In Fiscal year 2013, Comptroller General’s Department (CGD) had launched the Non-essential Drug
Prescription Criteria (NPC) measure (A-F measure) to encourage the rationale drug use and control drug
cost for patients under civil servant medical benefit scheme (CSMBS) in 168 public hospitals. The measure
indicated that NPC must be notified for each non-essential drug (NED) prescribing. This study aimed to
monitor and assess implementation of the measure. Data were collected in the study hospital which NPC
were notified for all prescribing of NEDs. The selected NED in this study were celecoxib and candesartan.
For each drug, 110 prescriptions and patient medical records of the out-patient department were reviewed.
The study was divided into two parts. For the first part, consistency between information in medical
records and reasons specified in prescriptions and rationale of prescribing based on the Ministry of Public
Health criteria were assessed during November 2012 to January 2013. For the second part, trend of prescribing
was monitored before and after the measure was implemented (August 2012 to October 2012 and
November 2012 to April 2013). Descriptive statistics were used in data analysis. Reasons for drug prescribing
were not completely specified in medical records. Therefore, the consistency between information
in medical records and reasons specified in prescriptions could be assessed in only 52 patients (47.3%)
who received celecoxib and 57 patients (51.8 %) who received candesartan. Data in medical records and
the notified NPC in prescriptions were consistent in only 7 patients (6.4%) who received celecoxib and 54
patients (49.1%) who received candesartan. Rational of prescribing could not be assessed for more than
40% of prescriptions. Prescribing was rational in 54 patients (49.1%) who received celecoxib and 7 patients
(6.4%) who received candesartan. Most common indicated reason for celecoxib prescribing was an intolerance
to side effect or allergy to drugs in essential drug (ED) list (N=74, 67.3%). For candesartan prescribing,
most common indicated reason was failure to achieve therapeutic goals (N= 100, 90.9%). After an
implementation of the NPC measure, prescribing of 35 patients (31.8%) who received celecoxib and 36
patients (32.7%) who received candesartan were changed to other ED drugs. In conclusion, the efficiency
of the measure was quite low as the completeness of NPC documentation and the change of prescribing to
ED were about 49 and 32 percent, respectively. Measure should be supported and promoted to enhance its
efficiency and precipitate into rationale drug use.


Worthiness of investment in the health promotion programs remains a question. The objective of
this study was to evaluate the achievement of the projects supported by the health promotion and disease
prevention fund in the fiscal year 2011. The project based evaluation following CIPP model was used.
Project documents and opinions of the program head and program participants were assessed. Two questionnaires were developed. The study was done between December 2012 and December 2013. Twentyseven
projects met study criteria. Of these, 11 projects had outcome measurements which mostly were
humanistic outcomes (68.57%). Of 577 self-administered questionnaires sent, the response rates were 59.26-
54.55%. Most scores of CIPP dimensions were at high to very high levels. The evaluation revealed the
lowest scores in the context; use of the information of the community need; the input; support from other
sources; the process; public relations; the product; continuous budget support. There was high satisfaction
of participants for an opportunity to get involved. Three out of four projects were found net benefits.
In conclusion, most projects had a high level of the achievement from 3 perspectives. Nevertheless, the
projects need to further develop for a project framework and clear defined outcomes which directly occurred
to the patients.


This study was a cross-sectional descriptive research. The purposes were to study motivation and
organizational support affecting an evaluation of the public health officers at subdistrict health promoting
hospitals in Buri Ram Province. Population size was 324 persons and a sample size of 207 persons was
selected by systematic random sampling. The research instruments were the questionnaires. The Cronbach
coefficient of instrument was 0.97 and validity was checked by 3 experts. The 207 questionnaires and The
12 in-depth interviews were collected by a research assistant during 1 February 2014 to 28 February 2014.
The data was analyzed by SPSS for windows program to acquire a percentage, mean, standard deviation,
percentile, Pearson Product Moment Correlation Coefficient and Stepwise Multiple Regression.
The findings revealed that most males (53.6 %) with the average age of 40.80 years. The marital
status was 67.1%. The educational degree was a Bachelor’s degree or equivalent for 87.9 %, Duration of
working as public health officers, at subdistrict health promoting hospitals was averaged at 10.35 years.
They were used in 60.4% of practice in evaluation programs. It was revealed from the study that The
overall motivation was in a high level at an average 3.68 (S.D. = 0.42). The organizational support at high
level averaged 3.64 (S.D. = 0.52). And an evaluation of the public health officers at subdistrict health
promoting hospitals in Buri Ram Province at high level, average 3.79 (S.D. = 0.54).The motivation factors
and hygiene factors, also an organizational support, were positive influence on an evaluation of the public
health officers (r = 0.649, p-value < 0.001; r = 0.575, p-value < 0.001; and r = 0.779, p-value < 0.001, respectively).
Six factors that could predict an evaluation of the public health officers at subdistrict health promoting
hospital in Buri Ram Province including Organizational Support in management, Company policy
and Administration, Responsibility, Organizational Support in Time, Organizational Support in Technology
and Job Security with a level of statistical significance (68.9%). The main problem from the study was
the Organizational Support in human resources for 37.21%


The objective of this study was to develop drug reimbursement prices for National Health Security Office (NHSO) Region #13, Bangkok. Specifically, it was intended to be used for outpatient referrals, disability, accident, and emergency. Proposed models were tested with claim data of nine hospitals. This study adopted three criteria, including quality, cost containment, and sustainability, to conceptualize the framework for the eimbursement prices.Results proposed 3 different models of regressive mark-up roportion for reimbursed price setting.These 3 models were tailored for 3 different groups of drug: pharmaceutical product in general, pharmaceutical product by GMP-PICs assured manufacturers and pharmaceutical product with Narrow therapeutic index; in order to promote uses of quality assured product and maintaining quality of health care
service. The mechanism to ensure system sustainability was assigned by employing the reference prices enacted by Ministry of Public Health as the based price to calculate reimbursed price. This consistent and updated input of based price data will be promised. A number of cost containment mechanisms were also built in this model: setting single reimbursed price for one generic name of drug, assigning lower rate
of markup proportion than what Comptroller General’s Department established, regressive markup proportion for the later baht of drug price which aimed to encourage cheaper pharmaceutical products prescribing. Finally, financial impact to stakeholders was thoroughly investigated and ensured. In conclusion, this study proposed a model of pharmaceutical reimbursed price setting for cases of out outpatient referrals, disability, accident and emergency. A number of crucial mechanisms has been deliberately incorporated in the model ensuring sustainability, promoting quality of care and optimal
expenditure. This reimbursed price setting model is an applicable policy option for Thai health insurance system.


The National Institute for Emergency Medicine specifies a criteria for triaging patients into five
levels according to the urgency of treatment needed. Canadian Triage and Acuity Scale (CTAS) is a five-level triage tool used worldwide that can rapidly assess patients, and is proved to be accurate and reliable.
However, no study in Thailand has confirmed CTAS as an initial predictor of the severity of patients. This
research aim study the correlation between CTAS level and early outcome of patients, including; 24-hour
mortality rate, intensive care unit (ICU) admission rate and rate of immediate life-saving interventions in
emergency department. Researchers conducted a retrospective observational study and reviewed medical
records from all patients presented to the ED and were triaged by using CTAS in August 2013. There
were 2,508 patients who were triaged by using CTAS and met the inclusion criteria. Five patients died in
24 hours after ED visit and CTAS levels were I and III in 4 (8.16 %) and 1 (0.12 %) patients, respectively. 84
patients were admitted to the ICU and theirs CTAS levels were ranged from I to IV in 18 (36.73 %), 47
(17.41 %), 17 (1.97 %) and 2 (0.17 %) patients, respectively. 115 of the patients received immediate lifesaving
interventions following their arrival and CTAS levels for these patients were from I to III in 29
(59.18 %), 59 (21.85 %) and 27 (3.12 %) patients, respectively. The differences were statistically significant
between each CTAS levels and each early outcomes of patients (p-value < 0.001), so the higher the patient’
s triage level, the higher the severity. Conclusion: Canadian Triage and Acuity Scale (CTAS) has a significant
correlation with early outcomes of patients, including 24-hour mortality rate, ICU admission rate and
rate of immediate life-saving intervention. Therefore, CTAS can be used as an effective five-level ED
triage tool.


One of the strategic plans for a current policy in an integrated management of the problem involving
violence against children and women is to develop the data register and management system. This research
aims to study the basic data and characteristics of children treated at the Maharat Nakhon Ratchasima
Hospital. The study found that during the year 2010-2012, 437 children were treated at OSCC, 412 cases
were female, and 25 cases were male, aged between 4 days and 17 years and 10 months. The main reason
for arrival at the hospital was sexual and physical violence. Nearly all cases were suffered from first time
violence. Main problem in teenagers were having sex with their boyfriends. In case of physical abuse,
most of those children were abused by their parents or close relatives. Event of violence usually occur
from January to March and October to December each year. Sexual violence tends to happens on weekdays
over weekends. Time of sexual violence was highest during 06:01 and 09:00 pm. Most of patients
came to the hospital within one day after the incident. Nearly all perpetrators were non-family member
persons, but the stranger was only 11 percent. The main external factor that encouraged acts of sexual
violence was an intimate environment and the opportunity allows. The scene of violence mostly occurred
at home. The main result of treatment was cure or palliative, however, some died of violence. The average
cost of medical-related care was 3,306.06 THB. In conclusion, sexual problem among teenagers are the
primary problem for OSCC. The major risk comes from the patient’s own and external factors. Parents
should take care to protect their children closely.


