“Health in All Policies” (HiAP) had been acknowledged as a concept and principle in the National Health Act B.E. 2550 and implemented accordingly. There was still a gap of knowledge regarding the assessment of the implementation of HiAP through the National Health Act. This article aimed 1) to explore the institutionalization and implementation of HiAP concept in Thailand, and 2) to understand the foundations and development of the concept of Health in All Policy (HiAP) in the stream of health system development in Thailand. It aims for comprehensive understanding and for more effective interventions to achieve the goals guided by this concept. This study employed a qualitative research methodology. Data collection was collected from document review and in-depth interviews with 50 key informants, between April and July 2022. Thematic analysis was used to guide data analysis. HiAP emerged concretely through the promulgation of the National Health Act, B.E. 2550 through three key mechanisms, with the following findings: 1) Redefining health was clearly expressed in Chapter I Rights and Duties in Respect of Health of the Act and in the 2nd Charter on the National Health System. Intellectual health was an extraordinary dimension of ‘health’ that was defined by the World Health Organization. There were challenges concerning the promoting of the new health definition more acceptable and beneficial to the implementation of the Act, specifically the development of processes and formats for communicating new health definitions. 2) There were prominent mechanisms for enabling public engagement identified in the Act, namely the National Health Assembly process (Section 40, 44) and health impact assessment, HIA (Section 11). The National Health Assembly and HIA mechanism created an enhanced level of participation, networking, and learning. The challenge to make participation more meaningful was the authentic representation of the participants in the process and using a variety of methods to develop better policy issues. 3) Cross-sectoral collaboration appeared prominently in Section 2 of the National Health Board that identifies the state, national, local, social, academic components within and outside the health sector. In addition, the cross-sectoral collaboration designed in the Act aimed to achieve policy coordination through representatives from various sectors, making policy decisions legitimacy and in line with the direction of society. The challenge was the synergies between policy and impact. The key findings are that the foundations and developments of the HiAP concept are the results of the interrelated dynamic change in the global and national context of politics and health development. Furthermore, they relate to the emergence of organizations, mechanisms, and tools in the development of health systems from the Thai Ministry of Public Health and World Health Organization to the Second National Health Statute. Therefore, the effort to develop a health system by the HiAP approach needs to go beyond the scope of the National Health Act B.E. 2550 and its mechanism. Also, building connections and collaboration across national and international sectors is essential, as well as emphasizing the collective awareness that health is beyond the roles of public health organizations and the interventions focus mainly on the implicit concept of sanitary.


This qualitative study is about the Thai primary health system's new mission and its impacts on the Provincial Administrative Organizations (PAO). The Thai primary health system's mission is a legal mechanism and process for the provision of primary health care services under the Thai Primary Health System Act of 2019 (B.E. 2562). It has never appeared in the powers and duties of the PAO before, which leads to obstacles in management that affect the provision of health services to the public. This research had 3 objectives: 1) to study how transferring health missions to the PAO had effects on the health services at both Chaloem Phrakiat Nawaminthachini Health Center (CPNHC) and Sub-district Health Promoting Hospital (SHPH), and 2) to study how the medical staff were taught about that transition, and 3) to develop policy proposals for the primary health service model during the transition period, using qualitative research methods. The results of this qualitative research showed that the primary health service system (PHSS) of CPNHC and SHPH after the transfer to the PAO focused on providing services in 5 dimensions, namely 1) primary medical care, 2) health promotion, 3) treatment, 4) disease prevention and control, and 5) rehabilitation, and consumer protection using the concept of the Primary Care Cluster (PCC) with the seamless services following the rights under the National Health Security Office (NHSO). The PHSS after the transfer to PAOs should be strengthened under the mechanism of Primary Health System Act (PHSA) B.E.2562 (2019) and other laws related to primary health services and Health Professions Act of health care providers at the primary level. There is a governance of the health system that aims to create a relationship between various sectors in providing a network of health services rather than controlling, supervising, monitoring, but emphasizing on the management of policy networks at 4 different levels: 1) the ministry level, 2) the department level, 3) the health service area, provincial, and district level, and 4) the sub-district level, in order to be able to work in an integrated way to meet health needs at the district, provincial, regional, and national levels. Factors affecting the success of administering and managing the PHSS of the CPNHC and SHPH after transferring to the PAO under the PHSA B.E. 2562 consists of strategic implementation, monitoring, evaluation and the encouragement of strategic implementation as well as promoting the linkage of health services in response to health development policies at each level and the overall picture of the country. Key policy recommendation for primary health care (PHC) systems on the development process of policies and strategies in primary care during the transitional period after the transfer of missions as follows. 