Abstract
The study aimed to develop a new rehabilitation service system for stroke patients at Maharaj Hospital, Nakorn Ratchasima Province. The situation analysis showed some pitfalls of the existing system. For instances: there were underserved for occupational therapy services; the routine services and information given were not responsive to clients’ needs, in terms of supporting their self-concept; inadequate system to follow up discharged patients; and the increasing need for home rehabilitation service because of the inconvenience of client transportation. Participatory action research (PAR) was applied to work out among other related service providers or stakeholders to identify an alternative system. Those were physicians, physiotherapists and community nurses. Duration of the study was during The modified service was described as follows; The rehabilitation services would cover physical therapy and occupational therapy for every consulted case, even though it was not mentioned by physician. The essential rehabilitation guidelines had been set up to fit with Isan context. The follow up system was set up, and had to correspond with physician appointment date. Making linkages with community nurses to provide rehabilitation home care. Setting up the record and report systems for continuity of care between hospital and home care. Recommendations from this study were that this system should be applied for patients with other chronic conditions, such as paralysis or cerebral palsies, to whom rehabilitation services were needed. However, implementation of the recommended system should take personnel existing workloads for granted.
