Background At present, there are an increase in the proportion of Thai elderly people who are patients with non-communicable diseases (NCDs) including diabetes and hypertension. The patients need holistic care within medical care and non-medical care in order to improve their quality of life. An investigator conducted the model development of primary care services for non-communicable disease patients using an innovative network of homecare providers. The study aimed to determine the quality of life outcome of NCDs patients who received WinCare, and to improve a non-formal health sector for NCDs patients. Methods A non-randomized trial was conducted in 2019-2020. NCDs patients were enrolled to the present study. The participants were divided into 2 groups including (1) Control group and (2) Intervention group (received non-medical care from WinCare). Baseline characteristics comprised of demographic data, blood pressure (BP), body mass index (BMI), and quality of life out come were obtained from face-to-face interview. The intervention group had been received WinCare for 6 months. The quality of life outcome, BMI, and BP were access at month 1, 3 and 6. Results A total of 99 NCDs patients were enrolled in the present study. There were 53 NCDs patients in the intervention group. After 6 months, compared to the quality of life (QOL) outcome of NCDS patients in the control group, the QOL outcome of those in the intervention group was relatively high. Conclusion WinCare are the volunteers who well trained and have a potential for provided non-medical care in the community. An innovative network of homecare providers will enhance the public health system to support the activities of NCDs patients at their home.


The reform of human resources for health (HRH) is an essential component of healthcare reform in having adequate number of HRH to achieve good health of population. Hence, effective HRH planning is one of key elements to have proper number of competent HRH at the right time according to demand in complex and dynamic healthcare shaping from internal factor, such as educational system and labour market dynamic, and external factors, such as technology advancement and vigorous economy. This study employs “system dynamic” approach to demonstrate future healthcare services by extensive participation of related stakeholders, called “group model building” approach then future demand of HRH is developed. 47 health facilities including regional, general and district hospitals in Health region 2 are study sites. This study employs information from primary and secondary data for quantitation part and focus group discussion and in-depth interview for qualitative part. Stella Software is used to demonstrate future model of services. This study emphasizes 5 areas of services, namely eye services, kidney services, general surgery services, services for non-communicable disease and cancer services. For Opthalmological services in the next 10 years, OPD patients will increase to 270,000 visits. Patients with cataract will slightly decrease to 135,000 patients while patients with glaucoma will increase to 108,000 patients. For kidney service, patients with hemodialysis will increase to 4,400 patients while ones with peritoneal dialysis will reach 1,700 patients. Furthermore, chronic kidney disease level 4-5 will increase to 47,000 patients which exceed service capacity in health region 2. For patients with non-communicable disease, patients with hypertension in health region 2 will approach 2 million in the next 10 year while ones with DM will reach 500,000 at the same periods. For general surgery services, non-elective cases will over 40,000 patients whereas elective cases will reach 47,000 patients. Patients with liver cancer will increase. However, mortality rate will decline stemming from early detection and more effective treatment. This study demonstrates that an imbalance of supply of resources to deal with an increase service demand still exists. In summary, to tackle with an increase demand of health services in the future need proper management of health resources. This study demonstrates some effective management, for example an increase staff’s capacity, expands utilization of medical equipment and infrastructures such as operating room and pool-resource including strengthening HR development and training.


OBJECTIVES: The purpose in the first year project was to set up the multicenter registry of patients diagnosed with SCARs in Thailand and to evaluate the diagnostic values of interferon-gamma ELISpot assay (IFN-γ ELISpot) for culprit drug identification compared to skin patch test in selected cases METHODS Patients diagnosed with drug-induced SCAR over a one-year period from 6 university hospitals were analyzed for demographic data, drug allergy phenotypes, and the causative drugs. Skin patch test and IFN-γ ELISpot assay were examined in selected cases for culprit drug identification. RESULTS There were 113 SCAR patients (42 males, 71 females) with the average age of 51.7±1.8 years, comprising of 50 Stevens-Johnson/toxic epidermal necrolysis (SJS/TEN), 46 drug rash with eosinophilia and systemic symptoms (DRESS), and 17 acute generalized exanthematous pustulosis (AGEP), respectively. Drug-specific IFN- γ releasing cells were detectable in 38.9% (44/113) of SCAR cases with the average frequencies of 214.8±52.5 cells/106 peripheral blood mononuclear cells. Among 30 SCAR patients, 6 cases (20% of them) had positive skin patch test while 16 cases (53.3% of them) had positive IFN-γ ELISpot assay. CONCLUSIONS SJS/TEN contributed to almost half of patients with severe cutaneous adverse reaction in Thailand. IFN-γ ELISpot assay helped to identify the culprit drugs in nearly 40% of the cases and yielded higher sensitivity than skin patch testing.


Health care system in an urban community is complicated due to a variety of health care settings. This descriptive research aimed to analyze and synthesize policy recommendation regarding input, process, output, outcome and impact of palliative care system in Chiang Mai city of Chiang Mai province, Thailand. Subjects were patients with terminal illness and their family caregivers, health care team from university hospital, provincial hospital, a hospital of municipality, private hospitals and health promoting hospitals of Chiang Mai city, staff from Chiang Mai municipality and local administrative offices of Chiang Mai city, village health volunteers and key persons in the community of Chiang Mai city, Thailand. Methods of data collection compose of literature review, focus group discussion, in-depth interview, and group meeting. Guided questions for focus group discussion and in-depth interview were developed and tested for validity by experts. Data were summarized and categorized according to the objective the study. Results from analysis showed that: 1. Health workforce was insufficient for palliative care at the community, private, and local unit levels. Health workforce was limited in terms of capability of palliative care management. There was a lack of teamwork among health care personnel and other related personnel. There was no committee overseeing palliative care in private hospitals, sub-district health promoting hospitals, hospitals under local administrative organizations, and community hospitals. 2. There was a system for palliative care service in provincial and university hospitals. Nevertheless, there was no system or model of palliative care in hospitals under local administrative organizations and private hospitals, nor model for palliative care service at a community level. 3. COC link system was used for end-of-life patient referral from provincial hospitals to community hospitals and sub-district health promoting hospitals. However, university hospitals and private hospitals were not connected to such system. 4. Medical equipment and supplies, as well as health care technology were not sufficient for supporting end-of-life patients when living at home. 5. There were limitations in the allocation of budget for the management of end-of-life care after discharge due to the lack of personnel in private hospitals and hospitals under local administrative organizations, as well as the lack of budget for capacity development of palliative care team. 6. The university hospital had palliative care centers and wards operated under the committee. There were three nurses directly responsible for operation. The provincial hospital had committee, but palliative care nurses were also responsible for other routine tasks. There were no palliative care wards but there were beds set aside especially for end-of-life patients referred from other network hospitals. For private hospitals and the hospital under local administrative organizations, there were no systems for palliative care. As regards sub-district health promoting hospitals, there was no committee overseeing palliative care independent from long-term care committee. Moreover, the practice in community care was similar to other types of patient care, including chronic and bed-bound elderly care. 7. End-of-life patients under health care coverage for government employees could access palliative care at university and provincial hospitals. Palliative care patients under social security and universal health coverage could access palliative care at their registered university and provincial hospital. However, after discharge to urban community, the access to care and preparedness for palliative care were limited, particularly home care to allow end-of-life patients to spend the last moments of their lives as they wished. The lack of out-patient unit especially for end-of-life care caused these patients to receive care at the hospital based on their health coverage like other general patients, despite emergency. 8. End-of-life patients receiving services at university and provincial hospitals had relatively comprehensive and efficient services in terms of setting, equipment, personnel, and continuity of care from hospital to home. This was in contrast to those receiving care at private hospitals or hospitals under local administrative organizations where there was no policy for palliative care. Thus, these patients could not access such service, leading to inability to achieve end-of-life quality of life. The findings from analysis and literature review of palliative care in other countries have contributed to recommendations both in regard to the policies and service management, including the development of palliative care by establishing structure, health workforce planning, budget planning, pharmaceutical, equipment and supply support, building care capacity of personnel and networks, as well as improving service system for palliative care to respond to the needs of end-of-life patients and their caregivers in a concrete and a standardized manner.


Neural tube defects (NTDs) is a congenital syndrome which might result in severe disabilities or deaths. Folic fortification in food including rice has been proposed as a prevention of the syndrome. However, the efficacy of the intervention have to be judged based on the baseline incident of the NTDs cases. Thorough analysis of the incident of NTDs cases is needed. Therefore, we proposed an analysis on the spatio - temporal distribution of the NTDs cases in Thailand using 43 folder database and develop a software needed for NTDs surveillance. Objectives: To assess the spatio - temporal distribution of NTDs cases in Thailand and to develop NTDs surveillance system for Thailand Material and Methods: In this study, the 43 folder database of Thai National Health Security Office was retrieved. The inpatient data were filtered with ICD-10 correlated with the diagnosis of NTDs. The hospital codes were then linked to the patient data to identify the probable district that the NTDs cases lived in. The choropleth maps were generated to describe the distribution of the NTDs cases by districts and year. The clustering of cases was assessed using Moran’s I. Results: The total numbers of NTDs cases from year 2014 - 2018 was 11,296 cases, including 4,531 congenital hydrocephalus cases, 2,655 Spina bifida cases, 2,638 Microcephaly cases, 979 Encephalocele cases, 224 Anencephaly and similar malformations cases, and 269 other congenital malformations of spinal cord cases. The district with the most numbers of NTDs cases was Ratchaburana district of Bangkok. There is no temporal trend observed. The average number of cases per year was 2,259 cases per year. The calculated incidence per 10,000 livebirths was 30.67 cases. The spatial autocorrelation by Moran’ s I does not shown any statistically significant clusters except for Bangkok and neighboring area in year 2014. The prototype of the NTDs surveillance program were developed. Conclusion: The incident of NTDs cases in Thailand is relatively high comparing to the incidents in Asian countries. Therefore, continuous NTDs surveillance might be needed. The folic fortification policy did not show a promising result. Therefore, the policy to improve the rate of antenatal care visits should be a better choice to reduce numbers of the NTDs cases in Thailand.