1) The Ministry of Public Health (MOPH) should be the host for policy-making and strategies for the primary care system. 2) Health Systems Research Institute (HSRI), National Board of Health (NBH), and Thai Health Promotion Foundation (THPF) collaborate in creating and synthesizing knowledge for development of primary health system in accordance with the policy of the Ministry of Public Health and creating a system and mechanism leading to the concrete implementation. 3) Strategic plan unit and primary care unit of Provincial Health Office, and PAO apply the knowledge acquired at the macro level to create a system and mechanism for learning into practice of the CPNHCs and SHPHs and to design a system to supervise and monitor the development of the PHSS continually. 4)Network node hospitals collaborate with family physicians or PHC providers in CPNHC and SHPH. 5) The CPNHCs and the SHPHs either under the jurisdiction of the MOPH or PAO conduct the strategic implementation as cascaded from the Provincial Health Office and PAO and synthesize it into practical guidelines in accordance with the context including designing a mechanism for supervising and monitoring primary health services, 6)The Provincial Public Health Office (PPHO) coordinates policy cooperation and builds a network for cooperation in collecting health indicator data with the PAO to cover the performance, policy of the country and the problems of the area.7) The responsible agencies for health information technology, MOPH analyze and design web application programing in collaboration with other agencies related to data in supporting health system governance. 8) PAO and PPHO make an agreement about an appropriate proportion of OP (basic payment). 9)MOPH set a policy for integration of resources in primary care system management and monitoring PCU and NPCU as well as coordinating the formation of a referral service network with PCU and NPCU in that area or other areas in accordance with the PHS Act B.E. 2562. Phase for strengthening the PHSS consists of 1) The MOPH sets a policy to develop the quality of primary care facilities across the country to meet standards to certify the quality of services delivered to people with equity. 2) The primary health system committee establishes a system and mechanism for developing primary care standards to be in accordance with section 24 (1), (2), (3) and (7). Sustainable development phase includes 1) The Cabinet should appoint a health system governance committee who understands the national health system as an authority to consider, supervise, monitor, inspect and direct health agencies to review the implementation and provision of health services in accordance with national health policies to continually improve the quality of health services and 2) The transferred CPNHC and SHPS under the PAO create a guideline for the participation of network partners in the local health system jointly providing health services and monitoring and evaluating to meet standards. PHS Act B.E. 2562 and in accordance with the guidelines set forth at the provincial and district levels.


The objective of the develop a database system project to support indicators of the rational use of drugs is to develop a database structure for answering various indicators related to the rational use of drugs at all levels. In this project, three parts were done: 1) development of a tool for calculating the indicators of rational use in hospitals; by relying on a database in the hospital information system. This is a new version of ThaiRDU with 3 platforms: a) HOSxP with MySQL database management b) HOSxP with PostgreSQL database management and c) Hospital OS can process 18 indicators for rational drug use in hospitals. All 3 platforms covered almost all the use of hospital information systems of the Ministry of Public Health. ThaiRDU tool was developed with the Delphi program and installed into the Windows operating system. The program was easy to use and no structural changes were made in the database of the hospital information system. It could be processed anytime online. A list of drugs used in hospitals could be set for calculating the indicators. Using hospital drug codes and not relying on 24-digit drug codes, the list of drugs that was imported into processing was accurate. In some indicators, the use of ThaiRDU might be a factor in obtaining indicator values that differed from those reported on the HDC website. 