Transcript ทัศนคติและความต้องการที

Research Presentation
Attitude and need of patients with heart
diseases at pediatric out patient department,
Naresuan University Hospital
5th year Medical students
Naresuan University Hospitral
Faculty of Medicine, Naresuan University
Tuesday 6th November 2012
Room Ekatosarod 2, 3rd floor, NUH
Researcher



Mr.Panapol
Mr.Paisit
Mr.Rapeepat
Varakornpipat
Student ID 51460919
Kosum
Student ID 51460940
Auekitrungrueng Student ID 51460988
“5th year medical students”
Consultant


Dr.Yuthapong
Dr.Taweesak
Buddharaksa (Content Expert)
Nopkasorn (Methodology Expert)
Research questions


Primary research question
• What are the attitude and need for health service
system of client at pediatric cardiology clinic,
Naresuan University Hospital (NUH)?
Secondary research questions
• How do they manage heath service system at
pediatric cardiology clinic, NUH?
• How can we improve health service system at
pediatric cardiology clinic, NUH?
Part 1 Introduction

Background

We found problem about health service system
Waiting time for doctor
 Ineffective medical communication
 Uncorrected date that specialist’s service
In 2008, client at OPD PED average 723/month (35.10/day)
In 2009, client at OPD PED average 848/month (42.55/day)
In 2010, client at OPD PED average 969/month (47.21/day)





According to the statistics, There are increase clients
each year despite of increase doctor
Part 1 Introduction (Cont.)

Background (Cont.)


Want knew attitude and need of client
Despite of limitation of time, we did pilot study at
pediatric cardiology clinic because
Patients with heart diseases is mostly total of patients
 They have many high risk for life-threatening medical
emergencies such as chest pain and heart attack, shock,
sudden cardiac arrest etc. (if there are not help quickly)

(American Heart Association: PEDIATRICS Vol. 113 No. 1 January 2004

Thereby, They are the way to effectively improve
health service system
Table shows patients at pediatric clinic,
Naresuan University Hospital
Time
Number
2009
2010
2011
Aug 2011
Total patients
in a month
848
969
1035
1079
Total patients
in a day
42.55
47.21
51.85
56.79
Patient : Doctor
in a day
10.64
11.80
12.96
14.20
Max Time of
patient gain service
/ day
31 min
27 min
25 min
23 min
Reference : Pediatric Out patient department, Naresuan University Hospital
5 Most common diseases, distinguish by department in 2010
Bar chart shows patients in special pediatric clinic at
Naresuan University Hospital
Table shows patients at pediatric cardiology
clinic, Naresuan University Hospital
Time
Number
Jan
Feb
Mar
Apr
May
June
July
Aug
Total patients
in a month
159
162
136
174
157
165
130
209
Total patients
in a day
17.6
20.25
15.1
21.75
17.4
18.3
16.25
23.22
Patient : Doctor
in a day
8.8
10.125
7.55
10.875
8.72
9.16
8.125
11.61
Max Time of
patient gain service
/ day
20 min
18 min
24 min
17 min
21 min
20 min
22 min
16 min
Reference : Pediatric Out patient department, Naresuan University Hospital
Part 1 Introduction (Cont.)

Objectives



To explain health service system, limitation, and
problem about approach health service system of client
at pediatric cardiology clinic Naresuan University
hospital
To study attitude, impression, and need of client at
pediatric cardiology clinic Naresuan University hospital
Boundary


Population : Client at pediatric cardiology clinic
Naresuan University hospital
Time : 5th September – 2nd October 2011
Part 1 Introduction (Cont.)

Expected Advantages
To know problems of health service system and
approach to health service system of client at
pediatric cardiology clinic, NUH
 To know need of client and provider on standard
medical service
 To get information for effective improvement health
service system
 Way for improvement clinical service in the other
departments

Part 2 Method

Research question


What are the attitude and need for health service system
of client at pediatric cardiology clinic, Naresuan
University Hospital ?
Population


Pediatric patients and their parents at pediatric
cardiology clinic NUH (5th September – 2nd October
2011) : Inclusion criteria --> history of treatment at least
1 time
Heath care Provider at pediatric cardiology clinic (work
experience at least 1 year)
Part 2 Method (Cont.)

Sample
Six pediatric patients and their parents at pediatric
cardiology clinic NUH (5th September – 2nd October
2011) : Inclusion criteria --> history of treatment at
least 1 time
 Two doctors and two nurses at pediatric cardiology
clinic (work experience at least 1 year)


Place
Pediatric cardiology clinic, NUH
 Echocardiograhy Room, NUH

Part 2 Method (Cont.)

