situation of using clinical services and effectiveness of health care model for elderly people rely on medical facilities in binh duong

MINISTRY OF EDUCATION AND TRAINING -MINISTRY OF HEALTH INSTITUTE OF HYGIENCE AND EPIDEMIOLOGY ---TRAN VAN HUONG SITUATION USING THE EXAMINATION TREATMENT SERVICE AND EFFECTIVENESS OF HE

MINISTRY OF EDUCATION AND TRAINING

-MINISTRY OF HEALTH

INSTITUTE OF HYGIENCE AND EPIDEMIOLOGY

-TRAN VAN HUONG

SITUATION USING THE EXAMINATION TREATMENT SERVICE AND EFFECTIVENESS OF HEALTH CARE MODEL FOR ELDERLY IN BINH DUONG MEDICAL FACILITIES

Specialization: Social Hygiene and Health Organizations

Code: 62 72 01 64

MEDICAL DOCTOR THESIS ABSTRACT

HA NOI - 2012

The work was completed at:

INSTITUE OF HYGIENE AND EPIDEMIOLOGY

Supervisor:

1 Ass Prof Dr Pham Van Thao

Review 1:

Review 2:

Review 3:

The thesis will be presented before Institute Thesis

Expertise Board, taken place in the National Institute of Hygiene and Epidemiology

At: on / / 2012

- National Library

- Library National Institute of Hygiene and Epidemiology

AI After intervention

Due to the aging process, resistance and self-adjustment of the elderly(EL) reduced, plus the absorption of nutrients, poor energy reserves werethese conditions that made the disease easy to generate, develop more severe

Of EL diseases was acute exacerbation of chronic diseases, diseases of thevast and silent making it difficult to diagnose and detect, less ability torecover So, if undetected, no care and treatment positive and timelymanner can easily lead to diminished health status and mortality

Limit the aging process and illness for EL, to extend healthy life, usefullife was the desire of thousands of people This depended on a very importantpart of prevention, health care (HC), improved resistance to the EL BinhDuong province in the South East region, was one of the dynamic localeconomy, attracting foreign investment, the rate of urbanization, increasingpeople's living conditions improved, the EL on a increase However, in BinhDuong so far, no studies on the status of health care needs, access to and use ofmedical services by the elderly and response capabilities of medical facilities.From the above fact, we conducted the subject to get the following objectives:

1 Describe needs, access to and use of medical services for elderly people

in Binh Duong province and ability to meet of commune health centers, 2010.

2 Assessing the effectiveness of health care model for elderly people rely on facility health in Binh Duong province (2010-2011).

* The new contribution of the thesis:

- Described the situation demands, access to and use of clinicalservices (CL) of EL in Binh Duong province Also, evaluated the ability ofhealth station (HS) to meet the demand for the CL needs of the people,including EL

- Construction and initial evaluated the effectiveness of model " ELhealth care based on facility health" After 1 year of implementing this model

in Khanh Binh commune, Tan Uyen District: CL management system for EL

to be consolidated and strengthened, EL had CL timely, periodic bloodpressure measured in commune Periodical examination result showed thatthe EL proportion of currently infected and the incidence of severe diseasereduced than before the intervention and compared to controls 5 operatingindicators of community-based of CL management activities and bloodpressure monitoring management were significantly higher than that incommune control, intervention effective (IE) was from 90.5% - 787.8 %

* Layout of the thesis: The thesis consisted of 129 pages, 4 chapters of

Introduction: 2 pages; Chapter 1 - Overview: 39 pages; Chapter 2 - Subjects andMethods: 20 pages; Chapter 3 - The Results: 36 pages; Chapter 4 - Discussion: 29pages; Conclusion: 2 pages; Recommendations: 1 page; 37 tables, 9 charts, 124references, of which 107 Vietnamese documents and 17 English documents

Chapter 1: OVERVIEW 1.1 The situation of the elderly

1.1.1 The concept of the elderly

World Congress on EL in Vienna (Austria) 1982 regulated: citizens

60 years old or older were classified as EL In Vietnam, the NationalAssembly promulgated Ordinance EL (4/2000) and the Elderly Law(11/2009), that ruled man from 60 years of age (irrespective of gender) wasthe EL