2) The results of the several indicators in three fiscal years obtained from the three data sources, i.e., the developed tools (ThaiRDU), the HDC website (HDC Service), and the Big Data on HDC (HDC Big Data) were similar. However, the results of some indicators were different which depends on many factors. One of those factors was transferring the correct information from the hospital into the HDC system in a timely manner. Using ThaiRDU has the advantage of being able to use primary sources directly. The relevant drug list can be defined without the need for a 24-digit drug code, and the drug list can be updated to be correct at any time. In the case that the hospital has already sent relatively accurate information to the system, the website provides a service plan processing service related to rational drug use that will process various indicators correctly. According to the policy, the hospital will have time to adjust the correctness to bring it into the processing at a certain time. Therefore, the reported values through this HDC website will not change. Researchers can use data from Big Data to process tasks of rational drug use, and 3) define a standard structure for rational drug use. Because the utilization of the accumulated information will be in the form of data analysis, the research team chose a design in terms of fact constellation, i.e., more than one fact table. In this research, two fact tables in two main modules were designed, i.e., the prescription_fact and literacy_fact were fact tables in a module of prescription which was used for analyzing drug use of patients, and a module of health literacy which was used for analyzing health literacy of people, respectively. In the rational use of a drug monitoring system, it can be seen that there is a need for a systematic database to process various indicators. The most systematic database that measures people's actual drug use is the HDC. It focused on drug use in hospitals in the Ministry of Health. This should be proposed to expand to all health services. It is important to measure health literacy. There is still a lack of a database that collects matters related to health literacy at the levels of health media, activities, and various questions used to measure health knowledge. The agencies responsible for such databases in the development of the database are therefore important parts of the further development of rational drug use at all levels.


The purposes of this were to study the health adjusted life expectancy (HALE) of people in health region 3, 2022, and prioritize diseases and health hazards that are important problems in health region 3. The cross-sectional study design was used. A sample of 1,230 Thai people aged 10 and over in the responsible area of health region 3, were randomly selected using a multistage sampling technique. The EQ-5D-5L Thai Version is composed of Mobility Self-care Usual activities Pain/discomfort, and Anxiety/drepression. The Sullivan method was used to analyze the data. For priority diseases and health hazards problems in health region 3, data was collected by the priority setting methods were seven components of the World Health Organization. From the committee of the health region 3. The results revealed that the HALE of people in health region 3, 2022 was 65.16 years. Lower than the Thailand target set by at least 68 years. The self-care dimension had the greatest effect on utility scores. Health status at best scores 48.94% and lowest score 0.08%. The priority diseases and health hazards that are important problems in health region 3, showed that the top three were stroke, ischemic heart disease, and road traffic injuries. Further research should be recommended to determine the model or approach to increasing HALE. as well as developing policies and measures to solve disease and health hazards and allocating sufficient resources to lead to more effective and efficient implementation.


Acinetobacter baumannii (A. baumannii) is a gram-negative bacterium that is the leading cause of nosocomial infections. This organism usually develops antimicrobial resistance, resulting in multi-drugs resistant A. baumannii. Adult and pediatric patients, including neonates with A. baumannii infections have a high mortality rate. The spread of A. baumannii in hospitals occurs through contact transmission, which could be direct contact with the hands of healthcare professionals, or indirect contact through contacts with the bacteria in various environments in the ward. This study aims to study the pattern of A. baumannii transmission in the Pediatric and Neonatal Intensive Care Unit of Thung Song Hospital, Maharaj Nakhon Si Thammarat Hospital and Tha Sala Hospital. Specimens were collected in 1) each patient's touch points, consisting of a bed or a cabinet of A. baumannii infected patients, an adjacent bed or cabinet, healthcare providers' hands and clothing. 2) Common touch points in the ward consisted of treatment record files, work desks in the ward, doorknobs, computers, telephones, sinks and bathtubs. The specimens were collected from October 2021 – September 2022. During the 12-month period, there were 27 patients with confirmed cultures of A. baumannii, of which 15 were from the infant intensive care unit of Thung Song Hospital, 5 patients from the pediatric intensive care unit of Maharaj Hospital and 7 patients from the pediatric intensive care unit of Maharaj Hospital. The results from both hospitals showed that the most contaminated areas of A. baumannii were each patient's bed (29.63%) and adjacent beds (29.63%). The other contaminated areas in the ward were healthcare providers' clothing (22.22%), infusion set (14.81%), monitor (11.11%) and healthcare providers' hands (11.11%). Regarding common touch points, the bathtub area (25.93%) was the most contaminated, followed by the patient's file (18.52%) and the desk in the ward (18.52%).


