This study aimed to develop health care delivery model in new normal era in subdistrict health promoting hospitals (SHPH) on the islands. The research and development were a method for this study. Data were collected by in depth interview and using the questionnaires in health care personal and people who came to receive care services at 53 SHPHs on the island. Focus group interviews were conducted among policy makers in 10 provinces to receive information related to structure, process, and care services. The preliminary analysis and the first draft prototype of health care delivery model in new normal era in SHPH on the island and the proposed policy were presented to local policy makers from 3 health zones to receive feedback and more recommendation. This process was conducted to make the health care delivery model and proposed policy relevant to each SHPH’s context and local people health need. The result of the study revealed that in Thailand, there are 58 SHPHs on the islands. During data collection process, the researchers were not allowed to collect data in 5 SHPHs in the southern part due to Covid-19 pandemic. In this study the report is based on 53 SHPHs on the islands including 50 SHPHs, 1 sub-district health station and 2 village health stations. About 87% of SHPHs were size S. the majority of people in the 6th health zone were Buddhists while the majority of people from the health zone 11th and 12th were Muslim and uses local dialogue to communicate. Local people were fishermen and agricultures while people from other places and living on the islands were wage workers. There were 201 health care personnel, 72.14 % were female with the ages ranged from 22 to 60 years (mean = 35.56 years). About 53% were community health personnel while 26.08% were professional nurses. In regard to work experiences in the studied SHPHs, the range of year were varied from less than 1 year to 30 years with the mean of 8.36 years. The majority of their responsibilities focused on providing primary medical care (86.34%), caring of people with chronic illnesses (85.30%) providing medical care procedures for patients with chronic illnesses at home. Work process barrios were staff shortage in particular nursing profession, communication with other health care staffs outside the islands, difficulty commute between islands and mainland and inadequate budgets. Work process facilitators were collaboration from local people and strong community network. All health care personnel stated that the workload was exceed manpower in SHPHs, they had to work overtime almost every day especially during the week ended and long holidays. In the famous tourist islands, health care personnel had to carry 3-4 folds of their workload during the holidays because of the large crowds of foreign and Thai tourists. After covid-19 pandemic, while Thai government encourage tourist business to booster country economic tourists flooded all famous tourist islands. In regard to their perception on work, they were very satisfying with their work because they realized that people in the community can rely on them. However, they were dissatisfying with their career advancement. Regarding the transferring of SHPHs from Ministry of Public Health to Provincial Administration Organization, all health care personnel had learned about this issue but most of them did not understand about the guidelines and did not assure their career advancement after the transfer. There were 642 people who come to receive care service and were invited to join in this study. The majority of them were female (78.66%) with the ages ranged from 20 to 90 years (mean = 49.80 years). Majority of them graduated from primary school, had chronic diseases, and received continuing care from SHPHs. Almost all of them stated that numbers of health care personnel should be increased and in every SHPHs nurses are main profession. During data collection we found that there was not a nurse in 16 SHPHs. High technology equipment was needed as well as the need for prompt emergency medical care while they have emergency and critical illnesses. Similarly, the local policy makers stated that people on the islands should receive standard care relevant to their health needs. Health equity is their right and access to health care services should be similar to ones who live on the mainland. In conclusion, in new normal era care services provided in SHPHs on the islands should be advanced the level of services up to the level of community hospitals. Three prototypes of SHPHs on the islands were developed based on the context of the islands including; SHPHs on the main tourist attraction island, SHPHs on the non- tourist spot island and SHPHs on the big island with a community hospital. The expected outcomes emphasize on rescuing patients with emergency and life-threatening illnesses and providing comprehensive care services for people living on the islands. The policy proposals from this study include, drafting the new standard for SHPHs on the islands using the 3 aforementioned prototypes, encourage people and community engagement, embed travel medicine in the foundation of SHPHs on the islands and allocate 2-3 emergency nurse practitioners for each SHPHs on the islands. Moreover, to make smooth transferring process of SHPHs to Provincial Administration Organization, definite guidelines should be announced to make all health care personnel become certain about this process.


The coronavirus disease 2019 (COVID-19) pandemic has spread across the globe and impacted everyone, everywhere. Despite COVID-19’s negative impact in several aspects, this pandemic has created an opportunity for researchers to explore new research questions and approaches to the challenging situation which the world is facing with the overall aim to support our communities. The purpose of this study was to address policy-relevant questions arising from the COVID-19 pandemic by investigating the impact of COVID-19 on outpatient (OPD) and inpatient (IPD) service utilization, ambulatory care sensitive conditions (ACSCs), mental health, low-value care (LVC), and mortality. Literature reviews and analyses of real world data from existing administrative databases were used to achieve the overall goal of creating evidence to support the healthcare system in Thailand. In conclusion, this study can consider to be the first study that use real-world data from existing administrative databases to address policy questions. The study delivers outputs on two main areas: 1) answering policy-related questions; and 2) raising new topics for future research based on the study results. This study seeks to turn a crisis into an opportunity and our research team hope that it will help spark and create a foundation for many further studies.


The objectives of this project are to develop patterns or mechanisms to support evidence-based policy decision-making, especially for issues that are complex, involve many stakeholders, and/or have a limited time frame. This project focuses on the transfer of the duties of Chaloem Phra Kiat 60 Years Nawamin Maharachini Health Center and Tambon Health Promoting Hospital (THPH) to the Provincial Administrative Organization (PAO), which occurred in the fiscal year 2023. There are four main processes: (1) building up two main teams, a small working group as a core team called “Working Ant Team” to monitor the situation of the transfer, and a larger working group called “Thailand Team” for stakeholder participation including policymakers, specialists, and academics; (2) monitoring the situation of the transfer of the duties of the health centers and THPHs to PAOs via several methods, such as literature review, attending training or meeting related to the transferring; 3) interviewing stakeholders; and 4) surveying the progress of policy implementation and opinions of PAOs and Provincial Public Health Offices (PPHO). Data were analyzed and consulted within the Working Ant Team for perspective sharing between researchers and policymakers. The concept of the six building blocks of the health system from the World Health Organization (WHO) was used as a framework for analysis. The concept of primary healthcare measurement framework and indicators from the WHO was used as a framework for monitoring the progress of related research and conducting a research mapping. The results revealed that, in the fiscal year 2023, three thousand two hundred and sixtythree health centers and THPHs transferred from the Ministry of Public Health to PAO in 49 provinces. The manual for transferring the duties of the Chaloem Phra Kiat 60 Years Nawamin Maharachini Health Center and THPH to the PAO in 2021 mentioned roles and responsibilities specified to responsible institutions. Analyzed the manual with the six building blocks of the health system, the issues of the drug and medical devices and health information systems were less detailed than other systems. Before the transfer, important activities were communicating the guideline in various methods such as official documents, orders for rehearsal of understanding, training workshops, or meetings, and introducing regulations for clarification procedures. One of the main problems to implement the manual was the lack of clarity in transferring health workforce issues, such as the issue of hiring, incentive, career path, and job description. The Ministry of Public Health’s employees faced the most impact of transferring because this type of hiring is specific to the regulation of the Ministry of Public Health while there has not been a regulation for hiring like this in the Ministry of Interior. The survey of readiness of PAO and PPHO for transferring the health centers and THPHs from August to September 2022 revealed that the three most ready activities of PAO are establishing “the Committee for Health in Area Level” (CHA), meeting of CHA, and documenting a plan for health in area level. Opinions those PAO and PPHO agree with are about the roles of PPHO. PPHO should 1) regulate and control the standard of care of the transferred health centers and THPHs 2) technical support and supervise the PAO, and 3) participate in the development of the health information system of PAO. Mapping of research related to transferring the health centers and THPHs revealed 18 research projects. Four projects finished are about the allocation of budget from the National Health Security Office, the standard of care, health workforce, and prototype of primary health care system. This study documented the situation before the transfer of the health centers and THPHs and after transferring on 2nd October 2022 to November 2023. There are 4 main issues to further follow up: (1) allocating of health workforces of both PAO and PPHO, (2) monitoring and regulating of transferred health stations and THPHs, (3) policy implementation of PAO such as management of health resource, development of health information system, and management of drug and medical devices system, (4) roles of the Ministry of Public Health according to the manual of transferring. For patterns or mechanisms to support evidence-based policy decision-making, the Working Ant Team and the Thailand Team should keep monitoring the situation continuously. The objectives for the further phase should be (1) to support evidence-based policy decision making for ensuring primary health care in Thailand keep progress with the least impacts from transferring and develop for better before transferring, (2) to monitor the situation after the transfer in the fiscal year 2023, as an overview of the country, connecting with stakeholders, and contextualizing with information in area level (3) to monitor the progress of research projects related to the transfer and update the research mapping (4) to expand stakeholder participating for both policymakers and implementers including the public health side, the local government side, and the academic side.