1.1.2 Situation of elderly people in the world

Worldwide, the proportion of EL from 8.2% in 1950 has increased 10% in

2000 2025 will be estimated over 1 billion EL, accounting for 14% of the totalworld population And in 2045, the first time in human history, population density

in children (0-14 years) and EL will be equal, or approximately 20.4%

1.1.3 Situation of elderly people in Vietnam

According to the results of Population Census and household 2009,the Vietnamese EL rate was 8.9%, increased 1.5 million from the previous

10 years As such, we are standing at the threshold of the aging population

EL in our country unevenly distributed among regions and in rural areas ELaccounted for 77.8% of EL in the country For every 100 old men and therewere over 140 elderly women, in particular, the higher age, the moreelderly women than men and who were more than 80 years old, the number

of elderly women over 2 times the old men

1.2 Situation use medical services for the elderly and the ability to meet of the commune health stations.

1.2.1 EL's health care needs were enormous, but conditions had limited support.

EL health care was prevention of premature aging, prevention andtreatment of diseases caused by old age generated by many differentmeasures to maintain physical strength, spirit and life of EL CL needs wereurgent requirements of the NCT to improve health, reduce chronic diseases,disability and death when entering old age EL CL needs not only depended

on the subjective but also depended largely on the quality, cost and severity

of illness, distance and ability to access to the medical facilities of each EL

1.2.2 Access to health care services of the elderly

In society, people have right to access to any health care services do sofor the most favorable However, for EL access to health care services havespecific characteristics needed to be taken seriously: the distance and time, cost,service quality, culture, traditions In addition, access to health care services

of EL was influenced by a deep belief that EL has established throughout hislife

1.2.3 Use of health care services in the elderly

Use of health care services was the ability to get to health facilitieswith each other when people get sick This did not only depend on thesubjective but also depended largely on the quality, price, severe of illness,distance and accessibility of the people.

1.2.4 Ability to meet of the commune health facilities about clinical services for the elderly

Ability to meet was the general condition, the available resources ofthe health facilities that made health services to meet health care needs ofthe people Ability to meet the medical facility for health care needsincluded the following contents: Health personnel (medical staff, medicalofficer) based on both quantity and quality; Conditions ensure healthservices: facilities ; Medical Equipment: drugs, chemicals ; Healthbudgets: State budget, local budgets, sources of socialization

Operating community-based health care (OCBHC-Community BasedMonitoring-CBM): a system was built by the Health Ministry in 1998 withthe aim of improving the management skills, planning health activities ofcommunal health stations, monitoring process objective support.With many different types of health services, but communal health stationsmainly implementing national health programs (HPr) and the work ofpreventive medicine, clinical ordinary activities for the people

1.3 Elderly health care models

1.3.1 Policy on Ageing

Being aware of the meaning and importance in EL health care as well as to

promote the role of the good traditions of our people "old prime lens life", in recent

years, the Government has issued many policies and regulations on physicaltreatment regime, health care for EL(health insurance card, clinical free )

1.3.2 Health care models for the elderly

Worldwide, there are many different models in EL health care as CL model

at home in the U.S., France, Russia In some other countries, state institutionsreduced 50% percent of medical expenses for EL as in Mongolia; free periodicscreening for low-income EL in North Korea In the Philippines, Indonesia held

EL health care activities in community through the training some of the mostbasic knowledge about health care for the EL volunteers in the community

Some EL health care models in the current period in Vietnam:

- Family Doctor model;

- Models of consulting and EL health care;

- Model of EL health care in the community;

- Models of EL health care at commune health facilities;

- Model of EL health care in the hospital;

- Models of nursing home care for EL;

- Model of private health care for EL;

In general, the pattern was not uniform and not comprehensive, therewere many factors that hinder the resources to maintain broad andsustainable development in communities.

Chapter 2: SUBJECTS AND METHOD 2.1 Object, place and time study

2.1.1 Subjects and study materials

- The elderly, households with EL in the study area

- Communal health stations: materials, medical staff, the operations

- The legal documents, the report on EL health care

2.1.2 Study location: The study was conducted in four communes wards of four

district/town in Binh Duong province, including An Phu - Thuan An district(commune control), Khanh Binh - Tan Uyen district (commune intervention),Phu Hoa - Di An district and Tan Dong Hiep - Thu Dau Mot Town

2.1.3 Research Time: From May 4/2010 to 6/2011, including two stages:

- Cross-sectional descriptive survey, theoretical modeling: April –June/2010

Developed and evaluated model effectiveness: July / 2010 June/2011

-2.2 Research Methods

2.2.1 Study design: cross-sectional descriptive study and research

community interventions would be based on quantitative research data

2.2.2 Sample size and sampling techniques

* Sample size was the elderly were calculated by the formula:

* Sampling Technique: Using a combination of technology targeted

sampling (selecting 4 districts/towns: Di An, Tan Uyen, Thuan An and ThuDau Mot), random sampling unit (choose a commune/wards in eachdistrict /town have chosen) and random system (selected EL) Intervention

commune in four communes/wards has been randomly chosen, selected acommune of the 3 remaining communes as commune control.

