Model development to improve primary care services using an innovative network of homecare providers (WinCare) to promote blood pressure control among elderly patients with noncommunicable diseases in Thailand: a prospective cohort study

Abstract

Background Thailand has been rapidly approaching an aging society in conjunction with an increase in noncommunicable diseases (NCDs) especially hypertension and type 2 diabetes. Demographics and epidemiologic transitions create several challenges to the health system in Thailand in the case of long term care policies, in particular, modality to support home care. Therefore, the model development to facilitate primary care home services for elderly patients with NCDs using an innovative network of homecare providers (WinCare) was established. The study aimed to evaluate the effectiveness of WinCare to improve blood pressure (BP) control as well as health-related quality of life (HRQoL) among elderly patients with NCDs. Methods A prospective cohort study was conducted between July 2019 and January 2020 in a suburban area, Chiang Mai Province, Thailand. The intervention included WinCare providers and WinCare application. WinCare provided check-in visits to measure subjects blood pressure and body weight (once weekly), played the roles of other home caregivers for the patients and recorded measurements and activities in the WinCare app for 6 months. The primary outcomes of the study were differences in systolic BP, diastolic BP, and controlled BP (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) at 6-month follow-up between the intervention and control groups, adjusting for age, sex, marital status, comorbidities, alcohol consumption and smoking status. Results A total of 104 subjects were initially recruited. Of the remaining 98 individuals, 52 were allocated to the intervention group and 46 to the control group. After adjusting baseline characteristics, no association existed between decreasing average systolic BP and intervention groups. However, diastolic BP of patients in the intervention group was on average 5.19 mmHg (95% CI -8.22, − 2.17) lower compared than that of the control group at 6-month follow-up. Furthermore, compared with patients in the control group, those in the intervention group were more likely to control BP, (AOR 3.03; 95% CI 1.02–9.01) at 6-month follow-up. Conclusion Establishing a network of homecare providers (WinCare) was feasible in a community setting. This innovative network was able to facilitate elderly patients with NCDs residing in a suburban community to improve BP control at least at 6-month follow-up. Trial registration Trial identification number was TCTR20200312007, First submitted date:12/03/2020.

Effect of the weight-loss program using daily self-weighing combined with personalized counseling led by village health volunteers in adults with obesity in a rural community, Thailand: a randomized controlled trial

“…Our results reported that there was no significant difference in mean change in BP at a twenty-week follow-up from baseline between intervention and control groups. However, a decrease in SBP and DBP over a 20-week follow-up among intervention participants was pinpointed, which is compatible with the related study in Thai patients with NCDs [ 27 ]. In the present study, the VHV also explored the adverse psychological and physical effects related to the weight-loss program.…”

“…The well-trained VHV of the weight-loss program visiting the intervention participants at home weekly may simplify the maintenance of a hypocaloric diet and self-weighing with records. The related studies in Thailand and the UK may support this finding that well-trained providers act as social supporters to improve health outcomes [ 27 , 47 ]. The VHV in the weight-loss program in this study stand for the community health workers who support healthcare providers at the local primary care units in rural communities.…”

“…However, given the burden of providing care for so many different people in the community, there are currently insufficient human resources. Thus, in the future, an innovative network of homecare providers (WinCare), novel human resources in the community who were not VHV on duty formerly [ 27 ], may perform this function rather than VHV.…”

“…However, a few studies indicated that the effect of self-monitoring intervention declined over time due to many difficulties in the adhesion of health promotion to self-control [ 25 , 26 ]. Hopefully, community organizations play an essential role in improving health [ 27 – 29 ], such as encouraging weight reduction intervention in a rural setting [ 30 ].…”