Development and Effectiveness Evaluation of a Community-Integrated Telemedicine Care Model for Patients with Noncommunicable Diseases through the Khlong Khuean District Health Board, Chachoengsao Province, Thailand

Abstract

Khlong Khuean District has a substantial of elderly people with noncommunicable diseases (NCDs), Going to the hospital for services creates a burden in terms of time, travel costs, and expenses for patients and their families. This mixed-methods research aimed to develop and assess the effectiveness of an integrated community-telemedicine care model that connecting Khlong Khuean hospital, subdistrict health promoting hospitals, village health volunteers, local administrative organizations, and the district-level quality of life development committee. The model was developed through three stakeholder meetings to design, review, refine, and finalize it with key adjustments namely: supporting DTX/BP, DTX quality control, using video consultation, and telepharmacy. Coordinating and preparing medications in advance, verifying patient identity, appointment reminders, and safety/referral pathways were emphasized. A prospective quasi-experimental controlled cohort was used to assess the model effectiveness. Fifty clinically stable type 2 diabetes and/or hypertension patients were enrolled in the experimental group while another 50 were assigned into the comparison group. Having assessment 3 times during 6 month trial at baseline (T0), month 3 (T3), and month 6 (T6). Both groups had the comparable basic characteristics. Regarding the key outcomes, it was found that the DM-based cohort group had HbA1c change from 5.93% to 6.26% in the experimental group and from 5.87% to 6.15% in the comparison group that was not significant different (p=0.750), and all patients had HbA1c <7.5% at T6. In the HT-based cohort group, the SBP decreased from 128.71 to 118.93 mmHg, compared to 134.67 to 133.04 mmHg of the comparison group, that the 8.16 mmHg difference was found (p=0.005). The total services cost of the experimental group was saved by 418.6 baht per visit compared to the comparison group, and the time spent was reduced by more than 3.72 hours per visit (p<0.001).In addition, no running out of medicines, ER visits, or hospitalizations due to NCD instability or switching from telemedicine to onsite/ER were found, and the experimental group had more satisfaction (p<0.001). The developed model was feasible for clinically stable NCD patients, preserved individualized glycemic control, improved systolic blood pressure, and reduced household time and financial burden. Interpretation should account for nonrandomized allocation and the  6 month follow up.