The purpose of this study was to develop indicators for monitoring and evaluating rational drug use (RDU) community driving outcome in Thailand. This study was classified into the following four parts. Part 1: Gathering the relevant indicators towards RDU promotion at the community level from literature reviews (i.e., WHO INRUD and other international and national organizations nations). Part 2: Investigating people’s drug usage in four pilot provinces under the Food and Drug Administration’s country project on rational drug use (RDU Province) includes the provinces of Chiang Rai, Uthai Thani, Sisaket, and Surat Thani. A total of 374 people participated in this study and well-trained personnel performed face-to-face interview with them. Open-ended questions about knowledge, attitudes, behavior of RDU, and perceptions of RDU project, household drug surpluses, and elderly drug usage were utilized. In addition, data from 827 samples were gathered for the RDU literacy rapid survey from four pilot areas and four additional provinces (Nakhon Nayok province, Saraburi province, Lampang province, and Narathiwat province). The relationship between explanatory factors and the people's rational drug use behavior was analyzed using multiple logistic regression. Including data gathering from guidelines for driving rational drug use in accordance with the five key activities and visiting grocery stores with pharmacists (RDU Coordinator), lessons learned in four prototype regions from the provider and the public sector representatives through focus group discussion. Part 3: Drafting a set of RDU community indicators (RDUCMI) and entering the process of selecting indicators with the help of experts (representing policy makers, academics, practitioners and public sector). The index of consistency between the list of indicators and the research objectives was applied at this point to determine content validity (Item-Objective Congruence Index; IOC). In addition, the Delphi technique for three rounds with the criteria of taking into consideration three indicators for the following: (i) appropriateness of indicators for monitoring and evaluating the results of driving RDU Community, (ii) the importance of the indicators in promoting the implementation of the RDU Community, and (iii) the possibility of evaluating (collecting data) and processing the indicators (feasibility) by using Median and Interquartile range (IQR) statistics to find consensus in selecting indicators and to test for Inter-rater reliability (IRR) using Cohen's kappa statistics (k) for confirmation of selected indicators. Part 4: testing the feasibility of RDUCMI for monitoring and evaluating the RDU community by using public hearing and database related indicators. The results of this study revealed that there were 13 key indicators of rational drug use in the community (RDUCMI) were extracted from this final research process. In order to assess the possibility of bringing developed and selected indicators for monitoring and evaluating the rational drug use in the community. Therefore, this set of indicators was taken to a public hearing at a forum with research areas in eight provinces and other provinces across the country. It was observed that the operation should be carried out over three flights of stairs. Starting at Level 1: there are five indicators that the area can be operated and can be measured as of 2023, (i) the presence of a proactive drug safety surveillance information system in the community; and (ii) the presence of a connected surveillance system, drug safety and health products in service units and communities, and reports to achieve surveillance and solve problems in the province; (iii) percentage of drug dealers in the community (Drug store type Khor. Yor. 2/ grocery store, hawker, flea market) that detects the sale of dangerous drugs, especially controlled drugs and drug combinations; (iv) percentage of drug combinations; and (v) percentage of steroid-contaminated health products found in households. Level 2: the area can implement a total of four indicators starting in 2023, which can be measured and evaluated starting in 2024. These indicators are: (i) inclusion of rational drug use content in the curricula for primary, secondary, vocational, and nonformal education; 2) reporting of the situation by area regarding the distribution of dangerous drugs, drug combinations and products that are unsafe for the public, including adverse drug reaction (ADR) and adverse drug event (ADE) from drug use and products. The community network at each level can monitor unsafe drugs in their local area and issue warnings to the community and to other networks; (iii) promoting knowledge about RDU at the community level; (iv) percentage of pharmacists who have had formal training in the rational use of drugs for pharmacists in pharmacies. Level 3: there are a total of four indicators that the area can operate starting in 2023 and can be measured and evaluated starting in 2025. These indicators are: (i) community network partners driving drug use consistently and sustainably in the community at the district/sub-district level; (ii) percentage of model districts of rational drug use in each province; (iii) percentage of provinces that have developed to rational drug use districts; and 4) the percentage of people in the community who have knowledge of rational drug use. Moreover, there are 8 additional indicators that the working group for the community's rational drug use and safety