Repeated pregnancy in postpartum adolescents is a crisis that affects their physical and psychosocial wellbeing, including the newborn, family, economic and society. This quasi-experimental study aimed to examine the effectiveness of program for promoting contraceptive behaviors to prevent repeated pregnancy in postpartum teenage mothers. The subjects were 170 postpartum adolescents attending postpartum units at Maharaj Nakorn Chiang Mai Hospital, Lamphung Hospital, Lamphun Hospital, and Phayao Hospital during August 2018 to November 2019. The subjects were purposively selected and divided into 89 as a control group and 81 as an experimental group. The control group received routine postpartum care and the experimental group received the program for promoting contraceptive behaviors. The intervention instruments consisted of 1) the Program for Promoting Contraceptive Behaviors and 2) Handbook of Contraceptive Used for Postpartum Adolescents which developed by the researchers. Instruments for data collection consisted of 1) the Intension on Contraceptive Use for Postpartum Adolescents Recording Form, 2) the Decision on Contraceptive Use for Postpartum Adolescents Recording Form, 3) the Selection of Contraceptive Uses Recording Form, 4) the Utilization Rate of Contraceptive Use for Postpartum Adolescents Recording Form, and 5) the Repeated Pregnancy Rate of Postpartum Adolescents Recording Form.  Data were analyzed using descriptive statistic, t-test for independent sample and Chi-square test.
The results revealed that:
1) The proportion of participant intended to use contraception after the 48-hour postpartum, both groups were not different. The period intended to start contraception in both groups is statistically significant different (p<.01). The experimental group intends to start contraception before returning home or at the postpartum check up more than the control group.
2) The experimental group, which recieced the Program for Promoting Contraceptive Behaviors, has a proportion of the participants that decide to use contraception for three months statistically significant higher than the control group (p<.05), however, there are no different proportions at 6 weeks, 6 months and 12 months after birth of both groups.
3) The experimental groups and control groups have no different proportion of utilization rate of contraceptive use in the three months, 6 months and 12 months after birth.
4) The proportion of repeated pregnancies at 1 year after birth of both groups is no different. The results of this study showed that the Program for Promoting Contraceptive Behaviors to prevent repeated pregnancies in the postpartum teenage mothers is suitable to the context of teenage mothers in the Northern region. Nurse-midwives can be used as a guideline to promote contraceptive use and to prevent repeated pregnancy in postpartum adolescents


Citizen participation in policy decision making process is a key component of good governance. The
National Health Security Act (NHSA) 2002 deliberately provides legal space for civic participation in governing
the Universal Coverage Scheme (UCS). Articles 13(4) and 48(8) mandate the representation of
civil society organizations (CSO) as members in the National Health Security Board and the Quality and
Standard Board. This paper aimed to analyze the processes and outcomes of citizen indirect participation
in Thai UC Scheme through CSO representation in UCS governance. Qualitative research method was
employed. Literature review and in-depth interviews with 10 informants were conducted.
The study found that CSO representatives actively participated through three functions of the UCS
governance: 1) participating in decision making and governance through representation as committee
members, 2) supporting the decision making process through representation as sub-committee members
appointed by the two committees, and 3) interlinking between CSO representatives in the two committees
and various sub-committees and the broad-based CSO networks at grass root level, for which
problems and concerns are seamlessly transmitted from local to policy decisions (at UCS governance)
which ensure effectiveness of the UCS. The outcomes of CSO contributions included successful expansion
of services in the benefits package and building public ownership of the UCS through surveillance, protect,
promote and support the implementation of the UCS for the benefit of people. Citizen participation,
which has advanced beyond legislative provision, was the result of policy space that allowed citizens to
indirectly engage (through CSO representative) in the governing body and the active citizenship has
maximized the use of policy space provided by the Law.


Health care system development had been the global basic health need goals of world population
by the year 2000. Signatory countries to the World Health Organization agreed that the primary health
care principles were the key for the development. However, current oral health data of Thai population
show gaps to the expected goal even by 2020. This article is a review of documents related to the
primary health care, aiming to understand the original intentions of this principle together with analyzing
oral health situation of Thai population, then synthesizing challenges in the overall development of oral
health care and proposing recommendations for improving the oral health service system to ensure oral
health fairness. Three challenges are presented; 1) The oral health goals should be clarified with agreement
among stakeholders including individuals who own their oral health, 2) Revising the six building block
components of the health system and managing these driving components towards the goals, and
3) Managing other oral health determinant factors not limited to the utilization of oral health service
delivery. In the end, three recommendations are proposed; 1) The long-term oral health goals review and
revision together with service delivery system goals through periodic monitoring, 2) Integrating these
long-term goals with the current policy practice of the Ministry of Public Health (the service plan, the
regional health, and the district health system driving forces), and 3) Providing oral health personnel with
appropriate competencies for the future oral health system, including planning skill, dental practitioner
skill, and the coordination skill.


The National List of Essential Medicines (NLEM) in Thailand was first developed in 1972 and has
been revised continuously. In 2008, health economic evaluation and budget impact analysis became a
part of the development process of the NLEM, especially for high-cost or high-budget medicines
to control healthcare expenses and promote the effectiveness of healthcare services. The Health Economics
Working Group (HEWG) under the Subcommittee for the Development of the NLEM has served
an important role in health technology assessment (HTA) to the Subcommittee. No studies had ever
attempted to review the processes and outputs of the HEWG’s authority. Therefore, this study aimed
to investigate HTA processes and outputs of the HEWG between 2016 and 2018. The study design was
descriptive research employing two main approaches, namely document reviews and participant
observations as secretariat members of the HEWG. Data analysis comprised descriptive statistics and
content analysis. Results were reported in two parts consisting of the HEWG’s work processes and research
outputs. The results on work processes indicated that the HEWG’s operational procedures consisted of
three main activities: the selection of research team, the managing of research compliant to HTA
guidelines, and the quality review and appraisal of research output. As for research outputs, 30 research
topics were proposed between 2016 and 2018, with 17 topics (56%) being completed and submitted to
the Coordination and Consolidation Working Group for further action. Additionally, the composition of
the HEWG and research teams came from multiple sectors of the health systems, leading to inclusive
participation and a high degree of transparency. The research process under the HEWG had clear
procedures and timelines to support the development of the NLEM in a timely manner, and included a
rigorous appraisal of research quality. However, the HEWG should further develop and update their
operational procedures to overcome certain problems and obstacles such as the lack of human
resources and an inefficient management system, and to prepare for new future challenges.


The Public Procurement and Supplies Administration Act, B.E. 2560 (2017) came into force on 23
August 2017 to replace the Rule of the Office of the Prime Minister on Procurement, B.E. 2535 (1992).
This Act aims to promote worthiness, transparency, efficiency, effectiveness, and accountability of government
procurement. However, in practice, the Act introduces many more processes and details and
lacks clear guidelines for operational compliance. This has impacted drug procurement in numerous ways
such as longer procurement time, an increase in workload for staff, and the risk of drug shortage due to
delays in the procurement process. The purpose of this study was to determine the current situation,
issues faced, and impact on hospital workload by using a qualitative descriptive design. The data collection
approach included reviews of various orders, regulations, and consequences affected by this Act,
and in-depth interviews with drug procurement staff in 7 public hospitals, policymakers, and other stakeholders.
Content analysis was employed for data analysis. The results revealed that one year after the
Public Procurement and Supplies Administration Act, B.E. 2560 (2017) came into effect, drug procurement
practices between hospitals varied depending on individual hospital policies and interpretations of the
Act. In terms of hospital workload, procurement based on this Act led to an increase in overall workload
such as the number of procured drugs, documentation, and operating expenses. Meanwhile, the number
of hospital staff tasked with the procurement process was inadequate, and many aspects of the public
procurement system and within hospitals themselves lacked readiness. Therefore, the Comptroller General’s
Department and the Office of the Auditor General, as the agencies responsible for supervising
operational compliance with the Public Procurement and Supplies Administration Act, should cooperate
with public hospital management and public and private drug manufacturers and distributors to determine
the optimal amount of staff required for procurement tasks. They should also support the use of
information technology to develop a procurement document management system, and continuously
monitor and assess the drug procurement process.