Introduction: Working in primary care pharmacy in the community Pharmacists have to work with village health volunteers (VHVs) because VHVs are people who are very close to the community. Impact of COVID-19 Happened to many countries around the world and in many ways, Including the public health system very much. Healthcare workers must deal with epidemics and service delivery needs to be adjusted. Therefore, it is necessary to develop long-distance village health volunteers (VHVs) to connect the primary care pharmaceutical service system. To be in line with the normal situation, the new normal. Objective: 1. Develop a platform for remote village health volunteers for village health volunteers to use in primary care pharmaceutical services in the community. 2. Develop village health volunteers to have the ability to use a remote platform to connect the primary care pharmaceutical service system. 3. Design a remote primary care pharmacy service system to connect the work of pharmacists and village health volunteers. 4. Synthesize current primary pharmaceutical policy recommendations to relevant agencies. The research model was a participatory action research divided into 3 phases as follows Phase 1: Develop a Tele Village Health Volunteer Platform (TeleVHV Platform) for village health volunteers to use in primary care pharmacy services in the community. Phase 2: Develop village health volunteers to have the ability to use remote platforms to connect primary care pharmaceutical service systems. Design a remote primary care pharmacy service system to connect the work of pharmacists and volunteers, including risk screening smoking cessation service home visit Addressing the problem of improper drug distribution in the community and pilot a service system designed in the target area. Phase 3: Evaluation in terms of access and use of the platform by pharmacists and village health volunteers, in terms of the effectiveness of services in the developed form. Satisfaction and opinions on the use of the remote village health volunteers platform in primary care pharmaceutical services. and take lessons. Conclusion: The tele village health volunteers platform can enable pharmacists and village health volunteers work together in primary care pharmaceuticals effectively. It should be practiced so that villagers can take advantage of the platform more and there should be further policy push Including the expansion of research results to be applied in primary care pharmaceutical services to achieve sustainability and benefit in a wider area.


Kidney transplantation (KT) prolongs life in patients with kidney failure. KT requires the use of immunosuppressive agents such as tacrolimus (TAC) and mycophenolate mofetil (MMF) to prevent rejection of the donor kidney, which will result in graft loss. Drug levels for both TAC and MMF vary very widely in individual patients. Too high levels may increase the risk of complications such as infections and bone marrow suppression whereas too low can lead to KT rejection. MMF is a prodrug, which is hydrolyzed to mycophenolic acid (MPA) after oral administration. Quantification of MPA levels requires several measurements to construct an area under the curve over a 12 hr. period (AUC0-12) as a single trough level is a poor predictor of AUC. Because of the time constraint and cost, a full MPA AUC is rarely performed, and MMF is usually given as a fixed-dose combination. Unlike MPA, trough levels of TAC are an accepted method to estimate TAC AUC and are widely used in clinical practice. Trough levels vary widely between individuals after a fixed dose. Low trough levels of TAC has been shown to be related to the risk of rejection and decreased long-term outcome. Known genetic polymorphisms in enzymes related to MMF hydrolysis, MPA excretion, and reabsorption have been shown to contribute to the highly variable individual MPA AUC Similarly, several genes have been identified to account for variations in TAC trough levels. Previously, we have demonstrated the importance of polymorphisms of a few genes linked pharmacokinetics of MMF and TAC in Thais that differs in some aspects from the Western population. Nonetheless, all known genes that can influence drug levels have not been evaluated in Thais. Moreover, additional genetic polymorphisms as yet unknown may be important to determine drug pharmacokinetics and could predict the risk of transplant complications. A complete knowledge of gene polymorphisms and their frequency in the Thai population would lead to the development of a more accurate algorithm for individualized prescription of immunosuppressive agents, reducing complications and leading to improved patient care. Study objectives i) Collect DNA for whole genome sequencing of patients undergoing kidney transplantation for Genomic Thailand 2) To identify novel polymorphisms and evaluate contributions of known and unknown polymorphisms linked to trough-level tacrolimus in KT patients 3) To identify novel polymorphisms and evaluate contributions of known and unknown polymorphisms linked to area under the curve level of MPA in KT patients 4) To develop algorithms to dose MMF และ tacrolimus using clinical and genetic data 5) To evaluate risk of gene polymorphisms of alleles linked to MPA and TAC levels and complications of KT Methods This was planned as a retrospective and prospective study of patients with diseased-donor and living-related KT from Ramathibodi Hospital, Siriraj Hospital, and Chiangmai Hospital (n=1000) over a 2-year period. Relevant clinical details and drug details will be collected. Blood was collected for Genomics Thailand, and a separate sample will be kept for on-site analysis. Results We have enrolled 841 patients (in excess of the 500 planned for the first year). We have set up an assay of MPA and metabolite assay by ultra-high-performance liquid chromatography-tandem mass spectrometry. We measured AUC 12 hr. of MPA in 200 patients and are measuring known gene polymorphisms using a targeted high-evidence pharmacogenomic PCR array, which includes 2,000 variants in 150 genes in these patients. We will link MPA levels and TAC to these genotypes as well as develop a predictive algorithm in the first part of year 2. Conclusions and plan We have enrolled 841 patients (of target of 500 in year 1). In year 2, we requested to increase our enrollment to 1500 patients. (in total years 1 and 2). In the early part of Year 2, we will conclude an analysis of associations of known gene polymorphisms with MPA AUC and trough TAC levels using PCR array as well as develop an algorithm to predict outcomes. Later in Year 2, we will evaluate the relationship between MPA AUC and TAC levels in the rest of the patients once the Genomic Thailand data becomes available. In addition, we will link the risk of complications such as rejection and infection or marrow suppression with gene polymorphisms linked to drug metabolism.


The proposal to conduct a situational assessment on disease prevention and control for the establishment of a Southeast Asia Centre for Infectious Disease Control (SEACID) was an academic study, led by the Saw Swee Hock School of Public Health, National University of Singapore (NUS) and the Health Intervention and Technology Assessment Program (HITAP). This project was funded by Health Systems Research Institute (HSRI), Thailand. The project aimed to offer recommendations to operationalise the establishment of a regional centre for disease control in the Association of Southeast Asian Nations (ASEAN) region and beyond. This initiative was conceptualised as a collaborative research endeavour, drawing on qualitative data such as inputs from scoping review and key informant interviews of regional health experts. The findings showed that there were many factors facilitating the operationalisation of the regional centre for disease prevention and control with the main ones included having strong governance, effective management and participation of stakeholders, as well as creating collaboration from external organisations. To have an effective regional centre for disease control and prevention, this initiative required mutual understanding of benefit, trust in sharing information, and collective work among member countries. These enablers would support the integration of differences of all country members, promote a sense of coownership, increase workforce capacity through training and knowledge sharing, and facilitate clear communication. A key risk factor to consider for the operationalisation of the centre was the political sensitivity of each area. This context could cause complications, jeopardising certain activities, such as information sharing and the implementation of public health projects which required working across borders. Therefore, the operationalisation of the centre should focus on supporting and working together with local organisations, rather than directing and intervening by setting the rules for member countries. Capacity building and support for knowledge transfer both within and among countries should be encouraged as it invigorated the efficiency and capability of the organisation. These actions would help start a cycle, where success would build image and confidence for the organisation, which, in turn, would help attract other donors to invest more in the organisation. Moreover, financial factor was considered very important for the sustainability of the management and operationalisation of the regional centre.


The disease model is crucial for discovering a new drug and therapy. Currently, organoid technology allows the generation of a self-assembled, 3-dimensional cellular structure. We aimed to use innovative tissue culture to create cancer organoids from cancer tissues of retinoblastoma and breast cancer patients. The success rate was 80 and 32 % for retinoblastoma and breast cancer organoids, respectively. Cancer organoids faithfully recapitulated genetics, gene expression, and histogenesis in the parental cancer tissues. For retinoblastoma, a candidate cancer drug exhibited high efficacy and potency for all subtypes of retinoblastoma in drug screening. The drug signature of retinoblastoma organoids suggested that the candidate drug had dual inhibition of retinoblastoma and angiogenesis. Retinoblastoma growth was inhibited via drug-induced cell cycle arrest and apoptosis. Of note, the candidate drug for retinoblastoma exhibited low toxicity to the retina compared with clinically used drugs. For breast cancers, the drug response profiles were alike between breast cancer organoids and the patients. Nine candidate drugs were more effective for killing cancer cells when compared with the drugs that failed to cure breast cancer of the patients. Generating and collecting cancer organoids would benefit the discovery of universal or personalized therapeutic agents for cancer treatment.