The objective of this study is to estimate unit cost per day of long term care for dependent elderly in
Lamsonthi district from government spending perspective. Long term care services comprised services
from hospital, services from formal care assistance and services from family. Unit cost of services from
hospital was calculated using data from cost accounting of Lamsonthi hospital, which used a traditional
costing method of Ministry of Public Health. Unit cost of services from local government mainly was
salary of formal care-assistants. Cost of long term care services from family member was estimated using
opportunity cost concept, which opportunity cost was assumed equal to labour cost of formal-care assistants.
Total cost of long term care of hospital services were disaggregated into 3 products; severe dependent
service, moderate dependent service and mild dependent service using allocation by labour approach.
Workload of physiotherapists using simple time motion study was used as an allocation criteria
for disaggregate 3 products of the long term care. The result showed that total actual cost of long term care
service unit in 2012 of Lamsonthi hospital was 4.5 million Baht and total actual cost of formal care assistant
was 420,000 Baht in the studied district. Unit costs per day of long term care from services of both
Lamsonthi hospital and formal care assistant without opportunity cost of family members were 41 Baht,
64 Baht, and 101 Baht for mild, moderate, and severe dependence, respectively. Sensitivity analysis for
estimation unit costs per day of long term care include opportunity cost of family members was done by
replacement of support from family members with formal care assistant using ratio of time spending for
dependent elderly among family members and formal care assistant from Siriphan Sasat et al.(9).Unit cost
per day of mild, moderate, and severe dependence increase to 41 Baht, 128 Baht, and 200 Baht, respectively.
However unit cost of long term care depends on level of dependence and level of support from
family. This study found that the cost of severe dependent elderly, who depend totally on formal careassistants,
is still only one fifth of the cost of long term care in private nursing home. However, further
studies are needed to confirm result of this study, which has limitation on statistics and came from only
one district.


This study aims to investigate the association between substitutes for leadership and organizational citizenship behavior of 534 public health officers in subdistrict health promoting hospitals under the inspection of Region 10, the Ministry of Public Health. The sample group was randomly chosen using stratified sampling. Data were collected by using questionnaires. Statistical analysis was performed using the computer program of Pearson’s Product Moment Correlation Coefficient and Multiple Regression. Results revealed that public health officers had moderate organizational citizenship behavior. Substitutes for leadership had a low positive association with the organizational citizenship behavior of public health officers (r = 0.266, p-value ≤ 0.05). Substitutes for leadership could explain 11.90% (Adjusted R2 = 0.119) of the variance in organizational citizenship behavior. To achieve effective substitutes for leadership of public health officers at subdistrict health promoting hospitals, the creation of a self-development manual is suggested for public health officers to develop the leadership and train public health officers at every level, introduce the mentoring system and promote on the job training approach.


Health workforce is one of the most important factors of health system. However, global society and Thailand have currently faced with shortage and maldistribution of health personnel especially rural doctors. This problem may affect the achievement of Millennium Development Goals and equity in accessing to health services. To solve the problem of rural doctor shortage, it needs systematic approach starting from medical education. Thai government has established the Collaborative Project to Increase Production of Rural Doctors: CPIRD with collaboration between the Ministry of Public Health and Ministry of Education to solve the problem since 1994. This article presents a good case study of transformative learning of Maharat Nakhon Ratchasima Hospital’s Medical Educational Center related to the activity “Medical camp for enhancing experiences of medical students”. This camp is an extra-curricular activity
using transformative learning. Outcomes of this activity are to enhance medical students to understand
rural people as a whole, be familiar with rural contexts, and be satisfied with rural work, as well as gain the skills required from the CPIRD and needed for the 21st century. This activity has also affected the development of teaching and learning processes of the medical instructors following the framework of transformative learning. Therefore, educational institutes producing physicians and other health professionals should organize this kind of co-curricular activity to enhance rural and inter-professional experiences of students who will become health professionals in the future. The Ministry of Public Health and the Ministry of Education may consider this activity to be policy for developing education of health professionals in the 21st century. However, systematic and continuous outcome evaluation of the activity is needed in order to develop a more beneficial and effective co-curriculum.


Although approximately 6,500 nurses graduate from over 80 nursing institutions each year, there
seems to be no end in sight to nursing staff shortage. This shortage is both in numbers and in terms of
essential skills to meet the complex needs of the community. In Khon Kaen province, public health care settings have also faced the nursing staff shortage problem, especially at health centers in the rural areas.
The health personnel data of Khon Kaen Provincial Office show that novice nurses prefer to work at the
hospitals more than at the health centers and the attrition rate of the nurses in all levels of health care
settings is high. To overcome the problem, the Community Nurse Production for Community and by
Community Project was launched in Nam Phong District in 2002. It was effectively run and sustained by
the collaboration of several organizations in the community. An evaluation revealed that the shortage was
decreasing while the retention rate was increasing. Thus, Khon Kaen Provincial Office, Khon Kaen Hospital,
readiness community hospitals and Boromarajonani College of Nursing, Khon Kaen agreed to expand
the project to produce 200 community nurses within seven years, from 2009-2015, to cover most areas of
Khon Kaen. After participating in the project, the college has adjusted teaching and learning activities of
both curricular and co-curricular activities by using integrated education approach to develop essential
knowledge and skills for community nursing students. Hence, it can be concluded that the Community
Nurse Production for Community and by Community Project has significantly transformed nursing education
and nursing workforce in Khon Kaen province.


Nursing shortage leads to health problems and health equity of people in rural areas of Thailand. Namphong and Ubolrat Hospitals are community hospitals in Khon Kaen province that used to have nursing shortage. Thus, they have integrated transformative learning to produce community nurses who can stay longer in community. They have collaborated with several stakeholders, such as sub-district administrative organization, Boromarajonani College of Nursing Khon Kaen and College of Asian Scholars to start çthe Community Nurse Production for Community and by Community Projecté. To enhance capability, newly qualified nurses have to participate in several activities, including: 1) learning community with experienced nursing mentor 2) training in “near home near heart” project, and 3) training in transformative learning for self reliance under a concept of the “Sufficient Economy and Sustainable Development Philosophy” of His Majesty King Bhumibol Adulyadej. The projects’ aim is to prepare newly graduated nurses to become change agents for self sufficiency and to live their life happily in their community.


Diabetes management is an essential strategy for better accessible to qualified health care services.
People with diabetes should have learned how they can live with diabetes by adjusting food intake, exercise,
medication regulation, monitoring blood sugar and interpretation. Theptarin Hospital is a role model
of public health that support people with diabetes for lifestyle modification through diabetes selfmanagement
education with varieties of activities of class, camp, and club. With public health concerns,
Theptarin Hospital builds partnership with the National Health Security Office and the Ministry of Public
Health to deliver diabetes case management and foot care education to nurses and physicians across
country. Family doctor should be a doctor who gives holistic care for a patient with diabetes. These
strategies propose that diabetes self-management education and multidisciplinary approach could prevent
complication and better diabetes control. Theptarin Hospital has developed a good practice of transformative
learning for better outcomes of diabetes management in Thailand.


This study is aimed at reviewing how elderly people in Thailand access to dental prosthesis service
comparing 2009 with 2013. Primary data was derived from two major household surveys conducted by
National Statistical Bureau in 2009 and 2013; health and welfare survey, and economic and social status
survey (n = 26,500 households in 2009 and 27,960 households in 2013). Extrapolation to total population
by weight was then calculated.
It was found that proportion of ageing population covered by health insurance in 2009 and 2013 was
97.3 and 97.9%, of which national health insurance scheme contributed 79.3% and 80.9% respectively.
Among them, dental health care utilization was low as 8.2-8.7%. Additionally, the percentage of accessing
to dental prosthesis services increased from 15.6% in 2009 to 15.8% in 2013. Most of the elderly (38.2-
40.3%) seeked dental prosthesis through private services. While a percentage of the omission of health
insurance scheme prevailed at 57.6 in 2009, reduced to 52.1 in 2013. On the other hand, utilization of
dental prosthesis among the elderly with high and low income in Bangkok and municipality areas in 2013
was found 2.8 times higher than the elderly with low income in rural areas. This viewed obviously the
inequity in access to dental prosthesis among elderly people in Thailand.


Despite substantial evidence about the benefits of fall prevention interventions, they have not been
well incorporated into primary care practice. Raising community awareness and attitude toward fall prevention
program is one of the effective strategies to translate the program into practice. The elderly patients need to be aware of the potentially deteriorating effects of their chronic diseases and falling, and
are prepared to manage to reduce fall risk. Educating the elderly and their family on fall prevention by
using audiovisual media and involving community volunteers can be key to successful intervention. This
embedded mixed methods study aimed to compare attitudes and awareness on fall prevention among
community-dwelling elderly (n =144) and their family (n = 100) before and after an educational program
that employed audiovisual media and involved community volunteers. A pre-test/post-test only design,
with structured questionnaires measuring attitudes and awareness on fall prevention, was used for the
quantitative arm. Focus groups were used to interview three groups (ntotal = 38: n1 = 8, n2 = 15, n3 = 15), and
these interviews generated narratives regarding the educational program for the qualitative arm. Quantitative
results showed that the attitudes and awareness scores were statistically higher after the educational
program. Statistically significant areas included exercise and fall prevention. In summary, educating
the elderly and their family by using audiovisual media and involving community volunteers was
found to be one of the important steps toward translating fall prevention guideline to Thai’s community
successfully.


