The Development of the Community-based Palliative Care Model in a District Health System, Phitsanulok Province, Thailand

Context: Palliative care (PC) refers to a set of basic health services in Thailand and is in the early stage of implementation. Aim: The aim of this study is to develop a community-based PC model in a district health system (DHS) based on the form of action and evaluation. Methods: A three-step action research: look, think, and act was designed with mixed methods of data collection. Results: A key finding was the confusion on the terminology of the PC, challenge of the referral system of PC patients in DHS, medical equipment and supplies for the PC patients, and insufficient access to opioid analgesics at home. The model of development comprised the training of health professionals, the management of the medical equipment and supplies by people sector, and the development of a referral guideline of the PC patient in DHS. The evaluation showed the higher score of the accessibility to PC than the score of accommodation for patients. It also showed the higher score of the care continuity over the longitudinal continuity for patients. For the carers, the score of guilt is higher than the score of the care burden. Conclusions: A community-based PC model should be monitored by district health managment. The methods of this study are expected to be useful advice on how to solve similar problems in the other regions of similar context.