attitude and need of patients with heart diseases at pediatric out patient department, naresuan...

Attitude and need of patients with Attitude and need of patients with heart diseases at pediatric out heart diseases at pediatric out patient department, Naresuan patient department, Naresuan

University HospitalUniversity Hospital

Research Research PresentationPresentation

Tuesday 6th November 2012Room Ekatosarod 2, 3rd floor, NUH

55thth year Medical students year Medical studentsNaresuan University HospitralNaresuan University HospitralFaculty of Medicine, Naresuan Faculty of Medicine, Naresuan

UniversityUniversity

ResearcherResearcher Mr.PanapolMr.Panapol VarakornpipatVarakornpipat

StudentStudent IDID 51460 51460919919 Mr.PaisitMr.Paisit KosumKosum Student ID Student ID 5146051460994040

Mr.RapeepatMr.Rapeepat Auekitrungrueng Student Auekitrungrueng Student IDID 51460 51460988988

““55thth year medical students year medical students””

ConsultantConsultant Dr.Yuthapong Dr.Yuthapong BuddharaksaBuddharaksa ((Content ExpertContent Expert)) Dr.TaweesakDr.Taweesak NopkasornNopkasorn

((Methodology ExpertMethodology Expert))

Research questionsResearch questions Primary research questionPrimary research question

• What are the attitude and need for health What are the attitude and need for health service system of client at pediatric service system of client at pediatric cardiology clinic, Naresuan University cardiology clinic, Naresuan University Hospital (NUH)?Hospital (NUH)?

Secondary research questionsSecondary research questions• How do they manage heath service system How do they manage heath service system

at pediatric cardiology clinic, NUH?at pediatric cardiology clinic, NUH?• How can we improve health service How can we improve health service

system at pediatric cardiology clinic, system at pediatric cardiology clinic, NUH?NUH?

BackgroundBackground We found problem about health service system We found problem about health service system

Waiting time for doctorWaiting time for doctor Ineffective medical communicationIneffective medical communication Uncorrected date that specialist’s serviceUncorrected date that specialist’s service

In 2008In 2008 , , client at OPD PED average 723/month client at OPD PED average 723/month (35.10/day)(35.10/day)



According to the statistics, There are increase According to the statistics, There are increase clients each year despite of increase doctorclients each year despite of increase doctor

Part 1 IntroductionPart 1 Introduction

BackgroundBackground (Cont.)(Cont.) Want knew attitude and need of clientWant knew attitude and need of client Despite of limitation of time, we did pilot Despite of limitation of time, we did pilot

study at pediatric cardiology clinic study at pediatric cardiology clinic becausebecause Patients with heart diseases isPatients with heart diseases is mostly total of mostly total of

patientspatients They have many high risk for life-threatening They have many high risk for life-threatening

medical emergencies such asmedical emergencies such as cc hest pain and hear hest pain and hear t attack, t attack, ss hock, hock, ss udden cardiac arrest udden cardiac arrest etc. (ifetc. (if there there

are notare not help quicklyhelp quickly))

Thereby, They are the way to effectively Thereby, They are the way to effectively improve health service systemimprove health service system

(American Heart Association: 113 1 2004PEDIATRICS Vol. No. January )

Part 1 Introduction Part 1 Introduction (Cont.)(Cont.)

Table shows patients at Table shows patients at pediatric clinic, Naresuan pediatric clinic, Naresuan

University HospitalUniversity Hospital TimeTime

NumberNumber

200200

99

201201

00

201201

11

Aug Aug 20112011

Total Total patientspatients

in a in a monthmonth

848848 969969103103

55

107107

99

Total Total patientspatientsin a dayin a day

425425

55

472.472.11

518.518.55

567.567.99

Patient Patient : Doctor : Doctor

in a dayin a day

106.106.44

118.118.00

129.129.66

142.142.00

Max Max Time of Time of patient patient

gain gain service / service /

dayday

31 31 minmin 27 27 minmin 25 25 minmin 23 23 minmin

Reference : Pediatric Out patient department, Naresuan University Hospital

5 Most common diseases, distinguish by department in 2010

Bar chart shows patients in special pediatric Bar chart shows patients in special pediatric clinic at Naresuan University Hospitalclinic at Naresuan University Hospital