The distribution problem and inequality of nurse workforce adversely affect health services in terms
of effectiveness and operational efficiency in health system and also affect the quality of health services.
Nurse workforce should be investigated for solving these problems. This study aimed to investigate
geographical distributions of Thai nurse workforce and to estimate nurse workforce inequality in Thailand.
Those data were obtained from two data sources, Thai Nurses Cohort Study: Health and Working
Life and surveys and the database of the Ministry of Public Health during the year 2005 - 2009. We
analyzed data by frequency and percentage to reflect the distribution of nurse workforce and Gini coefficients
were used to estimate the inequality. The study found that the distribution of nurse during the year
2005 - 2009, the north-east region has the highest ratio of population per nurse (825.30 to 1009.38) while
Bangkok has the lowest ratio (240.19 to 430.70). The level of nurse workforce inequality ranged between
11.42-18.91% and the trend of Gini coefficients demonstrated that the situation of nurse workforce inequality
tends to decrease in the year 2009.


This research is descriptive study. The objectives are:- 1) to study learning organization development
level 2) to study effectiveness level 3) to study the relationship between learning organization
development of nursing department and effectiveness of patient unit perceived by registered nurses in community hospitals in Phranakhon Si Ayutthaya Province 4) to study problems and obstacles in the
process of their works. The studying populalion of 156 registered nurses in 14 community hospitals in
Phranakhon Si Ayutthaya Province were involved. Data was collected by questionnaires devised by researcher
and tested for content validity and reliability. Data collection was done in November 2013, and
percentage, mean, standard deviation and Pearson’s product moment correlation coefficient were used
for data analysis.
The result showed that the overall learning organization development of nursing department in
community hospitals in Phranakhon Si Ayutthaya Province was at moderate level (x = 3.27, SD = 0.60).
The overall effectiveness of patient unit perceived by registered nurses in community hospitals in
Phranakhon Si Ayutthaya was at moderate level (x = 3.44, SD = 0.51). There was a significant positive
relationship at high level between learning organization development of nursing department and effectiveness
of patient unit perceived by registered nurses (r = 0.748) at P = 0.01 level. Problem and obstacles
were personnel shortage (16%) and lack of staff morale (12.82%).
Suggestions from this research:- head nurses should learn or study more about human resource
development and try to develop learning capacity of each personnel, promote team to participate in policy
development process, and provide other essential factors for organization development.


This study was aimed to compare health problems and health care behaviors between clinical nurses
and non-clinical nurses. This study used secondary data from Health and Working Life of Thai Nurses
Project that collected data from registered nurses who hold nursing licenses granted by the Thai Nursing
and Midwifery Council during 2002-2009. Data were analyzed using descriptive analysis with frequency,
percent, mean and standard deviation and using Chi-Square test for comparison.
Results: Total of 18,763 registered nurses includes 15,773 of clinical nurses (84.1%) and 2,992 of nonclinical
nurses (15.9%). Musculoskeletal diseases were the most common health problem in both clinical
and non-clinical nurses, 47.8% of clinical nurses and 53.7% of non-clinical nurses, followed by dyslipidemia,
hypertension and viral hepatitis. Clinical nurses experienced insomnia and job strain higher than nonclinical
nurses. In terms of health care behaviors, findings revealed that both clinical and non-clinical
nurses had awareness to get regular checkup. The non-clinical nurses preferred to visit medical specialist
more often than the clinical nurses, but used prescription drugs less often than clinical nurses.


The objective of this study was to determine outcomes of salmeterol/fluticasone (SFC) and budesonide
(BUD) for asthma control in real-life situation in community hospitals. A retrospective cohort study was
conducted to collect data from Easy Asthma Clinic database year 2007-2011 in seven community hospitals.
Uncontrolled asthmatic patients with medium-dose BUD who were prescribed SFC or BUD were
divided into three groups: 1) medium-dose BUD (n=170), 2) high-dose BUD (n=88) and 3) SFC 50/250 μg twice daily (n=128). The patients were followed for a year to measure the study outcomes. Comparative
treatment outcomes were analyzed using multivariable analyses to control potential confounders. The
results revealed that the proportions of well controlled patients were 7.6%, 20.0% and 28.9% in mediumdose
BUD, high-dose BUD and SFC group, respectively (p<0.001). The proportions of patients with emergency
room visit were 45.3%, 30.7% and 28.1% in medium-dose BUD, high-dose BUD and SFC group,
respectively (p=0.009) whereas the proportions of patients with hospitalization were 20.6%, 17.5% and
19.5% in medium-dose BUD, high-dose BUD and SFC group, respectively (p=0.902). Side effects of the
medications were 5.9%, 10.2% and 0% in medium-dose BUD, high-dose BUD and SFC group, respectively
(p=0.002). Comparing with medium-dose BUD group, SFC group achieved well controlled more than
9.16 times (OR=9.16, 95%CI: 3.88, 21.64) and decreased emergency room visits by 47% (HR=0.53, 95%CI:
0.35, 0.79). Differential outcome between high-dose BUD and medium-dose BUD was not found. In conclusion,
salmeterol/fluticasone provides better outcomes and fewer adverse effects than budesonide.


This study was conducted to determine the prevalence of medication non-adherence and identify
factors associated with medication non-adherence among 230 patients with type 2 diabetes mellitus in
Nongjik Hospital, Pattani province from August 2013 to December 2013. Medication adherence was assessed
by self-report patients in term of taking medications. Frequency, percentage, mean and standard
deviation were used to present the analysis results. Multiple logistic regression analysis was used to determine
factors associated with medication non-adherence. Adjusted odds ratios (aOR) and their 95%
confidence interval (CI) were used to present the strength of association.
Of the 230 study patients, 64.8% had medication non-adherence. Factors associated with medication
non-adherence included religion (aOR 2.68, 95% CI 1.10, 6.48) self- management (aOR 8.41, 95% CI 1.13,
62.72) combination of oral anti-diabetic drug and Insulin (aOR 7.16, 95% CI 1.35, 38.13) frequency twice
daily (aOR 4.44, 95% CI 1.51, 13.06) frequency three times daily (aOR 13.80, 95% CI 3.19, 59.78) and number
of tablets per day (aOR 2.28, 95% CI 1.16, 4.51)
The high prevalence of medication non-adherence among the study group needs corrective measures.
These may include assessment of medication adherence and modify treatment for each case especially
in Muslim patient with medication adherence.


One of the interventions in order to prevent unhealthy diet habits of children is law or regulations to
control advertising. This article is the review of an evolution and enforcement of the regulations in 6
countries, UK, USA, Brazil, Australia, Singapore and Thailand. A wide variety of publications, databases from websites, reports and books from 2001 to 2011 that involving about regulations of food advertisement
were studied. It was found that the content of laws and regulations related to advertising food and
drinks with high sugar, fat and sodium in all six countries indicated that advertising must not contain any
false, misleading, and deceptive statements, and/or misrepresentation on products. However the limitations
about times and duration of advertising were different. Brazil has a bill to ban advertising from
6 a.m. to 9 p.m. but Singapore has no time limitation.
In conclusion, Thai government should develop advertising legislation and regulations related to
food and drinks with high sugar, fat and sodium in order to reduce consumption of these risky foods and
beverages among children and youth in Thailand.


The research and development study aimed to develop a model of lifestyle intervention to prevent type 2 diabetes mellitus (DM) in high risk group.
Methods:	The study was divided into two phases, phase one developed a lifestyle program and phase two evaluated the effectiveness of the model using quasi-experimental study. According to phase two, the participants were selected from high risk group of DM in the local community, Kudjub district, Udonthani province, north-eastern part of Thailand. The lifestyle program was applied from the diabetes prevention program (DPP). Researcher team and public health nurses in District Health Promoting Hospitals (DHPH) performed seven meetings to deliver education and empowerment consisted of healthy diet, physical activity, stress management and social behaviors. The participants in intervention group were encouraged to match as a “buddy” for coaching each other throughout 16 weeks of the program. The outcomes were body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), health behaviors, and satisfaction of the program.
Results:    Totally, 30 persons in intervention and 30 in control group participated. Most of them were women (73.3%), and the mean age was 51.2 years. The mean of BMI was 28.4 kg/m2, FBS was 95.3 mg/dl, and waist WC was 93.8 centimeters. After 16 weeks, adjusted mean difference (MD) of FBS (90.1 mg/dl in intervention vs 95.3 mg/dl in control group) and BMI (25.7 vs 29.1 kg/m2) were not significant. WC was significantly decreased in intervention group compared to control group (MD –5.9 cm; 95%CI = –9.4 to –2.4; p=0.001) Health behavior score (MD 3.6 score; 95%CI = 0.3 to 6.9; p=0.035) and knowledge (MD 2.0 score; 95% CI=0.6 to 3.4; p=0.006) were significantly increased in intervention compared to control group. Overall, 96.7% of the intervention group was satisfied and very satisfied with the program.
Conclusion: 	Lifestyle intervention program demonstrated significant improvement in WC, health behaviors and knowledge. The program could lead to prevent type 2 DM in the local community.