Source of data
Interviewing client and observation
 OPD Card
 Statistics of pediatric out patient department NUH


Study design

Qualitative study
Observation
 In depth interview


Survey study

Questionnaire
Part 2 Method (Cont.)

Method
1. Qualitative study

Observation
Observe client at pediatric cardiology clinic, NUH
 Observe client at echocardiologygram room, NUH
 Observe heath care provider (non participant observation)


In depth interview
In depth interview individually
 Record by voice recorder (if interviewee permit)
 Two interviewers : interviewer and recorder

Part 2 Method (Cont.)

Method
2. Survey study

Questionnaire
After in depth interview, collect and analyze the data
 Design questionnaire
 Increase validity
 Analyze the data from questionnaire (result accord with in
depth interview?)
 If data oppose to in depth interview : further interview in
interesting issue

Part 2 Method (Cont.)

Triangulation
Ask from all the parents (In case of client more than
two people) such as father, mother, uncle, and
patient
 Two interviewers : interviewer and recorder
 Some information such as waiting time could verify
with time with staff recorded in OPD card
 In depth interview with observation
 Increase credibility of research

Part 2 Method (Cont.)

Analysis and Statistics

Observation and In depth interview
Principle of qualitative research
 Not focus statistics for analysis
 Focus on searching important issue that show overview of
need of patients


Questionnaire
Use descriptive statistics
 Present overview and recommendation
 If information accord with IDI : support, but information
opposite with IDI : further interview in interesting issue

Part 3 Result

Theme of research
•
•
•
•
•
Transportation to hospital.
Health care providers.
Locations and facilities.
Referral system.
Outpatients room and equipment used in the
treatment.
• Waiting time.
• Health service system.
Part 3 Result (cont.)
Transportation to hospital
 Facility of transportation
• Patient has difficulty in traveling. Especially in the
afternoon. As the saying.


“If we come to hospital too late , we will wait for the
examination and treatment in the afternoon ,then the bus
back home was less.”
(OPDC1I02-026)
“Bus is unpredictable. Sometimes I have to wait several
hours to get a bus.”
(OPDC2I03-026)
Part 3 Result (cont.)
Transportation to hospital
 The duration of travel
• Patients take a long time to come to the hospital. As
the saying


“I spent four hours on the road. I must wake at 3:00 am
then I’m here at 7.30 am.”
(OPDE1I05-010)
“I spent 1 hour and a half for the travel , it’s too long.”
(OPDF1I07-006)
Part 3 Result (cont.)
Transportation to hospital
 Parking
• Parking is not enough to meet demand. As the
saying

“Parking is minimal. Very difficult time finding parking.
Have to park far away from the hospital.”
(OPDG2I10-007)
Part 3 Result (cont.)
Health care providers
 Adequacy of care providers (nurse).
• Insufficient number of nurses per serving. The
hospital has a large workload. As the saying.


“If there is a specific point that there are more and more
people would be better. It's from 3 to 5 people, it may be
time for service may be faster.”
(OPDF1I07-014)
“I would like to have more nurses. If you increase the
number of nurses, the work would faster. Patients will not
wait too long.”
(OPDG2I10-024)
Part 3 Result (cont.)
Health care providers
 Adequacy of care providers (doctor).
• If the number of doctors is increase. it’s may be
made available more quickly. As the saying.


“I would like to have more doctors because the number
of patient is more than doctor.”
(OPDB1I01-065)
“If the number of doctors is increase I think the service is
more faster.”
(OPDE2I06-016)
Part 3 Result (cont.)
Health care providers
 The attention and friendliness of doctor.
• Patients appreciate the services of a physician. As the
saying

“Doctor helps me understand the disease. Sometimes
drawing to help with understanding. I'm very impressed in
a doctor.”
(OPDC1I02-028)
Part 3 Result (cont.)
Facilities and Locations
 Toys and playground
• Insufficient number of toys and should be aware of
the safety and cleanliness of toys. As the saying.


“Number of toys is not enough. Sometimes it’s not
clean.”
(OPDD1I04-021)
“I think it is safe for children if we have playroom.”
(OPDF1I07-018)
Part 3 Result (cont.)
Facilities and Locations
 The adequacy of the seats.
• Seats are not sufficient to meet the needs of patients.
As the saying.