Objective Thailand is experiencing demographic ageing. Consequently, the socioeconomic burden of neurodegenerative diseases (NDDs) is expected to escalate drastically posing a challenge for the middle-income country. Much can be done to mitigate the consequences NDDs including imposing preventive interventions, planning an integrated care chain, accelerating biomedical research etc. Using neuropathology-specific biomarkers is indispensable for successful implementation of such measures because they can detect NDDs in the long presymptomatic stages at which disability can be prevented. Nevertheless, their use is limited by cost and accessibility, perceived invasiveness and lack of validation in non-white population. The aim of this project is to develop biomarkers for NDDs including Real-time Quaking-induced Conversion (RT-QuIC) for diagnosing prion diseases and synucleinopathies, plasma phosphorylated tau (p-tau) for diagnosing Alzheimer's disease, and multimodal biomarker evaluation scheme for evaluating idiopathic normal pressure hydrocephalus (iNPH), that is affordable, accessible, non-invasive and accurate with regards to Thai people along with an effective guidance for their use. Materials and methods In-house recombinant truncated hamster prion protein (recPrP) purified using a pre-packed column and simultaneous refolding and dialysis (siphon method) served as the substrate for RT-QuIC, which was performed on two sets of cerebrospinal fluid (CSF) specimens. The first comprised of 30 CSF specimens of patients from various hospitals suspected of having sporadic Creutzfeldt-Jakob disease (sCJD). An identical set of aliquots was transferred to an established RT-QuIC facility to determine the inter-laboratory agreement. The second set comprised of CSF from 39 patients presenting at King Chulalongkorn Memorial Hospital suspected of having sCJD. Complete clinical data are available in this group enabling the evaluation of the diagnostic performance. In-house recombinant human α-synuclein (rec-humα-syn) purified using a single Q-Sepharose column served as the substrate for RT-QuIC, which was performed on 11 control CSF specimens as a pilot experiment. P-tau181 quantification using single-molecule array (SIMOA) were performed on plasma specimens from participants with dementia who had previously undergone 18F-Florbetaben positron emission tomography (PET) to determine the optimal cutoff for diagnosing Alzheimer’s disease (AD). Participants with amnestic mild cognitive impairment (MCI) were consecutively enrolled in another cohort whose plasma samples were collected and full neurocognitive assessment were done. The participants subsequently underwent 18F- fluorodeoxyglucose- PET 18F-Florbetaben PET and 18F- PI2620 PET to determined AD biomarker status and prospectively evaluated the diagnostic performance of plasma p-tau181. Participants who were suspected of having iNPH were and evaluated with the proposed multimodal biomarker evaluation scheme. NDD biobank was established for future research use of biological specimen. Results RT-QuIC using in-house recPrP conferred 90% (95% confidence interval (CI) 74.4% – 96.5%) agreement with the results from an established RT-QuIC facility whereas the Cohen’s kappa is 0.876 (95%CI 0.871 - 0.882). The sensitivity and specificity when tested on 39 CSF specimens from possible sCJD patients were 0.92 (95%CI 0.67-0.99) and 1.00 (95%CI 0.87-1.00) respectively. RT-QuIC using in-house rec-humα-syn was positive in 1 out of 6 positive controls and negative in all 5 negative control specimens. The optimal plasma p-tau181 cutoff for diagnosing AD (2.46 pg/mL) were derived from 29 individuals with known AD status. Using this cutoff, the sensitivity, specificity and accuracy of plasma p-tau181 were 0.80 (95%CI 0.64-0.90), 0.75 (95%CI 0.51-0.90) and 0.78 (95%CI 0.65-0.88), respectively, when tested prospectively on 51 amnestic MCI participants. The study had enrolled 6 iNPH participants to undergo the multimodal biomarker evaluation scheme. The NDD biobank is currently fully functional with 902 plasma specimens and 251 other types of specimens from 838 individuals and are operating according to consensus biobanking standard. Conclusion This research project focuses on developing accurate and assessable fluid biomarkers for ND including prion diseases, synucleinopathies, AD etc. Its second year had completed with substantial success. RT-QuIC for prion disease achieved near-perfect agreement with establish laboratory and equal diagnostic performance. Plasma p-tau SIMOA were completely evaluated in real-life settings and is considerably accurate. The results of other tests and biomarkers are underway.


Objective: To review the literatures and lessons learnt from foreign countries in implementing a comprehensive psychiatric service system, and preliminarily assessing the feasibility of comprehensive psychiatric service system in Thailand. Methods: Searching for literatures, policy documents, research related to the keyword “comprehensive psychiatric service system” for the provision of comprehensive psychiatric services in various countries over the past 5 years were 127 copies, then reviewed and selected based on objectives, leaving final to be reviewed 29 documents. Result: Comprehensive psychiatric service system is a collaboration between policy makers and budget health agencies, as well as personnel specialists in psychiatry, relevant network partners, people involved in community mental health, and including participation of psychiatric patients and relatives. This study presents examples of policy implementation and guidelines for organizing a comprehensive psychiatric service system in various countries, where considered as a recognized prototype such as Australia, United Kingdom, Canada, etc. The situation of psychiatric service system in the Thai context, which still encountered obstacles to development both at the national policy level that should focus on transition to human rights-based approach following the international guidelines, including manpower problems, mental health / psychiatric personnel knowledge and understanding of mental health/psychiatry among health personnel. The policy gap also found on linking systems between psychiatric service units in various affiliations and transferring policies into practice Including participation in policy formulation of stakeholders at each level. Summary: The development of comprehensive psychiatric service system emphasis on developing the potential of public health personnel and related agencies in caring for people with mental/psychiatric problems. Together with the development of the community's potential (including school and workplace) to care for and rehabilitate people with mental/psychiatric problems so that they can live life to the fullest possible.


In Thailand, the devolution of subdistrict health promoting hospitals to provincial administrative organizations (PAOs) depends on the readiness and willingness of each PAO. In Fiscal Year 2022, six PAOs took full responsibility of all the subdistrict health promoting hospitals in their provincial areas: Khon Kaen PAO, Nongbua Lumphu PAO, Mukdahan PAO, Prachinburi PAO, Roi-et PAO, and Suphanburi PAO. This study sought to develop a model of primary care for the PAOs that possess limited revenue streams and have agreed to take charge of all the subdistrict health promoting hospitals. A strategic framework for citizen engagement and intersectoral collaboration in primary care was also formulated for these PAOs. The research instruments used in this study included focus group discussions, in-depth interviews with primary care experts and local government scholars, workshops, and a survey of subdistrict health promoting hospital personnel and health volunteers in Prachinburi and Suphanburi provinces. Based on the research findings, Prachinburi province has more administrative capacity and social capital than Suphanburi province. Administrative capacity and social capital enabled the Prachinburi PAO to manage the transition period much more effectively. The Prachinburi PAO executives and leaders in the provincial health system followed the “shared leadership” style, while their counterparts in the Suphanburi province used the “paralleled leadership” style. Also, the PAO and provincial health authority in Prachinburi had a more robust working relationship prior to the devolution of subdistrict health promoting hospitals. When we used the “six building blocks” concept and the “ten building blocks of a high-performing primary care” concept to assess the two PAOs’ readiness to run their primary care systems, we found that the Prachinburi PAO performed better than the Suphanburi PAO in terms of service plans, personnel, medicine, information system, financial resources, and leadership and governance. In the end, we developed a model of primary care, which consists of the primary care management unit within the PAO Public Health Department, as well as three alternative models of primary care operations at the sub-provincial level. In addition, policy recommendations for other PAOs, the Ministry of Public Health, the Decentralization Commission, and the Department of Local Administration Promotion were offered.


Cause of death statistical information is important for health planning. The information enables policy planners to understand the medical nature of fatal health problems of the country. Priority can be set based on the information, which can also be baseline for evaluation of various health programs. However, in Thailand, the standard of death registry is still poor. My deaths took place outside the hospital and registered by non-medical personnel. The information is therefore not accurate enough for planning. In 2019, in order to solve this problem, a research team from the International Health Policy Program (IHPP) did a survey on causes of deaths using so-called ‘verbal autopsy’ method. After the data were analyzed, IHPP invited relevant experts to review the report. Tuberculosis (TB) was reported to be the 10th cause of death in male and 17th cause of death in female population. These figures indicated that TB is still a very important health problem. However, the above findings are in contrast with reports from the National TB registry, which show that TB notification rate is rapidly and steadily declining. To solve this problem of inconsistency, our research team carried out the current study with the following objectives: 1. The primary objective is to review the records of the verbal autopsy of the so-called TB deaths in order to check the accuracy of the reports 2. The subsidiary objectives include to assess clinical cause of these deaths Our research team were kindly supported by the IHPP team who provided the verbal autopsy data Our team consist of the following experts: (1) Senior Medical Epidemiologist who conceptualized and designed the study. (2) Senior Infectious Disease Expert (3) National Senior Expert on Tuberculosis (4) Statistician Experts No (2) and No (3) initially independently reviewed the data, write their comments and finally scored how much they agreed with the verbal autopsy reports. The score could be one of these 5 levels 1 Not agree 2 Somewhat disagree 3 Indecisive 4 Somewhat agree
5 Agree Out of 198 records provided by IHPP, the 63 duplicated records were removed, leaving 135 unique records. Frequency of the 1, 2, 3, 4 and 5 scores given by the National TB expert were 10, 12, 94, 11 and 8 Frequency of the 1, 2, 3, 4 and 5 scores given by the Infectious Disease expert were 14, 7, 21, 21 and 72. Weighted kappa statistic = 0.226, indicating fair agreement between the two experts. There were 3 types of weighting scheme were applied. The unweighted, linear weighted and quadratic weighted kappa statistic were 0.86, 0.141 and 0.226 respectively, which can be concluded as relatively low. In conclusion, the revision of history of cause died from TB in the verbal autopsy result got inconsistent rate of likelihood from two independent experts. The findings suggest the need to improve such data in the future.


Mycophenolic acid (MPA) is an immunosuppressant medication used to prevent rejection following organ transplantation and is under investigation for its efficacy against osteosarcoma. We investigated the genetic variability of whole-exome sequencing (WES) data from 15 osteosarcoma patients who receive mycophenolate mofetil (MMF), a prodrug of MPA. Using whole-exome sequencing (WES), we found 48 variants from the 15 genes which are related to MPA and its metabolite (MPAG) metabolism. Three variants were found to significantly correlate with the pharmacokinetic parameters of MPA after single-dose MMF administration including SLCO1B3 (rs4149117, T>G), SLCO1B1 (rs2306283, A>G) and ABCG2 (rs2231142, G>T). Moreover, five variants were found to significantly correlate with the pharmacokinetic parameters of MPA after multiple doses of MMF administration (at steady state) including SLCO2B1 (rs2306168, C>T), ABCG2 (rs2231137, C>T), UGT1A8 (rs3755323, T>C), UGT1A8 (rs3755321, T>C) and UGT1A8 (rs4148323, G>A). All of these variants are missense mutations. In addition, in this study, we could build the population pharmacokinetic models for MPA in Thai osteosarcoma patients and healthy volunteers, which include genetic covariates. It was found that the pharmacokinetics of MPA in both populations can be described by a two-compartment pharmacokinetic model with 1st order drug elimination. Furthermore, the addition of the absorption lag time in the model for drug absorption following multiple doses of MMF (steady state) could significantly reduce the objective function value. Based on the population pharmacokinetic study, genetic factors affecting the pharmacokinetic parameters of MPA have not been identified. Based on the results of this population pharmacokinetic study, the pharmacokinetic parameters of MPA are different between healthy volunteers and osteosarcoma patients. Osteosarcoma patients had lower CL/F and Vc/F of MPA compared to healthy volunteers. Moreover, in osteosarcoma patients, it was also found that MPA pharmacokinetic parameters differed between post-administration of MMF in a single dose and multiple doses (steady state). After a single dose of MMF administration, the CL/F and Vc/F of MPA were approximately 2-fold and 1.4-fold higher than after multiple doses of MMF administration (steady state), respectively.


