The Development of an Integrated Health Service Model for Vulnerable Groups, Wihan Daeng District, Saraburi Province.

Abstract

Thailand is rapidly transitioning into a complete aging society, with the proportion of elderly citizens projected to increase from 13.2% in 2010 to 32.1% by 2040. This demographic shift has led to a continuous rise in vulnerable populations and dependents; notably, in 2023, the number of bedridden patients reached 588,987, necessitating an efficient intermediate and long-term care system. This research aimed to (1) investigate the current challenges in health service provision for vulnerable groups, (2) develop an integrated health service model, and (3) evaluate the outcomes of the developed model. The study was conducted across three systematic phases. The primary stakeholders, selected through purposive sampling, consisted of 94 participants. Data collection involved in-depth interviews, focus group discussions, and participatory workshops, while data analysis utilized content analysis for qualitative data and descriptive statistics for quantitative records. The findings revealed significant systemic deficiencies, including a lack of service integration, high staff workloads, and inequitable access to healthcare. To address these issues, the "RUAM MODEL" was developed, comprising four core components: comprehensive registration and risk stratification, integrated care coordination, appropriate service delivery, and multidisciplinary team collaboration. Following the implementation of the model, the results demonstrated substantial improvements: registration coverage for vulnerable groups reached 92%, and 85% of personnel successfully completed case manager training. Furthermore, home visit coverage was recorded at 97.8%, while the hospital readmission rate decreased significantly by 50%. Participant satisfaction was exceptionally high at 96.7%. In conclusion, the RUAM MODEL is an effective, evidence-based framework that enhances the quality of life for vulnerable populations and can be sustainably expanded across various healthcare contexts to ensure long-term system resilience.