1 MINISTRY OF EDUCATION AND TRAINING HEALTH - MINISTRY OF 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: Ass Prof Dr Pham Van Thao Dr Nguyen Thị Thuy Duong 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 Thesis can be found at: - National Library - Library National Institute of Hygiene and Epidemiology HI HP CBM HC PHC FI HPr Co HS CBE PCA BP HH IE CL EL MP MHCM WHO BS CP SS PCI HS NC PC UNICEF VEA VNCA PH BI AI LIST OF ABBREVIATIONS Health Insurance Hospital Community Based Monitoring Health care Primary health care Efficiency index Health program Collaborators Health Services Community-based Executive Polyclinic area Blood pressure Households Intervention Effect Clinical Elderly Medical personnel Model of health care management The World Health Organization The Bureau of Statistics Census population Secondary school Per capita income Health Station National Committee People's Committee United Nations Children's Fund Vietnam Elderly Association Vietnam National Committee on Ageing Public Health Before intervention After intervention BACKGROUND Due to the aging process, resistance and self-adjustment of the elderly (EL) reduced, plus the absorption of nutrients, poor energy reserves were these conditions that made the disease easy to generate, develop more severe Of EL diseases was acute exacerbation of chronic diseases, diseases of the vast and silent making it difficult to diagnose and detect, less ability to recover So, if undetected, no care and treatment positive and timely manner can easily lead to diminished health status and mortality Limit the aging process and illness for EL, to extend healthy life, useful life was the desire of thousands of people This depended on a very important part of prevention, health care (HC), improved resistance to the EL Binh Duong province in the South East region, was one of the dynamic local economy, attracting foreign investment, the rate of urbanization, increasing people's living conditions improved, the EL on a increase However, in Binh Duong so far, no studies on the status of health care needs, access to and use of medical services by the elderly and response capabilities of medical facilities From the above fact, we conducted the subject to get the following objectives: 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 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 clinical services (CL) of EL in Binh Duong province Also, evaluated the ability of health station (HS) to meet the demand for the CL needs of the people, including EL - Construction and initial evaluated the effectiveness of model " EL health care based on facility health" After 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 blood pressure measured in commune Periodical examination result showed that the EL proportion of currently infected and the incidence of severe disease reduced than before the intervention and compared to controls operating indicators of community-based of CL management activities and blood pressure monitoring management were significantly higher than that in commune control, intervention effective (IE) was from 90.5% - 787.8 % * Layout of the thesis: The thesis consisted of 129 pages, chapters of Introduction: pages; Chapter - Overview: 39 pages; Chapter - Subjects and Methods: 20 pages; Chapter - The Results: 36 pages; Chapter - Discussion: 29 pages; Conclusion: pages; Recommendations: page; 37 tables, charts, 124 references, 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 National Assembly promulgated Ordinance EL (4/2000) and the Elderly Law (11/2009), that ruled man from 60 years of age (irrespective of gender) was the 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 billion EL, accounting for 14% of the total world 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 EL accounted for 77.8% of EL in the country For every 100 old men and there were over 140 elderly women, in particular, the higher age, the more elderly women than men and who were more than 80 years old, the number of elderly women over 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 and treatment of diseases caused by old age generated by many different measures to maintain physical strength, spirit and life of EL CL needs were urgent 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 so for the most favorable However, for EL access to health care services have specific 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 his life 1.2.3 Use of health care services in the elderly Use of health care services was the ability to get to health facilities with each other when people get sick This did not only depend on the subjective 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 of the health facilities that made health services to meet health care needs of the people Ability to meet the medical facility for health care needs included the following contents: Health personnel (medical staff, medical officer) based on both quantity and quality; Conditions ensure health services: facilities ; Medical Equipment: drugs, chemicals ; Health budgets: State budget, local budgets, sources of socialization Operating community-based health care (OCBHC-Community Based