Transfer of Health Mission is an additional aspect of the decentralization process of power to local government organizations in the field of public health. The research project, which proposes policies to promote the transfer of rural health promotion hospitals to provincial administrative organizations, is based on lessons learned from the transfer of schools. The objectives of the research are: 1) to study the experiences of personnel and extract lessons from schools managed locally to apply to the transfer of rural health promotion hospitals to provincial administrative organizations; 2) to study the transfer of rural health promotion hospitals to provincial administrative organizations in terms of organizational structure, personnel, finance, management, basic health service data, and primary healthcare mission; and 3) to synthesize policy proposals for promoting a systemic relationship in the transfer of rural health promotion hospitals to provincial administrative organizations. The research employs qualitative methods by collecting data from educational personnel (116 participants) and healthcare personnel (89 participants) in four provinces, namely Roi Et, Khon Kaen, Maha Sarakham, and Kalasin. The data is collected through interviews, focus group discussions, operational meetings, and participatory observations conducted from September 2022 to February 2023. Part 1 : Lessons Learned from Schools under Local Management The research found that the transfer of educational institutes to local management had a positive impact on educational management, manpower, budget, organizational media knowledge of information systems, leadership, and good governance. The lessons learned are: 1) Formulating educational policies and guidelines for educational institutions to achieve quality, emphasizing the concept of School-Based Management for Local Development (SBMLD) that provides research-based education and develops it into the context and culture of the area. 2) Developing personnel potential and providing adequate personnel. 3) Receiving a budget to support the development of learning management and special projects. 4) System development of information systems. 5) Building confidence in the leader and establishing good governance. Part 2 : Transfer of Sub-district Health Promoting Hospitals to Provincial Administrative Organizations. The research found that the transfer of sub-district health promoting hospitals in four provinces amounted to 656 transfers out of a total of 808 locations. The study shows that the transfer process needs to focus on service systems, manpower management, budget allocation, knowledge media, information systems, and leadership and good governance. The proposed guidelines are: 1) A framework for providing health services to the public that is consistent with the original affiliation so that the transferred hospitals can provide services according to the original guidelines. 2) Prepare a recruitment or recruitment plan for public health personnel to support the transfer. Provide information on the advantages and limitations of transferring to the Provincial Administrative Organization. During the initial transfer of PAOs, they should provide manpower support to areas lacking manpower until PAOs are sustainable. Part 3 : Policy Proposals.


The aim of this research was to characterize and evaluate the innovative effects of the Thai herbal extract, Andrographolide (AG), on the human suprapatellar fat pad (SPFP) in the osteoarthritis (OA) patients and also develop and optimize the formulation of AG using Poly Lactic-co-Glycolic Acid (PLGA) nanocarriers and gelatin-based hydrogel. Suprapatellar fat pad adipose-derived stem cells (SPFP-ASCs) were isolated by enzymatic digestion, cultured and analyzed by light microscopy to observe morphology and growtAh. The cells treated with AG or without AG were characterized in vitro by immunophenotype, gene expression, and ability to differentiate into multilineage potential to be further differentiated into the osteogenic, adipogenic and chondrogenic cells under the appropriate inductions. The medium SPFP-MSCs cells showed uniform morphology and good proliferation. They expressed CD29, CD73, and CD105 but were negative for CD34 and CD45. Multilineage potential became positive for Alizarin Red S, Oil Red O, Toluidine Blue, and Alcian Blue staining while the effect of AG revealed that AG had no cytotoxic effects when the concentration was less than 12.5 μg/mL. Interestingly, AG had significantly enhanced osteogenesis and chondrogenesis as evidenced by a the significantly intensified stain for Alizarin Red S, Toluidine Blue and Alcian Blue. Moreover, AG can upregulate the expression of genes related to osteogenic and chondrogenic differentiation, including Runt-related transcription factor 2 (Runx2), Osteopontin (OPN), SRYBox Transcription Factor 9 (Sox9), and Aggrecan. In contrast, AG suppressed adipogenic differentiation as evidenced by significantly diminished Oil Red O staining and the expression levels for adipogenic-specific genes for Peroxisome Proliferator-Activated Receptor gamma 2 (PPAR-γ2) and Lipoprotein lipase (LPL). For these therapeutic properties, AG was successfully prepared the nanoparticles by the single emulsion solvent evaporation method and incorporated with gelatin-based hydrogel. The results of in vitro release patterns showed that the AG significantly delayed the AG release more than 1 month when combined with gelatinbased hydrogel and successfully displayed a long term sustained release almost 2 months for implantation and over 2 months for injection providing a novel strategy for the local management of osteoarthritis disease. Therefore, AG has great potential as the therapeutic agent derived from natural sources for regenerative medicine. Furthermore, this research aims to develop a pharmacokinetic model of an intra-articular drug delivery system for predicting drug concentrations targeted to mesenchyme stem cells. Using ADMET PredictorTM program, the physical and chemical properties of AG were predicted from the chemical structure. Then we develop and test a model of the formulation when injected into the knee joint. By using GastroPlus® 9.8.2 program and using the formulation as 0.1, 1, 5, and 10 mg solution, the amount of AG was predicted at the synovial fluid, plasma, cartilage, intimal, subintimal and lymph node. The amount of AG in different layers is the dosage of the AG that can be completely dissolved since the drug is injected into the knee joint as a clear liquid formulation. And from the prediction, it was found that there was no precipitation. The elimination of AG in rats, normal humans, and humans with rheumatoid arthritis is a first-order reaction. The elimination of AG in rats is the slowest when comparing with that in normal humans and humans with rheumatoid arthritis. In normal humans, AG can be eliminated better than in humans with rheumatoid arthritis so elimination time of AG in normal humans is shorter than humans with rheumatoid arthritis. Moreover, it was predicted that approximate 30% of the AG in the synovial fluid is in free form and the AG was not able to enter the lymph node. Since this study has not yet developed a model of AG as a delivery system that may also be able to enter the lymph node. In addition, for delivery system, AG can be specifically targeted to the MSCs located at the knee joint. Unlike conventional AG small molecule drugs, the pharmacokinetics of AG delivery system can be simulated using the theory of Target-mediated drug disposition (TMDD) model. We have successfully developed this model using Berkeley Madonna program as well in this study.


Background: The global rise in non-communicable diseases (NCDs), particularly type 2 diabetes, is a major concern. Existing literature highlights the effectiveness of non-pharmaceutical interventions, such as weight reduction, in reducing the risk of diabetes among pre-diabetic individuals. Grounded in the integrated people-centered care concept and recent behavior change theories, researchers developed a peer-coaching program led by health professionals. Methods: The program was implemented across primary care settings in four districts, representing four regions of Thailand. A total of 423 pre-diabetic patients were enrolled in the experimental group, while 443 were assigned to the control group. Participants in the experimental group engaged in five behavior change activities. To evaluate the program's effectiveness, BMI, waist circumference, blood pressure, health behaviors, and blood glucose levels were measured pre- and post-activity. Satisfaction and perspectives were collected from healthcare professionals and patients using quantitative and qualitative methods. Program delivery costs were assessed, and a cost-benefit analysis was conducted. Results: A 97.2% attendance rate was recorded for the experimental group, who demonstrated statistically significant reductions in BMI, waist circumference, blood glucose levels, and diabetes risk scores compared to the control group. The 10-year diabetes risk score for the experimental group decreased by 12.65% after attending the program. The benefit-cost ratio was 2.96, indicating the program's value. High satisfaction levels were reported among both healthcare professionals and patients. Discussion and conclusion: The behavior change program designed for pre-diabetic patients, emphasizing people-centered care and modern behavior change concepts, proved effective and worthwhile for primary care settings. After minor revisions, the diabetes prevention program package should be included in benefit package of Thailand health insurance schemes to promote its widespread adoption and utilization.


The objective of this study is to examine access to and obstacles in accessing health promotion and disease prevention services in health-promoting hospitals Sub-district transferred to the Provincial Administrative Organization (PAO), Kamphaeng Phet Province. The data was collected through in-depth interviews, questionnaires, and group discussions. The participants were selected based on specific criteria through in-depth interviews and group discussions with service providers, recipients, and stakeholders, totaling 70 people. The questionnaire was distributed to 418 service recipients. Content analysis and statistical analysis were used to analyze the data. The study found that during the transfer of the Sub-district Health Promoting Hospitals to the provincial administration in Kamphaeng Phet, the primary healthcare services provided to socially isolated elderly people through the hospital network remained unchanged. For example, community hospital or hospital network continued to provide support in terms of medicine, medical supplies, and medical equipment to the health center just as before the transfer. However, there were still some obstacles to service delivery, including 1) Insufficient personnel for service delivery, particularly in cases where health centers did not have enough staff to support the transfer or did not meet the required staffing levels. 2) No family medicine physicians were available to provide services at health centers as required by law. 3) Delayed and restricted budget allocation for supporting health centers. 4) Personnel were concerned about compliance with the Ministry of Public Health regulations. 5) Village health volunteers were concerned about work practices. 6) Communication of information was not comprehensive. 7) In the long term, community hospital or hospital network may not be able to allocate resources (people, money, materials) to health centers outside its jurisdiction. On the patient side, the study found that patients without transportation or who worked on a daily basis were unable to access services/activities. In addition, it has been found that the public places importance on promoting health and preventing diseases. According to a survey of factors influencing the decision to use basic healthcare services among socially isolated elderly people in Kamphaeng Phet province, they generally expressed a high level of satisfaction with the basic healthcare services, at 67.7%. They also had a high level of interest in overall activities, at 51.9%, with the top five activities they wanted organized being group exercise, elderly schools, elderly clubs, vocational training for the elderly, and monthly meetings to reduce stress among the elderly. Furthermore, the majority of the elderly people believed that if the health-promoting hospitals Sub-district transferred to the PAO, the quality of service would improve, at 72.8%. This is because it would be a change in management and service delivery to a larger organization that would be better able to manage budget, personnel, vehicles, and equipment to provide better service. The desired activities after the transfer, ranked in order of importance, were having a resident physician at the public hospital, having exercise/health promotion activities for the elderly while waiting for medication, and having more staff available at the public hospital. The results of this study will be useful for guiding service provision in the context of health-promoting hospitals Sub-district under the PAO that are responsive to the needs of the population, comprehensive, and integrated, which will improve the quality of life of the people.