At present, patients’ accessibility to positron emission tomography/computed tomography (PET/
CT) service in Thailand is still not feasible due to high costs of diagnosis and limited disbursement of
government health insurance schemes. The objective of this study was to study the costs and break-even
point for the use of PET/CT devices in Thailand if additional indications were covered in health coverage
schemes. Data collection of PET/CT service was performed at 2 government hospitals. Diagnosis costs,
linear prediction, and budgetary impact were then analyzed.
The study showed that the unit cost of PET/CT would significantly decrease if the number of patients
increased. The cost was approximately 367,045 baht per case if performed only 1 case a week and
continuously decreased till 40 cases per week giving the unit cost only 22,725 baht. The disbursed rate
of 40,000 baht per case would cause no loss to the hospital if performed 14 cases per week. The
budgetary impact assessment expected an annual increase of 4.65% PET/CT uses with the disbursement
of 40,000 baht per case. The annual conservative burden would amount to 24-26 million baht for new
cases of patients with 9 types of cancer, excluding cases already underwent treatments, suspicious
cases and recurrent cases that needed to be examined by PET/CT.
However, it is recommended that the disbursement for PET/CT service should be considered in
Thai health service system due to low budgetary impact of 24-26 million baht per year. Moreover, the
budgetary support for this disbursement should not be managed within the capitation payment.


Background: ITEMS (information technology for emergency medical system) is a software program
designed to help emergency medical dispatchers identify the level of emergency condition and assign
proper response team to the scene. Objective: This study aimed to explore uses and problems related
to ITEMS. Method: This was a cross-sectional survey research. Questionnaires were sent to the emergency
medical personnel working in emergency dispatch centers in Health Region 1 from 1st November
2017 to 31st December 2017. Result: A total of 114 questionnaires were returned. Mean age was 36.5
years, and 65.8% were female. In all, 36.0% of the emergency medical personnel used ITEMS promptly,
36.8% used ITEMS in delayed data recording mode, and 26.3% did not use at all. For those who did not
use ITEMS, 83.3% used their own experience, 70.0% gave the reason of staff shortage and 46.7% said
the program took too long to finish. Among those who used ITEMS with delayed data recording, 92.9%
explained staff shortage, and 40.5% too long to finish data recording. No factors were found to be associated
with the decision to use ITEMS or the use in delay mode. Conclusion: Not many emergency
medical personnel used ITEMS due to shortage of staff and long duration to complete the program.
Improvement of ITEMS program and adequate staffing were recommended to solve the problem.


Thailand’s older populations aged 60 years and over will be increased by 20 percent in 2021.
Non-communicable diseases were the main cause of deaths in Thai older people while annual health
expenditure costed the government around 200 billion baht. Health promotion through senior schools
was one of the strategies to reduce the country’s health expenditure. This study aimed to investigate
the administration of senior schools including older people health promotion behaviors of senior schools
under the Bangkok Metropolitan Administration and an educational institution, and to explore success
factors of the senior schools. The research design was a mixed method consisting of qualitative research
of in-depth interviews with senior school directors and staffs regarding the administration, and quantitative
comparative research on health promotion behaviors of older people in two types of senior schools.
Data were analyzed using independent t-test. The results showed that the management of senior schools
were different in terms of management process and budget support. Health promotion behaviors of the
older people were significantly different at 0.05 level in the aspect of spiritual development and stress
management. There was no difference in the aspect of overall health promotion behaviors. Recommendations
to promote older people’s health in Bangkok were the policy supporting older people and
budget allocation for senior schools of the Bangkok Metropolitan Administration. Policymakers should
study more on senior schools’ management including factors that influence older people’s nutrition and
exercise behavior in the communities of Bangkok.


This study reports the simulation results of area-based network allocations for the health workforce
in all hospitals under the Office of the Permanent Secretary of the Ministry of Public Health. The objective
was to understand the workforce shortage status and results from alternative network allocations
in the health regions to mitigate the shortage of health workforce.
As of September 1, 2019, the weighted shortage intensity index shows 31%, 29%, and 26% shortage
on average for nurses, dentists, and medical doctors. This study found 80% of hospitals had nurses,
dentists, and medical doctors less than the minimum manpower requirements. The weighted average
shortages of nurses were 68 per hospital, and shortages of doctors and dentists are 10 and 3 per hospital,
respectively. The total shortages were 16,000 nurses, 3,400 doctors, and 1,000 dentists. There was a
severe nurse shortage in sub-district health promoting hospitals and tertiary hospitals, but no shortage
at secondary-level hospitals. Furthermore, the medical doctor shortage was severe at the secondarylevel
hospitals.
The empirical results show that area-based healthcare networking within the same hospital level
could not mitigate the shortage due to high workforce scarcity. However, the networking of the primary-
level with the first-and middle-secondary-level hospitals in the same districts could alleviate the nurse
shortage. This decreased the weighted shortage intensity index for nurses from an average of 69% in the
primary hospitals (status quo) to an average of 25% (ex-ante). Similarly, the networking of middle and
high levels of hospitals at the provincial and regional levels could also alleviate the shortage in medical
doctors. However, the area-based networking alternatives could not mitigate the shortage in dentists and
pharmacists.


Currently, lung cancer treatment has been developing in several approaches such as; conservative chemotherapy or novel targeted therapies which increase the overall response rate, survival rate with good quality of life for the patients. Thus, this research project’s goal is to explore the molecular alterations in Thai lung cancer patients which could be different from the other ethnicities. The result of this research will lead to targeted drug development in Thailand for Thai lung cancer patients. The final result of molecular alterations in 159 Thai lung cancer patients (178 tissue samples) from this research project by NGS method from both FFPE and fresh frozen tumor tissue (initial analyzed only the common mutations in lung cancer) showed EGFR mutation 54.7%, BRAF mutation 10.1%, KRAS mutation 28.3%, and MET exon14 splice site 8.8%. We also found 37 patients (23%) whom had more than one gene mutation. These results were very interesting and different from the other countries’ results, especially BRAF and MET exon14 splice site mutation which occurring only < 4% incidence in other populations. BRAF and MET inhibitors are in the clinical development. Furthermore, we confirmed the tumor heterogeneity of lung cancer from our study in 14 patients. One out of 3 patients had different gene profile in different organ at the same time. The other 2 patients had same gene profile even in different organ. Eight out of 11 patients had the different gene profile when they developed disease progression in different organ. These results are very interesting and very useful for exploration of resistant mechanism in lung cancer and developing targeted therapy drug for lung cancer patients. In addition, our research team also found 3.7% of EML4-ALK translocation and 1.3% of CD74-ROS1 translocation which currently we already have the targeted drugs for these two types of fusion genes. PDL1 expression is one of our interesting predictive and prognostic biomarker. We demonstrated that high PDL1 expression (≥ 1%) significantly correlated to higher stage of lung cancer disease (stage 3 and 4) which also had the worse prognosis compared to the early stage lung cancer. EGFR-positive lung cancer patient with high PDL1 expression (≥ 1%) also had significantly poor responded to EGFR-TKI and shorter survival compared to those with low PDL1 expression (< 1%) [16.3 vs. 25.0 months HR = 3.0 (1.17-7.73), P = 0.023]. These findings are very useful for the further drug resistant research together with targeted and immunotherapy drug development in the future. Even though we explore the diagnostic technique and the approach for lung cancer treatment as mentioned above, but the cancer prevention is also very important for the oncology world right now. The previous literatures reported the role of Metformin (anti-diabetic drug), Aspirin (anti-platelet drug), and Statins (lipid lowering agents) in decreasing cancer incidence rate, but the results were not homogenous and most of studies were small population-based studies only. These 3 groups of drugs involve in the metabolism of human body, thus cancer metabolism is the important and interesting field which could lead to cancer prevention in the future. This research project also focuses in cancer metabolism and cancer prevention by studying the largest and longest follow-up of population-based study in Thailand (EGAT database: Electricity Generating Authority of Thailand). Our final results showed ASA, Statins, and Metformin did not significantly decrease the cancer incidence rate. Alcohol drinking and increased aging significantly increased risk of gastrointestinal cancer. Hepatitis virus B carrier also significantly increased risk of liver cancer. However, this report had several of limitation due to nature of retrospective study, but it is very interesting and fascinating to explore more in term of cancer prevention with these group of drugs in prospective study. In this study, we also explored about serum metabolomics profile in 38 early stage lung cancer patients whom underwent surgery. We will report the final result in 75 patients next year. We found the significant changing in amino acid, biogenic amines, sphingolipids, and glycophospholipids in patients’ serum before and after surgery. It is very interesting that tryptophan was significantly increased while glutamate was significantly decreased after surgery. Kynurenine, a biogenic amine which use tryptophan as the initial compound, was also significantly increased after surgery. These finding are very useful to develop immunotherapy and predictive biomarker for immunotherapy. It is also useful to further explore in cancer prevention. In conclusion, the study of molecular alterations in Thai lung cancer patients is very important for targeted drug development in order to drive the innovative lung cancer treatment. However, the other important issue and concern is cancer prevention. Nowadays cancer is the most leading cause of death in Thailand and cancer also causes a lot of burdens in Thailand and Global public health. We believe that cancer metabolism is one of the key factors for cancer prevention in the future which could probably help to prevent and decrease the cancer incidence rate and solve the cancer burden in Thailand.