Monitoring-CBM): a system was built by the Health Ministry in 1998 with the aim of improving the management skills, planning health activities of communal health stations, monitoring process objective support With many different types of health services, but communal health stations mainly implementing national health programs (HPr) and the work of preventive 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 physical treatment 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 institutions reduced 50% percent of medical expenses for EL as in Mongolia; free periodic screening for low-income EL in North Korea In the Philippines, Indonesia held EL health care activities in community through the training some of the most basic 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, there were many factors that hinder the resources to maintain broad and sustainable 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: p1 (1 - p1) + p2 (1 - p2) n1 = n2 = Z (α, β) (p1 - p2)2 n1, n2: as of EL in commune intervention and commune control Z: coefficient of reliability α, β: was the probability of a mistake type and type 2, chose α =0.05, β=0.2 p1, p2: rate of EL was sick for weeks before the survey, before and after intervention; p1 = 0.35 (according to a study by Tran Ngoc Tu - 2008) p2 = 0.25 (percentage desired) Calculated out: n = n2 = 328 EL, the vote provision was 15%, so: n1 = n2 = 378, in fact, in commune intervention survey was 382 people, in commune control was 383 people Descriptive studies before intervention was conducted in four communes/ wards: 382 people x communes/wards =1528 people, actually 1530 people * Sampling Technique: Using a combination of technology targeted sampling (selecting districts/towns: Di An, Tan Uyen, Thuan An and Thu Dau Mot), random sampling unit (choose a commune/wards in each district /town have chosen) and random system (selected EL) Intervention commune in four communes/wards has been randomly chosen, selected a commune of the remaining communes as commune control 2.2.3 The study indicators - For the EL including: gender, population structure, per capita income, nutrition, personal activities, mental, symptoms/illness, health insurance, the frequency of illness, the demand for clinical and disease prevention, nutrition needs and demand for caring spirit access to health facilities, health services use - For households including family structure, vehicle, life, spirit care and care for EL - For the communal health stations including: human resources, facilities, medical equipment, medical activities of EL Ability to meet medical services for EL of communal health stations - The indicators intervention models including: + 10 indicators for organizational management EL CL + 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 and comparison with control: Intervention model "health care based on medical facilities", 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 communal health stations/wards studied - Medical examination for EL: Health staff of Nam Anh General Clinic, districts and communes health centers - Supervisor: PhD, district health centers leaders, staff from National Hygiene 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 Health and Hygiene and Epidemiology Institute accepted 2.2.7 Limitations of the research - New topics studied only in 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 old accounted for the highest percentage (52.3%), only 21.3% EL with secondary school or higher level; 40.9% EL was widowed; 12.2% EL remained to earn his living; only 9.6% EL was working normally There were 47.3% EL to cook, only 25.4% EL self-evaluation of conditions were adequate 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 Elderly patients (n = 770) Current status Quantity 472 61.3 298 38.7 205 26.6 Health Station 239 31.0 314 40.8 No need to treat Orientation for further treatment Mild disease Moderate and severe disease Cure at home Hospital Current condition % 12 1.6 Of the 770 EL currently infected, 61.3% EL had a mild illness, only 38.7% moderate and severe disease There were 40.8% needed treatment in hospital, the remainder could be treated in health stations (31.0%) and treatment at home (26.6%) and without treatment (1.6%) Table 3.9 Estimated frequency of illness/person/year of EL by gender Estimate the frequency of illness / Total Commune / Ward person / year (respectively) Elderly research Male (n = 452) Female (n = 1,078) (n = 1,530) Tan Dong Hiep 1.89 2.34 2.11 An Phu 1.92 2.23 2.07 Khanh Binh 2.08 2.12 2.10 Phu Hoa 2.15 2.19 2.17 Total communes /wards 2.01 2.22 2.11 10 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% Time at health facilities Health facilities Under 10’ 10’-30’ 31’-60’ Over 60’ Commune health centers 85.5 13.2 1.3 Private pharmacies 65.7 30.3 4.0 Private Physicians 60.5 28.5 8.1 2.9 Region General Clinic 58.2 23.5 11.7 6.6 Hospital 10.5 30.1 28.7 30.7 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 10-30 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 Unit: minutes Income group Q1 Q2 Q3 Q4 Q5 Health facilities p n1= 34 n2= 260 n3= 1,035 n4= 196 n5 = (1) Commune health centers 15.3 (1) 14.7 11.1 10.8 8.5(1)