitals, where limited human resources in health affected the staff workload. Village health volunteers provided various kinds of support, including performing basic tasks in the clinic, giving preliminary health advice, delivering medicine, and acting as the bridge between patients and health professionals in the community. Furthermore, they also played a significant role in preventive measures. Village health volunteers were the major players in performing diabetes and hypertension screening in the general population every year. Hence, training specific non-communicable disease competencies for village health volunteers to work on more sophisticated tasks with additional financial incentives could maintain sustainable community-oriented diabetes and hypertensive service deliveries.
Lastly, health technology adaptation could play a significant role in increasing the efficiency of care. Telemedicine is the most familiar technology and could be integrated into diabetes and hypertensive consulting services between multiple levels of providers. In addition, personal health records, accompanied by an increase in patients' digital health literacy, could be a potentially significant improvement in diabetes and hypertensive care. The combined technology and knowledge could help patients better understand their current health situation. Hospitals could use integrated information between providers to monitor and determine the best treatment plans for patients continuously.