development system agreed should be reinstated from the existing default set of indicators to be used as key indicators to completely drivethe RDU community in the future and consisted of 1) Number of patients screened for risk/problem from drug use by trigger tools separated by disease and product, 2) Use of ICD-P in the Hosxp program of hospitals, 3) Percentage of private hospitals, clinics with RDU labeling (Correct/Proper/Complete), 4) Percentage of drugstores (KorKhor.1) that met the criteria for GPP Category 5, 5) Percentage of households with antibiotics left over, 6) Percentage of antibiotics/NSAIDs sold in Khor.Yor. 2, grocery stores, hawkers and flea markets in the community, 7), the community participates in organizing RDU activities/ projects in the area, and 8) percentage of multidisciplinary health personnel in the community such as nurse practitioners, public health technical officer, public health officer with literate of rational drug prescribing and dispensing. In conclusion, there are a total of 21 key indicators. The following are important implementation levers for this draft RDUCMI indicator set for monitoring and evaluation: (i) Each phase of the community mobilization assessment should clearly define the main issues that need to be monitored and evaluated. Including use of specific drug combinations, as well as purchasing health products from media and online channels. (ii) In the private health sectors, such as clinics, pharmacies, grocery stores, and convenience stores, the implementation of RDU guidelines for monitoring and evaluating has been voluntary; however, systematic action are still a limitation. (iii) The design of the database structure in the form of “data storage” derived from surveys related to RDU activities “in the community” is important that should be developed from the RDUCMI set of indicators for follow and systematically assess the results in the community. This kind of database would support the set of indicators of rational drug use in the community as proposed in this research project.


The COVID-19 pandemic in Thailand is part of the global pandemic of coronavirus disease 2019 caused by SARS-coronavirus 2 (SARS-CoV-2). Because of the high population density, Bangkok Metropolitan Region was the one of the major epicenters of COVID-19 epidemic in Thailand during the Delta wave in 2021. The explosive number of COVID-19 patients during that time brought the Thai government to initiate home isolation program. Methods A retrospective cohort study was conducted. All recorded COVID-19 patients in Bangkok Metropolitan Region enrolled into the home isolation program (HI) were identified from A-MED Telehealth electronic health records (EHRs) data during 1 July 2021 and 31 December 2021. Furthermore, the vital status of the enrolled patients was evaluated from the National Civil Registration database on 20 September 2022. Mortality within 28 days and associated factors were analyzed using Kaplan-Meier method and Cox proportional hazard model. Results The total number of participants was 90,861, with the 14th of August having the highest admission of 3,391 registrants. The HI care system in Bangkok Metropolitan Region during the study period consisted of two major components: standard health systems and the services under the HI crisis response task force for COVID-19 patients. In standard health systems, the operation sectors included BMA Medical Service Department hospitals, public health service centers, and private clinics, whereas the services under the HI crisis response task force included Fammed CoCare (Tangerine Clinic) supported by the Royal College of Family Physicians of Thailand and the Thai Red Cross Society. Fammed CoCare was accountable for up to 50% of COVID-19 patients in July, the first month of HI protocol implementation. The average age was 37.28±18.96 years old. Almost half of the participants were men, and 55.70% were covered under the universal coverage scheme. Non-Thai was included in the protocol 5.48%. Obesity was (body mass index (BMI) ≥30.00 kg/m2) 14.12%. The percentages of healthcare centers in charge of the HI program (public health service centers, private clinics, Fammed CoCare (tangerine clinic)) were 38.76%, 24.18%, 20.86% respectively. Asymptomatic, mildly symptomatic, urgent symptoms, death, resolution, and urgent administration (42.80%, 29.50%, 1.20%, 0.01%, 0.70%, and 9.30%, respectively) are initial symptoms. Andrographis paniculate, Favipiravir, and oral steroid are among the medications prescribed (8.70%, 23.00%, and 0.53%, respectively). During a follow-up period 988.54 person-years, 1,349 participants died. 50% and 8% of the death was happened within 28 days after days of illness (DOI) and during the HI program, respectively. 20% of death was occurred at home. COVID-19 accounted for 70% of all causes of mortality, while non-expected natural causes accounted for 55.40% of all other causes of death. Suicide was the leading cause of death within 8 weeks of DOI. Conclusion The unprecedented COVID-19 pandemic outbreak needs adaptable systems capable of responding in timely manner to patient management. Standard health systems, particularly in the early stages, should coordinate with the services under the HI crisis response task force for COVID-19 patients, which has the flexibility to assemble multidisciplinary teams. The many lessons learnt from the current COVID-19 problem were used to guide the future paths of outbreak management systems in this situation.