This research and developmental project aimed to develop appropriate and practical evidence-based practice guidelines for prevention of multidrug resistant organisms (MDRO) transmission and infections for intensive care units (ICUs) of secondary and tertiary care hospitals, to increase knowledge and promote correct practices among ICU personnel in prevention of MDRO infections from invasive medical device procedures, to create collaborative network among ICU personnel of hospitals and to promote knowledge sharing to improve quality of patient care, leading to reducing hospital associated infections (HAIs) in ICUs, costs of treatment and length of hospital stay including HAI related death.
This project applied collaborative quality improvement concept of the Institute for Healthcare Improvement (IHI), USA. Fifty hospitals participated in the project, including regional and general hospitals under Ministry of Public Health, hospitals under Ministry of Defence and a university hospital. The duration of the project was from November 2013 to November 2014. The project activities consisted of preparation of “draft” guidelines for prevention of MDRO infection, prevention of ventilator-associated pneumonia (VAP), prevention of catheter-related bloodstream infection (CRBSI), prevention of catheter-associated urinary tract infection (CAUTI), Two workshops were conducted for participating hospitals in order to educate ICU personel on collaborative quality improvement and practices in prevention of MDRO infections and HAI related to medical devices invasive procedures, and hand hygiene and providing information toward MDRO problems and trend, consequences of MDRO to patients, personnel and hospitals, reviewing HAI surveillance, advantages, utilization of surveillance information, and diagnosis criteria of frequent HAIs in ICUs. Brainstorming sessions for hospital personnel were conducted to determine the draft guidelines, exchange experiences and determine the appropriate and practical methods in solving HAIs in ICUs. Participating hospitals continuously improved their practices in prevention of HAIs using the outcomes of the project workshop. Researchers supported useful information. Hospital personnel presented their works in the project workshop in order to encourage hospitals to work continuously. The project intervention was assessed by using information from HAI surveillance.
Outcomes of the project included guideline for prevention of MDRO infections in ICUs, including guideline for prevention of MDRO transmission, guideline for prevention of VAP, guideline for prevention of CAUTI, guideline for prevention of CRBSI, guideline for environmental control and guideline for diagnosis of HAIs. Information from HAI surveillance of 79 ICUs of 40 participating hospitals which regularly sent the information from September 2013 to September 2014 indicated the highest infection rate was from VAP (7.8 per 1,000 ventilator-days), followed by CAUTI 4.6 per 1,000 catheter-days and CRBSI 2.5 per 1,000 catheter-days. Case fatality rate from VAP and CRBSI were 36.4% and case fatality rate from CAUTI was 24%. Cost of antibiotic treatment for VAP , CAUTI and CRBSI were 30,734,713 Baht, 8,317,268 and 2,545,381 Baht, respectively.
Prevention of MDRO infections in the ICUs need to be implemented continuously. Establishing evidence-based practice guidelines in prevention of important HAIs in ICUs can help improve up-to-date knowledge of ICU personnel and create more confident in practices among them. All guidelines developed from this project can be distributed to ICUs of other hospitals not participating in the project for patient care practices and educating their personnel.


This research proposes using technique data mining modeling support an expert
system to advise nutrition and physical therapy for chronic disease elderly patient on
mobile device. The development of model with weka3.6.9 program, by using the algorithm
classification of patients with simple k-means and the apriori for generating association rules.
The distance measurement of data with percentage split66% from each of disease 250
samples. Then create rules in the group of 10 on minimum confidence level 0.9. That are
rules used for nutrition and physical therapy each of disease 80 rules for the use of
embedded code on the application to run through the user interface on mobile devices.
For example, patients with diabetes were K= 4 : 5 dimension and K= 4 : 4 dim, hypertension
K=4 : 5 dimension and K= 4 : 4, hepatitisB K=4 : 5 and K= 4 : 4, osteoarthritis K= 4 : 5 and K=
4 : 4, paralysis K= 4 : 5 and K= 4 : 4 and parkinson K= 4 : 5 and K= 4 : 4 for the physical and
nutrition therapy respectively.


The purpose of this study was to examine changes in body mass index among elderly in royal denture bestowed project. The study design was a retrospective cohort study. Data collection was carried out in 436 subjects, from 6 months to 2 years after denture services. Multiple linear regression was used to analyses the relationship between denture use and body mass index adjusted for gender, age, income level and baseline body mass index.
The results showed that the denture use significantly increased body mass index of elderly in royal denture bestowed project (P < 0.05)


The methodology of this research was a Mixed method ,combination of survey research and In-depth
interview. The Objective to study medical rehabilitation services situation , to study factors relating to access
of medical rehabilitation service amongst people with mobility impairment and to utilize information for
policy planning in the aspect of development of the service system. A sample of people with mobility
impairment were drawn using multi-stage sampling from 10 provinces in 4 regions of Thailand. The samples
used in the research were 400. The questionnaire was used to collect the data from June to September
2013.The response rate was 97.25%. The data were analyzed using percentage, mean, standard deviation, t –
test, F test, chi-square test, and Forward stepwise logistic regression analysis. The study results situation of 26
items of rehabilitation services, service sectors can provide only some items. The most accessibility of service
consist of evaluation, medication and advice & councelling. While the less accessibility consist of vocational
rehabilitation, skill & knowledge training for care giver and social skill training for people with mobility
impairment. Correlation factors according to rehabilitation accessibility consist of gender, medical right, type
of impairment, onset of disability, travelling to the health service and public facilities. These factors can be
used as a predictor of rehabilitation accessibility at 14.5 percentage.


Postoperative liver failure is a life-threatening complication after hepatic resection. Because of recent advances in liver surgery technique and a better patient selection, morbidity after hepatic resection has steadily decreased, but its incidence still ranges from 1.2% to 32%. The factors of postoperative liver failure, morbidity and early mortality in major hepatic resection in the modern era should be reevaluated.
STUDY DESIGN:Demographics, extent of resection, liver fuction, ICGR15, liver volumetry, operative and transfusion data, complications, and hospital stay were analyzed for patients undergoing major hepatic resection(no less than bisegmentectomies) from January2013 to September 2013 at RajavithiHospital. Factors associated with morbidity and mortality and trends in preoperative and perioperative variables over the period of study were analyzed.
RESULTS:Of 50 patients who underwent major hepatic resections, 6 patients (14.63%) developed postoperative liver failure after hepatectomy, 18 patients (36%) had morbidity and 2 patients (4%) died within 30 days postoperatively. Amount of segmentectomy was the significant risk factor for postoperative liver failure and 30-day mortality after major hepatectomy. ICGR15, blood transfusion operative time and more than 3 segmentectomies were the significant risk factors for morbidity. The only significant risk factor for morbidity by multivariated analysis were operative time.
CONCLUSIONS:Careful patient selection based on ICGR concurrent with decreasing blood transfusion and decreasing operative time in major hepatectomy cases could help prevent the occurrence of postoperative liver failure, morbidity and 30 day mortality.


Maternal and child health (MCH) situation in three southernmost provinces has
been in a critical stage. MMR was about three times higher than country’s targets and
almost two times in MDGs Plus target, lower than the performance in almost all
indicators. Most deaths due to causes that can be prevented in the context of modern
obstetrics. There is only a small detail that seems to be absent. Prenatal care to pregnant
women with traditional midwives. The way of life, religion and cultural norms determine
the practice of pregnant women. But it is not seen as important as surveillance and health
complications. Key factors which affect the success of maternal and child in three
southmost provinces are
1. Manpower : Turnover rates are frequent, bcause it is a difficult task,
required high skills and experience. More tools and indicators and some indicators are not
consistent with the context in three southmost provinces.
2. Belief : Two believes persists that determines the norms and practices of
pregnant women are 1) do not eat more and do not take the medicine 2) seek female
personnel’s service for delivery. Including lifestyle, religious values are very high in regard
to procreation, and that the death is natural. The attitude that contraception is wrong,
against the principles of Islam.
3. Traditional Birth Attendants (TBA) : TBA is the strength of maternal and child
health in the southmost provinces. Pregnant women are faithful and believe in TBA. While
Islam still had limited access to medical services.
Suggestion and Policy Brief
1. Urgent measures : Cooperation with TBA to reduce MMR (Maternal
Mortality Rate) in three southmost provinces. Development competency TBA to learn
assessment of high risk pregnancy, refer and delivery of emergency cases safely.
Appropriate Incentive measures are important. We should also encourage Muslim
husbands to have proper attitude and to help woman during pregnancy and childbirth.
2. Medium and long term measures : Department of Health and related
agencies should review policy, strategy and tools that is flexible, affordable and possible.
Provides analysis and support capacity in maternal and child health. We should put more
ostetricians in the three southmost provinces and enhance them and their MCH team to
understand the way of truly Muslim.


This research aimed to develop optimum health promotion model of local
administrative organizations. Development process consisted of four steps. The first
step, health promotion situation of local administrative organizations was analyzed and
evaluated. The second step, impossible health promotion model of local administrative
organizations was stipulated. The third step, health promotion model was practiced in
local administrative organizations. The forth step, practical result was assessed.
Research and development study with action research was used as research
methodology. Health promotion situation and problem in operating by local
administrative organizations was collected via document study and then people, officers
and stake holder were interviewed in pilot study. Health promotion model for local
administrative organizations, which was developed in previous step, was conducted in
focus group discussion comprised of scholars, experts and stake holders to find out
additional issues for drafting development. Health promotion model for local
administrative organizations was developed by implementation and then evaluation.
Result of document study revealed that health promotion model was belonged to
type 1, policy and key performance indicator - responded model, The model was
belonged to type 2, community’s health problem solving – responded model, The model
was belonged to type 3, both policy and community – responded model. In model
drafting development, data in previous step was conducted in focus group discussion
comprised of experts and model that integrated plan, policy and community problems
and participated with network would be an optimum model.
This research would lead the suggestion for Local Government Organizations’
potential development in health promotion. All public health organizations and related
organization should stipulate ways, model, operating procedure and supporting activities
for skill and knowledge training to Local Government Organizations’ committee which
would influenced their attitude and their concrete operation.