Background: There is a growing variety of pharmacogenetic tests that can be used to predict how someone would respond to different drugs. This will result in increased health care costs, compared to standard treatment without pre-treatment pharmacogenetic testing. However, healthcare resource and budget are limited. Consequently, it is important to prioritize pharmacogenetic testing and select pharmacogenetic testing in Thailand in order to be suitable to the Thai context and can be used for economic evaluation in the future. Objectives: This study aimed to prioritize and select pharmacogenetic testing in Thailand, perform economic evolution of selected pharmacogenetic testing, and 3) evaluate budget impact of pharmacogenomics testing, if included in the benefit package under the Universal Health Coverage (UHC). Methods: Prioritization and selection method for drug-related pharmacogenetic tests (gene-drug pairs) that are important in the Thai population were used to select pharmacogenetic testing for evaluating their cost-effectiveness through reviewing the literatures and recommendations from pharmacogenetic experts to be used as scoring criteria and selection. Apart from this, the cost-utility and budget impact analyses of HLA-B*13:01 testing before initiation of co-trimoxazole treatment to prevent DRESS and dapsone treatment to avoid SCAR compared to no testing were undertaken using a decision tree and Markov model. Results: From the prioritization of gene-drug pairs according to the prioritization criteria, in HLAs group, it was found that gene-drug HLA-B*15:02–phenytoin, HLA-B*57:01-abacavir, HLA-B*13:01-co-trimoxazole and HLA-B*13:01-dapsone should be considered for economic evaluation in Thailand. In non-HLA group, gene-drug CYP2B6- efavirenz, SLCO1B1-simvastatin และ NAT2-ethambutol, isoniazid, pyrazinamide, rifampin should be selected as a candidate for economic evaluation in Thailand. Results of economic evaluation showed that HLA-B*13:01 testing before initiation of co-trimoxazole treatment to prevent DRESS and dapsone treatment to avoid SCAR was not cost-effective, compared with the group without pharmacogenetic testing. The provision of HLA-B*13:01 testing resulted in the budget impact of 2,246,000 baht per year. Conclusions: The results of the study of the prioritization of gene-drug pairs can be used to consider the selection of gene-drug pairs for future economic evaluation in Thailand. HLA-B*13:01 testing prior to initiation of co-trimoxazole and dapsone was not cost-effective and therefore is not proposed to be included in the UHC Benefit Package.


This participatory action research study aimed to investigate the telehealth technology needs and situation in community health service centers in remote areas (Suksala) of Nan Province, Thailand. The study had two objectives: 1) to explore the situation and needs of telehealth technology in Suksala networks, consisting of nine locations in remote areas of Nan Province, and 2) to design and test a telehealth technology system for community health service centers in the study areas. The study was conducted from October 2022 to April 2023, and involved five practical steps such as diagnosing, action plan, taking action, evaluation, and specifying learning stage. The research employed both qualitative and quantitative data analysis. The study revealed that the telehealth service readiness in the study area had five components, including hardware, software, peopleware, database, and internet network system. The study found that access to quality and stable internet signals was crucial for the effectiveness of telehealth services. Moreover, the study identified the development of a service model for remote clinics, managed in the form of a district-level service network in four districts, Bo Kluea, Chaloem Phrakiat, Pua, and Mueang Nan, of Nan Province, with an appointed board. The service model had eight steps of service management involving multidisciplinary participation from three levels of service facilities, including Suksalas, tambon health promotion hospitals, and community hospitals. The service targeted 14 groups. The telehealth service was trialed for three months, from January to March 2023, with a total of 39 people receiving the service, representing 4.82 percent of those who received normal services. The trial service included appointment-based services and was offered both at Suksalas (74.36%) and through home visit services (25.64%). The study found that receiving services at Suksalas could reduce the average overall cost per person per time of traveling to receive treatment at public health hospitals or the Area-based Health Care System for patients and caregivers, accounting for 95.95-98.61 percent of the indirect costs and non-medical costs. The study provided suggestions for the project to ensure the continuity of telehealth services in the future. The suggestions included developing additional telehealth technology potential for staff and networks in the community, solving the problem of infrastructure readiness through joint management plans between government networks, local government organizations, and private organizations, and applying the telehealth system to provide health promotion services for problematic areas such as child development, maternal and child health, and the disabled. The study also provided policy recommendations, such as creating a central platform for providing telehealth services on a cloud database that can connect to patient record systems of all levels of service facilities, reducing redundant work, and providing a system that can be connected to the e-Claim program system to request expenses for public health services in case of remote health service fees according to the criteria of the National Health Security Office.


Background COVID-19 rapidly spread in the middle of 2021 lead to health system crisis in Bangkok, high occupancy of hospital beds; hence, Home Isolation (HI) policy was announced by the department of health, July 1st, 2021, although home isolation services provisions were limited to hospital facility. COVID-19 infection rate rapidly progresses with Delta strain and leading to health system crisis in Bangkok. The Royal College of Family Physicians of Thailand together with the GP/FP Association of Thailand agreed upon stepping in appointing a committee on July 7th, 2021, to help resolving the situation, building capacity for primary health care via three key strategies. The first strategy is to provide academic support, adjusting home isolation guideline to be more holistic, following family medicine principle, comprehensively covered all dimension of services need for the patient, family and community. Apart from this, continuous learning environment was developed via case study learning and sharing platform as well as providing relevant learning materials to build capacity of providers in primary care setting. The second strategy is to mobilize resources, recruiting health professionals for volunteering services, providing care for COVID-19 patients in Bangkok who need to get access to medical services under home isolation services package via telemedicine. To leverage maximal resource utilization, home isolation services provision via private primary care providers are essential. Hence, co-ordination was used as the third key strategy to enable services provision in primary care. In enabling primary care providers to provide services, co-ordination was used as the third key strategy. Coordinate with stake holders at various levels to enable service provision in primary care practice, including National Health Security Office, Institute of HIV Research and Innovation and Community Based Organizations, working in the community with increased number of case, and National Science and Technology Development Agency, the developer of AMED-Telehealth program, in order to establish COVID-19 Primary Care hub as one of key mechanism to solve health system crisis. This implementation research as objects to 1) analyze the key factors for success and barriers for the implementation 2) evaluate the result from the implementation and services outcome and 3) to synthesis policy recommendation in order to response to New Emerging diseases in the future. Methods This mixed-method study was conducted between February 2022 to March 2023. Consolidated Framework for Implementation Research was used to evaluate the implementation process and used Conceptual Model of Implementation Research was used to assess the implementation output and outcome. Both quantitative and qualitative information were collected from various sources of information including document used in the implementation process, focus group interview and in-depth interview, data from patient’s experience survey conducted by Health Accreditation Institute between 7-9 September 2021. Data recorded in AMED-telehealth was also used for the analysis of the implementation outcome and services outcome. Results The implementation of COVID-19 Primary Care Hub to strengthen the capacity of primary health care in Bangkok achieved to improve access to services. Two-thousand three hundred and forty health professionals recruited to Fammed-CoCare Volunteering network and work with Pribta-Tangerine clinic, by IHRI, of these 1,544 were physicians. From July 1st to December 31st. 2021, 90,816 patients with COVID-19 received home isolation in the record of AMED-Telehealth, of these, 18,592 received treatment from Fammed-CoCare-Tangerine Clinic. There were 26 private primary care clinics, under the brand wam community clinic, agreed upon working in collaboration with COVID-19 Primary Care Hub, to receive academic support, consultation with specialist and coordination to receive needed medical supply as well as referral coordination, and 5, 285 patients received home isolation care from these 26 clinics. Overall, there were 24,237 patients with COVID-19, received services under the support of COVID-19 Primary care hub. There were 190 warm community clinics joining the program to provide home isolation, and 21,966 patients received home isolation services from these clinics. There were 68 health centers by Bangkok Metropolitan Area (BMA), considered as pubic primary care services, providing home isolation services and 35,218 patients received from these public primary care facilities. Home isolation services were eventually provided by primary care providers since the coordination of the committee to work on Strengthening Primary health Care System in Bangkok. This committee achieved to communicate with NHSO, Department of Health and the Department of Services Support, enabling home isolation services being provided at primary care service facility, through the correction of regulations that were set as barrier. Home isolation services provided by primary care provider achieved to reduce the gap of inequity, with resource mobilization, strengthening the capacity of service provision in primary care, enable critical care services, and care for patients with severe illness who need hospitalization but could not get access to. Key factors for success include the characteristic of COVID-19 primary care hub that is relevant to the established primary care infrastructure in Bangkok, in which warm community clinics play important roles, although there was challenges in the beginning as the clinic staff needs preparation and there was shortage of medical supplies during that period. Academic Support and capacity building for staff in primary care settings as well as consultations and making needed medical supply available help in building confidence the capacity for service provision. Coordination with community-based organization, community leaders and volunteers in the community has key role in providing support and coordination for the vulnerable. Most importantly, financing and re-imbursement mechanism is the most important factors for the success in the implementation of home isolation services. Health System crisis has drive private sectors and people in the society to step in and provide support inorder to overcome the challenging situation, having insufficient human resources for home isolation in Bangkok. The working culture and value that prioritize integration, patient centered approach, putting patients, family and community at the central role of services enable harmonize collaboration, working towards a common goal to reduce inequity, of people working in the field of primary health care, achieved to have demonstrated model for integrated services delivery. Horizontal integration is the key function in the process of this implementation activity which allows public-private and people partnership. Conclusion Investment and resource management in order to have sufficient primary health care staff providing services at primary care level is essential. In addition to this, Continuous learning mechanisms to enable capacity building through routine workflow is important to strengthen primary care capacity, considered as leverage point to enable integrated high quality primary care services. Telehealth has a crucial role in primary health care strengthening, especially in the situation of an epidemic or pandemic, preventing the spreading of infection. Community leaders and community-based organizations are sensitive to changes or unusual situation that occurs in community and have crucial role in coordinating needed support to the vulnerable.


