Perspectives of Hill Tribe People and Healthcare Providers regarding Emergency Medical Conditions and Interfacility Transfer: A Qualitative Study in Rural Northern Thailand

Authors

  • Boonyapat Shatpattananunt School of Nursing, Mae Fah Luang University, Thailand.
  • Wongchan Petpichetchian College of Advanced Practice Nurse and Midwife, Thailand Nursing and Midwifery Council, Thailand.
  • Srisuruk Kietmaneerut School of Nursing, Mae Fah Luang University, Thailand.
  • Nathamon Wuttipan School of Nursing, Mae Fah Luang University, Thailand.
  • Vivat Keawdounglek School of Nursing, Mae Fah Luang University, Thailand.
  • Jadsadaporn Singtorn Mae Fah Luang University, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2023.263572

Keywords:

Hill tribes, Emergency medical conditions, Rural area, Interfacility transfer, healthcare providers, Thailand

Abstract

         Interfacility transfers of patients in rural mountain areas have many issues that require further investigation; for example, lack of resources and the inability to provide appropriate treatments for a patient’s conditions are the reasons for interfacility transfer. A qualitative descriptive study was conducted to explore the experience of hill tribe people (n = 16) and healthcare providers (n = 22) regarding emergency medical conditions and interfacility transfer in rural mountain areas of northern Thailand. Data were collected
from February to July 2019 via in-depth interviews. All interviews were transcribed verbatim, and the content analysis procedure of Elo and Kyngäs was used for data analysis. The study’s trustworthiness was established using Lincoln and Guba’s criteria.
         The finding revealed four categories reflecting hill tribe people’s experience of emergency medical conditions and interfacility transfer: 1) perceived barriers to rapid access, 2) helping hands, 3) the polarity of interfacility transfer services, and 4) ways toward a bright future. The healthcare providers’ experience was divided into three categories consisting of 1) the district system of interfacility transfer, 2) making it work: the three sources of power, and 3) hope for better interfacility transfer.
        These findings may contribute to a better comprehension of the nurses and healthcare providers who actively provide interfacility transfer support for emergency medical conditions suitable for hill tribe populations and healthcare settings.

Author Biography

Wongchan Petpichetchian, College of Advanced Practice Nurse and Midwife, Thailand Nursing and Midwifery Council, Thailand.

College of Advanced Practice Nurse and Midwife, Thailand Nursing and Midwifery Council

References

World Health Organization, International Committee of the Red Cross ( ICRC) . Basic emergency care: approach to the acutely ill and injured: participant workbook [Internet]. 2018 [cited 2023 Mar 20]. Available from: https://apps.who.int/iris/handle/10665/275635

Lawrence DS, Ssali A, Jarvis JN, Seeley J. Clinical research for life‑threatening illnesses requiring emergency hospitalisation: a critical interpretive synthesis of qualitative data related to the experience of participants and their caregivers. Trials [Internet]. 2023 [cited 2023 Mar 20];24:149. Available from: https://doi.org/10.1186/s13063-023-07183-6

Razzak J, Usmani MF, Bhutta ZA. Global, regional and national burden of emergency medical diseases using specific emergency disease indicators: analysis of the 2015 Global Burden of Disease Study. BMJ Global Health. 2019;4:e000733. doi:10.1136/bmjgh-2018-000733.

Pittalis C, Brugha R, Gajewski J. Surgical referral systems in low- and middle-income countries: a review of the evidence. PLoS ONE [Internet]. 2019 [cited 2023 Mar 20];14(9): e0223328. Available from: https://doi.org/10.1371/journal.pone.0223328

McNaughton CD, Bonnet K, Schlundt D, Mohr NM, Chung S, Kaboli PJ, Ward MJ. Rural interfacility emergency department transfers: framework and quality analysis. West J Emerg Med. 2020;21(4):858-65. doi: 10.5811/westjem.2020.3.46059.

National institute for emergency medicine. Interfacility transfer. Nonthaburi: National Institute for Emergency Medicine; 2014.

