The Evaluation of the seamless development of health systems for the elderly in Yasothon Province

Abstract

An acute ST-segment elevation myocardial infarction (STEMI) has remained a significant cause of morbidity and mortality especially in the elderly. Yasothon Province has continuously developed the health system for STEMI patients. However, a concrete evaluation has not been systematically conducted. This implementation research (IR) was to study the components and evaluation of outcomes of implementation in case the dissemination of seamless health care system based on integration and participation for elderly at risk of STEMI, Yasothon province. Applied the conceptual frameworks from CFIR and Proctor to conduct the research. To be carried out between April - June 2025.The samples were 520 elderly and 87 stakeholders in ​​five districts of Yasothon Province. The tools consisted of focus group and in-depth interview questions and questionnaires. Qualitative data were analyzed using content analysis, while quantitative data were analyzed using descriptive statistics and z-test. The results, policy implementation components found that it was an important policy, consistent with the current aging society. It had a clear operational framework and the personnel involved and resources were ready. The implementation outcome found that the policy was translated into practice through planning, integration with the provincial development plan and routine work, and adapted to the context of each area. The driving mechanism of policy was the integrated health board and the health board under the Ministry of Public Health to integrated the resources and participation, monitor and continuously empower using data-driven. The service outcome consisted of 4 periods: 1) Promoting, preventing and controlling risks; 2) Manage and request for help when an emergency 3) Health care when sick 4) Continuing of care at home. The health outcomes found that the elderly have increased access to health services. New patients and deaths from stroke tend to decrease. In implementing the policy, there are 7 components: 1) The policy is useful/clear, 2) The context in the area is ready, 3) Participation and acceptance, 4) Strong integrated driving with many levels mechanism, 5) The ability to translate policies into practice and good monitoring, 6) There is a complete health service system and 7) The elderly access to the health system, reducing the morbidity and mortality rate from STEMI but a statistically non-significant reducing. This policy should be expanded and taken into account. It must take into account the readiness and context of each area, focus on the elderly and the community, and link with the health service system with a referral system.