The prevalence of substance use among adolescents has been increasing and found in lower age, twelve years. It creates impacts on their health and future lives, as well as society at large. In Thailand, although there are laws and policies that supportive for problems solving but the implementation has been rather inefficient. Petchaboon province has actively put these policies into practice using integrative and collaborative concepts among all stakeholders since 2015. A community-based approach has been used particularly with school settings. However, it cannot mitigate the problems in terms of magnitude and access to treatment and rehabilitation services. This study aimed at developing a comprehensive treatment and rehabilitation model of adolescents’ drug and substance abuse at a provincial level which enhances access to care and improves retention until outcomes achievement. Community-based participatory action research approach was employed using both qualitative and quantitative data. The review of related literature and policy context, as well as an analysis of situation about drug use and access to treatment and rehabilitation of school adolescents in Petchaboon province were conducted. The participatory action case studies of community-based model were done in nine subdistrict units (Tumbol) and four school-based sites. All action sites were under supervised by the Family Medicine Unit of Petchaboon hospital. It was found that both community-based and school-based comprehensive treatment and rehabilitation model for school adolescents who use drug could be codesigned and operated by using interventions included a Low-intensity Cognitive behavioral therapy, (Li-CBT) and Motivational Interviewing (MI). The mechanism of changes at individual level could be explained while at a system level might need for further study in term of improving access and retention. It also suggested that school-based psychosocial therapy model would be an opportunity to bring in school students to actively participate as peers.


Background: Alzheimer’s disease (AD) is the most common cause of dementia worldwide. Despite the publication of numerous systematic reviews and meta-analyses that have summarized the evidence associated with pharmacotherapies (PTs) and non-pharmacotherapies (NPTs) for the wide range of interventions available for AD treatment, the implementation of PTs and NPTs in the real-world practice is limited. Due to PTs have frequent adverse reactions causing poor drug adherence and NPTs have various approaches which result in difficult to get accessed by the AD patients. Additionally, their comparative safety and efficacy remains insufficiently defined. Methods: The systematic reviews of randomized controlled trials (RCTs) and meta-analysis (MA) is identified through PubMed and Scopus from March 2021 to December 2022. The RCTs are selected according to the following criteria: conducted in elderly patients aged 60 years or older with AD living in community or institutionalized settings, applied pairwise meta-analysis (PMA) or network meta-analysis (NMA) approaches providing pooled relative treatment effects for at least one pair of PTs or NPTs, and providing at least one of the following outcomes for patients/caregivers: cognitive, functional status, behavior, quality of life and caregiver stress or burden. We used Revised Cochrane Risk-of-bias tool for Randomized Trials (RoB2) to assess quality and risk of bias in all articles by two dependent reviewers. The two stage NMA is performed and relative treatment effects e.g. standardized mean differences (SMD), unstandardized mean differences (UMD), odd ratios (OR) or relative risks (RR) and variance will be estimated for individual RCTs and pooled across RCTs using STATA 17 Results: Of 2,060 citations of systematic review and MA screened, 282 studies (37,399 people with AD) were included. In the NMA of PTs, PTs+NPTs (122 studies; 26,977 people with AD) found that donepezil+cognitive training (CT) Mini-mental state Examination (MMSE): mean differences (MD) = 5.56 [95% confidence interval (CI) = 4.05, 7.06], Huperzine-A (4.00, 95% CI =1.48, 6.52), Memantine+huperzine (2.58, 95%CI = 1.24, 3.92) improved cognition more than placebo. NMA also found rivastigmine+cognitive stimulation (CS) Neuropsychiatric inventory: MD = -11.54 (95%CI = -18.70, -4.37), Gingo biloba extract (Egb761) (-7.36, 95%CI = -10.64, -4.08), donepezil+memantine (-4.86, 95%CI = -9.42, -0.29) improved behavior more than placebo. The combination of PTs and NPTs; Rivastigmine+CS (MD = 0.92, 95%CI 0.39, 1.44) were also significant interventions that improve functional status (ADL) more than placebo. Regarding to the NMA of NPTs (160 studies; 10,422 people with AD) found that non-invasive brain stimulation (MMSE: MD= 2.45, 95%CI = 1.04, 3.86), CT (1.89, 95%CI = 1.00, 2.78), exercise (1.77, 95%CI = 0.44, 3.10) improved cognition more than usual care. In addition, exercise was associated with functional outcome improvement (0.93, 95%CI = 0.18, 1.68), reducing behavioral problems (-4.52, 95%CI = -8.37, 0.67), and caregiver stress (SMD = -0.69, 95% = -1.28, -0.09) comparing to usual care. NMA of NPTs also discovered that occupational therapy (OT) is the most efficacious to reduce behavior problems (MD = -11.04, 95%CI = -18.82, -3.25) and improve the quality of life (QOL) in AD patients (SMD = 1.00, 95%CI = 0.41, 1.59). Conclusion: In this systematic review and NMA, pharmacotherapies combined with non-pharmacotherapies were found to be most efficacious for improving cognition, functional status and reducing behavior problems in people with AD. The policy makers can support AD patients, caregivers and clinicians in developing health services that enable implementation of NPTs such as exercise, occupational therapy, cognitive training, and cognitive stimulation.


We conducted a test negative case control study to assess the Vaccine Effectiveness (VE) of various vaccine regimens for preventing COVID-19 infection and its severity during the period when Omicron was the dominant causative virus in Thailand. All 8,600 individuals, aged ≥5 years, at risk for COVID-19 (Patient Under Investigation, PUI) who presented for nasopharyngeal real time polymerase chain reaction (RT-PCR) testing were prospectively enrolled at Thammasat University hospital during January to June 2022. There were 3,546 cases who were infected. For preventing omicron variant associated infections, the VE increased along with the increase in the number of vaccine dose and the four dose regimen (2 boosters) had the highest but only moderate VE. For preventing severity, the three and four dose regimens (1 and 2 boosters) had comparable high VE and their effectiveness was more durable than the two dose regimens. Significant protective factors to prevent infection were vaccine doses, female and healthcare personnel. Significant risk of infection included elderly, at least one chronic morbidity and household infection. Significant risk of severe COVID-19 was incomplete two dose vaccination, at least one chronic morbidity and elderly. Longcovid condition was prevalent after 6 months of COVID-19. It consisted of multi system symptoms. Weakness and neurological symptoms were the most common manifestations. Risk factors of longcovid condition were female, cough symptom at acute infection and severe COVID-19. Based on the study findings, current mass vaccination programs should focus on reducing COVID-19 severity and mandate at least one booster dose after primary series vaccines. The heterologous boosters with viral vector and mRNA vaccines were highly effective and can be used in individuals who had previously received the primary series of inactivated viral vaccine.


