طراحي، اجرا و ارزشيابي الگوي ارائه خدمات مراقبت سلامت سرپايي به سالمندان تحت پوشش سازمان تأمين اجتماعي استان تهران

Designing, Implementing and Evaluating a Model for Delivering Outpatient Health Care Services to the Elderly Population of the Social Security Organization of Tehran Province

اراﺋﻪ ﺧﺪﻣﺎت ﺳﻼﻣﺘﯽ ﺑﻪ ﺳﺎﻟﻤﻨﺪان از ﺟﻤﻠﻪ ﻣﺴﺌﻮﻟﯿﺖﻫﺎي ﻣﻬﻢ ﻧﻈﺎمﻫﺎي ﻣﺮاﻗﺒﺖ ﺑﻬﺪاﺷﺘﯽ ﻫﺮ ﮐﺸﻮري اﺳﺖ. ﺳﺎزﻣﺎن ﺗﺄﻣﯿﻦ اﺟﺘﻤﺎﻋﯽ در ﺟﻬﺖ ﺑﻬﺒﻮد اراﺋﻪ ﺧﺪﻣﺎت ﺳﻼﻣﺖ ﺑﻪ ﺟﻤﻌﯿﺖ ﺳﺎﻟﻤﻨﺪان ﺗﺤﺖ ﭘﻮﺷﺶ ﺧﻮد، اﯾﻦ ﭘﮋوﻫﺶ را ﺑﺎ ﻫﺪف ﻃﺮاﺣﯽ، اﺟﺮا و ارزﺷﯿﺎﺑﯽ اﻟﮕﻮي ﻣﺮاﻗﺒﺖ ﺳﺮﭘﺎﯾﯽ ﺑﻪ ﺳﺎﻟﻤﻨﺪان ﺗﺤﺖ ﭘﻮﺷﺶ ﺳﺎزﻣﺎن ﺗﺄﻣﯿﻦ اﺟﺘﻤﺎﻋﯽ اﺳﺘﺎن ﺗﻬﺮان ﺑﻪ اﺟﺮا در آورد. روش ﮐﺎر: ﭘﮋوﻫﺶ ﺣﺎﺿﺮ از ﻧﻮع ﺗﺮﮐﯿﺒﯽ ﻣﺘﻮاﻟﯽ-اﮐﺘﺸﺎﻓﯽ اﺳﺖ. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ، اﻟﮕﻮي اوﻟﯿﻪ ﺑﺎ اﺳﺘﻔﺎده از روش ﻣﺮور ﯾﮑﭙﺎرﭼﻪ و اﻟﮕﻮي ﻧﻬﺎﯾﯽ ﺑﺎ اﺟﺮاي ﺗﮑﻨﯿﮏ دﻟﻔﯽ و ﺑﺤﺚ ﮔﺮوﻫﯽ ﺑﺎ ﻣﺘﺨﺼﺼﺎن، ﺗﺪوﯾﻦ و اﻋﺘﺒﺎرﺑﺨﺸﯽ ﺷﺪ. ﺳﭙﺲ ﺑﺮﻧﺎﻣﻪ آﻣﻮزﺷﯽ ﺑﺮاي ﺗﯿﻢ ﺳﻼﻣﺖ ﺗﺪوﯾﻦ و اﺟﺮا ﺷﺪ. ارزﯾﺎﺑﯽ اﺛﺮﺑﺨﺸﯽ اﯾﻦ ﺑﺮﻧﺎﻣﻪ آﻣﻮزﺷﯽ ﺑﺎ ﭘﺮﺳﺸﻨﺎﻣﻪ ﻣﺤﻘﻖﺳﺎﺧﺘﻪ داﻧﺶ و ﻧﮕﺮش ﻧﺴﺒﺖ ﺑﻪ اﺟﺮاي اﻟﮕﻮي ﺗﺪوﯾﻦﺷﺪه، ﺑﺎ آزﻣﻮن ﻗﺒﻞ و ﺑﻌﺪ اﻧﺠﺎم ﺷﺪ. در اداﻣﻪ، اﻟﮕﻮي ﺗﺪوﯾﻦﺷﺪه در درﻣﺎﻧﮕﺎه ﺧﺎﻧﺪان ﺣﮑﯿﻢ اﺟﺮا ﺷﺪ. ﺑﺮاي ﺳﻨﺠﺶ اﺛﺮﺑﺨﺸﯽ اﺟﺮاي اﻟﮕﻮ، از ﺗﺤﻠﯿﻞ ﻣﺤﺘﻮاي ﮐﯿﻔﯽِ ﻣﺼﺎﺣﺒﻪ ﺑﺎ ﺳﺎﻟﻤﻨﺪان و ﺗﺤﻠﯿﻞ ﻣﺤﺘﻮاي ﮐﯿﻔﯽِ ﻧﻈﺮات ﺗﯿﻢ ﺳﻼﻣﺖ اﺳﺘﻔﺎده ﺷﺪ. ﻧﺘﺎﯾﺞ: اﻟﮕﻮي ﻣﺮاﻗﺒﺖ ﺳﺮﭘﺎﯾﯽ ﺳﺎﻟﻤﻨﺪان درﺑﺮﮔﯿﺮﻧﺪه ﻓﺮآﯾﻨﺪ ﺑﺎﻟﯿﻨﯽ ﺳﺎزﻣﺎنﯾﺎﻓﺘﻪ ﻣﺘﺸﮑﻞ از 6 ﻣﺮﺣﻠﻪ ﺑﻮد. ﻣﯿﺎﻧﮕﯿﻦ ﺳﻦ اﻋﻀﺎي ﺗﯿﻢ ﺳﻼﻣﺖ 45/7±15/11 ﺳﺎل ﺑﻮد. اﺧﺘﻼف ﻣﯿﺎﻧﮕﯿﻦ ﻧﻤﺮات ﮐﻞ رﺿﺎﯾﺖ ﺗﯿﻢ ﺳﻼﻣﺖ ﻗﺒﻞ و ﺑﻌﺪ از ﺷﺮﮐﺖ در ﺑﺮﻧﺎﻣﻪ آﻣﻮزﺷﯽ ﻣﻌﻨﯽدار ﺑﻮد )p≤0/05(. ﻫﻤﭽﻨﯿﻦ ﻃﺒﻘﺎت اﺻﻠﯽ ﺣﺎﺻﻞ از ﻣﺼﺎﺣﺒﻪ ﺑﺎ ﺳﺎﻟﻤﻨﺪان ﺷﺎﻣﻞ ارزﯾﺎﺑﯽ ﻋﻤﻠﮑﺮد ﺷﻨﺎﺧﺘﯽ، ﺧﻠﻖ و ﺧﻮ و رﻓﺘﺎر"، ارزﯾﺎﺑﯽ ﺟﺴﻤﯽ"، ﺑﻬﺎ دادن ﺑﻪ ﺳﻼﻣﺖ و ﺷﺄن ﺳﺎﻟﻤﻨﺪ" و رﺿﺎﯾﺖ ﺳﺎﻟﻤﻨﺪ و ﻫﻤﺮاﻫﺎن" ﺑﻮد. ﻧﺘﺎﯾﺞ ﺣﺎﺻﻞ از ﺗﺤﻠﯿﻞ ﻧﻈﺮات ﺗﯿﻢ ﺳﻼﻣﺖ، ﺑﯿﺎﻧﮕﺮ رﺿﺎﯾﺖ آﻧﻬﺎ از اﺟﺮاي اﻟﮕﻮ ﺑﻮد. ﻧﺘﯿﺠﻪﮔﯿﺮي: اﻟﮕﻮي ﻣﻌﺮﻓﯽﺷﺪه، ﻣﯽﺗﻮاﻧﺪ ﻣﻮﺟﺐ ﺷﻨﺎﺧﺖ ﺳﺮﯾﻊ ﻣﺸﮑﻼت ﺳﻼﻣﺘﯽ و ﻣﺪاﺧﻠﻪ ﺑﻪﻣﻮﻗﻊ در ﺳﺎﻟﻤﻨﺪان ﺷﻮد. ﭼﺮا ﮐﻪ ﺑﺎ اﺟﺮاي آن، اﻣﮑﺎن ﭘﯿﺸﮕﯿﺮي در ﺳﻄﻮح ﻣﺨﺘﻠﻒ ﻓﺮاﻫﻢ ﻣﯽﺷﻮد و از ﺑﺮوز ﺑﯿﻤﺎريﻫﺎ و ﻋﻮارض آﻧﻬﺎ ﺟﻠﻮﮔﯿﺮي ﺑﻪ ﻋﻤﻞ ﺧﻮاﻫﺪ آﻣﺪ. ﻧﺘﺎﯾﺞ اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﯽﺗﻮاﻧﺪ اراﺋﻪﮐﻨﻨﺪﮔﺎن ﺧﺪﻣﺎت را در اراﺋﻪ ﺑﻬﺘﺮ ﻣﺮاﻗﺒﺖ و ﺧﺪﻣﺎت ﺳﻼﻣﺖ ﺑﻪ ﺳﺎﻟﻤﻨﺪان ﯾﺎري ﻧﻤﺎﯾﺪ.