TimeTime

NumberNumberJanJan FebFeb MarMar AprApr MayMay JuneJune JulyJuly AugAug

Total Total patientspatients

in a in a monthmonth

159159 162162 136136 174174 157157 165165 130130 209209

Total Total patientspatientsin a dayin a day 17.617.6 20.220.2

5515.115.1

22

1.1.77

55

17.417.411

8.8.33

11

6.6.22

55

23.23.2222

Patient Patient : Doctor : Doctor

in a dayin a day

8.8.88

10.110.12525 7.557.55

11

0.0.88

77

55

8.728.729.9.11

66

8.8.11

22

55

11

1.1.66

11

Max Max Time of Time of patient patient

gain gain service / service /

dayday

22

0 0minmin

18 18 minmin

22

4 4minmin

11

7 7minmin

22

1 1minmin

22

0 0minmin

22

2 2minmin

11

6 6minmin

Table shows patients at pediatric Table shows patients at pediatric cardiology clinic, Naresuan cardiology clinic, Naresuan

University HospitalUniversity Hospital

Reference : Pediatric Out patient department, Naresuan University Hospital

ObjectivesObjectives To explain health service system, limitation, To explain health service system, limitation,

and problemand problem about approach health service about approach health service system of client at pediatric cardiology clinic system of client at pediatric cardiology clinic Naresuan University hospitalNaresuan University hospital

ToTo study attitudestudy attitude , , impression, and need of impression, and need of client at pediatric cardiology clinic Naresuan client at pediatric cardiology clinic Naresuan University hospitalUniversity hospital

BoundaryBoundary Population : Client at pediatric cardiology Population : Client at pediatric cardiology

clinic Naresuan University hospital clinic Naresuan University hospital Time : 5Time : 5thth September September – – 22ndnd October 2011 October 2011


Expected AdvantagesExpected Advantages To know problems of health service To know problems of health service system and approach to health service system and approach to health service system of client at pediatric cardiology system of client at pediatric cardiology

clinic, NUHclinic, NUH To know need of client and provider on To know need of client and provider on

standard medical servicestandard medical service To get information for effective To get information for effective improvement health service systemimprovement health service system

Way for improvement clinical service in Way for improvement clinical service in the other departmentsthe other departments


Research questionResearch question What are the attitude and need for health What are the attitude and need for health

service system of client at pediatric cardiology service system of client at pediatric cardiology clinic, Naresuan University Hospital ?clinic, Naresuan University Hospital ?

PopulationPopulation Pediatric patients and theirPediatric patients and their parents at parents at

pediatric cardiology clinic NUH (5pediatric cardiology clinic NUH (5thth September – 2September – 2ndnd October 2011) : Inclusion October 2011) : Inclusion criteria --> history of treatment at least 1 timecriteria --> history of treatment at least 1 time

Heath care Provider at pediatric cardiology Heath care Provider at pediatric cardiology clinic (work experience at least 1 year)clinic (work experience at least 1 year)

Part 2 MethodPart 2 Method

SampleSample Six pediatric patients and theirSix pediatric patients and their parents at parents at

pediatric cardiology clinic NUH (5pediatric cardiology clinic NUH (5thth September – 2September – 2ndnd October 2011) : Inclusion October 2011) : Inclusion criteria --> history of treatment at least 1 criteria --> history of treatment at least 1 timetime

Two doctors and two nurses at pediatric Two doctors and two nurses at pediatric cardiology clinic (work experience at least 1 cardiology clinic (work experience at least 1 year) year)

PlacePlace Pediatric cardiology clinicPediatric cardiology clinic , , NUHNUH EchocardiograhyEchocardiograhy Room, NUHRoom, NUH

Part 2 Method (Cont.)Part 2 Method (Cont.)

