PP.15.05

Abstract

Objective: This research was devided in 2 phases that the 1st phase of the qualitative study was aimed to develop the nursing service system by using integrated disease management model and case management concept for hypertension patients and to test the effect of this developed model on clinical outcomes and psycho-social outcome of patients in the 2nd phase of quasi-experimental study. Design and method: The 1st phase, the samples included 7 persons of administrative team of King Narai Hospital Hospital Contracting Unit of Primary Care, 11 persons of multidisciplinary team, 3 persons of Sub-district Administrative Organization, and 20 hypertension patients. Collecting data by using semi-structure and analyzed data using content analysis. The 2nd phase, the samples were patients with hypertension who were treated at medical unit of out-patient department at three health care settings. 100 samples were randomly assigned to an experimental and 100 samples were control group. The experimental group received treatment and care using Integrated Disease Management Model and Case Management (IDMM and CM) developed in the 1st phase for six month. The control group received the routine care. Clinical outcome, cost of care, self care behaviors, patient satisfaction, and quality of life were collected pretest and posttest of both groups. Data was analyzed using Independent T-test, and Mann Whitney U Test. Results: The 1st phase showed the model of nursing service developed by using Integrated disease management collaborated with Nurse case managers. The model included: a job description and accountability of multidisciplinary team, updated practice guideline, outcome indicator with network of continuing care and treatment. The 2nd phase showed that after using the IDMM and CM model in post experimental intervention, clinical outcomes (Blood Pressure, Cholesterol level, Fasting Plasma Glucose), cost of care, self care behaviors, patient satisfaction, and quality of life of experimental group and control groups were significantly different at p < 0.05. Conclusions: This study showed light the evident based practice of nursing service system using integrated disease management model and case management concept. The model could improve clinical outcomes, cost of care, self care behaviors, patient satisfaction, and quality of life of hypertension patients.