The development of guideline for health management of the older people with diabetes and hypertension based on health literacy model in the context of Primary Care Cluster (PCC) plays a vital activity for effective control of A1c and blood pressure (BP) levels to decrease or retard the complication occurrence. Currently, there is no approach for promotion of the older people’s health literacy with family participation in health management despite the fact that the family’s role in providing helping and supports in every stage of self-management suits in a Thai context. The primary objective of this study was to examine health management situation of the older people with diabetic and hypertension in the context of PCC ; to develop the survey instrument for assessment the health literacy in health management of the older people with diabetic and hypertension patients in the context of PCC; to assess the effectiveness of health literacy program in health management of the older people with diabetic and hypertension in the context of PCC; and to develop policy recommendations on health literacy in health management of the older people with diabetic and hypertension The sample consists of 140 early older people and stakeholders in PCC. The quantitative and qualitative methods were conducted in this study. Questionnaires and in-depth interviews were used for data collection. The results were founded as follows: 1) The health management mean scores in the older people with diabetes and hypertension was moderate level (x ̅= 2.15). The aspect with the highest mean score was ‘Continuing care’ (x ̅= 2.53), following by aspects with a moderate level of mean score, namely, ‘Stress management’ (x ̅= 2.22), ‘Drug use pattern’ (x ̅= 2.13) and ‘Food consumption behavior’ (x ̅= 2.12). The ‘Exercise’ is the aspect with the lowest mean score (x ̅= 2.01) 2) With regard to health literacy in health management of the older people with diabetes and hypertension in the context of PCC, the overall of health literacy level was found to be insufficient at 52.72% (n= 78) and sufficient at 44.28% (n= 62), respectively. 3) Regarding the effectiveness of health literacy program in health management of the older people with diabetic and hypertension in the context of PCC, the average A1c in the experimental group was lower than the control group with statistically significant differences (p < 0.01). The average systolic blood pressure (SBP) of the experimental group was lower than the control group with statistically significant differences (p < 0.001). Likewise, health management mean scores of the experimental group were higher than the control group with statistically significant differences (p < 0.001). With regard to the health literacy, there were statistically significant differences between the intervention and control groups (p < 0.001).Concerning, the average of A1c, systolic and diastolic blood pressure, as well as health management and health literacy mean scores were significantly higher than before receiving the program at statistic significant level of p < 0.001. Indeed, the average A1c and systolic and diastolic blood pressure was decreased by 7.20%, 16.46% and 18.03%, respectively. In addition, the health management and health literacy means scores were increased by 4.80% and 7.20%, respectively.4) With respect to policy recommendations on health literacy in health management of the older people with diabetes and hypertension, the PCC should enhance family members’ role in providing support and care as well as supervision to older people considering food consumption, exercise and more engagement with physical activities, drug use, stress management and continual self-care. This will eventually enable the older people and his/her family to manage diabetes and hypertension or possible complications.


This study examined the relationship between health conditions and poverty. The study groups were selected by the community team according to their own perception of the poverty condition. Totally 458 children from 4 provinces, namely Bangkok, Samut Sakron, Samut Prakan and Nakhon Pathom, were enrolled. The study revealed that children living in low income families (< 3000 baht per person per month), in severe deprived families (deprivation index ≥4 in 9 factors), and in dysfunctional families (family dysfunction index ≥2 in 5) were associated with poor parenting leading to unmet health needs (poor grade care profiles ≥2 in 6 categories). Low income families (< 3000 baht per person per month) increased risk 2.4 times. Severe deprived families (deprivation index ≥4 in 9 factors) increased risk 1.8 times and dysfunctional families (family dysfunction index ≥2 in 5) increased risk 2.6 times. We grouped all children with family dysfunction index ≥2 and those with the combination of low income index and multiple deprivation index together as a high risk group. It was found that this group had three times more risk than those with a low risk group (the group of children with family dysfunction index <2, without or only one index of low income and deprivation family). This study developed the Integrated Health – Learning – Protection team (H-L-P team) to promote the well-being of poor children. This community based team composed of the community leaders, child care providers, health care volunteers and community development volunteer. Totally the 39 H-L-P teams were developed in 4 provinces. The integrated team has been trained in programs for building newborn childcare skills and enhancing health and promoting early childhood learning for the community, caring for a child who has had an adverse childhood experiences, children's rights and how to protect them, and how to refer for help. This training give staff members confidence in assessing and promoting poor children's health before visiting areas of their responsibility. A health promotion model for poor and needy children was developed by the H-L-P team, which consisted of 4 steps: 1) Identify the complex health and development problems by the home visit program 2) Action planning by the various members of the H-L-P team 3) Assisted operations by members of the integration team each side and connect relevant local or state departments in each area, including education and advice to empower the families. 4) Evaluation by the model development team in cooperation with the integrated health team. A total of 101 cases in the high-risk groups were followed up by the H-L-P team. It was found that only 38% of children in this high-risk group were enrolled in the government's cash transfer program for children in poor families (600 baht per month until the age of 6 years). 69 % of the high-risk groups experienced the poor parenting leading to unmet health needs (poor grade care profiles ≥2 in 6 categories). 73% were not receiving adequate emotional care, with either neglect or emotional and physical abuse. 65% had to live in the single, divorced, or separated families. 55 % experienced the domestic violence. 26 % were in families with drug abuse or drug trafficked. 31 % were in the incarcerated families. 24% had developmental delays and 9% had a severe development Even though the children were in an extremely poor, deprived, and low potential family, 64% of them were still raised by their own family without using the community early childhood learning and care services in any way. The assessment of the H-L-P team by the model development team found that the factors that promote the team's work were the specific knowledge and skill training program for the different work of the member in the team and getting them to know each other. Each member in the H-L-P team had different strengths. The child care provider had a strong role in finding vulnerable children and promoting cognitive development, learning and mental well-being of children. Public Health Volunteers strength was the expertise in home visits. This allowed children to be continuously monitored for health problems. The social development and human security volunteers (NGOs) or the community leaders had a strength to make it easy for children to have access to those welfare system. At least 2 home visitation sessions will see a positive change in results. The professional teams such as health workers, psychologists, social workers, occupational therapist, child protector, supplementing the H-L-P team in some home visits was a great addition, and might get the better results for the high-risk groups. Encouraging caregivers to enjoy giving closed supervision for children, being interest in stimulating the learning skill for children was easily starting by introducing them for the program of making-toy-yourself, practicing playing with children, practicing storytelling, supporting toys and some books as a starting point. Supporting the ongoing work processes of the the H-L-P team with the systematic quality improvement process (PDCA cycle) will enable the poor children and their families to receive real and sustainable assistance. Tackling the child in poverty and family dysfunction must be supported by a public and local policy that had an extensive understanding and practice. The power of community volunteer, in conjunction with various community based health centers and early childhood development centers, was a complementary force that was an important community capital. In caring for these vulnerable children, we need to expand our results to policy by: 1. Promote public and local support policies in establishing the H-L-P integrated team for early childhood development and protection and implementing screening mechanisms for high-risk groups with an intensive home visit for this group as a key of success. 2. Promote the investment for more physical structures related to early childhood learning and care for children in poor families and dysfunctional family to cover all early childhood age groups from birth to 6-8 years. 3. Driving innovation of early childhood education and care such as tools, process manuals, training courses to create knowledge, awareness, care and protection skills for poor children and children in adversity. Those innovations were needed for the child care-takers, community administrators, community volunteers, child care providers in nursery-daycare center kindergarten school, or other community based health centers or development learning centers established for early childhood or families. 4. Currently, early childhood development centers are systematically established in most communities. It must be the central network of the H-L-P integrated teams to work with poor children in the communities. This should be supported and invested by both local and national policy.