Source of dataSource of data Interviewing client and observationInterviewing client and observation OPD CardOPD Card Statistics of pediatric out patient Statistics of pediatric out patient

department NUHdepartment NUH Study designStudy design

Qualitative studyQualitative study ObservationObservation In depth interviewIn depth interview

Survey studySurvey study QuestionnaireQuestionnaire


MethodMethod

1. Qualitative study1. Qualitative study ObservationObservation

Observe client at pediatric cardiology clinic, Observe client at pediatric cardiology clinic, NUHNUH

Observe client at echocardiologygram room, Observe client at echocardiologygram room, NUHNUH

Observe heath care provider (non participant Observe heath care provider (non participant observation)observation)

In depth interviewIn depth interview In depth interview individuallyIn depth interview individually Record by voice recorder Record by voice recorder ((if interviewee permitif interviewee permit)) Two interviewers : interviewer and recorderTwo interviewers : interviewer and recorder


MethodMethod

2. Survey study2. Survey studyQuestionnaireQuestionnaire

After in depth interview, collect and analyze After in depth interview, collect and analyze the datathe data

Design questionnaireDesign questionnaire IncreaseIncrease validityvalidity Analyze the data from questionnaire (result Analyze the data from questionnaire (result

accord with in depth interview?)accord with in depth interview?) If data opposeIf data oppose to into in depth interview : further depth interview : further

interview in interesting issueinterview in interesting issue


TriangulationTriangulation Ask from all the parents (In case of Ask from all the parents (In case of

client more than two people) client more than two people) such as such as father, mother, uncle, and patientfather, mother, uncle, and patient

Two interviewers : interviewer and Two interviewers : interviewer and recorderrecorder

Some informationSome information such assuch as waiting time waiting time could verify with time with staff could verify with time with staff recorded in OPD cardrecorded in OPD card

In depth interview with observationIn depth interview with observation Increase credibility of researchIncrease credibility of research


Part 2 Method (Cont.)Part 2 Method (Cont.) Analysis and StatisticsAnalysis and Statistics

Observation and In depth interviewObservation and In depth interview Principle of qualitative researchPrinciple of qualitative research Not focus statistics for analysisNot focus statistics for analysis Focus on searching important issueFocus on searching important issue that that

show overview of need of patientsshow overview of need of patientsQuestionnaireQuestionnaire

Use descriptive statisticsUse descriptive statistics Present overview and recommendationPresent overview and recommendation If information accord with IDI : support, but If information accord with IDI : support, but

information opposite with IDI : further information opposite with IDI : further interview in interesting issueinterview in interesting issue

Part 3 ResultPart 3 Result Theme of researchTheme of research

• Transportation to hospital.Transportation to hospital.• Health care providers.Health care providers.• Locations and facilities.Locations and facilities.• Referral system.Referral system.• Outpatients room and equipment used Outpatients room and equipment used

in the treatment.in the treatment.• Waiting time.Waiting time.• Health service system.Health service system.

Part 3 Result (cont.)Part 3 Result (cont.)

Transportation to hospitalTransportation to hospital Facility of transportationFacility of transportation

• Patient has difficulty in traveling. Patient has difficulty in traveling. Especially in the afternoon. As the saying.Especially in the afternoon. As the saying.

““If we come to hospital too late , we will wait If we come to hospital too late , we will wait for the examination and treatment in the for the examination and treatment in the afternoon ,then the bus back home was less.”afternoon ,then the bus back home was less.”

(OPDC1I02-026)(OPDC1I02-026) ““Bus is unpredictable. Sometimes I have to Bus is unpredictable. Sometimes I have to

wait several hours to get a bus.” wait several hours to get a bus.” (OPDC2I03-026) (OPDC2I03-026)


Transportation to hospitalTransportation to hospital The duration of travelThe duration of travel

• Patients take a long time to come to the Patients take a long time to come to the hospital. As the sayinghospital. As the saying

““I spent four hours on the road. I must wake I spent four hours on the road. I must wake at 3:00 am then I’m here at 7.30 am.” at 3:00 am then I’m here at 7.30 am.”

(OPDE1I05-010)(OPDE1I05-010) ““I spent 1 hour and a half for the travel , it’s I spent 1 hour and a half for the travel , it’s

too long.”too long.” (OPDF1I07-006)(OPDF1I07-006)


Transportation to hospitalTransportation to hospital ParkingParking

• Parking is not enough to meet demand. Parking is not enough to meet demand. As the sayingAs the saying

““Parking is minimal. Very difficult time Parking is minimal. Very difficult time finding parking. Have to park far away from finding parking. Have to park far away from the hospital.”the hospital.”

