Search

Introduction: Chronic kidney disease (CKD) is a major health problem in Thailand and health behaviors are central to its risk and progression. Because of the shortage of healthcare personnel, village health volunteers (VHVs) have been collaborating in the primary health care system. However, the contribution of VHVs to CKD reduction has not been evaluated yet. This study aimed to evaluate the efficacy of the VHV-integrated model in preventing and slowing down CKD and its risk factors. Methods: The population-based cohort study was conducted in a rural community of Thailand between 2017 and 2019. Baseline clinical and behavioral characteristics including CKD, diabetes, hypertension, and other high-risk factors of the participants were collected. The integrated care model was initiated by the multidisciplinary care team that facilitated, empowered, and trained VHVs targeting risk factors of CKD, health literacy, and health promotion. Then the participants were educated and trained for lifestyle modification and were monitored continuously for 18 months by VHVs. Changes in the CKD risk factors, and kidney functions before and after the application of integrated care model were compared. Results: A total of 831 subjects participated in the study with an average age of 57.5 years, and 69.5% were female. Among them, 222 participants (26.7%) were diagnosed as having CKD, the vast majority (95%) of which were in the early stages (G1-G3 and A1-A2). CKD risk factors such as high salt intake, smoking, alcohol consumption, self-NSAID (non-steroidal anti-inflammatory drugs) use were significantly decreased after application of the care model. Also, hemoglobin A 1c was significantly reduced in diabetic patients, and blood pressure was controlled better than before in the hypertensive patients. Most importantly, a decline of estimated glomerular filtration rate of the CKD group was improved and lower than the non-CKD group. Conclusion: The integrated care model through VHV significantly attenuated the risk factors associated with CKD in the general and high-risk population and effectively slowed down the progression of CKD.

Background: Telepharmacy shows an effective option to provide pharmacy services in several settings. It could improve patients’ outcomes and save costs. However, the impact of a telepharmacy services in low resource settings remains limited. Objectives: This study assessed the feasibility and effect of telepharmacy services on patient-reported clinical and economic outcomes among patients with epilepsy in Thailand. Methods: A prospective descriptive study was conducted at a university hospital. Patients with epilepsy visiting the clinic from February 2021–December 2021 were included. Telepharmacy services were provided by hospital pharmacists through an application platform. Patients met a pharmacist synchronously using a video conference feature embedded in our developed website. Patients were interviewed for improved clinical symptoms, drug-related problems (DRPs), and health and social behaviors. Travel costs, food and accommodation costs and productivity costs due to hospital visits were also evaluated. Results: A total of 80 patients were included. Of those, 39 patients (48.75%) were men, averaging 35.44 ± 15.09 years old. A total of 22 patients (27.50%) reported better clinical symptoms after the telepharmacy service. Sixty-four DRPs (69.56%) were observed, along with 28 health and social behavior problems (30.44%). The most common DRPs were adverse drug reactions (20/64; 69.56%), followed by patients' non-adherence (20/64; 31.25%). Sixty-six problems (68.04%) were corrected during the telepharmacy service. From the patient's perspective, the average direct nonmedical cost per visit was 1257 ± 857 THB/visit. Travel costs were the major cost driver, accounting for 67.7% of the total cost. Cost savings averaged 6511 ± 4996 THB/year or 54.75% of usual care. Conclusion: Telepharmacy services are likely to improve patient outcomes, detect DRPs, and effectively provide cost-savings. However, further studies hosting a larger number of participants are warranted to assess the impacts of telepharmacy services.

The objective of this study was to develop, implement, and evaluate a collaborative smoking cessation program (CSCP) involving community pharmacists and village health volunteers (VHVs) in a rural community. Our strategy included establishment, implementation, and reflection. The CSCP was established through group discussions among community pharmacists, VHVs, and a local officer. VHVs identified smokers and provided basic counselling, while community pharmacists provided smokers specific and intensive counselling. We also assessed clinical outcomes, such as peak expiratory flow rate (PEFR), exhaled partial carbon monoxide (PCO), and continuous abstinence rate (CAR). Finally, interviews from the reflection phase were conducted to investigate attitudes towards participating in the CSCP and unsuccessful quitting. CSCP was completed by 101 out of 108 initial participants. All were men, with an average age of 55.2±10.75 years. After six months, the CSCP resulted in a significant decrease in the mean PCO (P=0.010). Moreover, 23 smokers successfully quit smoking, yielding a sixmonth CAR of 22.8% and stated that the CSCP enforced their perseverance. However, 78 volunteers (72.2%) could not quit smoking owing to withdrawal symptoms and influence from their immediate environment. CSCP is a novel smoking cessation model, which should be promoted to enforce smoking cessation in the community. However, significant efforts and coordination of relevant stakeholders are required. [ABSTRACT FROM AUTHOR]