Abstract
This participatory action research study aimed to investigate the telehealth technology needs and situation in community health service centers in remote areas (Suksala) of Nan Province, Thailand. The study had two objectives: 1) to explore the situation and needs of telehealth technology in Suksala networks, consisting of nine locations in remote areas of Nan Province, and 2) to design and test a telehealth technology system for community health service centers in the study areas. The study was conducted from October 2022 to April 2023, and involved five practical steps such as diagnosing, action plan, taking action, evaluation, and specifying learning stage. The research employed both qualitative and quantitative data analysis. The study revealed that the telehealth service readiness in the study area had five components, including hardware, software, peopleware, database, and internet network system. The study found that access to quality and stable internet signals was crucial for the effectiveness of telehealth services. Moreover, the study identified the development of a service model for remote clinics, managed in the form of a district-level service network in four districts, Bo Kluea, Chaloem Phrakiat, Pua, and Mueang Nan, of Nan Province, with an appointed board. The service model had eight steps of service management involving multidisciplinary participation from three levels of service facilities, including Suksalas, tambon health promotion hospitals, and community hospitals. The service targeted 14 groups. The telehealth service was trialed for three months, from January to March 2023, with a total of 39 people receiving the service, representing 4.82 percent of those who received normal services. The trial service included appointment-based services and was offered both at Suksalas (74.36%) and through home visit services (25.64%). The study found that receiving services at Suksalas could reduce the average overall cost per person per time of traveling to receive treatment at public health hospitals or the Area-based Health Care System for patients and caregivers, accounting for 95.95-98.61 percent of the indirect costs and non-medical costs. The study provided suggestions for the project to ensure the continuity of telehealth services in the future. The suggestions included developing additional telehealth technology potential for staff and networks in the community, solving the problem of infrastructure readiness through joint management plans between government networks, local government organizations, and private organizations, and applying the telehealth system to provide health promotion services for problematic areas such as child development, maternal and child health, and the disabled. The study also provided policy recommendations, such as creating a central platform for providing telehealth services on a cloud database that can connect to patient record systems of all levels of service facilities, reducing redundant work, and providing a system that can be connected to the e-Claim program system to request expenses for public health services in case of remote health service fees according to the criteria of the National Health Security Office.