(OPDG2I10-007) (OPDG2I10-007)


Health care providersHealth care providers Adequacy of care providers (nurse).Adequacy of care providers (nurse).

• Insufficient number of nurses per serving. The Insufficient number of nurses per serving. The hospital has a large workload. As the saying.hospital has a large workload. As the saying.

““If there is a specific point that there are more and If there is a specific point that there are more and more people would be better. It's from 3 to 5 more people would be better. It's from 3 to 5 people, it may be time for service may be faster.”people, it may be time for service may be faster.”

(OPDF1I07-014) (OPDF1I07-014) ““I would like to have more nurses. If you increase I would like to have more nurses. If you increase

the number of nurses, the work would faster. the number of nurses, the work would faster. Patients will not wait too long.”Patients will not wait too long.” (OPDG2I10-024)(OPDG2I10-024)


Health care providersHealth care providers Adequacy of care providers (doctor).Adequacy of care providers (doctor).

• If the number of doctors is increase. it’s If the number of doctors is increase. it’s may be made available more quickly. As may be made available more quickly. As the saying.the saying.

““I would like to have more doctors because I would like to have more doctors because the number of patient is more than doctor.”the number of patient is more than doctor.”

(OPDB1I01-065) (OPDB1I01-065) ““If the number of doctors is increase I think If the number of doctors is increase I think

the service is more faster.”the service is more faster.” (OPDE2I06-016) (OPDE2I06-016)


Health care providersHealth care providers The attention and friendliness of The attention and friendliness of

doctor.doctor.• Patients appreciate the services of a Patients appreciate the services of a

physician.physician. As the sayingAs the saying ““Doctor helps me understand the disease. Doctor helps me understand the disease.

Sometimes drawing to help with Sometimes drawing to help with understanding. I'm very impressed in a understanding. I'm very impressed in a doctor.”doctor.” (OPDC1I02-028)(OPDC1I02-028)


Facilities and LocationsFacilities and Locations Toys and playgroundToys and playground

• Insufficient number of toys and should be Insufficient number of toys and should be aware of the safety and cleanliness of aware of the safety and cleanliness of toys. As the saying.toys. As the saying.

““Number of toys is not enough. Sometimes Number of toys is not enough. Sometimes it’s not clean.”it’s not clean.” (OPDD1I04-021)(OPDD1I04-021)

““I think it is safe for children if we have I think it is safe for children if we have playroom.”playroom.” (OPDF1I07-018)(OPDF1I07-018)


Facilities and Locations Facilities and Locations The adequacy of the seats.The adequacy of the seats.

• Seats are not sufficient to meet the needs of Seats are not sufficient to meet the needs of patients. As the saying.patients. As the saying.

““I think it would increase the number of seats. I I think it would increase the number of seats. I see some of whom he later had to take the floor. see some of whom he later had to take the floor. Some people still have to stood waiting.”Some people still have to stood waiting.” (OPDC1I02-037)(OPDC1I02-037)

““I think there are a few seats. If I come fast I can 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 get the seat but if I come too late I will sit on the floor.”floor.” (OPDG1I09-033)(OPDG1I09-033)


Facilities and LocationsFacilities and Locations Other facilitateOther facilitate

• There’re not enough about facilities eg. There’re not enough about facilities eg. Book , drinking water , etc. As the sayingBook , drinking water , etc. As the saying

““I think this OPD will add more facilities. I I think this OPD will add more facilities. I think the patient is boring.”think the patient is boring.” (OPDG2I10-029)(OPDG2I10-029)

““I would like to have a brochure distributed I would like to have a brochure distributed that the brochure described how to get that the brochure described how to get medical care.”medical care.”

(OPDH1I11-037) (OPDH1I11-037)

Part 3 Result (cont.)Part 3 Result (cont.)Referral systemReferral system Publicity in referral system has problem. As the Publicity in referral system has problem. As the

sayingsaying• ““There’re less publicity, so it’s error in referral There’re less publicity, so it’s error in referral

system eg. The patient go to see the doctor in the system eg. The patient go to see the doctor in the day that not available.”day that not available.” (RJI13-019)(RJI13-019)

Incompleteness of referral document. As the Incompleteness of referral document. As the sayingsaying• ““This document is not complete. Patients have to This document is not complete. Patients have to

pay themselves unnecessarilypay themselves unnecessarily..”” (RJI13- (RJI13-024)024)


OPD room and equipment OPD room and equipment The adequacy of outpatient roomThe adequacy of outpatient room

• The outpatient room is not enough. As the The outpatient room is not enough. As the saying.saying.

