DEVELOPMENT OF CARE MODEL FOR HIV INFECTED PATIENTS IN CHAROEN SIN HOSPITAL

Abstract

          The objectives of this research were to study the developed model for HIV care, and access to services of HIV infected patients Study was conducted during January-May 2019. Study was divided into 4 steps. The first step was to develop operational planning consisting of data collection from purposively selected samples. There were 2 group of samples. Group 1 sample was health care personnel who provided care service to HIV infected patients and 22 HIV infected patient leaders. Data on problem in providing services and suggestion of solutions were collected from this group via focus group discussion. Group 2 sample was 90 HIV infected patients who were able to participate in the project. Subjects in group 2 participated in “Mind map” activity. In addition, data was also collected from records and feedbacks from health care provider. Collected data were reported to the Hospital Administrative Committee and the Quality Improvement Working Group to develop a plan to solve the problems and for development. Then the study moved to the second step which was implement the operation plan followed by the third step which is monitoring and evaluation, and the fourth step which was reflection from the implementation.
          Data from “Mind map” included problems related to facilitation and the form of services for HIV infected patients. Focus group discussion revealed 1) clinic nurse could not run duties in time, 2) there should be Clinical Practice Guideline (CPG), 3) would like to have trainings on new knowledge. Data found from
records review and feedback from health workers were 1) patients having loss to follow up, taking up medicine not by the time as scheduled. 2) sending laboratory samples in an appropriate way. In order to solve the problems and to further develop the service, a plan was set up by proposing the problems into the consideration of the Hospital Administrative Committee and the Quality Improvement Taskforce. Issues which were improved included manpower, multi-professional team development, improvement of counseling and group activity room by renovation of building, development of 2 CPGs, development of guideline and flow of works to be provided in the Relationship Clinic. The newly develop service model was launched for trial for a month and found many missing points. The second Flow chart was then developed by adding several items including provision of ARV for new patients both who disclosed and did not disclose their HIV status, history taking, assessment of opportunistic infections, management of co-morbidity, first and next appointment, and referral when needed. The second Flow chart was used since April 2019 up to present and resulting in 5 anonymous old HIV infected, consenting to reveal themselves, an 5 out of 6 missing appointment patients, returned to receive medication.