Hip fracture in older people is one of the major public health issues worldwide including Thailand. Appropriate care for older people with hip fracture includes fast track surgery and perioperative multidisciplinary team care. This study aimed to monitor pilot hospitals involved in ‘Fast Track Surgery for Hip Fracture Program’ to explore patients’ outcomes and factors associated with the clinical outcomes. We discovered that the operation rate for hip fracture in older people in Thailand remains suboptimal. The rate of non-operative surgery remains high around 40 %. Hospitals in pilot project had higher rate of patients received ‘fast track surgery’ compared to hospitals nationwide. Moreover, pilot hospitals had made significant changes to the policy and process of care for this group of patients. However, some recommended processes could not be arranged. With respect to patients’ outcomes, the mortality rates tend to be reducing in pilot hospitals but did not reach statistically significant. This could stem from the finding that several recommended quality indicators could not be arranged. Multivariate linear regression models were carried out to determine factors at hospital level affecting mortality. Having internists involved in postoperative care significantly associated with lower one-year mortality. Having rehabilitation specialists involved in postoperative care is also associated with lower three-month mortality. Covid-19 pandemic did not have negative impact to operation rate and mortality for hip fracture patients in Thailand.


COVID-19 pandemics effected health systems in term of increasing of workload caused by the number of infectious, also the effected on routine health services especially continuity of healthcare deliveries for the patients with chronic conditions. The Ministry of public health and the National health security office established the new-normal healthcare policy which emphasized on outside hospital care deliveries by strengthening primary care services together with the partnership including private rehabilitation clinics, nursing clinics and drug stores. This project applied the evaluation development concept by applying mixed-method research design to evaluate the implementation of the policy and synthesized the policy recommendations based on the findings. We performed the literature review, together with analysis of secondary quantitative data and qualitative data collecting from multi-stakeholders. We found that health burden of non-communicable diseases and conditions are high and increasing over the time especially on hypertension, diabetes, and related complications such as stroke. The services utilizations of this group of patients were disrupted by lock-down policy during COVID-19 pandemics. There were existing of new-normal care deliveries during 2020-2022 especially there were the high number of telemedicine which performed by public health facilities. However, the services provided by private rehabilitation clinics and private nursing clinics were still limited in term of number of clinics, number of patients, and also in the term of geographical distributions of services. According to our findings, we strongly emphasized that primary care should be the core of new-normal health services for the patients with chronic conditions. To delivery high effective coverage care, the area manager position and role should be established and should be paid by NHSO at primary care level. Individual care plan should be done by care team and should be monitored and evaluated by area manager. Effective information systems should be designed and implemented and should be able to connect every stakeholder in primary care network. Also, the information systems must allow the patients to confirm their received care by private partners. The authorities should arrange the platform that allow all partners working together effectively and analyzing the routine data for better policy designing and decisioning.