““Now in one room, there’re 2 doctor to give the Now in one room, there’re 2 doctor to give the health service that it should be split in 2 room. health service that it should be split in 2 room. And the echocardiogram is in the outpatient room And the echocardiogram is in the outpatient room that should be have the room for that should be have the room for echocardiography.” echocardiography.” (OPDD1I04-029)(OPDD1I04-029)

““The outpatient room is not private. It should be The outpatient room is not private. It should be only doctor and patient in that room.”only doctor and patient in that room.” (OPDF1I07-022)(OPDF1I07-022)


OPD room and equipmentOPD room and equipment Equipment for physical examination Equipment for physical examination

and treatment is not enough. As the and treatment is not enough. As the saying.saying.• ““The echocardiogram is deteriorated The echocardiogram is deteriorated

and outpatient room don’t have and outpatient room don’t have accessories explanations about heart accessories explanations about heart disease in easy to understand.”disease in easy to understand.”(RII12-023)(RII12-023)


Waiting timeWaiting time Approximately 1.5 to 2 hours to wait for Approximately 1.5 to 2 hours to wait for

patients to receive treatment. As the saying.patients to receive treatment. As the saying.• ““The time it takes to wait at least one hour for The time it takes to wait at least one hour for

the medical examination for almost two hours.”the medical examination for almost two hours.”(OPDE1I05-(OPDE1I05-

014)014)• ““Some of the patients require additional tests, Some of the patients require additional tests,

such as echocardiogram. May cause the other such as echocardiogram. May cause the other patient to wait too long.”patient to wait too long.” (OPDG1I09-(OPDG1I09-027)027)

Part 3 Result (cont.)Part 3 Result (cont.)Health service systemHealth service system In the morning before office hours. They do In the morning before office hours. They do

not have the staff or nurses at the OPD. As not have the staff or nurses at the OPD. As the saying.the saying.• ““I wanted to update it a little. That the patient I wanted to update it a little. That the patient

is now waiting since 6 am to 7 am so they could is now waiting since 6 am to 7 am so they could be someone to help me.”be someone to help me.” (OPDF2I08-011)(OPDF2I08-011)

• ““I did not hear the call to service.”I did not hear the call to service.”(OPDF1I07-(OPDF1I07-020)020)

• ““I think they will have the mobile medical I think they will have the mobile medical service unit.”service unit.” (OPDE1I05-(OPDE1I05-031)031)

QuestionnaireQuestionnaireBar graph shows educational Bar graph shows educational

status of clientstatus of client58.3

25

8.3 8.3

0

10

20

30

40

50

60

ประถมศึ�กษา ม�ธยมต้�น/ปวช. ม�ธยมปลาย/ปวช. ปร�ญญาต้ร�

Percent

Education

Primary school

Secondary

school

Highschool

BachelorDegree

16.7

8.3 8.3 8.3

33.3

25

0

5

10

15

20

25

30

35

น�กเร�ยนน�กศึ�กษา ข้�าราชการ ธ�รก�จส่�วนต้�ว ร�บจ�าง เกษต้รกร แม�บ�าน

QuestionnaireQuestionnaireBar graph shows occupation of Bar graph shows occupation of

