ประสิทธิภาพและความคุ้มค่าของผู้ปฏิบัติการพยาบาลขั้นสูง ในระบบสุขภาพไทย

บทคัดย่อ

This descriptive study aimed to compare the outcomes of patients receiving care from care team with advanced practice nurse (APN) with those who receiving care from care team without APN. Samples consisted of eleven advanced practice nurses and patients under their care. These groups of patients were patients with different disease as follow; chronic obstructive pulmonary disease, diabetes mellitus, breast cancer, AIDS, carebrovascular accident, critically ill condition, elderly with chronic illness, schizophrenia, children with cancer, pregnant women, clients receiving treatment at two health promoting hospitals with and without community health nurse practitioner (CHNP), and children with cancer and their families. Questionnaires were used to collect quantitative data and observation and interview were used to collect qualitative data. Results revealed that 1. Patients with obstructive pulmonary disease receiving care at community hospital with APN as leader of chronic care team had higher self-care abilities and satisfaction with care, better quality of life than those receiving care at community hospital without APN. 2. Diabetic patients who joined diabetic group organized by APN had lower systolic blood pressure, higher self-care abilities and better quality of life than those who did not join the group. 3. After having APN in breast cancer care team, patients with breast cancer had declined in hospital readmission rate and complications after surgery and chemotherapy and the rate of success in receiving chemotherapy as scheduled had increased each year according to duration of APN experiences. 4. After APN had developed and implemented clinical practice guidelines for Cryptomeningitis in person with AIDS (PWA) with spinal indwelling cord catheter, the rate of infection had declined from 26.10% to 0%. In PWA under care by team with APN had higher self-care abilities in every dimension except exercise and higher satisfaction with care compared with before receiving care from team with APN. 5. After APN implemented case management method and organized continuity of care system, patients with carebrovascular accident had less infection complications. From report by APN’s study, rate of hospital readmission within 28 days, pneumonia, bed sore and urinary tract infection were declined. 6. In surgical critical care unit, after APN developed and implemented clinical practice guideline for respirator weaning, the duration of weaning, duration of respirator assisted used, prevalence of pneumonia, bed sore and duration of critical care hospitalization had reduced. The duration of weaning is less compare to other hospital in the closed area. These results led to reduce cost of care. 7. In elderly with chronic illness, continuity of care from hospital to home provided by APN, professional nurses with experiences and newly graduate nurses were not difference in functional abilities, complications and used of hospital service, but caregiver in APN group had higher satisfaction than those two groups. 8. After APN implemented case management and organized service through various programs in patients with schizophrenia, rate of hospital readmission, duration of hospitalization, and cost of care within 28, 90 and 180 days had reduced significantly. 9. In children with cancer APN was the leader in development of care system to provide holistic and continuity of care which result in decrease length of stay, rehospitalization, increase children’s self-care abilities and quality of life as well as increase families’ confidence in taking care of their children 10. Pregnant women receiving childbirth preparation from APN had fewer complications during pregnancy, fewer drugs for labour induction; shorten stage of labour, less anxiety and pain, more husband participation, higher satisfaction with care and more breasts feeding than those who received usual care. 11. Persons with common/minor health problem were satisfied with services provided by advanced practice nurse/community health nurse practitioner (APN/CHNP) at health promoting hospital than those provided at health promoting hospital without APN/CHNP. The average cost of services by APN/CHNP was 34.40 baht. APN/CHNP organized various program resulted in reduces cost of drug utilization, children had abilities in minor emergency care, reduce unsafe sex and reduced enter to gambling. Qualitative data from physicians, nurse administrative, professional nurses, other health care providers, patients and caregivers revealed that APNs were accepted as a very useful health care provider in the complex health care system.

คำสำคัญ