The Ministry of Public Health’s constant formulation of primary health care policy and carry forward to Primary Care Act 2019 in order to develop Primary Care Cluster (PCC) system and primary care network in addressing healthcare access problem and medical care gap, supporting the primary health care workers are able to collaborate with Family Medicine in order to improve the services quality. Primary colleges under Praboromarajchanok Institute Act play an important role in strengthening personnel to support primary care cluster team and perform quality works. This mixed-method research aims to 1) examine the situation of public health personnel development to support Primary Care Cluster (PCC) team; 2) study public health personnel’s competencies in supporting Primary Care Cluster (PCC) team; 3) explore competencies of lecturers under Praboromarajchanok Institute in public health personnel development to support Primary Care Cluster (PCC) team; 4) analyze Praboromarajchanok Institute Act in light of strengthening of public health personnel to support Primary Care Cluster (PCC) team; and 5) synthesize policy proposals to develop the role of colleges under Praboromarajchanok Institute Act in strengthening health personnel to support primary care cluster team. The research method was used a mixed method design. Both qualitative and quantitative data are gathered in this study. The data were collected within 12 months between August 2010 and July 2020. The in-depth interviews and focus group were used to collect qualitative data. The key informant includes the Ministry of Public Health’s senior experts in charge of manpower and primary care service and network, primary care system division directors, provincial public health officers and heads of related sections in provincial public health offices, directors and deputy directors of colleges under Praboromarajchanok Institute, Ministry of Public Health, lecturers in charge of academic services or personnel development of Colleges of Nursing and College of Public Health under Praboromarajchanok Institute, Ministry of Public Health, primary operation personnel for supporting the policy on Primary Care Cluster (PCC) team and general residents and public as well as services recipient. The sample The quantitative and qualitative data are analyzed using descriptive statistics and content analysis, respectively. The following research resultsare found: 1. All colleges are prepared for operations according to the roles and missions of respective colleges and Professionals Council in the fulfillment of higher education standards of the Office of Higher Education Commission. Meanwhile, public health personnel development is executed according to Praboromarajchanok Institute’s policy or to the needs of local area or Area Health to support the service plan such as emergency practitioner nurse curriculum, critical care nursing curriculum and palliatives care curriculum. Also, the training program is arranged in response to the country’s demand such as “Thailand’s increasing number of elderly leads to the introduction of elderly-related curriculum” or to the expertise of lecturers in respective colleges e.g. family practice training program and cancer nursing curriculum. The training plans are in line with future needs of healthcare, while the colleges develop the lecturers’ expertise in each discipline in accordance with curriculum formulation as required by Area Health or with problems in local areas. Moreover, training programs that derive from university’s needs in uninterruptedly promoting expertise are also performed in collaboration with other agencies. 2. Staffs in Primary Care Cluster (PCC) team have a high level of overall picture of opinions towards all aspects of competency of public health personnel to support Primary Care Cluster (PCC) team. In particular, the ones with the highest and lowest mean scores are ‘good service’ (Mean=4.18, SD=.79) and ‘accumulated work expertise’, respectively.( Mean=3.83, SD=.97) 3. There is a high level of overall picture of competency of lecturers under Praboromarajchanok Institute in developing public health personnel to support the policy on Primary Care Cluster (PCC) team. When each competency is examined, most competencies are found at a high level, except the knowledge and understanding of Primary Care Cluster (PCC) principle, which is at a moderate level. (Mean=3.58, SD=.93) 4. Regarding the production and development of primary health care personnel by Colleges of Nursing under Praboromarajchanok Institute Act, the understandings and competencies of lecturers should be promoted in order to jointly introduce nursing curriculum for other agencies, which collaborate with health services or the Faculty of Nursing overseas. Besides, the primary health personnel development includes the introduction of specialized curriculum, extended from the curriculums of nursing practice and of family practice. The participation and learning in collaboration with the relevant communities is also created. 5. The research results indicate that the guidelines for development of roles of colleges under Praboromarajchanok Institute to support the primary care cluster team’s operations can be done as follows: 1) improvement of nursing curriculum or adjustment of instructional activities integrated with primary care systems to enhance the graduates’ post-graduation work ability; 2) survey of needs for development of public health personnel’s competencies in operating primary care cluster team and primary care system at both national and health canter level; 3) arrangement of training programs related to primary care covering all multidiscipline of Primary Care Cluster (PCC) team according to the local area’s needs; 4) formulation of long-term academic service plans and of colleges’ clear administration guidelines for public health personnel competency development; 5) development of an apparent plan for lecturer-related manpower development and of lecturers’ competencies in promoting knowledge and ability of nursing students to perform quality primary care services. This is to facilitate public health personnel competency development to support primary care cluster team’s operations; 6) building of network collaboration in developing a center of expertise or excellence that meets standards to support primary care cluster team’s operations; and 7) development of inclusive manpower information management system, especially lecturers under Praboromarajchanok Institute, for decision-making purpose in light of number, qualification, expertise and distribution according to Area Health.


The objectives of the mutual collaborations action research were to 1 ) develop the model of service activities in health services system for delaying progression of chronic kidney disease in all stages of kidney damage, 2) analyze the expense of resource investment in health services system for delaying progression of chronic kidney disease, and 3) synthesize the policy suggestions for health services system development to delay progression of chronic kidney disease in community hospitals. Purposive sampling was used and study subjects were 2 3 4 patients with chronic kidney disease (CKD) in all stages of kidney damage which were coursed by diabetes mellitus, hypertension, or both, at Chumpae Health Center or Primary Care Cluster (PCC), and Kidney Clinic at Chumpae Hospital, Khon Kaen Province. Secondary target group was healthcare team in both sites including 3 physicians, 4 professional nurses, and 1 pharmacist, and primary caregiver of CKD patients. There were 1 family doctor, 1 professional nurse at PCC; 2 medical doctors, 3 professional nurses at Kidney Clinic; 1 pharmacist running in both sites. Study Process: The study period was between April 2 5 6 2 and March 2 5 6 3 , however, was extended to July 2563. Study process was divided into 3 major steps; step 1 Implementation phase: a situation review of health services system for delaying dialysis according to the model developed from study in phase 1 ; step 2 implementation phase: planning, implementing, and evaluating the outcomes of health services system for delaying dialysis (Chumphae DDCKD model obtained from step 1); and step 3 evaluation phase: clinical outcomes were an average rapid eGFR decline < 4 ml/min/1 . 7 3 m2 / year in patients in all stages of kidney damage, selfmanagement behaviors, quality of life, and feasibility outcome of applying Chumphae DDCKD model in a real situation, including patient satisfaction, economic outcome: Cost-effectiveness analysis (CEA), and policy suggestions to health services system. Result: The effectiveness of applying DDCKD model for delaying progression of CKD or dialysis was tested at 3 rd and 6 th months and rapid eGFR decline was found to be decreased, rapid eGFR decline > 2 ml/min/1.73 m2/ in 6 months was only 29.06%, Patients having rapid eGFR decline < 4 ml/min/1.73 m2/year or < 2 ml/min/1.73 m2/in 6 months were 70.94%. rapid eGFR decline ≤ 2 ml/min/1.73 m2/in 6 months of CKD Patients in stage 1-2, 3a-3b, and 4-5 was found to be 74.68%, 64.71%, and 60.0%, respectively. The efficiency of Chumphae DDCK model for delaying dialysis in CKD patients with hypertension group showed that the median of rapid eGFR decline was significantly improved (p = 0.04). The study showed that score on self-management behaviors and eGFR in different periods were correlated. Prior to implementation of Chumphae DDCK model, total score on self-management behaviors changed 1 score, rapid eGFR decline would decrease to 2. 5 7 ml/min/1.73 m2. After implementation, rapid eGFR decline in 3rd and 6th months was 1.46 and 1 . 0 0 4 , respectively. An average total score on self-management behaviors before and after implementation 6 months was not significant difference. However, score on self-management behaviors in each item was significant difference, including eat bland food or less salty, eat dehydrated food or pickle food, eat high-cholesterol food, eat offal, water intake by estimating from urine output, and eat ready meal or food bought from convenience store. CKD patients in stage 1-2, 3a-3b, and 4-5 reported their quality of life score was mostly fine in every dimensions. The majority of subjects were satisfied with the new health services system in high level, followed by the highest level, and no report on less or the least levels. Cost-effectiveness analysis (CEA): after implementation of Chumphae DDCKD model, an average cost of CKD patients was 2,392.49 baht/person, 4,248.42 baht/person, and 4,181.42 baht/person in stage 1-2, 3a-3b, and 4-5, respectively. An average cost of CKD patients in stage 3 a-3 b and 4 - 5 was increased because of medical supplies, not insulin injection. Chumphae DDCKD model could delay > 5 0 % progression of chronic kidney disease in all stages of kidney damage. Cost-effectiveness analysis in this study was calculated based on numbers of CKD patients delaying progression of chronic kidney disease by considering from rapid eGFR decline < 4 ml/min/1.73 m2/year. Chumphae DDCKD model was more worth for CKD patients in stage 1-2 than for CKD patients in stage 3a-3b and stage 4-5, with the cost effectiveness of 3203.50 baht, 6,565.74 baht, and 6969.03 baht, respectively, on delaying progression of kidney damage for 1 person. The important policy suggestion was to implement Chumphae DDCK model for CKD patients because this model could delay progression of chronic kidney disease in all stages of kidney damage. However, it was worth for CKD patients in stage 1 - 2 when compared to other stages. Therefore, implementation of this model should establish in Kidney Clinic for CKD patients in early stage of kidney damage.


This mixed methods (qualitative and quantitative) study aimed to 1) illustrate the situations of intermediate care for older adults according to the Ministry of Public Health’s policy, 2) evaluate the implementation of intermediate care to older adults according to the Ministry of Public Health’s policy and 3) propose policy recommendations to improve intermediate care in Thailand. Seventeen healthcare facilities providing intermediate care to older adults were multi-stage sampled from the Ministry of Public Health provider sampling frame of 897 hospitals covering 4 regions from the North, Northeast, Central and the South. Key informants comprised 30 executives at the central and provinces, 1,008 intermediate care providers, and 23 academic experts attending final policy meeting. Questionnaires and guidelines for interview including group discussion were the tools used for data collection during September 2019 and June 2020. Quantitative data were analyzed with descriptive (frequency, percentage, mean, standard deviation) and inferential statistics (median test, paired t - test, t - test, Pearson correlation, and stepwise multiple regression). Qualitative data were analyzed by content analysis. The followings are main findings. 1. The hospitals in 8 provinces can be divided based on service data into 3 groups: 1) intensive intermediate care services, 2) moderate intermediate care services, and 3) moderate intermediate care services with limited evidence from questionnaire and individual inpatient data. Group 1 hospitals had longer length of stay (LOS) than other groups in all 3 conditions; stroke 9.2 days, traumatic brain injury 13.6 days and spinal cord injury 26.8 days. The stroke patients in group 1 hospitals showed better patient functional improvement by higher difference of Barthel index (DBI) than in group 2 hospitals (4.0 vs 1.8, independent t-test 3,381 = 12.51, p<0.01). The medical expense had a low positive correlation with LOS (r = .17, p< .01). The DBI has a positive correlation with LOS (r = .17, p<.05) but a negative correlation with age (r = -.04, p<.05). 2. Responses from 1,008 questionnaires gave a fair mean score for intermediate care service to older adults (x ̅ =3.6, S.D.=.5). The highest score was for policy acceptability (x ̅ = 4.0, S.D .= .6), followed by the feasibility of policy (x ̅ = 3.7, S.D. = .6), and lowest for cost support (x ̅ = 3.2, S.D. = .7). By Pearson’s correlation, the policy appropriateness had the highest correlation with the adoption (r=.73, p<.01), followed by the policy acceptability and the adoption (r=.67, p<.01). The sustainability of intermediate care was positively correlated with all dimensions of policy process and years of experience in intermediate care, with highest correlation with policy penetration (r = .57, p<.01). By multiple regression analysis, policy penetration (B = .411, t = 12.603, p<.01), policy feasibility (B = .161, t = 4.833, p<.01), and policy acceptability (B = .134, t = 4.425, p<.01) were predictors of sustainability (Adj. R2 = .367, p<.01). 3. Key success factors of the implementation of intermediate care policy from qualitative methods were listed: 1) executives with visions plan, set clear goal and constantly monitor results, 2) service provider commitment with good multidisciplinary teamwork, and 3) the service system preparedness, efficient resource sharing, shared practice guideline and care models with strong multidisciplinary network. Constraints were lack of staff’s understanding on policy and practice; inadequacy workforce and competent staff; shortage of resources or material including budget, and medical supply; and inefficient patient referral and information system. 4. Policy recommendations include clear policy communications cascading with localization flexibility, integrated seamless care by enhancing the role of family medicine, health workforce recruitment that fits with intermediate care demands, common information platform facilitating referral of data among providers and payers, extension of service scope to more health conditions and age groups, and establishment of appropriate and comprehensive payment systems.


