โครงการเยี่ยมบ้านผู้ป่วยโรคเรื้อรังด้วยแนวคิดเวชศาสตร์ครอบครัวในระบบบริการปฐมภูมิ...

1

..

District Health System .

.

(access to care)(1) (reducing

health disparities) (integrating health care with public

health systems)(2)

(continuous interprofessional care of patients)(3)

... ""

(, , )

Disease Illness

4

2

Social Determinant of Health Ecological Model Patient individual

(illness) (Disease) (Idea)

(Feeling) (Function) (Expectation) (Suffering)

Social Determinant of Health

Family Determinant of Health

3

Physician-Patient-Family-Community Relationship

(4)

(5)

(6, 7)

Human Capital in Working with Family

Family Medicine & Primary Care Perspective (8)

1

/

3

2

/

4

4

(9)

3 5

5

(Core group)

(Change agent)

(Champion)

(Continuity)

( in Come and in kind)

(advoCate)

Health and Social Care,

(context based learning )

family

resource community resource

.

case case Humanized Health care

(10)

6

4

(11)

1. Faber M, Voerman G, Erler A, Eriksson T, Baker R, De Lepeleire J, et al. Survey Of 5 European

Countries Suggests That More Elements Of Patient-Centered Medical Homes Could Improve Primary Care.

Health Affairs. 2013;32(4):797-806.

2. Grant R, Greene D. The Health Care Home Model: Primary Health Care Meeting Public Health Goals.

American Journal of Public Health. 2012;102(6):1096-103.

3. Berryman SN, Palmer SP, Kohl JE, Parham JS. Medical Home Model of Patient-Centered Health Care.

MEDSURG Nursing. 2013;22(3):166-96.

4. Williams W. Family-Centered Care. Journal for Specialists in Pediatric Nursing. 2006;11(3):203-6.

5. Collaborative and Supervisory Relationships Between Attending Physicians and Advanced Practice

Nurses in Long-Term Care Facilities. Journal of the American Medical Directors Association. 2011;12(1):12-8.

6. Adams M, Robert G, Maben J. Catching up: The significance of occupational communities for the

delivery of high quality home care by community nurses. Health: An Interdisciplinary Journal for the Social Study

of Health, Illness & Medicine. 2013;17(4):422-38.

7. Wilson CB. Developing community in care homes through a relationship-centred approach. Health &

Social Care in the Community. 2009;17(2):177-86.

8. ...

. 2553.

9. Meng A. Informal home care and labor-force participation of household members. Empirical Economics.

2013;44(2):959-79.

10. Wilson N. Compassionate Care: at what cost? British Journal of Community Nursing. 2013:S5-S.

11. Hall D, Shucksmith J. Making life richer: creating a compassionate community. Nursing & Residential

Care. 2012;14(6):314-7.