Moonpanane K, Pritchard K, Thepsaw J, Singkhorn O, Potjanamart C. Healthcare service utilization of hill tribe children in underserved communities in Thailand: barriers to access. BMC Health Serv Res [Internet]. 2022 [cited 2023 Mar 20];22:1114. Available from: https://doi.org/10.1186/s12913-022-08494-1

Kitchanapaibul S, Udplong A, Apidechkul T, Tamornpark R, Mulikaburt T, Srichan P, Suratana S, Yeemard S, Wongnuch P. Experiences and expectations regarding COVID-19 prevention and control measures among the hill tribe population of northern Thailand: a qualitative study. BMC Public Health [Internet]. 2021 [cited 2023 Mar 20]; 21:1060. Available from: https://doi.org/10.1186/s12889-021-11145-5

Apidechkul T. Seroprevalence and factors associated with hepatitis B virus infection among the hill tribe youths, northern Thailand. BMC Infect Dis [Internet]. 2019 [cited 2023 Mar 21]; 19:125. Available from: https://doi.org/10.1186/s12 879-019-3747-3

Apidechkul T, Chomchoei C, Upala P. Epidemiology of undiagnosed type 2 diabetes mellitus among hill tribe adults in Thailand. Sci Rep [Internet]. 2022 [cited 2023 Mar 21]; 12:3969. Available from: https://doi.org/10.1038/s41598-022-07977-9

Wongnuch P, Mulikaburt T, Apidechkul1 T, Srichan P, Tamornpark. R, Udplong R. Suratana S, Kitchanapaibul S. Acceptance and accessibility to the early phase COVID‑19 vaccination among the healthcare workers and hill tribe population in Thailand. Sci Rep [Internet]. 2022 [cited 2023 Mar 21];12:11035. Available from: https://doi.org/10. 1038/s41598-022-15149-y

Sungbun S, Tangkawanich T, Thanakumma O, Sukrueangkul A. Perceived barrier in accessing emergency medical services of ethnic groups in the highlands of Chiang Rai Province, Thailand. J Health Sci Med Res. 2020;38(2):125-33. doi:10.31584/jhsmr.2020731.

Atrash HK. Health disparities: challenges, opportunities, and what you can do about it. J. Hum Growth Dev. 2018, 28(3):223-31. doi: 10.7322/JHGD.152156.

Thutsanti P, Apidechkul T, Inta C, Upala P, Tamornpark R. Adaptation to Thai citizenship: a case study of Thai-Chinese Yunnan, Mae Fah Luang District, Chiang Rai, Thailand. J Health Sci Altern Med. 2019,1(1):8-13. doi:10.14456/jhsam.2019.4.

Shannon EM, Schnipper JL, Mueller SK. Identifying racial/ethnic disparities in interhospital transfer: an observational study. J Gen Intern Med. 2020;35(10):2939-46. doi:10.1007/s11606-020-06046-z.

American College of Emergency Physicians. Emergency physicians’ duty to care for anyone, anytime [Internet]. 2022 [cited 2023 Apr 10]. Available from: https://www.acep.org/life-as-a-physician/ethics--legal/emtala/emtala-fact-sheet/

Revue E. Emergency medicine in the world. Brazilian J Emerg Med. [Internet]. 2022 [cited 2023 Apr 10]; 2:34-47. Available from: https://cdn.publisher.gn1.link/rebrame.com.br/pdf/v2n1a08.pdf

Heaton J, Kohn MD. EMS inter-facility transport. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Sep 26 [cited 2023 Apr 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555916/

Hort K, Gilbert K, Basnayaka P, Annear PL. Strategies to strengthen referral from primary care to secondary care in low- and middle-income countries. Policy brief [Internet].2019 [cited 2023 Apr 10];6(2). Available from: https://apps.who.int/iris/handle/10665/325734

McCullough K, Whitehead L, Bayes S, Williams A, Cope V. The delivery of primary health care in remote communities: a grounded theory study of the perspective of nurses. Int J Nurs Stud. 2020;102:103474. doi: 10.1016/j.ijnurstu. 2019.103474.

Su CW, Warren A, Kraus C, Macias-Konstantopoulos W, Zachrison KS, Viswanathan A, Anderson C, Gurol ME, Greenberg SM, Goldstein JN. Lack of racial and ethnicbased differences in acute care delivery in intracerebral hemorrhage. Int J Emerg Med [Internet]. 2021 [cited 2023 Apr 15];14(1):6. Available from: https://doi.org/10.1186/ s12245-021-00329-w

Asavasaetakul C. Determinants of expenditure in the hill tribes of Thailand [Internet]. 2019 [cited 2023 Apr 15].Available from: https://mpra.ub.uni-muenchen.de/93918/