Delivering health services to the elderly is one of the most important responsibilities of the health care system of any country. In order to improve the provision of health services to the elderly population under its coverage, the National Social Security Organization conducted this study with the aim of designing, implementing and evaluating a model for providing outpatient health care services to the elderly population under the coverage of its Tehran Province Office. Materials and Methods: This was a sequential-exploratory mixed-method study. The initial model was developed and validated using the integrated review method and the final model using the Delphi technique and group discussions with experts. Then the educational program was developed and implemented for the health team. Assessment of the effectiveness of the program was done using a researcher-made knowledge and attitude questionnaire (pre- and post-test). The model was then implemented in the Khandan-e-Hakim Clinic. The effectiveness of the model implementation was determined based on the qualitative content analysis of the interviews with the elderly and qualitative content analysis of the health team comments. Results: The outpatient care model of the elderly included an organized clinical process consisting of 6 phases. The mean age of the health team members was 45.7±15.11 years. The difference between the health team satisfaction total scores before and after participating in the educational program was statistically significant (P≤0.05). Further analysis of the data showed, based on the interviews with the elderly, the main categories to be "assessment of cognitive function, mood and behavior", "physical assessment", "appreciation of the health and dignity of the elderly" and "satisfaction of the elderly and their companions". Analysis of the comments of the health team revealed their satisfaction with the implementation of the model. Conclusion: The introduced model can make possible rapid identification of health problems and timely intervention in the elderly population. This implementation model will help disease prevention and complications at different levels. The findings of this study can help service providers to provide better care and health services for the elderly.