Abstract
During the past 5 years, the Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET) project has been working on a model to change behavior and reduce health problems in the community. It was found that the factors to obtain a good outcome are the intensive approach providing by the multidisciplinary team, health education training, and stimulate health volunteers and clients to promote health care continuously, including the use of media that affect to the five senses. This will be effective in changing behavior in a positive way to prevent and delay chronic kidney disease. However, when the COVID-19 pandemic occurs, the multidisciplinary team cannot work in the community as before. Therefore, the telehealth system is established and applied to fit the situation. The trial was conducted in 8 pilot areas under the supervision of Subdistrict Health Promoting Hospitals in Ubonratana and Nam Phong districts, Khon Kaen province and 751 people were screened for chronic kidney disease. The 8 areas were then divided into 2 groups, the experimental group and the control group, in which both groups having no statistical differences in age, sex, and numbers of people with diabetes, hypertension and chronic kidney disease. Both groups received the same standard of care, but the difference was that the KKU CKD Telehealth Platform, application "Or Sor Mor Rak Tai" for health volunteer and CKD registry were implemented in the experimental group for periodic health education and monitoring of high-risk persons and patients. The effectiveness was then assessed based on clinical outcomes and efficacy based on access to health services, comparing between the experimental and control groups. The results indicate improved health outcomes, including control of weight, blood pressure, and blood sugar levels compared to the control group. The experimental group had changed systolic/diastolic blood pressure by 7/4 mmHg in the CKD group, the BMI decreased by 1.09 kg/m² , and in people with diabetes, blood sugar levels decreased by 14.95 mg/dl. However, no effect has been seen in reducing the severity of kidney disease. It may be because the duration of the second phase of the procedure is as short as 8 months, so there may still be no change effect. which from the previous reports, it should take about 1-3 years to see a decrease in kidney deterioration. In addition, the results showed that it was able to reduce behaviors at risk of kidney disease and non-communicable diseases, namely salt reduction, smoking, the use of a series of drugs containing NSAIDs (nonstearoidal anitiinflammatory drugs) and steroids, the use of chemicals to combat pests in agriculture, and alcohol consumption. When evaluating the effectiveness, It was found to reduce the new cases of hypertension as well as increase access to healthcare services (94.9 %) compared to controls (60.4% ) and have economic value which can be developed as a model and can be expanded at the national policy level.
