The development of medicine therapy for health promotion model for type-2 diabetes mellitus patients with chronic kidney disease at Phosai Hospital, Phosai district, Ubon Ratchathani Province

Abstract

This action research aims to develop a model of medicine therapy for health promotion for diabetic patients with chronic kidney disease by employing the participant including: 1) caregivers, 2) village health volunteers and 3) public health personnel. The subjects were created an appropriated medicine therapy to solve the problems of medicine use of diabetic patients. The study included 99 patients who were attended diabetes clinic service at Phosai hospital and 114 of the stakeholders who involved in caring patients. The quantitative data were collected using questionnaires through quality checks from experts with validity 0.67-1.00. The reliability level with Cronbach’s alpha coefficient of the three questionnaires was 0.873, 0.877 and 0.965, respectively. The qualitative data was collected from observations and suggestions from the participants. The quantitative data analysis used descriptive statistics and the qualitative data using content analysis for classification principles to organize information systems to answer questions to find out the cause in the relationship and process of changing.

The results found that the majority of diabetic patients with renal impairment were female (55.60%), average age 71.78±9.86 years, agricultural occupation (58.58%), average monthly income less than 1500  baht  (66.67%) (mean=1765.15±2015.05) living with their family as their children as caregivers (52.53%) . The programme of a medicine therapy for health promotion indicated to be success by participation of caregivers and village health volunteer working with public health personnel, encourage their educating especially for diabetes and nephrotic syndrome as well a proper medication use, follow-up visits to the patient with diabetes at their home, including encouraging patients for medication behaviour and appropriated medication use. The problem of medicine therapy use was decreased from 88 problems (average of 0.89 problems per patient) to 16 problems (average of 0.16 problems per case). The knowledge of patients and their caregivers were increased to high level by 31.31% and 39.39%, respectively, the medicine use behaviour scores increased to the high level by 43.43% and 60.61, respectively, and statistical significance at 0.05 level (p-value<0.001).

In summary, the model of medical therapy for health promotion for type-2 diabetes mellitus patients with renal impairment indicated the PCHK model, which consists:  1) Participants as patients, 2) Counselling to solve problems by pharmacists, 3) Home visits and 4) Knowledge to make sure that patients and their caregivers using the appropriately medicines to reduce medicine using problems.