Apidechkul T, Wongnuch P, Sittisarn S, Ruanjai T. Health situation of Akha Hill Tribe in Chiang Rai Province, Thailand. J Public Hlth Dev [Internet]. 2016 [cited 2023 Apr 25];14(1):77-97. Available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/

Treeaekanukul L, Wichai C. Cultural identities in multicultural ethnic societies in the Chiang Rai special border economic zone. TJEAS [Internet]. 2021 [cited 2023 Apr 15]; 25(1):32–42. Available from: file:///C:/Users/User/Downloads/ampa,+3.Lela(180521)%20(1).pdf

Turale S. A brief introduction to qualitative description: a research design worth using. Pacific Rim Int J Nurs Res. [Internet]. 2020 [cited 2023 July 23];24(3):289-91. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/243180

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007:19(6):349-57. doi: 10.1093/intqhc/mzm042.

Elo S, Kyngas H. The qualitative content analysis process. J Adv Nur. 2008;62(1):107-15. doi:10.1111/j.1365-2648.2007.04569.x.

Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park: Sage Publication; 1985.

Jewjinda C, Chalermnirundorn N. The development of village health volunteers (VHVs) model with a participatory process. RSU International Research Conference 2018. 2018 May 4. 329-36. https://rsucon.rsu.ac.th/files/proceedings/inter2018/G4-IN18-012.pdf

Chauhan A, Walton M, Manias E, Walpola RL, Seale H, Latanik M, Leone D, Mears S, Harrison R. The safety of health care for ethnic minority patients: a systematic review. Int J Equity Health [Internet]. 2020 [cited 2023 Apr 20]; 19:118. Available from: https://doi.org/10.1186/s12939-020-01223-2

Kongcheep S, Arpanantikul M, Pinyopasakul W, Sherwood G. Thai nurses’ experiences of providing care in overcrowded emergency rooms in tertiary hospitals. Pacific Rim Int J Nurs Res [Internet]. 2022 [cited 2023 July 16]; 26(3):533-48. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/258076/175796

Greene KK, Dawkins S, Theofanos MF, Steves M, Furman S, Choong YY, Prettyman SS. Voices of first respondersexamining public safety communication from the rural perspective [Internet]. 2019 [cited 2023 Apr 20]. Available from: https://doi.org/10.6028/NIST.IR.8277

Mamalelala TT, Mokone DJ, Obeng-Adu F. Health-related reasons patients transfer from a clinic or health post to the Emergency Department in a District Hospital in Botswana. Afr J Emerg Med. 2022;12(4):339-43. doi:10.1016/j. afjem.2022.07.014.

Chui Z, Gazard B, MacCrimmon S, Harwood H, Downs J, Bakolis I, Polling C, Rhead R, Hatch SL. Inequalities in referral pathways for young people accessing secondary mental health services in southeast London. Eur Child Adolesc Psychiatry [Internet]. 2021 [cited 2023 Apr 20];30:1113-28. Available from: https://doi.org/10.1007/s00787-020-01603-7

Blattner K, Clay L, Nixon G, Richard L, Miller R, Cringle S, Anton R, Stokes T. The place of rural hospitals in New Zealand’s health system: an exploratory qualitative study. Rural Remote Health [Internet]. 2023 [cited 2023 Apr 20];23(2):7583. doi:10.22605/RRH7583.

Singkhorn O, Harmtanon P, Moonpanane K, Pitchalard K, Sunsern R, Leaunsomnapa Y, Phokhwang C. Evaluation of a depression care model for the hill tribes: a family and community-based participatory research. BMC Psychiatry. 2023;23(1):563. doi: 10.1186/s12888-023-05058-3.

Jiaviriyaboonya P. Anthropological study of village health volunteers’ (VHVs’) socio-political network in minimizing risk and managing the crisis during COVID-19. Heliyon. 2022;8(1):e08654. doi: 10.1016/j.heliyon.2021.e08654.

Downloads

Published

2023-09-28

How to Cite

1.
Shatpattananunt B, Petpichetchian W, Kietmaneerut S, Wuttipan N, Keawdounglek V, Singtorn J. Perspectives of Hill Tribe People and Healthcare Providers regarding Emergency Medical Conditions and Interfacility Transfer: A Qualitative Study in Rural Northern Thailand. PRIJNR [Internet]. 2023 Sep. 28 [cited 2024 Oct. 6];27(4):811-26. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/263572