The Global Diet Quality Score (GDQS) is a comprehensive metric that covers both the risks of nutritional deficiency and the risk of diet-related noncommunicable diseases (NCD). Validation tests were previously performed using secondary data from various countries. However, the study of the application of the GDQS to the Thai population is still necessary. Because Thai food usually consists of a variety of components, the GDQS may reflect the risks of nutrient inadequacy and the risks of NCD differently from the previous studies. Objective: This study aimed to characterize the GDQS’s performance by estimating the associations between the GDQS and diverse outcomes reflective of undernutrition and diet-related NCD risks. Methods: A cross-sectional study was conducted in Thai adults aged 40-60 years. GDQS was calculated from dietary data collected using a 24-hr dietary recall (24HR), a semi-quantitative food frequency questionnaire (FFQ), and the GDQS-Assessment System (GDQS-AS). Additional metrics were also calculated, including the Minimum Dietary Diversity for Women (MDD-W) and the Alternative Healthy Eating Index-2010 (AHEI-2010). Nutritional status was determined through anthropometric, body composition, blood pressure, and biochemical marker assessments. Spearman rank correlations and multivariable adjusted regression models were performed to evaluate the associations between GDQS and diverse outcomes reflective of undernutrition and diet-related NCD risks. Wolfe test and Wald test were used to compare the strength and trend of the correlations of the GDQS and outcomes between different dietary data collection methods and different metrics. Results: The prevalence of overweight to obesity (Body mass index ≥25 kg/m2) was 47.5%. Anemia was reported in 8.9% of men and 23.8% of women, hypertension in 54.1% of men and 39.4% of women, and metabolic syndrome in 42.5% of men and 35.9% of women. Mean urinary sodium excretion was 3,397 mg/day (147.7 mmol/day). The GDQS calculated by GDQS-AS and FFQ were relatively similar, while the GDQS-24HR was lower. Multivariable adjusted regression analysis found that GDQS-AS performed better in reflecting nutrient intakes, nutrient adequacy, and nutritional outcomes than GDQS computed from 24HR and FFQ. GDQS, MDD-W, and AHEI-2010 similarly performed in indicating nutrient adequacy and risks of NCD. Nevertheless, GDQS computed from FFQ better reflected nutrient adequacy. Conclusion: Overall, GDQS-AS had a relatively stronger performance in capturing both nutrient intakes and nutritional outcomes compared with GDQS computed from other methods, whereas GDQS scored from FFQ was outperformed
in capturing nutrient adequacy. Findings from this study only reflected a cross-sectional correlation between GDQS and nutrient adequacy and NCD risks. Thus, further study to longitudinally explore the correlations between GDQS and NCD risks is required.


This study is a developmented research with the objectives as analysis purposes. synthesis and development electronic Personal Health Record (PHRs) systems that are desirable to the health system
of Thai people by connecting the database of the COVID-19 Vaccine Information Management Program. Health Region 9 was selected as the target area. and establishing a framework for the development of a prototype central platform and an information network for the exchange of PHR systems between people and healthcare unit. Development system for connecting and retrieving data for display on smart phone. And central cloud development for interoperability between the different databases. Including designing user interface on the Mohpromt application. The results showed that The electronic personal health record should be Hybrid or Interconnected that can display the healthcare treatment and able to record health data by themselves. Developing program on Mohpromt platform which supports collaboration from multiple departments. Standards data and level of information to be displayed on the application in 3 levels: 1.) General information is the basic that shown immediately after registering Mohpromt application. 2.) Health information for individual That must go through a verification process and verify their identity before accessing and 3.) Treatment information for Healthcare Provider to view history treatment from others and must be obtained permission from the data’s owner before accessing. Personal health data is connected and retrieved between the COVID-19Vaccine management program and various hospital information systems via API to display on the Mohpromt application with more than 1,000 healthcare units. covering both the target group in region 9 and others. Established data governance regarding to the collection and use of personal data in limited According to the Personal Data Protection Act. Application evaluation divided into two aspects: satisfaction on technical quality and application content. Evaluation results from 100 users in region 9 in terms of technical quality and application content. Application development results in terms of technical quality and application content overall, it was a high level (x = 4.14) and users were satisfied with the PHR on the application overall, it was at a very good level (x = 4.89). The overall rating for the application, from 1 to 5 points, users gave an average score of 4.22 and satisfaction with the PHR menu on the application very favorably. 95 percent of users want to use PHR menu and will recommend the others. and suggested that other health behavior data should be recorded manually.


