Assessing system-based trainings for primary care teams and quality-of-life of patients with multimorbidity in Thailand: patient and provider surveys

Abstract

Background Strengthening primary care is considered a global strategy to address non-communicable diseases and their comorbidity. However, empirical evidence of the longer-term benefits of capacity building programmes for primary care teams contextualised for low- and middle-income countries is scanty. In Thailand, a series of system-based capacity building programmes for primary care teams have been implemented for a decade. An analysis of the relationship between these systems-based trainings in diverse settings of primary care and quantified patient outcomes was needed. Methods Facility-based and community-based cross-sectional surveys were used to obtain data on exposure of primary care team members to 11 existing training programmes in Thailand, and health profiles and health-related quality of life of their patients measured in EuroQol-5 Dimension (EQ-5D) scale. Using a multilevel modelling, the associations between primary care provider’s training and patient’s EQ-5D score were estimated by a generalized linear mixed model (GLMM). Results While exposure to training programmes varied among primary care teams nationwide, District Health Management Learning (DHML) and Contracting Unit of Primary Care (CUP) Leadership Training Programmes, which put more emphasis on bundling of competencies and contextualising of applying such competencies, were positively associated with better health-related quality of life of their multimorbid patients. Conclusions Our report provides systematic feedback to a decade-long investment on system-based capacity building for primary care teams in Thailand, and can be considered as new evidence on the value of human resource development in primary care systems in low- and middle-income countries. Building multiple competencies helps members of primary care teams collaboratively manage district health systems and address complex health problems in different local contexts. Coupling contextualised training with ongoing programme implementation could be a key entity to the sustainable development of primary care teams in low and middle income countries which can then be a leverage for improving patients outcomes. Electronic supplementary material The online version of this article (10.1186/s12875-019-0951-6) contains supplementary material, which is available to authorized users.

Assessing a national policy on strengthening chronic care in primary care settings of a middle-income country using patients’ perspectives

“…Despite the presence of universal healthcare coverage (UHC) in Thailand over the past two decades, provision of chronic care for patients with hypertension and/or diabetes in primary care settings has faced a challenge of shortage of health care workforce especially nurses [ 9 ]. Furthermore, the policymakers have been increasingly aware of the importance of training needs for quality improvement of chronic care [ 10 ]. To address the limitations, the Ministry of Public Health has taken a policy initiative to strengthen the chronic care for patients with diabetes or hypertension with a two-pronged strategy: a) allocation of a family physician and multidisciplinary health professional as a team to primary care settings at subdistrict with a well-defined population of approximately 10,000; and b) training of the team to deliver healthcare based on the concept of CCM.…”

Assessing a national policy on strengthening chronic care in primary care settings of a middle-income country using patients’ perspectives.

“…9 Furthermore, the policymakers have been increasingly aware of the importance of training needs for quality improvement of chronic care. 10 To address the limitations, the Ministry of Public Health has taken a policy initiative to strengthen the chronic care for patients with diabetes or hypertension with a two-pronged strategy: a) allocation of a family physician and multidisciplinary health professional as a team to primary care settings at subdistrict with a wellde ned population of approximately 10,000; and b) training of the team to deliver healthcare based on the concept of CCM. Recently, a systematic review has con rmed that Self-management Support is the most frequent CCM intervention which is associated with statistically signi cant improvements, predominately for diabetes and hypertension.…”

Development of competency model for family physicians against the background of ‘internet plus healthcare’ in China: a mixed methods study

“…Facing with the challenges posed by ageing and increasing global healthcare demand, there has been an increase in the emphasis placed on the importance of primary care models that can provide continuous, coordinated, and comprehensive care services for individuals and families [1]. As the comprehensive health service provider in communities, family physicians have played a critical role in public health worldwide [2].The family doctor system is also the most effective approach to achieving universal health coverage and the foundation of health system globally [3,4].…”