clientclientPercent

Occupation

Student Government officer

business employee cultivatorHousekeeper

66.7

16.7

8.3 8.3

0

10

20

30

40

50

60

70

0-5000 บาท 5000-10000 บาท 10000-20000 บาท 20000-50000 บาท

QuestionnaireQuestionnaireBar graph shows income per Bar graph shows income per

month of clientmonth of clientPercent

Income (baht)0 - 5000 5000 - 10000 10000 - 20000 20000 - 50000

InformationAmount Percenta

ge

7. What influenced you to choose NU Hospital’s service? (Can be more than 1 answer)

71 Hospital’s fame 3

72 Convenience in traveling 2

73. Proficient doctors and nurses 7

74 Recommendation from friends/ family 3

75 Good service 6

76. Fully-equipped of medical equipments 5

77. Reasonable price 0

78 Patient transfer 3

8. What transportation do you use to reach NU Hospital? 81. Private car 7 583. 82. Bus 3 25

83. Motorcycle 1 83. 84. Taxi 1 83.

Questionnaire resultsQuestionnaire results

Information AmountPercentage

Patient’s information

1. Gender

11. Male 5 417.

12. Female 7 583.

2. Time(s) of service use

21. First time 4 3333.

22. More than 1 time 8 6667.

3. Health care/ treatment preference of patients

31. None 0 0

32. Gold card 11 917.

33. Government officer’s rights 1 83.

34. Social security rights 0 0

4. How patients come to receive treatment at Children’s Heart Disease clinic, NU Hospital

41. non-transferred 3 25

42. Transferred 9 75


Opinion on servicesScore**

5 4 3 2 1

1. Transportation from your place to NU Hospital is convenient.

216( .7 *)

216( .7)

3

(2 5 )

433( .3)

1

83( .)

2. Patient transference service from other hospitals to NU Hospital is convenient.

183( . )

325( )

7

58( .3)

183( . )

0

3. NU Hospital has an adequate amount of nurses. 0

5(4 1 .7)

6

50( )1

83( . )0

4. Patients have suitable time period of queuing2

16( .7)

216( .7)

2

16( .7)

650( )

0

5. NU Hospital has sufficient facilities e.g. chairs and kids corner

183( . )

325( )

3

(2 5 )

433( .3)

1

83( .)

6. NU Hospital has proper medical examination rooms (e.g. privacy)

183( . )

433( .3)

5

41( .7)

216( .7)

0

7. Dispensing system takes a reasonable time2

16( .7)

325( )

5

41( .7)

216( .7)

0

8. During the queuing, patients have no relapses e.g. bruises, fatigue

216( .7)

325( )

3

(2 5 )

216( .7)

2

16( .7)

9. Registration system is fast and convenient4

33( .3)

5(4 1 .7)

1

83( . )

216( .7)

0

10. Other services are adequate: coffee corner, drinking water, copy-making service

216( .7)

183( . )

2

16( .7)

5(4 1 .7)

2

16( .7)

*X (Y) refers to amount of people (Percent)

** 5 = Very true, 4 = True, 3 = Moderate , 2 = Partially, 1 = Untrue


Part 4 discussion and Part 4 discussion and conclusionconclusion

• TransportationTransportation• Inconvenient bus transportationInconvenient bus transportation• Time-taking transportation for patients Time-taking transportation for patients

from other provincesfrom other provinces• Inadequate parking lotInadequate parking lot

• Health personnelHealth personnel• Excellently friendly doctors and nursesExcellently friendly doctors and nurses• Insufficient amount of medical personnelInsufficient amount of medical personnel• Physicians, at times, give no required Physicians, at times, give no required

behavior/practice to patientsbehavior/practice to patients• Physicians have an unstable Physicians have an unstable

temperament at timestemperament at times

• Facilities and locationFacilities and location• Facilities in OPD area, Department of Facilities in OPD area, Department of

Pediatrics: Insufficient seatsPediatrics: Insufficient seats• Insufficient toysInsufficient toys• Toys’ safety and cleanness should be Toys’ safety and cleanness should be

consideredconsidered• There should be more facilities There should be more facilities

providedprovided• Overall, OPD section of pediatrics is Overall, OPD section of pediatrics is

still too small crowded, and untidy. still too small crowded, and untidy. Development is required.Development is required.


• Patient transfer systemPatient transfer system• Poor coordination with other hospitals, Poor coordination with other hospitals,

causing appointment misunderstandingcausing appointment misunderstanding• Incomplete transferring documents Incomplete transferring documents

causing customers/patients to miss causing customers/patients to miss their preferential health care/treatment their preferential health care/treatment


• Medical examination rooms and Medical examination rooms and medical equipmentsmedical equipments• Insufficient examination roomsInsufficient examination rooms• Requires more privacyRequires more privacy• EchocardiogramEchocardiogram does not work does not work

efficientlyefficiently• Lack of illustrative equipments that Lack of illustrative equipments that

help with patients’ understanding help with patients’ understanding toward sickness/ symptoms/ diseasestoward sickness/ symptoms/ diseases• Queuing time periodQueuing time period

• Queuing time period takes too long. Queuing time period takes too long.