This action research aimed to develop the community-based cardiac rehabilitation (CR) model for patients with post myocardial infarction, Muang Roi-Et district, Roi-Et province. Participants consisted of post myocardial infarction patients, caregivers, community leaders, stakeholders, and multidisciplinary teams. The study processes followed three phases: 1) situational analysis 2) development and 3) evaluation. Research instruments included in-depth interview questions, questions for a focused group discussion, field note record, after action review record form, readmission record form, six-minute walk test record form, questionnaires of Duke Activity Status Index, questionnaires of Thai Depression Inventory, and questionnaires of The Revised Illness Perception. The data were analyzed using percentage, mean, standard deviation, logistic regression analysis, one way repeated measure ANOVA, inductive content analysis and deductive content analysis. Results: 1) Readmission rate was found at 35.8%. Needs for the development were identified in five dimensions: community participation in the CR, promoting the self-efficacy of patients in the CR, enhancing the capacity of a caregiver network in the community, continuing care, and care coordination between hospital and community 2) the development process consisted of four steps: building awareness and the development needs, building up caring and managing team, a pilot study for the development in a health-promoting hospital model, and expanding networks for the CR in community to other health-promoting hospitals 3) outcomes of the development were as follows. The care network in community, environments and facilities, guidelines, and innovations that contributed to the CR were improved. Health outcome of the patients were improved including (a) the readmission rate in four months decreased from 35.8% to 10% (b) After hospital discharge in 1 week, 1 months, and 4 months, the six-minute walk test and the illness perception scores were significantly differences (F=51.458, p<.001; F=27.092, p<.001, respectively). 100% of patients had an improvement in functional status outcomes, and no patients had depression. The results indicate that the developed model contributes to improving the CR resulting in patients’ better health


Ministry of Public Health (MOPH) has continuously driven Health Area Development. However, in practice, there were many obstacles and barriers that prevented expected health area development, that is the health area development issue has become one of important agendas that the MOPH and other related authorities have paid attentions to. This issue was continuously a part of the strategic plans of the MOPH and health reform plan of the Health Reform Commission. In an attempt to define and propose solutions that could lead to health area development, this research chose the 6th Health Area of the MOPH as the pilot area to in depth collect data, analysis, and design system and mechanism to drive health area development in the 6th Health Area. The researchers collected secondary information and data including National Health Reform Plan, Heath Area Development Proposals, health area development evaluation report, health area strategic/ action plans in the National Health Reform Plan, foreign experiences regarding health system management and health area development, regulatory sandbox’s concept and experiences, and MOPH and the 6th Health Area’s works regarding health system management, and health area development. Moreover, opinions of those responsible for the 6th Health Area development were also collected during the data collecting process. This was aimed to reflect expectations, problems and obstacles in the previous development attempts, as well as suggestions of conditions solutions to achieve goals in health area development. Conceptual idea in health area development and progress evaluation referred to WHO Health System Framework with 6 Building Blocks which led to identify health area development strategies that would achieve health developments of population in health area. The strategies are comprised of (1) human resource management, (2) Information system or database that could support works and health services, (3) enhancing of productions and usage of qualified and accessible technology, (4) financial management that could enhance sustainability and support health services in the health area, and (5) work mechanism that could enhance direction, policies, strategies setting for the whole health area. Moreover, the 6th Health Area is a location of the Eastern Economic Corridor that there were plenty of investment demand in service improvement and leverage. These led to conclusions that measures to drive health area development should cover (1) Health Area and Health Area Office Management, (2) Human Resource Management, (3) Health Area Management Authorization, and (4) Efficiency Improvement and Financial Sustainability. To lead concrete action the researchers propose to make proposals for system and mechanism to drive health area development in the 6th Health Area in a manner to operate in the form of a Regulatory Sandbox by conducting experiments to improve regulatory constraints that impede the action of driving the work of health area. Which has clear terms and conditions for the trial operation and evaluate the results of the experiments conducted to support the implementation of the regulation and set concrete action guidelines in the overview. Regulatory Sandbox for experiments to drive the work of the health area, consisting of 3 field test operations, which are 1) Regulatory Sandbox 1 for restructuring of work / personnel structure of the health area and the health district office, 2) Regulatory Sandbox 2 for improvements in procurement conditions and investment to increase work efficiency and create a fiscal sustainability of health area, 3) Regulatory Sandbox 3 for collaboration in health area. In the implementation in health area, found that some parts of Regulatory Sandbox 1 and Regulatory Sandbox 2 had been performed through various mechanisms that can finalize the implementation and monitor the progress of the operation to lead the proposals for action in the next phase. Finally, all of the proposals have been put forward for trials in pilot health areas under the supervision of the National Health Reform Commission.


Neuromuscular diseases (NMD) are chronic non-communicable disorder mostly caused by genetic abnormality. NMD are considered rare and their treatments are mainly supportive treatment. Genetic-based therapy is a promising specific treatment for the diseases. However, most of them are still in clinical trial phase 2, 3 and expected to be costly and not available in the very near future. We aimed to conduct systematic review of the medical treatments for NMD including repurposing drugs and genetic-based therapy in order to identify best available treatments and prepare for commercial genetic-based therapy. The outcomes of the study are systematic review of the treatments for NMD and a meta-analysis of genetic-based therapy as well as cost of illness in Duchenne Muscular Dystrophy that are expected to shape the treatment guideline in medical practice and contribute the regulation of national drug list.


Background The Coronavirus disease (COVID-19) pandemic invoked the government’s declaration of state of emergency nationwide taking effect from March 26 to April 30, 2020 in Thailand. The country promoted the public health campaign “Stay Home, Stop the Virus, For the Country” hoping to bend down the epidemic curve. This research aims to assess people’s adherence to such lockdown measures in order to provide recommendations for policy adjustments based on the changing situations from population’s side as well as inform the results and recommend desirable behaviours to the general public. Methodology We used online survey platform run by Google Forms service. Questionnaires were adjusted every week throughout the survey period from April 2-30, 2020 making four sets of questionnaires in total. Population were recruited by convenient sampling advertised through communication channels of various public or ganisations and social media influencers. Results These surveys achieved 99,865 respondents in total. Key demographic data were: 28.4% male and 71.6% female; average age of 42 years; and 84.8% holding bachelor’s degree or higher. We found that 99.8% understood how to follow “Stay Home, Stop the Virus, For the Country” campaign and 93.7% believed that such measure could slow down the outbreak. As much as 53.0% of respondents reported they stayed home all day whereas the main reasons among those who went out were going to work (62.3%) and doing necessary activities such as buying consumables or seeking healthcare (62.1%). The support needed most to make staying home possible was discounted utility bills (35.4%). The surveys showed that Personal Prevention Indices, a geometric mean of five desirable behaviours namely 2-metre physical distancing, wearing face mask, hand washing, avoid touching face, nose, eyes and mouth, practicing good food hygiene, were 0.70, 0.76, 0.75, and 0.78 respectively for Weeks 1-4. Most respondents (80.2%) agreed to have state/local quarantine located in their residing communities. Household’s economic impact was observed as 43.3% of respondents found experiencing income loss in Weeks 1-2 and 52.1% in Weeks 3-4. In addition, 49.1% of respondents believed their provinces were not ready for easing lockdown restrictions and 60.1% stated that they could bear living with these measures for additional four weeks or longer after April. However, 22.3% of the respondents planned to travel out of their residing provinces within a week should the government allowed. Conclusion The public health campaign “Stay Home, Stop the Virus, For the Country” achieved good adherence by the public in terms of trying to stay home and practicing personal preventive behaviours although a significant number of people facing detrimental impact on incomes. Overall, people did not believe the country was ready for easing lockdown and could accept this strict policy for at least another month after April. We propose the following policy recommendations: continue promoting the stay home policy and personal prevention behaviours; considering easing lockdown based on risk of transmission and essential activities for daily lives as well as preparing adequate state/local quarantine; and continue monitoring people’s behaviours until the situation becomes desirable.