The incidence of childhood obesity in Hat Yai District, has become increasingly
high and its effects are likely to worsen in the future. To control and prevent obesity
effectively by behavioral changes, various levels of control and factors are needed.
This quasi-experiment are two-group pretest-posttest non-equivalent control. The
main objectives of the study were to compare health behavior and weight loss among
secondary school students whose weights were higher than the standard body weights
before and after participating in the programs, and to investigate the results of the
programs in terms of policy of school administrators, school physical environments,
peer influence, health service systems, school food sellers program, overweight
students program, and parents and guardians program. The subjects consisted of
school administrators, school physical environments, peer groups, health service
systems, school food sellers, parents and guardians. The key subjects were male and
female secondary school students with body weights higher than the standard body
weights in Hat Yai District, Songkhla Province. There were 51 students in each group of
the control and the experimental groups. The behavioral change tools consisted of
administrative policy, physical environmental development, peer influence, health
service systems, parents program, food sellers program, and health behavioral change
program for overweight children. The experiment was from July 2014 to February
2015. The general data were analyzed with frequency and percentage, health
behavior and weights before and after the experiment were compared using Wilcoxon
Signed Ranks Test and Mann-Whitney U Test. Analysis was performed with qualitative
data on school administrative policy, physical environmental development, health
service system, and food sellers in the school.
The study found that after the experiment, the experimental group had a
higher level of health behavior in food consumption than the control group at a
statistically significant level of p<.05, the level of health behavior in exercise for the
experimental group was also higher than that for the control group at the level of
p=.05. The effects of the programs on weight loss revealed that the average of
ordinal scale for the experiment group decreased with a statistic significance of (p<
0.05) while that for the control group increased with a statistic significance of (p< 0.05).
The results of the study indicate that the health behavioral change program
improved health behavior among the overweight secondary school students, and
decreased their weights.


This study aimed to determine the amount of energy in total and by physical activity domains (Activity
at Work, Transportation, Recreational Activities, and Sedentary Behavior) of Thai adults, and disaggregated
by subgroups of participants. The study re-analyzed data of 22,136 Thai adults aged 15 and above from the 2007 National Physical Activity and Obesity Survey conducted by ABAC Poll Centre of
Assumption University. Descriptive statistics were defined in the analysis. The results showed that the
average total daily energy expenditure was 1,239 kcal and the average daily energy expenditure in work
domain was the highest at 523 kcal, followed by sedentary, transportation, and recreational activity domains
at 409, 180, and 126 kcal, respectively. Male participants aged 25-44 living in rural areas including
farmers and laborers, and those who had the lowest education level and income level spent the highest
total daily energy expenditure and energy expenditure in work domain. In contrary, women, elderly,
unemployed people and students spent the lowest energy.


This study aimed to explore administrative and management system of the Collaborative Project to
Increase Production of Rural Doctor (CPIRD), and the One Doctor One District (ODOD) programs by
using qualitative study methods: document reviews, in-depth interviews and group interviews of 56
stakeholders. The stakeholders consisted of the Office of Permanent Secretary, the Office of Collaborative
Project to Increase Production of Rural Doctor, medical faculties, medical education centres in affiliated
hospitals, and provincial health offices (PHOs). Content analysis was employed for data analysis.
The results showed that the Office of Collaborative Project to Increase Production of Rural Doctor
plays important roles for overall management including proposal endorsement to the cabinet, quotas and
the criteria for admissions determination, budget and procurement procedures, and student database
establishment. Medical schools are responsible for the selection of medical students and teaching medical
students in preclinical years while medical education centres have been taking care of students in clinical
years. All three units are highly coordinated and consistent. While the PHOs play vital role on monitoring
the contract and the work of the medical graduates under the project. The budget and personnel
administration are managed under the Ministry of Public Health regulations and universities.
This study recommended the Ministry of Public Health establishes long term status of the CPIRD
and ODOD program. In addition, it requires the improvement of management for overlapping location of
student recruitment by establishing the network among the program and medical schools according in
individual geographical areas. Moreover, promoting roles of PHOs in tackling with rural physician
shortage is recommended.


The objective of this study was to analyze the utilization of oral health care among Thai working age
population by using database of the Health and Welfare Surveys conducted by the National Statistical
Office in 2013. The surveys covered 27,960 households nationwide. Data were then weighted to represent
the total population. It was found that in overall, 98.7% of working age population was covered by any
health insurance scheme, of which national health insurance scheme (UC) shared 64.8 %. Among those
insured, only 9.3% reported having oral health care during the past year. Regarding area and income, it
was found that Civil Servants’ Medical Benefit Scheme (CSMBS) with high income clients from Bangkok
Metropolitan have the highest accessibility to oral health care of 22.5% compared to those national health
insurance scheme of 7.0-8.5% or 2.7-2.9 times higher. Furthermore, 45% of cases reported abstain to use of
their health insurance for oral health care and even 51.7% for UC scheme. Among UC scheme holders,
84.4% preferred seeking private services. The result reflects the challenge in access to oral health care. It is
necessary to develop measures to increase access to public services with effective and appropriate mechanisms.


Objective: This empirical study investigates hospital’s incentives in responding to the difference in
reimbursement policies. Specifically, it seeks to identify and analyze possible cross-subsidization across
health schemes within the public hospitals in Thailand.
Methods: This observational study employed a mixed-methods research design. Qualitative
contents were collected from focus-group interviews of 30 hospital administrators in three selected public
hospitals, and content analysis was primarily used to synthesize a mental model of how hospital
administrators making decisions related to the concept of cross-subsidization. Quantitative data analysis
was used to compliment the qualitative contents on the issues of unit-cost difference, difference between
charge and cost, and difference between reimbursement and cost across health schemes.
Results: Content analysis reveals four emerging themes. First, the concept of cross-subsidization
is perceived differently among hospital administrators. Second, payment policies create obstacles to
hospitals’ financial management. Third, organizational factors also create obstacles to hospitals’ financial
management. Lastly, hospitals respond to payment policies of health schemes by various measures. These
findings are supported by quantitative results, which suggest the unit costs and the differences between
reimbursement and cost vary across health schemes after controlled for other patient characteristics.
Nonetheless, no evidence suggests that hospitals cost-shift by increasing prices charged to out-of-pocket
payment patients to compensate for the loss.
Discussions: Despite no strong evidence of cross-subsidization, we found three patterns of
decision-making of hospital administrators related to cross-subsidization, including implementing no
management practices for cross-subsidy, initiating organizational practices to reduce negative financial
impacts, and attempting to negotiate with health schemes on a fair reimbursement rate. Hence, policymakers
should adjust financing policies to adequately pay for health services provided. When evaluating the
impact of any payment policies, policymakers should consider not only an impact to patients of any
particular health scheme, but also an impact to other patients groups within the hospitals. Future studies
should utilize time-series data to determine a causational relationship between payment policies and
cross-subsidization at the hospital level.


In 2010, the Dental Council has prepared Thai Dental Safety Goals and Guidelines 2010 which was
distributed to members to learn and put into practice. It could be adjusted according to different context
of use to ensure maximum safety for both service providers and recipients. The purpose of this study was
to evaluate the dental service quality in Dontan Hospital against the Thai Dental Safety Goals and Guidelines
2010. Data was collected from 240 patients using a questionnaire to access patient treatment quality
according to Thai Dental Safety Goals and Guidelines 2010. The evaluation also assessed 240 copies of
complete medical records and self-evaluation was included. The methodology used is the quantitative
analysis of frequency, percentage, mean and standard deviation. The process started from July 1 and
ended on July 30, 2014. The study found that : 1. On average, patient evaluated the quality of treatment at
92.8 percent. 2. The average of completeness of information, especially in dentistry was about 66.3 percent.
3. Self-assessment evaluation was done at 89.09 percent for patient safety, the improvement of communication,
safe dental treatment, safe infection control and complete record. Nonetheless, there are also
rooms for improvement. Written treatment plan in complicated cases needs to be recorded. Quality of
service in pediatric treatment could be improved by using the dental dam.


Chest x-ray is one of the examinations/tests of the annual check-up program in Thailand. Routine
CXR is also occasionally required of future employees, or university students before admission. However
in many countries prevalence of abnormal chest x-ray on annual checkup is low yield and high cost. Purpose: The study aims to determine the prevalence of abnormal annual check-up CXR in Pua Crown
Prince Hospital and to find out the correlation between age group and prevalence of abnormal CXR.
Methodology: Descriptive analysis and to cross sectional design were used in this study. All patients
who came for annual checkup and CXR at Pua Crown Prince Hospital during 1 January to 31 December
2013 were included. All of CXR evaluated by radiologist were analyzed by using SPSS 21. Findings:
Among 1,569 cases of annual checkup at Pua Crown Prince Hospital during 1 January to 31 December
2013, 1,446 routine CXRs were found and 21 films were technically poor. Consequently 1,425 films were
included in this study. Prevalence of abnormal CXR was 3.15% and 1.82% of abnormal CXR was cardiomegaly.
Lung abnormality was 0.63%. The remaining abnormalities were scoliosis of thoracic spine and
renal stone. Discussion: Prevalence of abnormal screening chest x-ray on annual medical checkup is low.
Most of abnormal findings were cardiomegaly. Findings of lung abnormality were low. Screening CXR
would also lead to unnecessary radiation, and false-positive screening resulting in physical risk, unwarranted
anxiety and more expenditure. Screening CXR is appropriately reserved for high-risk patients and
those with relevant clinical findings.