“I think it would increase the number of seats. I see some
of whom he later had to take the floor. Some people still
have to stood waiting.”
(OPDC1I02-037)
“I think there are a few seats. If I come fast I can get the
seat but if I come too late I will sit on the floor.”
(OPDG1I09-033)
Part 3 Result (cont.)
Facilities and Locations
 Other facilitate
• There’re not enough about facilities eg. Book ,
drinking water , etc. As the saying


“I think this OPD will add more facilities. I think the
patient is boring.”
(OPDG2I10-029)
“I would like to have a brochure distributed that the
brochure described how to get medical care.”
(OPDH1I11-037)
Part 3 Result (cont.)
Referral system

Publicity in referral system has problem. As the
saying
• “There’re less publicity, so it’s error in referral system eg.
The patient go to see the doctor in the day that not
available.”
(RJI13-019)

Incompleteness of referral document. As the saying
• “This document is not complete. Patients have to pay
themselves unnecessarily.”
(RJI13-024)
Part 3 Result (cont.)
OPD room and equipment
 The adequacy of outpatient room
• The outpatient room is not enough. As the saying.


“Now in one room, there’re 2 doctor to give the health
service that it should be split in 2 room. And the
echocardiogram is in the outpatient room that should be
have the room for echocardiography.” (OPDD1I04-029)
“The outpatient room is not private. It should be only
doctor and patient in that room.”
(OPDF1I07-022)
Part 3 Result (cont.)
OPD room and equipment
 Equipment for physical examination and
treatment is not enough. As the saying.
• “The echocardiogram is deteriorated and outpatient
room don’t have accessories explanations about
heart disease in easy to understand.”
(RII12-023)
Part 3 Result (cont.)
Waiting time
 Approximately 1.5 to 2 hours to wait for
patients to receive treatment. As the saying.
• “The time it takes to wait at least one hour for the
medical examination for almost two hours.”
(OPDE1I05-014)
• “Some of the patients require additional tests, such
as echocardiogram. May cause the other patient to
wait too long.”
(OPDG1I09-027)
Part 3 Result (cont.)
Health service system
 In the morning before office hours. They do not
have the staff or nurses at the OPD. As the
saying.
• “I wanted to update it a little. That the patient is now
waiting since 6 am to 7 am so they could be
someone to help me.”
(OPDF2I08-011)
• “I did not hear the call to service.”(OPDF1I07-020)
• “I think they will have the mobile medical service
unit.”
(OPDE1I05-031)
Questionnaire
Bar graph shows educational status of client
Percent
60
58.3
50
40
30
25
20
8.3
10
0
Primary
ประถมศึ
กษา
school
มัSecondary
ธยมต้น/ปวช.
school
High
มัธยมปลาย/ปวช.
school
8.3
Bachelor
ปริญญาตรี
Degree
Education
Questionnaire
Bar graph shows occupation of client
Percent
35
33.3
30
25
25
20
16.7
15
10
8.3
8.3
8.3
5
Occupation
0
นักStudent
เรียนนักศึกษา
Government
ข้าราชการ
officer
ธุbusiness
รกิจส่วนตัว
รับจ้าง
employee
เกษตรกร
cultivator
House
แม่
บา้ น
keeper
Questionnaire
Bar graph shows income per month of client
Percent
70
66.7
60
50
40
30
20
16.7
8.3
10
8.3
0
บาท
00-5000
- 5000
5000-10000
บาท
5000
- 10000
10000-20000
บาท
10000
- 20000
20000-50000
บาท
20000
- 50000
Income (baht)
Questionnaire results
Information
Amount
Percenta
ge
7. What influenced you to choose NU Hospital’s service? (Can be more than 1 answer)
7.1 Hospital’s fame
3
7.2 Convenience in traveling
2
7.3 Proficient doctors and nurses
7
7.4 Recommendation from friends/ family
3
7.5 Good service
6
7.6 Fully-equipped of medical equipments
5
7.7 Reasonable price
0
7.8 Patient transfer
8. What transportation do you use to reach NU Hospital?
8.1 Private car
8.2 Bus
8.3 Motorcycle
8.4 Taxi
3
7
3
1
1
58.3
25
8.3
8.3
Questionnaire results
Information
Amount
Percentage
Patient’s information
1. Gender
1.1 Male
5
41.7
1.2 Female
7
58.3
2.1 First time
4
33.33
2.2 More than 1 time
8
66.67
0
0
11
91.7
3.3 Government officer’s rights
1
8.3
3.4 Social security rights
0
0
2. Time(s) of service use
3. Health care/ treatment preference of patients
3.1 None
3.2 Gold card
4. How patients come to receive treatment at Children’s Heart Disease clinic, NU Hospital
4.1 non-transferred
3
25
4.2 Transferred
9
75
Questionnaire results
** 5 = Very true, 4 = True, 3 = Moderate , 2 = Partially, 1 = Untrue
Opinion on services
Score**
5
4
3
2
1
2
(16.7)*
2
(16.7)
3
(25)
4
(33.3)
1
(8.3)
1
(8.3)
3
(25)
7
(58.3)
1
(8.3)
0
0
5
(41.7)
6
(50)
1
(8.3)
0
2
(16.7)
2
(16.7)
2
(16.7)
6
(50)
0
5. NU Hospital has sufficient facilities e.g. chairs and kids
corner
1
(8.3)
3
(25)
3
(25)