The global spreading of Coronavirus Disease 2019 (COVID-19) started in late 2019 and still last until today. Globally, more than 30 million people infected and nearly million people died from COVID-19. This emerging infectious disease creates massive impacts to not only health but also social, wellbeing and economic. Tackling with the pandemic, we require multisectoral collaboration across sectors. This study set the aim with “Reclining Infection, Reducing Morbidity and Avoiding Mortality of COVID-19”. In order to achieve this aim, the study 7 strategic areas for Thailand to cope with the outbreak; 1) situation and trend, 2) social measures, 3) public health measures, 4) health system response, 5) research & development, 6) communication and 7) governance. Each strategic area covers situation analysis, measures/interventions implemented, gaps and recommendations. This strategic framework can be applied at national and provincial levels.


Antibiotic-resistant bacterial infections are a major problem at the national level, especially for patients admitted to hospitals. Additionally, patients with infections have a high mortality rate, prolonged length of hospital stay, and high hospital cost. The most common concerned gram-negative bacteria as the major problem is Acetobacter baumannii and Enterobacteriaceae, particularly the strain which is resistant to carbapenam antibiotics. Objectives To study the clinical and molecular epidemiology of carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae in the lower southern hospital network as well as spatiotemporal analysis of these two species from clinical specimens and from screening in patients with systemic survey as well as from the hospital environments in each hospital and in the hospital network. To measure the efficacy of infection control strategies based on the investigational data. Methods To collect the specimens of carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae from clinical practices and surveillance and do the laboratory to identify molecular strain of those specimen. Clinical data was used to analyzed the factors influencing mortality as well as probability for colonization of those bacteria. Clinical and non-clinical outcomes were compared between the patient with colonization and those without colonization. Molecular data and demographic data was used to performed spatio-temporal analysis. The number of the patients infected with these two bacteria was compared before and after intervention. Results From February 2019 to July 2019, there is the distribution of both bacteria every hospital in the network as well as in the whole of network with identically detection of molecular closeness and spatio-temporal relation. The infection due to both bacteria had relatively high mortality and unfavorable economic burden. Factors influencing mortality is Acute Physiology and Chronic Health Evaluation II (APACHE II) score and appropriate empirical antibiotics. Among of the patients with colonization of these two bacteria, unfavorable clinical outcomes and particularly high hospital costs were identified. The significantly associated factors influencing colonization is previous use of antibiotics, particularly carbapenems even the short duration of administration. The number of cases infected with carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae were significantly decreased after implement of infection control measures based on the finding from surveillance data. Conclusion Systematic control of the use of antibiotics is sufficient to reduce the infection due to carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae. Measures for screening patients before admission is potentially necessary supplementary measures.


The increase of older persons accompanying with increasing chronic diseases resulted in high demand for long term care services. To meet the needs of dependent elderly, integration between social care and health cares are needed and that health workforce should be adequate in term of number, distribution, skill, and motivation. This study thus aimed to forecast health workforce requirements and supply as well as develop policy recommendations to address health workforce challenges for long term care services. Secondary data and primary data from surveys and in-depth interview were used. Sample size for self-administered questionnaires comprised 51 representatives and 331 health workforce from long term care facilities, 130 care managers, and 271 care givers. In additional, 42 concerned stakeholders were interviewed. The results showed that, in term of number, the requirements of health professional and care givers are likely to meet the supply in 2026, except those of nurses, social workers and care managers. Other health workforce challenges concerned with distribution, skill and motivation. Health workforce were poorly distributed to long term care and primary care services, skills to look after long term care were inadequate especially those of care givers, and turnover rate of care givers were high particularly at institutional care. To address health workforce challenges for the long- term care services, Thailand should increase the production of health workforce professional and care givers in relation to number and skills. In additional, increase motivation in order to retain them in the system is in need.


Rehabilitation therapy requires stroke patients to train muscles controlled by the brain that have been damaged. The challenge of the therapy is caused by improper and irregularly training from patients. An effective recovery process requires patients to cooperate in a training course designed by the medical team. The current practices of trainings are plain and might be discouraging resulting in a somewhat unsatisfied outcome. This research is to create an interdisciplinary intervention tool by integration of “Serious game” and rehabilitation body of knowledge. This proposed system is a 3D game having features to encourage the patient by immersing the patient in the Thai temple fair atmosphere games where they must make movements to complete the virtual reality games (VR). The games help patients to train in three patterns of movement required in daily living. The first pattern is focused on practicing a reaching out gesture, which involves practicing movement in the following muscles: Deltoid, Triceps, Biceps, Pectoralis and Serratus anterior muscles through selling ice-cream game. Second movement is to train arm-sweeping from left and right, which involves practicing the following muscles Deltoid, Pectoralis, Infraspinatus, Latissimus, Rhomboid and Trapezius through a shooting game. Third movement training is to train arm-lifting involved practicing the following muscles Deltoid, Triceps, Trapezius and Serratus anterior through the picking stars game. Moreover, in every game, players and patients will use their small muscles by stimulating picking up an object gesture. The game collects data from plays to formulate progression planning. Thirty eligible patients with stroke who were admitted to the Rehab ward, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University Medical School were randomly allocated into an intervention group (6 patients treated with conventional therapy and VR) and a control group (7 patients treated with conventional therapy only).  Rehab outcome measurements including Fugl-Meyer Assessment of the arm (FMA), ArmA, Barthel index (BI) and Wolf Motor Function test (WMFT) were evaluated before, during and at the protocol completion. Our results revealed significant FMA score differences within group in both groups (p=0.039) implying that motor and sensory recovery was equivalent, however there was a trend toward better outcome in the intervention group. The ArmA, WMFT and BI scores showed no significant differences between groups on nonparametric analysis at any point of time. The FMA scores were moderately correlated with the “ice-cream selling” game scores (r = 0.57) which might be related to arm recovery. The “ice-cream selling” and “star picking” game scores were moderately to highly correlated with ArmA score (r = 0.65). The WMFT showed no significant correlation with all game scores which might be attributable to less hand and arm use in most of the WMFT items. The BI scores had significantly moderate to high correlation with “ice-cream selling” and “star picking” game scores as the game plays stimulated postural and balance training (r = 0.64 and 0.61, respectively). To sum up, combination of rehabilitation through virtual reality system and conventional therapy showed a trend toward better efficacy for stroke patients than the conventional therapy alone, especially arm and shoulder recovery.


Background: Based on national and international guidelines (Kidney Disease Outcomes Quality Initiative-K DOQI) in patients with end staged renal disease, arteriovenous access (AVA) creation without history of central venous catheter (CVC) insertion is the recommended approach, but in Thailand, most hemodialysis patients had experiences of CVC insertion beforehand. Underestimation of consequences of such approach in our patients and medical personnel, might be a cause. Therefore, we aimed to develop the protocol that can improve the outcomes. Methods: Expressed Protocol in Thailand (EPT) was formulated. EPT was composed of: 1) patients who did not have any experience of CVC insertion before AVA creation, 2) patients almost used vein for AVA creation, 3) AVA was under good surveillance after operation. This study plan followed up in 24 months, but this report compared and illustrated the outcome between EPT and non-EPT patients in the 24 months. The outcome included the rate of maturation, AVA complications, central vein stenosis, sepsis, major adverse cardiovascular event (MACE), and the score of Quality of life by SF-36. Results: There were 100 EPT patients and 101 non EPT patients. EPT group had lower cumulative rate of AVA infection (EPT: 0% vs non EPT 7.53%, p = 0.038) than those in non EPT. Also 11.9% in non EPT patients had history of CVC sepsis. Also EPT group had lower rates of central vein stenosis (EPT: 4.34% vs non EPT 11.11%, p = 0.047), than those in non EPT group. However there was no significant difference in the rates of maturation, AVA complications, and cardiovascular morbidity/mortality including MACE between two groups. The score in the Physical Functioning and General Mental Health in EPT group was significantly better than those in non EPT group during 6-18 month. Conclusion: EPT patients had a trend toward lower rates of AVA infection and central vein stenosis, and better quality of life score in terms of Physical Function and General Mental Health than those non EPT patients. Therefore the EPT approach should be recommended more and more in Thailand.


Peripheral arterial disease (PAD) is commonly caused by atherosclerosis. PAD is one of the major health problems in the modern society. Most patients who suffer from diabetes mellitus type II tend to suffer also from a severe PAD complication, i.e., critical limb ischemia (CLI). The main therapeutic approach for CLI is either surgical debridement or endovascular revascularization in order to improve blood flow to the affected body area, like extremity. However, approximately 20-30% of patients with CLI are not able to receive vascular or endovascular procedures and amputation appears to be the only option. This is to say that CLI patients have a relatively high tendency to have their afflicted body parts removed and the mortality rate of this group of patients is also high. With severe obstruction of blood flow, type II diabetic patients often have their limb loss from debridement. To search for the new therapeutic option of PAD/CLI, most of the researchers are focusing on progenitor cells, which were identified as a potential new therapeutic option to induce therapeutic angiogenesis. Recently, cell-based therapy for treating CLI has been introduced. Several studies show that the cell-based therapy for vascular regenerations is safe and effective. Especially, the new culture medium called culture medium which able to enhance quality and quantity mononuclear cell. The recent study reveals the efficacy of QQMNC in angiogenesis and vasculogenesis function already. This study was conducted to further investigate the efficacy and safety in animal model. The QQMNCs were injected to the critical ischemic limb mice model at the site of occlusion intramuscularly, then, the blood perfusion was assessed by using Laser doppler image scan. In this study, the group of nude mice which was injected with QQMNC show a promising angiogenesis and vaslucogenesis significantly while the group of PBMNC injection was not. The PBMNC injection group show gangrene and finally lost their limb. This study show the efficacy and safety in animal model which will pave the way to the next phase of the study about applying this method of QQMNC for treating in critical limb ischemic patient.