• Health service systemHealth service system• No standby officers before office hoursNo standby officers before office hours• Sound when calling patients is too soft. Sound when calling patients is too soft. • Slow examination process, and Slow examination process, and

insufficient office hoursinsufficient office hours• Copy-making service is availableCopy-making service is available• No appointment call reminding. No appointment call reminding.

Appointment with patients are not Appointment with patients are not related to patients’ aptness.related to patients’ aptness.

• Some hospital’s services are not Some hospital’s services are not completely readycompletely ready

• No medical mobile unitNo medical mobile unit


• QuestionnaireQuestionnaire• Questionnaires are given out to patients Questionnaires are given out to patients

after the intensive interviews are madeafter the intensive interviews are made• Most questionnaire results are related to Most questionnaire results are related to

intensive interviewsintensive interviews• Most patients are farmers, have low Most patients are farmers, have low

income, and receive education in income, and receive education in primary level only. primary level only.

• Because 75% of patients are transferred, Because 75% of patients are transferred, coordination with other hospitals are coordination with other hospitals are necessary. This includes date and time necessary. This includes date and time of office hours, and all documents. of office hours, and all documents.


• Benefits of researchBenefits of research• Service system awareness, patients’ Service system awareness, patients’

accession to pediatric cardiology clinicaccession to pediatric cardiology clinic• Necessary needs of patients and Necessary needs of patients and

physicians awareness, on the standard of physicians awareness, on the standard of excellent medical practice. excellent medical practice.

• Important information to develop Important information to develop pediatric cardiology clinicpediatric cardiology clinic

• A guideline to develop the A guideline to develop the clinical servic clinical servicee

Part 5 Benefit and Part 5 Benefit and outcomeoutcome

• Problems and limitation in Problems and limitation in researchingresearching• There were only 2 days to collect There were only 2 days to collect

informationinformation• The index case should be focused on The index case should be focused on

patients who miss the appointmentpatients who miss the appointment• Researcher could not reach one Researcher could not reach one

interesting case while collecting data at interesting case while collecting data at echocardiogram clinicechocardiogram clinic

• There was no tryout on the There was no tryout on the questionnaires due to the limited time.questionnaires due to the limited time.

Part 5 Benefit and Part 5 Benefit and outcomeoutcome

Recommendation Recommendation

Health care providersHealth care providers Doctor Doctor

• explain about disease and how to behave.explain about disease and how to behave.• use language that is clear and easy to use language that is clear and easy to

understand.understand.

Referral systemReferral system Document Document

• Completeness of referral documentCompleteness of referral document

SuggestionSuggestion The suggestion about this researchThe suggestion about this research

• The interview should be do with patient The interview should be do with patient that have problem about health service.that have problem about health service.

• The interview should deep in issue that The interview should deep in issue that interview according to questionnaire.interview according to questionnaire.

• The questionnaire should try out for The questionnaire should try out for reliability.reliability.

• This research should do in other group This research should do in other group of patient.of patient.

Yuthapong Buddharaksa, M.D.Yuthapong Buddharaksa, M.D.

((Content expertContent expert))

Taweesak Nopkasorn, Taweesak Nopkasorn, M.D.M.D.

((Methodology expertMethodology expert))

Special ThanksSpecial Thanks

......P’Ann (Miss P’Ann (Miss Sasinipa Tiwalai)Sasinipa Tiwalai)Clinical Research Clinical Research

UnitUnit

Thank youThank youfor your for your attentionattention

Attitude and need of patients with Attitude and need of patients with heart diseases at pediatric out heart diseases at pediatric out patient department, Naresuan patient department, Naresuan

University HospitalUniversity HospitalTuesday 6th November 2012

Room Ekatosarod 2, 3rd floor, NUH

attitude and need of patients with heart diseases at pediatric out patient department, naresuan...

Documents

special pediatric clinic

patient department

heath service system

heart diseases

opd ped average

heart attack

paisit kosum student

common diseases