Cause of death (COD) data is important as it reflects the health problems of a population. The data can be used to assess and monitor the performance of a health system and develop plans for public health work at the national level. Although the country's death reporting system is covered by the civil registration system, it was found that the quality of COD data reported in the civil registry is still poor, especially of natural deaths outside health facilities which depends on information that the deceased’s relative give to the registrar. A Model development for the improvement of data quality on cause of death: A pilot study on deaths outside health facilities in 12 health regions was developed with a primary objective to improve the quality of COD data for deaths outside health facilities according to the policy of the Office of the Permanent Secretary (OPS), Ministry of Public Health (MOPH) with financial support from the Health Systems Research Institute (HSRI). Secondary objectives were 1) to develop a pilot model for COD data quality improvement for deaths outside health facilities, 2) to develop tools and systems for regular review of COD data by community health personnel, and 3) to expand the operational results of improving the quality of COD data for deaths outside health facilities. The study was a research and development study, by developing and piloting a model for improving the quality of COD data for deaths outside health facilities. It consisted of 2 parts: 1) deaths with medical history within 1 year prior to death; medical records (MR) are reviewed by the hospital’s medical coders to ascertain the correct COD in the data collecting program and 2) deaths without medical history during the same period; a community public health officer conducts a verbal autopsy (VA) via an online tool. The VA tool was adapted from the 2016 WHO VA to be short and appropriate for the Thai context for interviews by community public health officer in hospitals and Tambon (sub-district) health promotion hospitals (THPHs). A Provincial Public Health Office (PHO) was responsible for the operations in the province, both monitoring performance and reporting to their Chief Officer. The study was carried out in 12 pilot provinces, one from each of the 12 health regions across the country, namely Chiang Rai, Sukhothai, Nakhon Sawan, Ang Thong, Suphan Buri, Chanthaburi, Maha Sarakham, Udon Thani, Buriram, Ubon Ratchathani, Surat Thani and Songkhla. Death data from the Bureau of Registration Administration (BORA) which was sent to the Strategy and Planning Division, OPS, MOPH was used in conjunction with medical information in the Health Data Center (HDC) database from the Information and Communication Technology Center, OPS, MOPH. The 29,410 deaths between January and May 2022 for natural deaths outside health facilities were allocated to the pilot provinces for review. The study operations included development of tools and systems, training, site preparation, implementation, field visits for reflection, and result summarization, and was carried out between October 2021 and February 2023. Quantitative analysis evaluated the performance according to the pilot model, i.e. percentage of goals achieved. Comparative analysis of COD was performed using COD from death certificates and COD obtained from the pilot study model, i.e. accuracy of COD and decreases in percentage of ill-defined cause. Qualitative analysis using information from meetings with relevant parties, in-depth interviews with executives, and focus group discussions with community health personnel including success factors, problems, obstacles, and solutions, to summarize results and make recommendations. Results Data for natural deaths outside health facilities in the 12 pilot provinces between January and May 2022 included 29,410 deaths. Of these, 28,629 deaths, or 97.3%, were successfully synced and had a medical history within one year before death and/or no medical history but an identified primary care unit. Of the synced cases, 43.8% were deaths outside health facilities with a medical history one year prior to death. There were 781 death cases with no identifiable primary care unit because of a lack of medical history in the HDC database and a lack of details in house registration addresses corresponding to responsible primary care units, such as unspecified municipalities but instead specifying roads or alleys, etc. As of January 3, 2023, data showed that pilot provinces had successful operations for up to 74.1% (21,202) of deaths. A total of 90.3 % of deaths with medical history were reviewed by hospital medical coders, for deaths without a medical history, 61.4% of deaths were followed up with an interview of the deceased’s relatives by a community public health officer. Analysis of COD from death certificates and data from the pilot model implementation found that: 1) In the comparison of COD between death certificates and medical records (MR) reviewed by the hospital medical coders. in 11,318 deaths and 2) In the comparison of COD between death certificates and verbal autopsy conducted by community public health officers. in 9,884 deaths. Factors for success, problems, challenges and solutions. and Policy recommendations.


The research in this online mobile platform and deep learning artificial intelligence for oral cancer screening project aims 1) To develop an online platform for collecting clinical images of lesions at may change into oral cancer and oral cancer 2) To develop deep learning artificial intelligence technology for the screening of lesions that may turn into oral cancer and oral cancer from a database of clinical photographs and biopsy results in a developed online platform; and 3) To develop an automated oral cancer screening system for assisting medical personnel in oral cancer screening for oral cancer surveillance in areas lacking specialists using a qualitative research model. The samples were patients at risk of developing oral cancer and medical personnel/dentists/medical students which brings the oral cancer screening application to trial use. The results of this research revealed the development of an online platform for collecting clinical images of lesions that may change into oral cancer and oral cancer. There are 350 images of oral cancer images, 300 images of lesions that may be transformed into oral cancer, and 300 images of lesions that may be transformed into oral cancer, and 300 images of normal tissues in the oral cavity, 350 mouth images (this is the minimum number of images that can be used to create a deep learning model. The number of images will increase in the future according to the use of the developed system, which will make the automatic screening system more accurate), with the entry criteria being intraoral photographs of oral cancer and lesions. Before all oral cancers were confirmed by standard lesion diagnostic methods, namely pathological biopsy and the exclusion criterion was intraoral photograph data without pathological confirmation and incomplete oral photographic data for use as prototype images for the development of automatic screening systems. Development of deep-learning artificial intelligence technology for the screening of lesions that may turn into oral cancer and oral cancer. From a database of clinical photographs and biopsy results in a developed online platform, the analysis process is to mark the location of the lesion from the image (annotate) before analyzing the lesion with a program by a dental specialist in oral surgery. Then, a deep-learning artificial intelligence program was used to classify clinical images of oral cancer and oral precancerous lesions. And development of an automated oral cancer screening system assists medical personnel in oral cancer screening for oral cancer surveillance in areas lacking specialists by medical personnel able to take oral pictures of patients at risk of developing oral cancer with a smartphone. And can choose the picture to send to the server for analysis for preliminary diagnosis including being able to contact experts to consult the analysis results. From the development of mobile online platforms and deep learning artificial intelligence. For oral cancer screening PrimeKG (Precision Medicine Knowledge Graph) has been shown to have the potential to help a new generation of dentists and researchers understand the relationship between risk factors and oral cancer. Deep learning (Deep Learning) to detect oral cancer from pictures taken by smartphones. It has added significant potential to this application for effective diagnostics. A new generation of dentists and researchers can compare their own diagnoses with the results obtained from the model. In addition, the usability and utility of the application was evaluated by 100 subjects, showing good results in increasing the knowledge and diagnostic skills of young dentists and researchers. By evaluation, it was found that the application is highly effective in adding new knowledge and is useful in identifying associations between risk factors and oral cancer.


Background: Digital health governance was identified as an essential foundation for establishing e-health in Thailand by the Ministry of Public Health (MOPH) and World Health Organization (WHO) Thailand since 2010. Despite many health information systems and digital health developments, there is still no consensus amongst stakeholders on national digital health governance mechanism. Objective: This study aimed to identify appropriate digital health governance mechanism for Thailand health systems. Methodology: There were two parts to the study. First, we reviewed literature including digital health governance and health systems from international reports and various digital health governance documents from Malaysia, the Philippines, Australia, England, the USA, and Canada. Second, a qualitative study design was used involving a semi-structured in-depth interview method. Eleven health information technology scholars, executives, and startup entrepreneurs were interviewed face to face or online. Result: The review on digital health governance in the six countries showed the influences of political systems, culture, and health systems leading to diverse implementation models. In-depth interviews employed the governance models of the Broadband Commission 1) the health ministry mechanism, 2) a government-wide digital agency mechanism, and 3) a dedicated digital health agency mechanism. Majority of key informants agreed with the dedicated digital health agency mechanism. More than two-thirds made pertinent suggestions: 1) leaders should be decisive in their decision-making with continuity of leadership, 2) strong collaborations to reduce working in silos, and 3) proper health information standards. Conclusion: In the context of Thailand, the MOPH alone cannot govern digital health. However, the MOPH can lead governance mechanism through collaborating with other ministries and stakeholders. Good collaborative governance is the key to an effective digital health governance system, with decisive leaders and continuity of leadership. The preferred model is the dedicated digital health agency mechanism and health information standards are crucial.


The objective of this research project is to experiment with a public-private partnership model for dental services. Local government organizations coordinate with the area-level health promotion fund to purchase preventive dental care services from private dental clinics to increase access to dental services for children aged 3-6 years in the education area. This is to expand the coverage of dental services provided by the Ministry of Public Health agencies. Prior to the research project, according to the education area data, primary care units in the area were able to provide dental services such as dental check-ups and fluoride varnish to approximately 50% of the population of children aged 0-5 years. This indicates the limitations of the capacity of state agencies in areas with limited resources and the need to care for all age groups, in addition to the COVID-19 pandemic situation in 2021 which halted the provision of dental services from primary care dental units in the area and resulted in a significant decrease in access to dental services for children before school age. Data from a survey showed that during the COVID-19 pandemic, there were children before school age who needed oral health care but did not receive it. The results of the project show opportunities to use dental health resources in the area more efficiently to better care for the dental health of the population. The public-private partnership model can be a way to increase access to dental services for children. The cooperation of various organizations, including local government organizations and private dental clinics, is an important factor in the success of the project. The results of this study have interesting and beneficial issues for the development of policies to improve access to dental services for children in urban areas. There are four main issues: (1) The involvement of local government organizations in providing dental services using budget from the local health promotion fund. (2) Increasing the dental care access for children in urban area via PPP model (3) Using digital information systems for managing oral health services (4) Management of oral health systems at the regional level. Policy notes: To increase access to dental services for the public, especially children in urban areas, developing new service models by coordinating cooperation from local government organizations and utilizing budgets from new sources is an opportunity and challenge for Thailand, particularly in the context of decentralization and the increasing number of private dentists in a situation where the Ministry of Public Health limits funding for dental services. Coordination of dental services by the public health sector, local government organizations, and private dental service providers is a potential model for developing the dental service system in areas that should be supported. This support should involve various relevant sectors as follows: Ministry of Interior/ Ministry of Finance, supporting local government organizations to expand their role in healthcare in the area, amending regulations to facilitate health-related projects. National Health Security Office, providing consultation on the process of using the health fund and supporting the connection of health data. Provincial Health Office, developing the role in policy direction, service performance indicators, coordination, and system management, and supporting academic activities. Dental Council, supporting academic activities, setting standards for preventive dentistry, supporting policy promotion and implementation. The Department of Dental Public Health/General Dentists, supporting raise awareness and knowledge among the public about oral health to develop the behavior of taking care of their oral health.