The research article aims to study to the problem of drug addicts, want to see the legal problems to develop a system for the treatment of drug addiction among adolescents in the problem of Thailand. Study, review and analyze various legal problems In Thailand and the practice of drug addiction treatment among adolescents. Compare the relevant laws of Thailand and other countries. Following the principles of the United Nations on the treatment of drug addiction among adolescents. Study and analyze support mechanisms for quality development. The effectiveness of the treatment policy for adolescents using drugs inappropriate practice and using the results of the study as suggestions for improving the laws and procedures related to the practice of drug addiction in adolescents. The research team has studied the laws and policies of Thailand. Interesting foreign law and policy And conduct interviews Small group meeting Study visit public health agencies in each of the four sectors and the central agencies. Making it known to the problems and obstacles of the operation It's not just a legal barrier But also obstacles in practice When the study was conducted, it was found that Problems with the development of that law The main problem lies in defining the offense of substance abuse as a crime. Cause no matter how child Youth or adolescence Must enter the criminal justice system inevitably With the introduction of the criminal justice system, having a lifelong criminal record, especially teenagers who use the same law as adults, are damaging to adulthood, are entering adulthood. This causes concern for them about their future stigmatization. Besides, when considering the criminal theory of drug offenses, especially the drug base, It is a criminal act that should not be punished. Also, when conducting a study visit of Surat Thani Province, there was an interest that was consistent with not bringing drug therapists into criminal proceedings and treatment guidelines with community participation of the Office of Drug Administration. Addiction and Crime of the United Nations (UNODC) through drug camps in adolescents. Other agencies operate under the law on drug abuse rehabilitation. In each area, there were insufficient operational, personnel and site problems resulting in the inability to perform the rehabilitation work for drug patients as a result of establishing the provisions of the law to enter the rehabilitation process that still exists. Need a screening process or a rehabilitation system that has a variety of sectors to work together Also, rehabilitation was forced to recover from illnesses resulting from drug abuse. Otherwise, the rehabilitation will be deemed unsuccessful, and the criminal proceedings must be continued. The researchers saw that several dimensions of adolescent drug administration law have to be developed, such as the criminal determination dimension. The dimension of integrated patient management services, which must arise from multi-sectoral cooperation, is not the only function of one agency, it may have separate functions, but integrate missions. The patient data management dimension does not lead to stigmatization, especially criminal history for adolescent patients


This retrospective research is aimed at; to study the situation, results of performance based compensation and analyze factors influencing the compensation according to the performance of service units under the Ministry of Public Health. The qualitative study was performed on group discussion committees (Focus group) involving in performance – based compensation, In-depth interviewing with health personnel. Moreover, the quantitative study was hold in this research which are the secondary data from related documents, data analyzation from various institutes. Including, the financial and accounting information form the hospitals that under Office of the Permanent Secretary, Ministry of Public Health, Health Data Center information, performant - base compensation scoring, human resources information and others. The results explore that Pay for Performance (P4P) is not a burden situation. Rather, it is an administrative tool that affects to the quality development of the hospital. Various hospitals pay for their performance less than the limits set by the Ministry of Health. P4P arrearage was found in many hospitals doe to financial liquidity. The compensation received by each profession in each hospital varies from person to person. P4P can be a drive for tangible outcomes clearly. The management of the P4P has an influence on the success of the P4P payment. It should be integrated P4P system with the hospital accreditation system and routine works development.


This study aimed at describing an investigation of a confirmed coronavirus disease 2019 (COVID-19) case in Chonburi, Thailand. He was the first imported case of COVID-19 from Europe to Thailand. The case was an Italian expatriate working in Chonburi. He left for Italy on 14 February 2020 and returned to Thailand on 1 March 2020. At the port of entry, he passed the temperature scan. The following day, he developed upper respiratory symptoms. The providers at a private hospital performed nasopharyngeal swab (NPS) and throat swab (TS). On 3 March 2020, positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were reported. Subsequently, he was referred to Chonburi Regional Hospital. The investigation team of the Department of Disease Control (DDC), Ministry of Public Health (MoPH), could identify 75 contact persons. Of these 75, 56 were classified as high-risk. Of these 56, 40 were tested for NPS and TS and all were found negative for SARS-CoV-2 infection. The rest 16 contacts could not be reached at the time of investigation but their name list was submitted to the incident commander (IC) and the Immigration Bureau for further tracing. Later, the investigation team found that none of these 16 contacts became positive. Another important discovery from this investigation was that a number of healthcare workers were counted as high-risk contacts due to improper use of personal protective equipment (PPE). The report of this investigation raised the concern for proper PPE application amongst healthcare workers to the Emergency Operating Center (EOC) of the MoPH. Outcomes from this event in combination with other events alike were fed into policy decision making process of the MoPH. The MoPH later launched a message to emphasize the importance of proper PPE application amongst healthcare providers to minimize the number of high-risk healthcare-worker contacts who would be subject to a 14-day quarantine. In addition, the MoPH also underpinned that the self-quarantine measure must be strictly enforced to mitigate the risk of wider disease spreading.


Background and Rationale: An implementation research on integrated people-centered primary care has developed protocols and piloted new care processes to patients with diabetes and hypertension in 20 primary care clusters (PCCs) in Thailand. This study was conducted after 4 months of implementation aiming to assess care process provided by the piloted PCCs compared with other types of health facilities within the same district. Methodology: A survey of providers’ opinion on care process provided by themselves was conducted. Samples were all health workers providing care to patients with diabetes and hypertension in 4 types of health facilities in 20 districts, these included 301 piloted PCCs, 240 PCCs outside the project, 172 hospital non-communicable disease clinics, and 351 non-PCC health centers. A self-assessment form developed by the researchers was employed. The form covered 5 care process components: patient-provider relationships, shared care plan, health information system, self-management support, continuity of care and coordination including organizational supports. Data analysis was done using ANOVA test and the least significant difference test. Results: People working in piloted PCCs reported high mean scores on patient-provider relationships, shared care plan, health information system, self-management support, and continuity of care and coordination as 6.3, 6.1, 6.7, 5.9 and 6.3 respectively. Mean scores of all dimensions of the piloted PCCs were significantly higher than those of other types of health facilities (p-value < 0.05). Conclusion and discussion: The piloted PCCs reported highest integrated people-centered care to patients with diabetes and hypertension compared with all other types of health facilities. However, the self-management support got the lowest score that needed further strengthening. Further research on implementation outcomes was proposed including capacity building of staff on essential skills in providing integrated people-centered care.


Background & Rationale: Duplicate medication is irrational drug use that can cause adverse drug events to patients and wasteful health expenditure. There have been a limited number of studies on duplicate prescribing in Thailand. The objective of this study was to develop a computer software to prevent therapeutic duplicate prescription and to determine its effects in Mahasarakham Hospital. Methodology: This research and development comprised three parts. Part 1 described characteristics and magnitudes of duplicate drug prescribing in the hospital using electronic database of 12 drug groups (39 drug items) during 1 October 2018 – 30 September 2019. Part 2 developed a computer software based on results of part 1 and implemented the software in November 2019. Part 3 examined effects of the software by comparing proportions of duplicate drug prescriptions during, before (November 2017 – April 2018) and after software implementation (November 2019 – April 2020). Results: Of total 218,179 prescriptions, 818 duplicates (0.37%) were found, of which 576 (0.26%) were duplicate medication at the same therapeutic groups and 242 (0.11%) at the same drug item. Moreover, 530 duplicates (0.24%) were detected in the same prescription and 288 duplicates (0.13%) detected in the same patient. The highest duplicate medication rate was found in the gastric secretion inhibitors group (378/36,495 prescriptions, 1.04%), followed by antihistamine (130/13,433 prescriptions, 0.97%) and NSAIDs (184/29,783 prescriptions, 0.62%). These duplicates costed around 19,740 – 79,591 baht/year. The software detected any duplicate medications prescribed in the same therapeutic drug, same patient and same day and alert prescribers/ pharmacists for clarification. After software implementation, the duplicate drug prescribing decreased significantly from 0.27% (266/100,367 prescriptions) to 0.08% (75/95,350 prescriptions) or a 70.3% reduction (OR 0.296, 95%CI: 0.226-0.384, p < 0.001). The excess healthcare cost declined by 4,098 – 18,360 baht/6 months or 8,196 – 36,720 baht/year. Conclusion: The developed computer software was effective in preventing duplicate prescription and reducing unnecessary healthcare cost. Future studies should determine duplicate drug prescription and prevention program at national level to support rational drug use and reduce healthcare cost in Thailand.