DEVELOPMENT OF THE SYSTEM FOR CARING SCHIZOPHRENIC PATIENTS IN THE COMMUNITY FOR BEHAVIORAL DRUG USE PER MEDICATION ADHERENCE
Faculty of Nursing, St. Theresa International College, 1Moo 6, Rangsit, Nakhon Nayok Road, Klong 14, Bungsan, Ongkharak, Nakhon Nayok- 26120, Thailand, Email: firstname.lastname@example.org
This action research aims to develop a system for caring schizophrenic patients in the community and to study the effectiveness of the developed system on medication adherence according to care network hospital’s therapeutic criteria. Research participants include the caregivers and schizophrenic patients with a composed mental state who received treatment at care network hospital, Nakornnayok, between October 2020 and October 2021, totaling up to 20 people, selected using purposive sampling. The system development process is carried out by 1) Analyzing the situation of the problem 2) Creating a temporary therapy system by raising awareness of schizophrenic patients and providing individualized therapy through motivation-enhancing and cognitive-behavioral therapy based on the stage of behavior change 3) Testing the system outcome reflection 4) Improvement and follow-up evaluation, conducting tests and improving the system following two action research cycles 5) Concluding the community-based care system for schizophrenic patients to encourage patients to receive medication according to the complete treatment criteria. Research instruments include the care system for schizophrenia patients in the community, motivation-enhancing counseling, and counseling for adjustment of mentality and behavior. Data collection tools include personal data record forms, assessment forms for medication adherence, and interview forms to collect data on medication intake of schizophrenic patients. Quantitative data analysis is conducted using descriptive statistics and Repeated Measures ANOVA. Qualitative data is analyzed and compared throughout.
Research results showed that the developed system consisted of 3 phases: 1) Forming a network of caregivers in the community 2) Finding the primary caregiver from members of the family 3) Nursing practice in the community by providing counseling for medication adherence. Evaluation results of the system effectiveness discovered that the scores for medication adherence immediately after project completion and three month after project completion are higher than scores prior to the project with statistical significance (p < 0.01). The medication adherence scores before and immediately after participating in the program and three month after participating in the program differs by at least one pair (p < .001), with results immediately after project completion and three month after project completion shown to be better than before the project started with statistical significance (p < 0.01). The developed system was shown to be effective in caring for schizophrenic patients of the community, helps encourage patients to have medication adherence successfully, and improves patients’ quality of life, reducing recurrence of psychotic symptoms. Suggestions were made that professional nurses were working in community psychiatry, both in community hospitals and health promoting district hospitals, could use this system as a guideline for organizing the care system for schizophrenic patients in the community, in order to provide continuous care. In addition, there should be a follow-up of the study results in the long term.
Keywords: Care system, Schizophrenic patients, and Medication adherence