This study retrospectively investigated the effectiveness of the vaccine in real-life situations. The objective focused on the reduction in deaths of elderly people infected with COVID-19 who received the complete 3-dose COVID-19 vaccine compared to those who did not. Data were collected from the electronic database of the Samut Prakan Provincial Health Office, linked to the Ministry of Public Health’s database on vaccination. Data were collected retrospectively from January 1, 2022 to March 31, 2022. Result: The study found that there were 5,891 COVID-19 elderly individuals resulting in 56 deaths. Of those 2,236 patients who received the complete 3-dose vaccine faced 5 deaths, while 3,655 who did not face 51 deaths; odds ratio of 0.16 (95% CI = 0.06-0.40) or an 84% reduction in mortality (p < 0.001). Conclusion: Elderly individuals who received the complete 3-dose vaccine had a reduced risk of mortality if contracted COVID-19 in real-life situations. Therefore, the results should be disseminated to encourage complete 3-dose COVID-19 vaccine in elderly individuals.


This study aimed to assess the situation of premature mortality due to four noncommunicable diseases (cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases) between 2000-2018 in the Thai population aged 30 to 70 years, and the feasibility of achieving the Sustainable Development Goals (SDGs) of reducing premature death by one-third by 2030. We estimated premature mortality using civil registration and vital statistics (CRVS) from the Bureau of Registration Administration with cause of death coded by the Strategy and Policy Division. Verbal autopsy data were applied to improve accuracy of causes of death from the vital registry. We predicted the premature mortality up to 2030 using Bayesian model averaging (BMA). The findings showed that given the current historical trend, achievement of the SDG target of 9.9% by 2030 was unlikely, as we predicted it to be 12.0% (95%CI, 10.6-3.6). However, this goal is more likely to be achievable in women than men. Among the four NCDs, respiratory diseases are most likely to reach the target.


A monitoring system of food and beverage marketing plays a crucial role in tracking progress in the marketing of food industry particularly the marketing of unhealthy food and beverage. The objective of this study was to review the existing monitoring system of food and beverage marketing in Thailand and foreign countries, and to analyze the gaps and opportunities for improving the monitoring system of food and beverage marketing in Thailand. Document review and in-depth interviews with the stakeholders were conducted. Searches were performed through PubMed, Google Scholar, websites of international organizations (such as UNICEF) and relevant organizations in Thailand, selected country databases such as Chile, Republic of Korea, and Australia from 2007 to 2021-timeframe. Purposive sampling was used to identify key informants from government agencies, academia, and civil societies for interviews. Content analysis by using the World Health Organization’s set of recommendations on marketing of foods and non-alcoholic beverages to children was performed on the data from stakeholder interviews and document reviews. Results showed that Thailand, Chile, and the Republic of Korea had government agencies responsible for monitoring the marketing of food and beverage. While the governments of Thailand and Chile cooperated with relevant agencies to monitor the marketing of food and beverage, Australia was active in co-regulation between government and private sectors to monitor food and beverage marketing in collaboration with active civil society sector. Key challenges for Thailand included lack of human resource, outcomes monitoring, and progress report on complaint management. Opportunities for improvement included technology utilization, collaboration and information sharing with relevant agencies and civil society.


Currently, there has been an increasing number of psychiatric patients. From 1 in 5 people in the country to have mental health problems, Thailand has 14.3% or 7 million psychiatric patients at risk of mental health crisis with a chance of inflicting self-harm or violent behaviors towards people and surrounding property. The present research aimed to implement a seamless locally integrated emergency medical service system for emergency mental health crisis patients, monitor, evaluate, and provide policy recommendations. The mixed methods research comprised quantitative and qualitative analysis. The sample group is a multidisciplinary stakeholder in the field of “Emergency Medical Service Systems for Locally Integrated Emergency Mental Health Patients”. The research is conducted in 12 provinces distributed across Health Region 1-12 using a purposive sampling. The tool consisted of a knowledge set, risk evaluation survey, warning sign knowledge assessment form, and questions for the group discussion. The data were analyzed with descriptive statistics and content analysis. The results showed that 1,858 risk groups in 12 pilot sub-districts were mostly male (76.7%), aged 21-50 years (71.4%), with a history of intermittent treatment for psychiatric disorders (43.8%). From these 2,099 relatives/caregivers, most had good understanding on “warning symptoms and requests for help for emergency mental health patients”. As for the self-management community system, most pilot areas had working guidelines before, during, and post treatment, especially on organizing a response team to assess and mitigate before external teams enter the scene. This is connected to the local police unit in conjunction with the initial emergency operations to bring the health service system to the appropriate destination hospital. As an outcome, patients with mental health crises have faster and more access to emergency medical services. In addition, there were no reports of injuries to patients, officer or surrounding people as well as being able to extend the results through the service plan of the Mental Health and Substance Abuse. The impact for the expected effects, those at risk of mental health crisis can access the health system quickly and appropriately, reducing complications and preventable dangers. In addition, it is expected that the community become more self-reliant, increase in health literacy in promoting, preventing, and providing basic assistance for mental health crisis situation, as well as having established integrated guidelines for the health service system including prevention, pre-hospital care, in-hospital care and inter-facility transfer seamlessly.


Currently, there is no epidemiological study of diabetes diagnosed before the age of 30 in Thailand. The aim of this study was to determine type of diabetes and clinical characteristics of Thai diabetic patients diagnosed before age 30 years. Six hundred and forty-six patients were enrolled from 31 network hospitals in Thailand between August 2018 to December 2021. Type 1 diabetes was identified in 63.6% of patients, type 2 diabetes in 19.8%, and other specific types of diabetes in 16.6%. For type 1 diabetes patients, the median age at diagnosis was 11 years and presentation with diabetic ketoacidosis (DKA) was common (45%). The average glycated hemoglobin (HbA1c) at diagnosis was 9.9%. For type 2 diabetes patients, the median age at diagnosis was 18 years and the presentation of DKA was 4.7%. The average HbA1c at diagnosis was 10.9%. In conclusion, type 1 diabetes was more common in diabetes diagnosed before age 30 years and DKA was frequent. The prevalence of type 2 diabetes increased with age and HbA1c increased during adolescence. This study can be used as reference and may lead to applicable public health policies related to diagnosis, treatment, and prevention of diabetes in young people in Thailand as well.


At present, it is apparent that the incidence of obesity keeps increasing. It has also been discovered that there is a strong positive correlation between body mass index and the prevalence of chronic diseases. However, there are still many undiagnosed obesity patients. Therefore, the present research aimed to determine the prevalence of obesity in terms of underdiagnosed cases and chronic diseases in all obese patients from the Prince of Songkla University Hospital information system. This study employed a cross-sectional descriptive approach. We gathered data of all outpatients older than 18 years, excluding pregnancy cases. Data collection was taken from the hospital information system between 1 January 2016 and 31 December 2020. From 327,300 patients, a total of 135,112 patients were included in the study and 35.6% of patients met the Asia Pacific criteria for obesity (BMI ≥ 25 km/m2), but only 15.9% of them were given a diagnosis of obesity using Asia. The prevalence of 3 chronic conditions in obese patients was 21.3% for hypertension, 12.3% for type 2 diabetes mellitus, and 32.4% for dyslipidemia. Moreover, 9.5% of patients met the World Health Organization criteria for obesity (BMI ≥ 30 kg/m2), but only 33.5% of them were given a diagnosis of obesity. The prevalence of 3 chronic conditions in obese patients was 16.3% for hypertension, 18.8% for type 2 diabetes mellitus, and 11.3% for dyslipidemia. This present study showed that despite having a BMI exceeding the threshold for obesity, many people are still not given a diagnosis of obesity. Moreover, the prevalence of hypertension, type 2 diabetes mellitus, and dyslipidemia found among obese patients were lower than research in western countries.


Background: Acute kidney injury can occur from many reasons. As a result, the body cannot excrete wastes from the body. In Thailand, the number of acute kidney injury patients accessing renal replacement therapy show a decreasing trend with two potential assumptions: true reduction in the number of patients; or inaccessible to the treatment. There are no measures from relevant agencies to address this problem, in addition to different service systems even in the same service providers. Moreover, the reimbursement for continuous renal replacement therapy (CRRT) does not reflect the actual cost of the service. Objective: The objective of this study was to survey the hospital resources for providing CRRT in Thailand. Methods: The study used data from a document review and secondary data from a previous study in Thailand including distribution of hospitals, medical personnel training information and characteristics of patients receiving services. A questionnaire survey on CRRT services in 280 public and private hospitals registered to the National Health Security System in the fiscal year 2020 was undertaken. Results: The survey revealed that hospitals were capable of providing CRRT services to more patients if the reimbursement to hospital increased to an average of 25,563 baht per patient. Given the appropriate reimbursement rates for CRRT services, 88% of the hospitals could provide services to more number of patients with acute kidney injury in critical periods, leading to greater access to CRRT.


The purpose of this study was to estimate the cost of outpatient care for older patients with a primary diagnosis of hypertension, heart attack, and stroke at community hospitals in Thailand. This cross-sectional study used cost information in 2014 from four community hospitals. The hospital cost information consisted of service data, hospital statistics, and financial reports. We used the International Classification of Diseases (ICD-10), the 10th revision coding system to identify hypertension, heart attack, and stroke. Traditional cost and the cost to charge ratio methods were used to estimate average cost per visit and cost per person-year. Inflation rate was used to report the average cost in 2021. Overall, the major costs were for labor (53%), followed by material (42%), and capital (6%). The unit cost per visit for older outpatients in 2014 was between 447-688 THB for hypertension (531-817 THB in 2021), 634-1,171 THB for heart attack (753-1,392 THB in 2021), and 611-1,238 THB for stroke (726-1,470 THB in 2021). Our cost analysis used actual cost data, which provided useful information for budgetary planning and management for outpatient care among older adults with a primary diagnosis of hypertension, heart attack, and stroke.