Nurses in Primary Care and the Nurse Practitioner Role in Thailand

By Hanucharurnkul, Somchit | Contemporary Nurse : a Journal for the Australian Nursing Profession, August 1, 2007 | Go to article overview

Nurses in Primary Care and the Nurse Practitioner Role in Thailand


Hanucharurnkul, Somchit, Contemporary Nurse : a Journal for the Australian Nursing Profession


Internationally, primary care plays an increasingly important role in improving health outcomes particularly in Thailand. This global trend is consistent with the philosophy of economic sufficiency as proposed by His Majesty King Bhumibol Adulyadej of Thailand. Primary care can be expected to lower the costs of care, improve health through access to more appropriate services and reduce the inequities in the population's health (Starfield, Shi & Macinkio 2005). Other benefits include integrated, accessible health care services by primary care providers who are accountable for addressing a majority of personal health care needs, sustained partnership with patients and care provided in the context of the family and community (Institute of Medicine 1996). Having a regular primary care provider is one of the best predictors that a person will receive appropriate comprehensive care ranging from health promotion, disease prevention, early detection of illness, management of common health problem, management of chronic illness/conditions, and rehabilitation.

NATIONAL HEALTHY CARE SYSTEM AND PRIMARY CARE IN THAILAND

Universal or near universal coverage of health care has been a prominent objective of health care reform in many countries, particularly in Thailand.

Universal coverage can ensure equitable access to health care and help to achieve a nation's dual objectives of equity and efficiency for its people's health (Nitayorumphong & Mills 2005). This can only be possible under the appropriate design of the nation's health care system.

Thailand's health care system is designed for three levels; primary, secondary and tertiary care. It is recognized that primary care is the key to success in a universal health care coverage system. However, networking among these three levels of care to ensure quality and continuity of care is essential. Figure 1 represents the network of the health care system in Thailand.

Primary care in Thailand is defined as the basic health care provided for every person. It includes health promotion, disease and illness prevention, and treatment of local common health problems, rehabilitation and palliative care. It is a holistic continuum of care in healthy, high risk, minor illness, chronic illness/conditions and end of life care at home. Networking with various levels of care from primary to secondary and tertiary care is essential for quality of care at all levels. Also, primary care emphasizes self-care and self-reliance and incorporates local wisdom or complementary therapy in the health care services (Boonthong et al. 2000). Philosophies underpinning primary care are provider-consumer relationships, providercommunity relationships, and service changes from facility-based to community-based services. To provide this kind of service, the primary care unit (PCU) must be a part of the community and be located closest to where people live so as to enable service access whenever needed. The scope of primary care services includes:

1. Health promotion in all age groups ranging from children to elderly, including family planning for women and in every stage of health.

2. Surveillance, prevention and control of illness, accident, poisoning, and domestic or community violence which includes:

* immunization;

* promotion of healthy environment;

* surveillance and management of outbreak disease;

* comprehensive health assessment of individual, family and community;

* early detection and management of illness and risk behavior of individual, family and community.

3. Management of chronic illness/conditions at home and in the community;

4. Management of the terminally ill patients at home;

5. Empowerment of people to utilize their maximum potential for their health;

6. Active participation in community development.

This scope of primary care necessitates a mixedskill team to provide comprehensive health care services. …

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