2.2.3 The study indicators

- For the EL including: gender, population structure, per capitaincome, nutrition, personal activities, mental, symptoms/illness, healthinsurance, the frequency of illness, the demand for clinical and diseaseprevention, nutrition needs and demand for caring spirit access to healthfacilities, health services use

- For households including family structure, vehicle, life, spirit careand care for EL

- For the communal health stations including: human resources,facilities, medical equipment, medical activities of EL Ability to meetmedical services for EL of communal health stations

- The indicators intervention models including:

+ 10 indicators for organizational management EL CL

+ 5 indices of community-based executive

2.2.4 The data collection techniques

- Interview by questionnaire

- Medical examination for EL to determine disease status

- The intervention community compared before and after andcomparison with control: Intervention model "health care based on medicalfacilities", including the following contents:

+ To build EL health management network;

+ Develop indicators OCBHC to evaluate intervention model result;+ Manage CL periodically for EL in the commune;

+ Manage EL blood pressure monitoring in rural areas;

+ Communication, health counseling and some other health care activities

2.2.5 Resources took part in

- Investigators: Health staff of 4 communal health stations/wards studied

- Medical examination for EL: Health staff of Nam Anh GeneralClinic, districts and communes health centers

- Supervisor: PhD, district health centers leaders, staff from NationalHygiene and Epidemiology Institute

2.2.6 Moral in research

- Information collected was only for research purposes

- With the consent of the government, local health and research subjects

- The Board of Moral Health of Binh Duong Department of Healthand Hygiene and Epidemiology Institute accepted

2.2.7 Limitations of the research

- New topics studied only in 4 communes / wards of four

districts/towns in Binh Duong province should not be high representative

- Merely studying a number of health care contents for EL, the contents of:nutrition, nursing exercise regime research has not been mentioned.

Chapter 3: RESULTS 3.1 Situation needs, access to and use of medical services for elderly people and ability of commune health stations to meet the demand in Binh Duong

3.1.1 Some characteristics and living conditions of elderly people

70.5% EL in this study were women; groups from 70-79 years oldaccounted for the highest percentage (52.3%), only 21.3% EL withsecondary school or higher level; 40.9% EL was widowed; 12.2% ELremained to earn his living; only 9.6% EL was working normally Therewere 47.3% EL to cook, only 25.4% EL self-evaluation of conditions wereadequate food, comfortable; main caregiver for EL was the daughter,wife/husband

3.1.2 Needs, access to and use of medical services for elderly people

3.1.2.1 Health care needs of elderly in four commune studies

Table 3.8 Distribution of the elderly under the condition and needs treatment at health facilities

Current status Quantity Elderly patients (n = 770)%Current condition Moderate and severeMild disease 472 61.3

Table 3.9 Estimated frequency of illness/person/year of EL by gender

Estimates of the incidence of illness in EL commune research was

2.11 / person / year However, the frequency of EL sick women was 2.22

times, of EL male was 2.01 times

3.1.2.2 Accessibility of health cilities of the elderly in four commune studies.

Table 3.10 Distribution of the lderly over time access to health

facilities

Unit:Ratio%

Health facilities Under 10’ Time at health facilities10’-30’ 31’-60’ Over 60’

