Abstract
Chronic kidney disease is a public health problem both globally and nationally. A
report on the situation of chronic kidney disease in Khon Kaen Province found that the
cumulative number of chronic kidney disease patients over the past five years has increased
every year, with 3,500-4,000 new patients reported annually. This indicates an increase in the
number of chronic kidney disease patients due to environmental conditions, an aging society,
and the main causes being diabetes and hypertension, which are becoming more prevalent.
Therefore, the research team has initiated this project with funding support from the Health
Systems Research Institute (HSRI) for building a collaborative network among relevant
government institutions in addressing the issue, including Khon Kaen University, Khon Kaen
Provincial Public Health Office, the 7th Disease Prevention and Control Office in Khon Kaen,
and the Khon Kaen Provincial Administrative Organization, all of which recognize the necessity
and urgency of jointly solving the problem. It was a combined model that the network has
previously implemented and studied for effectiveness, showing that it could reduce the
severity and progression of diseases. The initiative was being expanded to 24 districts in Khon
Kaen Province. The working process involved creating network collaboration, forming a model
multidisciplinary team, which consisted of specialists in diabetes, hypertension, and chronic
kidney disease, pharmacists, nurses, nutritionists, and physical therapists. This team was
created as a central hub for transferring knowledge in building multidisciplinary teams in five
health zones, so as to disseminate knowledge to Subdistrict Health Promoting Hospitals
(SHPHs) within their respective zones, covering 220 SHPHs across 24 districts in Khon Kaen
province. After the training, each sub-district health promotion hospital staff was responsible
for transferring knowledge to 30 community health volunteers (CHVs) to take care of 3-5
patients over a period of 6 months. There were supplementary tools for home visits by health
volunteers, including a health volunteer manual and a home visit record form, as well as
supplementary tools for health promotion hospitals in providing knowledge to patients for
behavior modification, including flip charts, salt content measuring devices for food, and
fingertip blood sugar test strips, in order to enhance the capacity of the primary healthcare
system in caring for patients with chronic non-communicable diseases. The evaluation results
at the end of the project found that the sub-district health promoting hospital (SHPH) had
increased confidence (84.4%) in providing advice and care for non-communicable diseases
and admitted that the supplementary tools (flip charts and the village health volunteer
manual) enhanced the efficiency of patient care. This aligns with the evaluation results from
the CHVs, which found that the majority were satisfied with the training on providing guidance
and care for patients with non-communicable diseases (86.9%). They were satisfied with the
overall use of teaching materials (CHV manuals) (84.8%) and the home visit record forms for
patient care (83.6%). They also expressed a desire to continue using the manuals and home
visit record forms in patient care. Importantly, 72.5% of CHVs reported an increased
confidence—ranging from moderate to significant—in providing guidance and care for noncommunicable diseases. An evaluation comparing knowledge levels regarding the
management of non-communicable diseases among physicians, multidisciplinary teams, SHPH
personnel, and CHVs revealed a statistically significant increase in scores following the training
intervention. Regarding the overall clinical outcomes for Khon Kaen Province, significant
improvements were observed in several key indicators: 1) the efficacy of diagnostic follow-up
and confirmation for suspected cases of diabetes and hypertension, 2) the percentage of
diabetic patients achieving blood pressure control within established clinical criteria, and 3)
the proportion of hypertensive patients maintaining well-controlled blood pressure levels.
Furthermore, a preliminary analysis of health outcomes among a cohort of 9,000–10,000
patient volunteers—who received care from CHVs participating in the project—indicated that
systolic and diastolic blood pressure, body weight, and waist circumference significantly
decreased. Additionally, a marked improvement in health-risk behaviors was observed postintervention, with all aforementioned changes reaching statistical significance.