The first treatment option for end stage renal disease patients is dialysis. However, some patients
select non-dialysis treatment (NDT). Currently, data on clinical outcome of this treatment modality is
limited. Therefore, a retrospective cohort study was performed to evaluate clinical outcomes of chronic
kidney disease (CKD) stage 5 patients managed with NDT, including survival, factors affecting survival,
and hospitalization. The data was reviewed from the first date approaching to stage 5 (glomerular filtra-tion rate < 15 ml/min/ 1.73 m2) for at least 2 years, until death, or until the end of the study. A total of 72
patients who fulfilled the eligibility criteria were included to the study. The mean age was 65.4 years old.
The most common cause of CKD was diabetes mellitus (n = 35, 48.6%). The most common co-morbidity
was hypertension (n = 54, 38.6%). The most common reason for selecting NDT was lacking of a caregiver.
The median overall survival was 26.1 months. One-year and two-year survival rates were 80.0% and
59.0%, respectively. There were 307 occasions of unplanned visit, and 115 of these were related to renal
causes (37.5%). A total of 56 (77.8%) patients were hospitalized on 179 occasions. One hundred and two
(57.0%) of these were due to renal causes. This study demonstrates that the survival time of NDT patients
was approximately 2 years. There were high numbers of unplanned visits and hospitalization among
these patients. Therefore, NDT modality should be considered as a choice only for patients who are
contraindicated or not eligible for dialysis, or who would not be beneficial from dialysis.


A total of 517 samples Salmonella strains isolated from stool and blood patients, hospitalized in Trang,
Phathalung and Songkhla provinces in 2011-2014. The ratio of female to male was 1 : 0.98. The predominant
age group of isolates were < 1 year (137 cases 26.5 %). Serotypes of Salmonella isolated from stool were
438 samples and blood were 79 samples by Kauffmann-White scheme and Sven Gard method. Salmonella
serotype Weltevreden was the most predominant 120 samples (27.4%) followed by serotype Typhimurium
97 samples (22.1%) isolated from stool. Salmonella serotype Enteritidis was the most predominant 31 samples
(39.2%) followed by serotype Typhi 19 samples (24.1%) isolated from hemoculture Drug susceptibility of
Salmonella by the disk diffusion method with 5 antimicrobial agents such as Ampicillin, Tetracycline,
Co-trimoxazole, Chloramphenicol and Norfloxacin. Salmonella strains isolated from stool were the most
predominant resistant to Ampicillin (54.5%), followed by Tetracycline (45.2%). Salmonella strains isolated
from hemoculture were the most predominant resistant to Ampicillin (36.0%), followed by Tetracycline
and Co-trimoxazole (28.0%). All of Salmonella isolated were susceptible to Norfloxacin (100%).
The results showed serotype and drug resistance pattern of Salmonella isolated from stool and blood
for fundamental data and guidance in selecting antimicrobial agents in Trang, Phathalung and Songkhla
provinces


The rate of payment or reimbursement for health care services has been used by The Comptroller
General’s Department (CGD), Ministry of Finance of Thailand in Civil Servant Medical Benefit Scheme
since 2006. This rate does not comply with the cost of medical care services and the advancement in
medical technology. The Executive Committee of the Civil Servant Medical Benefit Scheme has resolved
to improve that public health service rate. Thus, the Health Insurance Research Office (HISRO) has been
assigned the responsibility to reviewing the reimbursement rate for health services. This review will bring
about several recommendations and modifications that are aimed to reduce the financial burden of the
reimbursements on revenues and control the costs of the drugs used. The existing reimburse rate that is
inconsistent with the operating costs.
Qualitative and quantitative analysis were used to discuss on the current data of anesthesiology
category. The first step was to conduct a focus group discussion with experts from 10 hospitals (Hospitals
under Ministry of Public Health, Ministry of Defence and Hospital Medical School) and The Royal College
of Anesthesiologists of Thailand. The second step was to consider the related items and then collected
and analyzed cost structures consist of labor cost, material cost and capital cost.
The results indicated increasing units of two services, anesthesia services and equipment usage,
from the period of 2006 to 2014. In anesthesia service, there were 8 items in 2006 and it had increased to 13
items in 2014. Meanwhile, the equipment usages cost was increased by 10 items from 6 items in 2006 to 16
items in 2014. In terms of structure cost, there are three highlighted findings. First, the total direct cost
structure equals to the sum of labor cost, material costs and capital costs. Second, the administrative cost
is accounted for 25 per cent from total direct cost. The updated price is derived from the full cost (total
direct cost structure plus 25 percent overhead). Third, the future development cost composed of the sum
of full cost and 5 percent of full cost.
The evidence suggested important findings in terms of Anaesthetic time records, at average of 1,342
hours. The average labor cost for an anesthesiologist was 11.68 baht per minute and 6.34 baht per minute
for a nurse anesthetist. In terms of material cost, the combination of anesthesia care and the basic material
used in the opening line, cost started from 1,053 baht. The equipment costs started from 490 baht per total
Anaesthetic time per 5 years. The ratio of direct cost, labor cost: material cost: capital cost by General
Anesthesia (GA), is estimated at 37:43:20, meanwhile the General Anesthesia for Complicated patient
(GA (C)) ratio is estimated at 49:35:16. Regional Anesthesia (RA) first-hours service in sequence is estimated
at 52:21:27 and Local Anesthesia with Monitored Anesthetic Care (LA with MAC) in the first-hours
service is estimated at 62:5:33.
In conclusion, this above mentioned figure of the cost structure reflects the actual cost in present
year, 2014. Labor cost recorded as the highest expenditure. However, additional cost can be requested
when necessary. It is suggested, the expensive equipment has to be separated from basic instruments and
form into new item. In addition to that, it is important and necessary to build comprehensive data for
hospital cost to improve the public health service rate. Lastly, the study recommends that the systematic
data collection and real-time data record have to be made.


The  purpose  of  the  research was to investigate model and study the effects of  the  community participation model to reduce alcohol consumption behavior. The study was
research and development, included 3 phases: the first phase was  to review documents and  urban context study, the second phase was to investigate community  participation  model and the final phase was to  the effects  of  the  community participation  model to reduce alcohol consumption behavior. The sample consisted of  30 leaders and others. The  research  instrument  was   empowerment  participation  action  research. Data were analyzed by the content analysis was also used.
	The  results  indicated  that  the  process for development of community participation model of reduce alcohol consumption behavior, the  sample consisted of  village leader, headman, village health volunteers,  teachers,  health officer, health leader and  the other  have  a  top level participation and more than 80 percentage of samples  participated  in  all  processes. The result of  the  community participation model to reduce alcohol consumption behavior included social measures by community, strong of community and network, people in community to reduce alcohol consumption behavior, the alcohol free zone in school temple and official place, many shops in the community not for sale alcohol drinking, the  people have knowledge about toxic alcohol and innovation of community to reduce alcohol consumption behavior.
	It can be conclude that the community participation model to reduce alcohol consumption behavior was an effective developing ability community and  to solve behavioral problems related to drinking behavior. Family and community  to be realize about health problems and behavior problems and it were made personal and community change for cooperation of community.


The purpose of the research was to investigate model and study the effects of the community participation model to reduce alcohol consumption behavior. The study was
research and development, included 3 phases: the first phase was to review documents and urban context study, the second phase was to investigate community participation model and the final phase was to the effects of the community participation model to reduce alcohol consumption behavior. The sample consisted of 30 leaders and others. The research instrument was empowerment participation action research. Data were analyzed by the content analysis was also used.
The results indicated that the process for development of community participation model of reduce alcohol consumption behavior, the sample consisted of village leader, headman, village health volunteers, teachers, health officer, health leader and the other have a top level participation and more than 80 percentage of samples participated in all processes. The result of the community participation model to reduce alcohol consumption behavior included social measures by community, strong of community and network, people in community to reduce alcohol consumption behavior, the alcohol free zone in school temple and official place, many shops in the community not for sale alcohol drinking, the people have knowledge about toxic alcohol and innovation of community to reduce alcohol consumption behavior.


Health information system for project and budget management (HIS4PM) of Health Service Area 12 (HSA 12) had been web-base application which was developed base on a Rapid Prototyping Design Model (RPDM) and a participation action research that consisted with both qualitative and quantitative methods. This included four phases, gathering requirement form health agencies in HAS 12 (Zonal Health Office; ZHO, Provincial Health Office; PHO, and District Health Service Network), setting objectives, constructing and utilizing of prototype. The prototype was installed in many health agencies (PHO, DHO, Hospitals and Health Promoting Hospitals) at 7 provinces that were Songkha, Satoon, Trang, Pattalung, Pattani, Yala, and Naratiwat. The focus group method was used to hear form users, and then HIS4PM was improved follow by users’ need. During February to April 2015, it was evaluated satisfaction by users.
	Relational Database Concept was used to deploy Web Base Application for accessibility of all users that could be accessed and updated their data in real time especially at the important points for instance budget arrangements and budget withdrawal etc.
	The result showed that HIS4PM could respond to all health agencies’ monitoring and evaluating systems in HSA 12. Most of users rather highly satisfied to HIS4PM’s utilization in all dimension such as application using policy, strategy implementation, utilization of project and budget managements, information completeness, and appropriateness of application.


