A model of health services for hypertension in primary care unit in Patumthani Province.

OBJECTIVE To determine an appropriate, cost-effective and sustainable model of health services for prevention and control of hypertension in a primary care unit. STUDY DESIGN Operational research. MATERIAL AND METHOD The presented study was to develop a model that utilized health personnel, village health volunteers (VHVs) and family health leaders (FHLs) to improve health services to prevent and control hypertension in three primary care units (PCU) in Patumthani Province. The model was designed to include two intervention groups (Group I, II) and a control group (Group III). In Group I (Bangdaeu 1), health personnel, VHVs and FHLs took part in the design of services to help prevent and control hypertension, while in Group II (Bangkayang) and Group III (Banklang), only health personnel and VHVs participated Five hundred and forty villagers participated in the present study, with an approximate equal number in each group. The project included training of persons involved in the project at the beginning with subsequent designs of community-based interventions (Part I), cost effectiveness study (Part II), and assessment of participation of VHVs and FHLs' impact and project's sustainability (Part III). Three measurements on various outcome variables were done at baseline (Measure 1), right after community-based activities were implemented (Measure 2) and at the end of project (Measure 3) by Cochran 's Q test. RESULTS Group I showed a steadily improving trend in outcome variables such as high level of knowledge were higher in Measure 2, 3 than Measure 1, (11.6%, 89.9%, 100% respectively). The trend in Group II showed a defection at Measure 3 (5.7%, 50.9%, 43.4%). However, an improving trend in Group III was also observed, but less obvious than in Group I (8.1%, 21.7%, 24.8%). Determining the costs for the real program effects showed that Group I model is most cost-effective, with least unit cost per a unit of improvement. Result from Part III showed that the project is sustainable if obstacles found in the present study could be removed. CONCLUSION The present study demonstrates the effects of community-based approaches by VHVs and FHLs, with support from health personnel with a high prospect of sustainability and transferability to other areas.