Region General Clinic 58.2 23.5 11.7 6.6

About time EL access to medical facilities For communal health stations

most under 10 minutes EL approach (85.5%), while 13.2% EL reach from 10-30

minutes and only 1.3% was approached from 31-60 minutes For private pharmacies,

private physicians and Region General Clinic, from 58.2% - 65.7% EL approached

under 10 minutes, from 23.5% 30.3% EL reached from 1030 minutes, from 4.0%

-11.7% EL reached from 31-60 minutes, the EL remain to reach over 60 minutes

Particularly for hospitals to reach 40.6% EL approached under 30 minutes; 28.7%

EL reached from 31-60 minutes and 30.7% EL reached over 60 minutes

Table 3.11 The average time to reach health facilities

of the elderly by income group 

For the group Q 1 (very poor group), the average time to reach communal

health stations, private pharmacies, private physicians and Region General

Clinic range from 15.1 to 18.5 minutes, but access to the hospital was 62.8

minutes For the very rich group (Q 5), the average access time to the hospital

30.4 minutes, to other medical facilities from 8.5 to 11.0 minutes

Time access to communal health stations and hospitals of the group

was 2 times Q 1 versus Q 5 and this difference was statistically significant with

p <0.05

Table 3.13 Distribution of the elderly by the opinion about the first medical facilities to reach when health care needs

Health facilities QuantityElderly (n = 1.530) %

Communal health stations 610 39.9

Region General Clinic 202 13.2

Hospital districts and provinces 282 18.4

When EL need clinic, 39.9% EL came to communal health stations; 18.4%

EL came to district or provincial hospital; 13.2% EL came to Region General Clinicand 9.5% came to private clinics or to private pharmacies to buy medicine

3.1.2.3 Use of medical services for elderly people

Table 3.15 Opinions of elderly people on why not choose commune health stations to treat the disease

The reason QuantityElderly (n=1,107) %

The attitude is not good 143 12.9

Like the private health sector 41 3.7

Reviews of EL about reasons not to choose communal health stations

to have clinic when being sick, there was 29.5% EL for mild disease and27.7% did not trust the ability clinic of communal health stations Also,from 10.9% - 14.7% EL thought communal health stations lack ofmedicine, Health staff attitude was not good and less interest in the clinic atstations

20 40 60 80 100

Table 3.6 BLorenz chart about EL rate use Medical services is

Communal HS and Hospital by income group

là trạm y tế xã và bệnh viện theo 5 nhóm thu

nhập/năm

When EL had demand, 31.9% EL self-treating, 27.6% El came to healthstations and 17.7% EL to hospital Only a small percentage of EL did not havetreatment but traditional drugs (2.2% and 6.3%) In terms of income groups,when needed clinic, the proportion of very poor EL group (Q1) selected form

of self-treating and to stations higher than the very rich group (Q5) (44.7%versus 5.4% and 36.4% versus 17.2%), with p<0.05 In addition, the hospitalrate of EL was much lower in group Q1 versus Q5 (0.3% versus 31.9%), withp<0.05

3.1.2.4 Health care costs and affordability of the elderly

Table 3.16 Medical expenses of elderly people by health services

Clinical outpatient hospital 89.5

Clinical inpatient hospital 1315.3

Clinic average cost / EL / time, the highest was inpatient hospitalclinic (over 1.3 million), followed by private health (247.8 thousand),Region General Clinic and treatment in traditional medicine, outpatienthospital clinic (from 89.5 to 145.1 thousand)

Chart 3.7 Distribution ratio the average cost/1 time clinic

compared to PCI / month of the elderly

The average of a time clinic cost compared to PCI / month of EL in

the hospital inpatient services was 9.5 times, while private health sector was

2.1 times; traditional medicine was 1.1; outpatient hospital was 0.7 times

especially at health stations just 0.6 times

Table 3.18 The rate of elderly households with debt 1 month before

the survey in five income groups

Unit: Ratio%

Content

Income group Total

(n=153 0)

Q 1

(n 1 = 34)

Q 2

(n 2 = 260)

Q 3

(n 3 = 1035)

Q 4

(n 4 = 196)

Q 5

(n 5 = 5)

20.4% of EL households had loans a month before the survey Among

them 69.1% of households in group Q1; 37.4% households in group Q2;

14.5% of households in Q3 group; 19.9% of households in group Q4 and

57.2% in Q5 group However, the purpose of debt in each group was

different For Q1 and Q2 groups, nearly 50% (41.9% - 45.8%) households

in the household debt used for treatment, while this rate in group Q4, Q5

was very low (5.6% and 0%) The difference between the Q1 and Q4 was

statistically significant with p<0.05

3.1.3 Ability of the commune health center / ward to meet the medical services

Table 3.19 Indicators of health workforce by 4 commune health

stations / ward

Index manpower

Commune/ward health stations Average/

Commune Tan An Khanh Phu