The Effectiveness of a Telemedicine-Based Chronic Disease Clinic System Development for Elderly Patients at Kaset Wisai Hospital

Abstract

This research and development study aimed to develop a telemedicine service system for chronic disease management among elderly patients at Kaset Wisai hospital. The implementation period was from November 2024 to September 2025, divided into 3 phases: Phase 1 studied the context, Phase 2 developed the telemedicine system, and Phase 3 evaluated the effectiveness of the service model. The sample group consisted of patients with diabetes and hypertension divided into 2 groups: the experimental group, which received services through the telemedicine, and the control group, which received services at the regular chronic disease clinic at Kaset Wisai hospital, with 97 patients in each group. Data were collected using the HosXP electronic database program and questionnaires. Main outcomes measured included fasting plasma glucose(FPG), HbA1c, blood pressure (BP), waiting time, and service costs. This research used descriptive statistics including frequency distribution, percentage, mean, and standard deviation, and used inferential statistics to compare outcomes between groups using independent t-test and to compare pre-post outcomes within groups using paired t-test with a significance level set at 0.05.

Results: The telemedicine system was developed using Application Line OA/Google Meet/Dietz and was initiated in areas with readiness, including Ban Khwao Takhlong health promoting hospital, and Ban Um Mao health promoting hospital. The comparison of the effectiveness of developing the chronic disease clinic service system for the experimental group using the telemedicine system after 6 months of implementation found that the sample group had a statistically significant decrease in FPG of -15.83 mg/dL (p<0.001), a non-statistically significant increase in HbA1c of +0.10 mg% (p=0.58), a statistically significant decrease in SBP of -15.63 mmHg (p<0.001), a statistically significant decrease in DBP of -5.06 mmHg (p<0.001), and for services in the chronic disease clinic after 6 months of implementation, it was found that the control group had a statistically significant decrease in FPG of -8.73 mg/dL (p<0.001), a non-statistically significant increase in HbA1c of +0.27 mg% (p=0.14), a statistically significant decrease in SBP of -11.18 mmHg (p<0.001), a non-statistically significant decrease in DBP of -2.46 mmHg (p=0.54). The average cost that patients had to pay per visit in the telemedicine group was 81.83 Thai Baht and 349.76 Thai Bath in control group, which was approximately 4.2 times higher. In terms of average service duration per visit, the telemedicine group used approximately 92 minutes less time than the control group.

In conclusion, the development of a chronic disease clinic service system for the elderly using the telemedicine system is another effective system that can be used to help manage chronic diseases, especially in the elderly group, because it has comparable effectiveness in controlling blood glucose levels and blood pressure levels, and it was also found to help reduce travel costs for patients and reduce congestion in healthcare facility services, and can be used as a guideline for expansion to other services in the future.