This study is a descriptive study (descriptive research) where qualitative data is collected (qualitative method). The objectives are to study processes, factors and obstacles related to the data quality of services provided for outpatients, health promotion and disease prevention (21 standard folders) of Tambol Health Promoting Hospital personnel in Chon Buri. Data were collected using    in-depth interviews from of 20 participants who served on the preparation of health information of Tambol Health Promoting Hospital in 10 districts. By selecting 2 personnel who prepared 21 standard folders reports with the highest and lowest data quality in each district then the data were analyzed (content analysis).
The study found that: 1) the preparation of the information; the group with high scores, recorded data in real time, recorded the required personal information, backed up data daily, checked for accuracy and completeness of the reports and gave feedback if error(s) found. If the responsible personnel were unavailable, other personnel could interchangeably export the reports within specified time. Those with low scores, some did not record data daily and recorded by temporary employee and could not take advantage of the data. 2) Factors related to data quality including; the personnel have a positive attitude towards the preparation of the information, understand the structure of the folders, received training, responsible and circumspect, a number of staff and workload were reasonable. Budgeting and up-to-date equipment were adequate. Management executives are key factors to monitor and encourage to record accurate data and check the completeness of the data. 3) The obstacles including; some data recording personnel lack of knowledge because they have not been trained, no personnel to interchangeably export data, computer break down and unable to connect to the internet.


This study is a descriptive study (descriptive research) where qualitative data is collected (qualitative method). The objectives are to study processes, factors and obstacles related to the data quality of services provided for outpatients, health promotion and disease prevention (21 standard folders) of Tambol Health Promoting Hospital personnel in Chon Buri. Data were collected using in-depth interviews from of 20 participants who served on the preparation of health information of Tambol Health Promoting Hospital in 10 districts. By selecting 2 personnel who prepared 21 standard folders reports with the highest and lowest data quality in each district then the data were analyzed (content analysis).
 The study found that: 1) the preparation of the information; the group with high scores, recorded data in real time, recorded the required personal information, backed up data daily, checked for accuracy and completeness of the reports and gave feedback if error(s) found. If the responsible personnel were unavailable, other personnel could interchangeably export the reports within specified time. Those with low scores, some did not record data daily and recorded by temporary employee and could not take advantage of the data. 2) Factors related to data quality including; the personnel have a positive attitude towards the preparation of the information, understand the structure of the folders, received training, responsible and circumspect, a number of staff and workload were reasonable. Budgeting and up-to-date equipment were adequate. Management executives are key factors to monitor and encourage to record accurate data and check the completeness of the data. 3) The obstacles including; some data recording personnel lack of knowledge because they have not been trained, no personnel to interchangeably export data, computer break down and unable to connect to the internet.


Health information system for project and budget management (HIS4PM) of Health Service Area 12 (HSA 12) had been web-base application which was developed base on a Rapid Prototyping Design Model (RPDM) and a participation action research that consisted with both qualitative and quantitative methods. This included four phases, gathering requirement form health agencies in HAS 12 (Zonal Health Office; ZHO, Provincial Health Office; PHO, and District Health Service Network), setting objectives, constructing and utilizing of prototype. The prototype was installed in many health agencies (PHO, DHO, Hospitals and Health Promoting Hospitals) at 7 provinces that were Songkha, Satoon, Trang, Pattalung, Pattani, Yala, and Naratiwat. The focus group method was used to hear form users, and then HIS4PM was improved follow by users’ need. During February to April 2015, it was evaluated satisfaction by users.
 Relational Database Concept was used to deploy Web Base Application for accessibility of all users that could be accessed and updated their data in real time especially at the important points for instance budget arrangements and budget withdrawal etc.
 The result showed that HIS4PM could respond to all health agencies’ monitoring and evaluating systems in HSA 12. Most of users rather highly satisfied to HIS4PM’s utilization in all dimension such as application using policy, strategy implementation, utilization of project and budget managements, information completeness, and appropriateness of application.


Introduction: Drug-related problems (DRPs) that cause hospital admission are a major cause of morbidity and pose a substantial burden on limited healthcare resources. Risks of DRPs have been highlighted in policy documents worldwide.
Aim: The overall aim of this study was to examine the natures of DRPs that lead to hospital admissions in terms of prevalence, risk factors, and medications. The DRPs in this study included adverse drug events (ADEs), adverse drug reactions (ADRs), non-adherence to medication (NA) and medication errors (MEs).
Methods: A prospective observational study was conducted in 10 hospitals in the Lower Northern Region of Thailand over 3 months. A review of medical records of patients admitted to medical units was undertaken by pharmacists supplemented by patient interview to detect DRPs. All DRPs were clinically assessed to determine contribution to hospital admissions, causality, severity and preventability. The main outcome measures included the proportion of screened hospital admissions that were due to overall DRPs, ADEs, ADRs, NA, and MEs. All statistical analyses were performed using STATA version 9.
Results: A total of 4112 patients were screened of whom 1999 patients were elderly, and of these, 56 admissions (2.8%) were due to causal DRPs. The corresponding number of hospital admissions associated with ADEs and ADRs was 47 (2.4%) and 46 (2.3%). NA was responsible for 18 (0.9%) of admissions. Nearly half of hospital admissions associated with causal DRPs (44.0%) were judged to be preventable. When classified by type of DRPs, nearly one third of hospital admissions associated with causal ADEs [22 (31.4%)] including causal ADRs [20 (29.4%)] were preventable; 90.6% of hospital admissions associated with causal NA were preventable. Most casual drug related problems (98.9%) were of moderate severity. Risk factors of hospital admissions associated with the study population including 60% of the elderly patients were patient age, receiving new medications within 1 month, polypharmacy (≥ 5 medications). Other risk factors identified in the study population included receiving medications from private clinics, receiving medications from drugstores, education, alcohol  drinking, and family. Harm to patients from hospital admissions associated with drug related problems were often hypoglycaemia, hypokalemia, gastrointestinal/intracerebral haemorrhage, hyperglycaemia, hypertensive urgency/ascites, COPD exacerbation and drowsiness. Medications targeting the endocrine, cardiovascular and central nervous systems were the drug classes most frequently involving hospital admissions associated with ADEs including ADRs. Medications involving the endocrine, cardiovascular and respiratory systems were frequently involved in hospital admissions associated with non-adherence.
Conclusion: Hospital admissions associated with drug-related problems in elderly Thais are common. Effective risk management programmes and interventions for reducing risk from DRPs are needed for ensuring safety in medication use in the elderly.


The Objectives of this study were to investigate family participation in
supporting drug use for Thai elderly with chronic diseases and to create a
handbook for families who are assisting in treatment of Thai elderly with chronic
diseases.
Key informants are elderly's family, where the elder has at least one
chronic disease, in lower northern areas. The key informants are composed of
two main groups; the elderly with a chronic disease and their family members.
Purposive sampling and in-depth interview with interview guide were used for the
study. Data collection and content analysis were conducted from early in
October, 2013 until late in June, 2014. Data saturation was achieved with 50
cases. The results from this part were employed to make a handbook for families
who are assisting in treatment of Thai elderly with chronic diseases. The
handbook was reviewed by three specialists. After editing, the handbook was
evaluated by those families. Frequency, mean and standard deviation were
employed for analysis in this part.
The results showed that there were nine types of family participation
in supporting drug use. Those were 1) taking the elderly to see their physicians,
2) travelling to get medicine for the elderly, 3) tracking physician's appointments,
4) assisting with correct drug use, 5) assisting with appropriate diet, 6) maintaining
correct medication schedule, 7) preparing drugs for each meal, 8) monitoring
symptoms of drug use, and 9) building both self-esteem and esteem in others.
Several obstacles to good support were identified. They are
employment outside the family, misunderstandings between family members
and the elderly about the capabilities/self-support of the elderly, lack of
knowledge about chronic diseases and drug use in the elderly and weak family
relationships. In terms of handbook evaluation, the families had a good level of
satisfaction in every item evaluated.


Healthcare Healing Environment Design research project consist of objective for: (1)
Surveying the problem of healthcare environment setting (2) To design an assessment tool for
Healthcare Healing Environment Design. Research focus on 12 of 30-120 beds community
hospitals countrywide with specific selection.
Research found that settings for healthcare healing environment in most of research
participant hospitals have problem on space management, way findings/ signage, knowledge
boards, visual objects, color tones, crowded waiting area, air quality in service area. Besides,
there are more problems outside buildings such as cars parking area, connecting corridor also
garden landscape those cannot support practical usage.
To design an assessment tool for healthcare healing environment, research team were
reviewing international literatures and related research papers combine with experiences from
working in Healthcare Accreditation Institute (Public Organization) and visiting countrywide
hospitals in order to get a preliminary self-assessment tool for participant hospitals. Core
principles of the assessment tool are based on the six factors that affect the human senses.
After trial implementation in participant hospitals, the assessment tool was developed to be
the final version for first year research program by dividing assessment parameters into 3 areas:
(1) buildings outdoor (2) common facilities and (3) indoor function; as (1) and (2) are common
area and (3) is for each units/ wards.
This Healthcare Healing Environment Assessment Tool Kit will be implementing in
participant hospitals as for evaluating the tool and develop to be a more complete tool in the
second year of the research program.


