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Research Presentation

Research Presentation. Attitude and need of patients with heart diseases at pediatric out patient department, Naresuan University Hospital. 5 th year Medical students Naresuan University Hospitral Faculty of Medicine, Naresuan University.

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Research Presentation

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  1. 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 2012Room Ekatosarod 2, 3rd floor, NUH

  2. Researcher • Mr.PanapolVarakornpipat StudentID 51460919 • Mr.PaisitKosum Student ID 51460940 • Mr.RapeepatAuekitrungrueng Student ID 51460988 “5th year medical students” Consultant • Dr.YuthapongBuddharaksa (Content Expert) • Dr.TaweesakNopkasorn (Methodology Expert)

  3. 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?

  4. 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

  5. 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 ismostly total of patients • They have many high risk for life-threatening medical emergencies such aschestpainandheartattack, shock, suddencardiacarrestetc. (ifthere are nothelp quickly) • Thereby, They are the way to effectively improve health service system (American Heart Association: PEDIATRICS Vol. 113 No. 1 January 2004)

  6. Table shows patients at pediatric clinic, Naresuan University Hospital Reference : Pediatric Out patient department, Naresuan University Hospital

  7. 5 Most common diseases, distinguish by department in 2010

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

  9. Table shows patients at pediatric cardiology clinic, Naresuan University Hospital Reference : Pediatric Out patient department, Naresuan University Hospital

  10. Part 1 Introduction (Cont.) • Objectives • To explain health service system, limitation, and problemabout approach health service system of client at pediatric cardiology clinic Naresuan University hospital • Tostudy 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

  11. 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

  12. 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 theirparents 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)

  13. Part 2 Method (Cont.) • Sample • Six pediatric patients and theirparents 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 • EchocardiograhyRoom, NUH

  14. 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

  15. 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

  16. Part 2 Method (Cont.) • Method 2. Survey study • Questionnaire • After in depth interview, collect and analyze the data • Design questionnaire • Increasevalidity • Analyze the data from questionnaire (result accord with in depth interview?) • If data opposeto indepth interview : further interview in interesting issue

  17. 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 informationsuch aswaiting time could verify with time with staff recorded in OPD card • In depth interview with observation • Increase credibility of research

  18. 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 issuethat 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

  19. 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.

  20. 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)

  21. 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)

  22. 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)

  23. 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)

  24. 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)

  25. 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)

  26. 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)

  27. 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)

  28. 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)

  29. 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)

  30. 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)

  31. 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)

  32. 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)

  33. 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)

  34. QuestionnaireBar graph shows educational status of client Percent Education Bachelor Degree Primary school Secondary school Highschool

  35. QuestionnaireBar graph shows occupation of client Percent Occupation House keeper Government officer Student business employee cultivator

  36. QuestionnaireBar graph shows income per month of client Percent Income (baht) 0 - 5000 5000 - 10000 10000 - 20000 20000 - 50000

  37. Questionnaire results

  38. Questionnaire results

  39. Questionnaire results ** 5 = Very true, 4 = True, 3 = Moderate , 2 = Partially, 1 = Untrue *X (Y) refers to amount of people (Percent)

  40. 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

  41. 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

  42. 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

  43. 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 Part 4 discussion and conclusion • Queuing time period • Queuing time period takes too long.

  44. 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

  45. 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 4 discussion and conclusion

  46. 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 clinicalservice Part 5 Benefit and outcome

  47. 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. Part 5 Benefit and outcome

  48. 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

  49. 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.

  50. YuthapongBuddharaksa, M.D. (Content expert) TaweesakNopkasorn, M.D. (Methodology expert) Special Thanks ...P’Ann (Miss SasinipaTiwalai)Clinical Research Unit

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