Khlung Community Hospital, Thailand
Title: Establishing a Primary Care Cluster, Khlung District, Chanthaburi Province, Thailand
Ministry of Public Health has prepared a strategy to develop primary care cluster. The main purpose of that was to provide effective public health care in the right size area. Khlung district was a model of community hospital operations in Chanthaburi. During the operation, we has encountered with many problems. Therefore, it was necessary to know the situation of the operation and find a way to develop a new primary care cluster. The purpose of this study was to explore the way to establish the primary care cluster and to propose the operating model for establishing the proper primary care cluster.
The qualitative research conducted in three groups of sample including 5 administrators, 12 practitioners and 8 clients. Focus group discussion and in-depth interview used to collect the data. The research instrument a semi-structured interview questionnaire with 3S model: staff, structure, system and clients. The results reveal as follows: 1) The situation of the establishment of the primary care cluster, we found that the strength of the staff was well preparation of an appropriate portion of a multidisciplinary profession and team work. The development opportunity of the staff was the knowledge and ability in practicing in primary care cluster among staff was limited and there was a little involvement of family and community in health care. The strength of the structure was having a building or place to work and the budget from the community donation. The development opportunity of the structure was one of the health promotion hospital has no car and boat to drive health care team to provide home visit. The strength of the service system was the modification of an appointment scheduling system to see the doctor directly 2 days a week and 24-hour consultation. The development opportunity of the service system was incomplete of basic information of the population and illness information that result to not cover care for all population, registered nurse cannot participate with family physician every time to provide home visit, the clients did not receive the medication prescribed by the family physician as well as the referral of the patients to the regional hospital must be commenced at the community hospital. 2) For the proper model of primary care cluster, the staff should provide a forum for exchange knowledge and experiences such as a case conference among registered nurse, Thai traditional medicine and family physician should be involved in learning and leading the conference. Moreover, the driver position should appoint in family care team. For the structure, it should be cooperated and coordinated with other health promotion hospital in sharing resources. For the system, increasing the number of medication, laboratory examination and referral guideline in order to be the same approach.