Model Development of Telemedicine for Hypertension Patients in a Rural Primary Healthcare Center in Thailand: A Qualitative Study
Main Article Content
Abstract
Background: Hypertension services were disrupted by the COVID-19 pandemic. Telemedicine was heavily
used to overcome this disruption. The aims of this study were to describe a typical hypertension
service and recommendations for telemedicine development for hypertension patients in a rural,
Sub-District-level, primary healthcare center.
Methods: A qualitative case study was utilized. In-depth interviews were conducted with healthcare
staff at a rural primary healthcare center in April 2023. The interview process was continued until
data saturation had been achieved. Data from the interviews were assessed via the triangulation
method. Analytic induction was used to analyze the data.
Conclusion: The total number of participants was 10 persons (3 male and 7 female). The median age
was 42 years old (min. 32, max. 58). The qualitative results revealed that participants believed
that telemedicine provided adequate hypertension services. The patients’ data was sent from the
primary healthcare center to the secondary hospital (Provincial level) via the internet system.
Communications between the patients and doctors at the provincial hospital were executed via video
calls. All services were performed and completed at the primary healthcare center. The use of
telemedicine by Sub-District healthcare hospitals could mitigate the limitations of traditional
care, such as the lack of physicians, delays in treatment, and limited medical equipment. The
engagement of stakeholders was the key factor in the success and sustainability of the program.
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
References
World Health Organization. Hypertension 2023 [updated 2023 Mar 16; cited 2023 Apr 25]. Available from: https://www.who.int/news-room/ fact-sheets/detail/hypertension.
GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1659-724.
Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet. 2016;387(10022):957-67.
World Health Organization. HYPERTENSION: ACT NOW! [cited 2023 May 4]. Available from: https://cdn.who.int/media/docs/ default-source/documents/hypertension- infographic-005-web.pdf?sfvrsn=f0973d0c_2.
World Health Organization. The impact of the COVID-19 pandemic on noncommunicable disease resources and services: results of a rapid assessment [updated 2020 Sep 23; cited 2023 May 4]. Available from: https://www.who.int/ publications/i/item/9789240010291.
World Health Organization. Telemedicine: Opportunities and developments in Member State: World Health Organization; [cited 2023 May 4]. Available from: https://www.afro.who.int/publications/ telemedicine-opportunities-and- developments-member-state.
Omboni S, McManus RJ, Bosworth HB, Chappell LC, Green BB, Kario K, et al. Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper. Hypertension. 2020;76(5):1368-83.
Barbosa W, Zhou K, Waddell E, Myers T, Dorsey ER. Improving Access to Care: Telemedicine Across Medical Domains. Annu Rev Public Health. 2021;42:463-81.
Hoffer-Hawlik M, Moran A, Zerihun L, Usseglio J, Cohn J, Gupta R. Telemedicine interventions for hypertension management in low- and middle-income countries: A scoping review. PLoS One. 2021;16(7):e0254222.
Hossain MM, Tasnim S, Sharma R, Sultana A, Shaik AF, Faizah F, et al. Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development. Digit Health. 2019;5:2055207619896153.
Yatabe J, Yatabe MS, Okada R, Ichihara A. Efficacy of Telemedicine in Hypertension Care Through Home Blood Pressure Monitoring and Videoconferencing: Randomized Controlled Trial. JMIR Cardio. 2021;5(2):e27347.
Wang H, Yuan X, Wang J, Sun C, Wang G. Telemedicine maybe an effective solution for management of chronic disease during the COVID-19 epidemic. Prim Health Care Res Dev. 2021;22:e48.13. Krishnan S. Telemedicine: Decreasing Barriers and Increasing Access to Healthcare 2017 [cited 2022 Nov 1]. Available from: https://www.healthcarevaluehub.org/ advocate-resources/publications/telemedicine- decreasing-barriers-and-increasing-access-healthcare.
Yodmai K. The barrier of using digital health in older people: a study in rural community, thailand. BMJ Evidence-Based Medicine. 2019;24(Suppl 1):A45-A.
World Health Organization. Regional Office for the Western P. The Kingdom of Thailand health system review. Manila: WHO Regional Office for the Western Pacific; 2015 2015.
Kulrattanamaneeporn S, Tuntideelert M, Kost GJ. Using Telemedicine With Point-of-Care Testing to Optimize Health Care Delivery in Thailand. Point of Care. 2006;5(4):160-3.17. World Health Organization. PRIMASYS: Abridged case study from Thailand [updated 2017 June 11 cited 2013 May 10]. Available from: https://ahpsr.who.int/publications/i/item/ primasys-abridged-case-study-from-thailand.
Hanucharurnkul S. Nurses in primary care and the nurse practitioner role in Thailand. Contemp Nurse. 2007;26(1):83-93.
Ruth M-M, Patricia H, Faith D, Kim R, Kelley K, Nancy C, et al. Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review. BMJ Open. 2015;5(6):e007167.
Pfeil JN, Rados DV, Roman R, Katz N, Nunes LN, Vigo Á, Harzheim E. A telemedicine strategy to reduce waiting lists and time to specialist care: A retrospective cohort study. Journal of Telemedicine and Telecare. 2020;29(1):10-7.
Department of Older Persons. Situation of the thai older persons 2021 2022 [cited 2023 May 10]. Available from: https://www.dop.go.th/ download/knowledge/th1663828576-1747_1.pdf.
World Economic Forum. How stakeholder alignment on sustainability unlocks a competitive advantage 2022 [updated 2022 Fab 1; cited 2023 May 11]. Available from: https://www.weforum.org/agenda/2022/02/how- to-strengthen-sustainability-by-engaging-with-stakeholders.