Inappropriate medication use behavior is one of major causes of drug related events which lead to acute episodes and hospital visits among older adults. The purposes of this study were to investigate medication use behaviors, determine factors related to medication use behaviors, and explore means to prevent and solve problems related to medication use behaviors among older Thai adults. Using a descriptive qualitative design, this study employed an in-depth interview in 23 adults aged 60 years and older who experienced drug-related problems on a hospital visit and their caregivers. The study focus groups were conducted in 26 health care personnel.
Using a content analysis, this study revealed that medication use behaviors required capability to perform medication administration and capability to make a proper decision. Medication use behaviors involved: medication use method (medication non-adherence and unsafe self-medication), making choices of drug sources, and keeping and dispensing medication. Factors related to medication use behaviors comprised (1) pre-existing factors including individual capacity factors (e.g. knowledge, attitude, memory, and vision), and daily activity factors (e.g. working job, social activities, and caring for others) (2) precipitating factors including disease manifestation (e.g. severity, duration), and response to medication (e.g. experience relief and side effect), and (3) modifying factors including social influences (family, health care personnel, and media), medication-related factors (medication regimen complexity), physical environment (distance to hospital), and financial status.
The results of this study proposed 3 approaches to solve the problems related to medication use behaviors: reactive, proactive and systematic approaches. The results can be used in nursing education and other allied disciplines. Suggestion for future research was to test the model of factors related to medication use behaviors and to determine influencing factors. The results of the study also suggested that national and local governments develop database network system, and provide services to fulfill basic needs of the older Thai adults.


Proper facilities for elderly is important for preparation for being an aging society of
Thailand in a near future. Number of elderly in elderly home care is increasing during the past
few years. This trend is expected to continue for decades.
This paper determines a priority of facilities for elderly in elderly home care in
Nakhon Ratchasima province namely Thamma Pakorn Poeklang. Three groups of information;
including capability of the facilities to prevent falling in elderly, frequency and violence of
falling in elderly, and level of self-care ability, are used for a determination of the priority of
facilities for elderly. This study shows that facilities relating to environmental arrangement and
balance of elderly are the most important depending on locations. For the wide court area,
facilities relating to environmental arrangement are this most important. While, facilities
relating to balance of elderly are the most important for limited space area. Results from this
study are based on elderly sampled from the studied area. For other areas, it is suggested to
determine the level of self-care ability of elderly in the interested area and re-determine the
priority of facilities for elderly in the same way presented in this paper.
This research explored basic information, physical characteristics, and strength of
elderly in Thammapakon Pho Klang nursing home, Nakhon Ratchasima. Fifty nine subjects, 41
males and 18 females, participated in this study. Average age of the subjects was 75.07 years
old. Average heights were 160.42 and 144.97 cm for males and females, respectively. Average
shoulder heights were 134.24 and 119.22 cm for males and females, respectively. Average
hand thickness were 4.00 and 2.90 cm for males and females, respectively. Average grip
breadths, inside diameter, were 3.55 and 2.89 cm for males and females, respectively.
Strength of males was greater than that of females. Data obtained from this research can be
used to design facilities for elderly. For example, handrail diameter should be 3-4 cm. and
handrail height should be 80 cm. These dimensions conform to stipulating accessibility in
buildings for disabled persons and elderly ministerial regulation B.E. 2548.
Design of buildings of Thammapakon Pho Klang nursing home, Nakhon Ratchasima
based on green building principles is a suggestion of design guidelines. These guidelines
include layout of project and buildings in Thammapakon Pho Klang nursing home which
conform to green building and energy saving principles and also efficiency increase. Moreover,
building utilization, water management, waste management, environment friendly material
selection, effect of buildings on health of building users and environment, construction, operations, maintenance, and high quality disposal are included. The researchers have made
3 dimensional animation in order to transfer knowledges and understanding of building design
for elderly based on green building and accessibility of people at all ages.


The purposes of this research were 1) to study the Resilience Quotient situation of elderly in the East 2) to study a suitable model for the difference elderly and 3) to develop a resilience model through the integration of family’s involvement, civil society network and counseling process.  The research’s process and results were as follows;
Step 1: A study of the Resilience Quotient situation of elderly was conducted in two sub steps:
1) A survey of Resilience Quotient of the Elderly in 8 eastern provinces include Sakaew, Chanthaburi, Nakhonnayok , Rayong, Trat, Chachoengsao, ChonBuri and Pracheenburi ; each 240 with a total of 1,920. The instrument used was a Resilience Quotient Questionnaire developed by the researcher. The results showed that the resilience of elderly in the East was in medium with average score at 2.41. When making comparisons in each component it found that the fifth component (Self-management in living) was highest average, followed by the fourth (Coping), the third (Interaction with each other), the first (Goal in life) and the second (Optimism) with mean of 2.49, 2.47, 2.45.2.34 and 2.32 respectively.
2) A study of the context of family, civil society network and counseling model to support elderly  show that there are a number of civil society networks who work with the elderly in the East, both public and private, but there was no cooperation in elderly support. A counseling style was going to meet the need of each organization. There was no sustainability in the implementation of the project.
	Step 2: A study of a Resilience Quotient model which healthy for the difference elderly showed that there were no institutions in the East who develop the Resilience Quotient model for elderly. There are only to improving health, psychological well-being, economic and life style. The model used was in the form of training, knowledge sharing, guidance, education,
potential development and promoting the use of the potential of the elderly.
	Step 3: A development of elderly‘s resilience enhancing model with the integration of family involvement, civil society networks and counseling process. A model was developed by the researcher in a form of training course with a combination of various approach include the concept of civil society network synchronization, the involvement of the family and the counseling process. The content of the course was a development of resilience in four components: 1) goal in life 2) optimism 3) interaction with each other 4) coping and 5) self-management in living. The course was designed with the integration of the involvement of family and civil society networks to meet the needs of elderly in every context. The curriculum is focused on enhancing cognition, awareness of their roles as a model of a social, a coping skill to deal with life and the use of psychological principles to view themselves and help others.  A structure of a courses consist of;
1) the elderly with families, communities and networks
2) the power of relationships
3) to live in a meaningful way
4) self - awareness
5) optimism created by aesthetic dialogue
6) to added, repair and interact with around people
7) a storm of problems ... I can do
8) thank you for the value life
9) to exchange for a changing.
The researcher has assessed the program in terms of attitudes, skills, and overall performance and found that the elderly who participated in the program had high resilience quotient in all components. The overall scores were higher statistically significant at .05.
Step 5: to offer a policy recommendations to enhance elderly’s resilience the researcher had held seminars and has concluded the following policy recommendations.
1) To enhance elderly’s resilience it should be a synchronization of the network both public and private sectors to work together. Creating a better understanding will make strong networks with higher potential, and it should be operation for the continuously movement.
2) The model developed by the researcher was interesting and appropriate. It was a concept that integrates combined operations with a focus on developing of resilience as well. So there should be the extension of this model to the area to be able to use efficiently and effectively.
3) The brainstorming to reflect the idea from the various associated agencies, both public and private, was important and necessary because it can develop resilience to meet the needs of both target group and related other.


Treating ischemic stroke patients with rt PA no more than 3 hours or 180 minutes after the stroke can increase the chance of recovery or improved condition.  If, however, treatment is delayed, the potential outcome may be permanent disability or death.  This descriptive study was conducted with the objective of assessing time elapsed before treatment in ischemic stroke patients and analyzing the factors influencing the amount of time elapsed before ischemic stroke patients receive hospital treatment.  The sample group was composed of 300 ischemic stroke patients treated at Sanphasitthiprasong Hospital in the province of Ubonratchathani, Thailand.  Data were collected from November 2014 to February 2015.  The following three sets of instruments were employed:  1) Demographic Data Questionnaire; 2) Ischemic Stroke Evaluation Form and 3) Time to Treatment Evaluation Form.  Data were analyzed by descriptive statistics and by finding the correlations by using Spearman's correlation coefficient.
According to the research findings, 229 of the 300 ischemic stroke patients (76.3%) had pre-hospital times of more than 180 minutes.  The median pre-hospital time from the occurrence of stroke to hospital arrival was equal to 302.5 min (S.I.Q. = 589.38). The amount of time elapsed from arrival in the emergency room at Sapphasitthiprasong Hospital until receipt of treatment (in-hospital time) was equal to 107 min (S.I.Q.= 43.125). Therefore, the median time from the initial presenting symptoms until treatment was equal to 590 min (S.I.Q.= 635.63).  Furthermore, the pre-hospital time, the distance from the site of the incident to the hospital and the in-hospital time from arrival until laboratory test results were received were found to be positively correlated with the pre-hospital time from the initial presenting symptoms until receipt of treatment (rs= .661, .185, .235, p<.01).  The severity of symptoms evaluated with NIHSS scores was found to be negatively correlated with pre-hospital time (rs= -.129, p<.05).
In summary, most ischemic stroke patients within the boundaries of Ubonratchathani receive delayed treatment in which the pre-hospital time has the highest correlation with receipt of treatment and instructing patients, people at risk for ischemic stroke and their relatives.  Moreover, the development of an emergency medical service provision system and a hospital referral system that minimizes procedures and time in transferring ischemic stroke patients is vital to helping ischemic stroke patients receive timely treatment.