4
(33.3)
1
(8.3)
6. NU Hospital has proper medical examination rooms (e.g.
privacy)
1
(8.3)
4
(33.3)
5
(41.7)
2
(16.7)
0
2
(16.7)
3
(25)
5
(41.7)
2
(16.7)
0
2
(16.7)
3
(25)
3
(25)
2
(16.7)
2
(16.7)
4
(33.3)
5
(41.7)
1
(8.3)
2
(16.7)
0
2
(16.7)
1
(8.3)
2
(16.7)
5
(41.7)
2
(16.7)
1. Transportation from your place to NU Hospital is
convenient.
2. Patient transference service from other hospitals to NU
Hospital is convenient.
3. NU Hospital has an adequate amount of nurses.
4. Patients have suitable time period of queuing
7. Dispensing system takes a reasonable time
8. During the queuing, patients have no relapses e.g.
bruises, fatigue
9. Registration system is fast and convenient
10. Other services are adequate: coffee corner, drinking
water, copy-making service
*X (Y) refers to amount of people (Percent)
Part 4 discussion and conclusion
• Transportation
•
•
•
Inconvenient bus transportation
Time-taking transportation for patients from other
provinces
Inadequate parking lot
• Health personnel
•
•
•
•
Excellently friendly doctors and nurses
Insufficient amount of medical personnel
Physicians, at times, give no required behavior/practice
to patients
Physicians have an unstable temperament at times
Part 4 discussion and conclusion
• Facilities and location
•
•
•
•
•
Facilities in OPD area, Department of Pediatrics:
Insufficient seats
Insufficient toys
Toys’ safety and cleanness should be considered
There should be more facilities provided
Overall, OPD section of pediatrics is still too small
crowded, and untidy. Development is required.
Part 4 discussion and conclusion
•
Patient transfer system
•
•
Poor coordination with other hospitals, causing
appointment misunderstanding
Incomplete transferring documents causing
customers/patients to miss their preferential health
care/treatment
Part 4 discussion and conclusion
•
Medical examination rooms and medical
equipments
•
•
•
•
•
Insufficient examination rooms
Requires more privacy
Echocardiogram does not work efficiently
Lack of illustrative equipments that help with
patients’ understanding toward sickness/
symptoms/ diseases
Queuing time period
•
Queuing time period takes too long.
Part 4 discussion and conclusion
•
Health service system
•
•
•
•
•
•
•
No standby officers before office hours
Sound when calling patients is too soft.
Slow examination process, and insufficient office
hours
Copy-making service is available
No appointment call reminding. Appointment with
patients are not related to patients’ aptness.
Some hospital’s services are not completely ready
No medical mobile unit
Part 4 discussion and conclusion
•
Questionnaire
•
•
•
•
Questionnaires are given out to patients after the
intensive interviews are made
Most questionnaire results are related to intensive
interviews
Most patients are farmers, have low income, and
receive education in primary level only.
Because 75% of patients are transferred, coordination
with other hospitals are necessary. This includes date
and time of office hours, and all documents.
Part 5 Benefit and outcome
•
Benefits of research
•
•
•
•
Service system awareness, patients’ accession to
pediatric cardiology clinic
Necessary needs of patients and physicians awareness,
on the standard of excellent medical practice.
Important information to develop pediatric cardiology
clinic
A guideline to develop the clinical service
Part 5 Benefit and outcome
•
Problems and limitation in researching
•
•
•
•
There were only 2 days to collect information
The index case should be focused on patients who
miss the appointment
Researcher could not reach one interesting case
while collecting data at echocardiogram clinic
There was no tryout on the questionnaires due to the
limited time.
Recommendation
Health care providers
 Doctor
• explain about disease and how to behave.
• use language that is clear and easy to understand.
Referral system
 Document
• Completeness of referral document
Suggestion

The suggestion about this research
• The interview should be do with patient that have
problem about health service.
• The interview should deep in issue that interview
according to questionnaire.
• The questionnaire should try out for reliability.
• This research should do in other group of patient.
Special Thanks
Yuthapong Buddharaksa, M.D.
(Content expert)
Taweesak Nopkasorn, M.D.
(Methodology expert)
...P’Ann (Miss Sasinipa Tiwalai)
Clinical Research Unit
Thank you
for your attention
Attitude and need of patients with heart
diseases at pediatric out patient department,
Naresuan University Hospital
Tuesday 6th November 2012
Room Ekatosarod 2, 3rd floor, NUH