Integrated Care Model by the Village Health Volunteers to Prevent and Slow down Progression of Chronic Kidney Disease in a Rural Community, Thailand.

INTRODUCTION: Chronic kidney disease (CKD) is a major health problem in Thailand and health behaviors are central to its risk and progression. Because of the shortage of healthcare personnel, village health volunteers (VHVs) have been collaborating in the primary health care system. However, the contribution of VHVs to CKD reduction has not been evaluated yet. This study aimed to evaluate the efficacy of the VHV-integrated model in preventing and slowing down CKD and its risk factors. METHODS: The population-based cohort study was conducted in a rural community of Thailand between 2017 and 2019. Baseline clinical and behavioral characteristics including CKD, diabetes, hypertension, and other high-risk factors of the participants were collected. The integrated care model was initiated by the multidisciplinary care team that facilitated, empowered, and trained VHVs targeting risk factors of CKD, health literacy, and health promotion. Then the participants were educated and trained for lifestyle modification and were monitored continuously for 18 months by VHVs. Changes in the CKD risk factors, and kidney functions before and after the application of integrated care model were compared. RESULTS: A total of 831 subjects participated in the study with an average age of 57.5 years, and 69.5% were female. Among them, 222 participants (26.7%) were diagnosed as having CKD, the vast majority (95%) of which were in the early stages (G1-G3 and A1-A2). CKD risk factors such as high salt intake, smoking, alcohol consumption, self-NSAID (non-steroidal anti-inflammatory drugs) use were significantly decreased after application of the care model. Also, hemoglobin A1c was significantly reduced in diabetic patients, and blood pressure was controlled better than before in the hypertensive patients. Most importantly, a decline of estimated glomerular filtration rate of the CKD group was improved and lower than the non-CKD group. CONCLUSION: The integrated care model through VHV significantly attenuated the risk factors associated with CKD in the general and high-risk population and effectively slowed down the progression of CKD.

From health situation to health education and health service reforms for Thai society.

BACKGROUND: Health problems and service utilization patterns among Thai populations have changed significantly over the past three decades. It is imperative to scrutinize the changes so that the health service and human resource development systems can appropriately respond to the changing health needs. OBJECTIVE: To synthesize critical issues for future planning of health service reforms, medical education reforms and health research for Thai society. MATERIAL AND METHOD: The authors analyzed data on health service utilization, types of illnesses and hospital deaths among Thais in the fiscal year 2010. Information on the illnesses of in-/out-patients and hospital deaths was extracted from the three main health insurance schemes providing coverage to 96% of the population. The authors then synthesized the key issues for reforming medical education and health services. RESULTS: In summary, Thai patients have better access to health services. The total number of out-patient visits was 326,230,155 times or 5.23 visits per population. The total number of in-patient admissions was 6,880,815 times or 0.11 admissions per population. The most frequent users were between 40-59 years of age. The most common conditions seen at OPD and IPD and the causes of in-hospital mortality varied between age-groups. The key health issues identified were: psychosocial conditions, health behaviour problems, perinatal complications, congenital malformations, teenage pregnancy, injury, infectious diseases, cardiovascular diseases and neoplasms. Medical education reforms need to be designed in terms of both undergraduate and post-graduate education and/or specialty clinical needs. Health service reforms should be designed in terms of patient care systems, roles of multidisciplinary teams and community involvement. CONCLUSION: The government and other responsible organizations need to actively respond by designing the health service systems and human resource development systems that are relevant, appropriate and integrated. Different levels of care need to work collaboratively in order to achieve the greatest quality and efficiency.