At present, the problem of hospital congestion is becoming increasingly severe. One approach to solving the problem is to provide medication refills from accredited pharmacies located outside of hospitals. In addition, as a result of the coronavirus disease 2019 (COVID-19) pandemic, it is vital to restrict the number of non-urgent hospital visits in order to reduce hospital overcrowding and the spread of infection and transmission among patients. Moreover, it will improve resource utilization for addressing more difficult situations. This research aims to support the implementation of the policy to achieve the goal of reducing the congestion in hospitals and being able to meet the needs of service users, so that the policy can be implemented effectively and appropriate approaches for adapting during the challenge period can be obtained. The research results on “Approach and Feasibility for Transfer Pharmacy Service from Hospital to Community Pharmacy” are summarized as follows. According to the results of a survey of 255 service users in Bangkok and its vicinities, the results reveal that a majority of the samples faced problems with congestion in hospitals. 84.30% of the sample experienced a long waiting time for outpatient to see a doctor, while 74.10% experienced a long waiting time for outpatient pharmacy. In terms of service users’ behavior, most of them visit pharmacies every two to three months and visit pharmacies near their homes or workplaces. The most requested additional services in pharmacy are initial screening for disease, followed by medicine refills for chronic non-communicable diseases (NCDs), emergency care related to medicines, and vaccinations, respectively. Furthermore, more than 80 percent of service users want to participate in the hospital congestion reduction project. However, the project is still relatively unknown, with nearly 75% of service users do not know the details of the project. For the study of the expansion of pharmaceutical services to community pharmacies and additional cost of services, we use in-depth interviews with (1) 70 pharmacists and owners of community pharmacies (2) related-network organizations such as the Pharmacy Council of Thailand, Thai Pharmacies Association, and
Community Pharmacy Association (Thailand) and (3) 24 staffs and hospital administrators who participated in the program. The results indicate that all three sectors agreed that there are eight services that hospitals can transfer to community pharmacies: 1) blood pressure measurement 2) blood glucose test 3) medicine home delivery service 4) consultation on medication matters and supervising the appropriate prescription of medication for patients 5) explanation of medication side effects and monitoring for adverse drug reactions (ADRs) 6) Counseling via email/telephone/other channels 7) initial screening for disease and 8) medicine refills for chronic non-communicable diseases (NCDs). Moreover, all community pharmacies agree that the additional expenses associated with the services are not substantial, and all costs are variable costs. The additional costs are the opportunity costs which are in the range of 822-1,378 baht per day or 24,660-41,340 baht per month. Suggestions for expanding pharmacy services to community pharmacies, the community pharmacies should expand their services by acting as “Screening and initial counseling unit for treatment under the supervision of the host hospital” and adding all eight services to community pharmacies. However, we should focus mainly on essential services such as initial screening for disease, medicine refills for non-communicable diseases (NCDs) treatment, consultation on medication matters, and supervising the appropriate medicine prescription for patients. Nevertheless, extending pharmacy services incurs opportunity costs for the pharmacies. As a result, the government should provide budget support to participating pharmacies in the range of 24,660–41,340 baht per month or cover the expense of time spent consulting and delivering services, in the range of 187.50–312.50 baht per person per time.


This research aimed to study dental nurses’ satisfaction and effectiveness of moisture control innovation (for tongue and cheek retractor, and saliva contamination (SS-suction)), toward dental sealant service without dental assistants compared to standard service; moisture control with cotton roll and dental assistant. This study was randomized controlled trial implemented among 15 dental nurses who attended a workshop on using SS-suction, recording satisfaction data toward using and safety, recording students’ data and revised dental sealing technic. Dental nurses received SS-suctions and then provided sealant service to 482 children aged 6–8 years old at sub-district health-promoting hospitals. Children were simply randomly allocated into either experimental or control groups. The children in the experiment group were 244, and in the control group, 238. Data collection on dental nurses’ characteristics, satisfaction with SS-suction for each sealed tooth during service. At 15-18 months, sealed teeth were assessed for retention and caries. Quality control for data collection was the validity and reliability of the satisfaction questionnaire and calibration on sealant retention examination. The results showed the median satisfaction level for SS-suction use was 9 out of 10, and the percentage of children with pain during insertion or removal was 17–18. The pain was from a feeling of pressure and disappeared when the suction was in place. Retention and caries were not significantly different between the experiment and control groups. Full retention on the occlusal surface were 32.5% and 31.4% and on the buccal surface were 16.8 and 18.3 in the experiment and control groups, respectively. Caries on the occlusal surface were 26.6% and 27.6% and those on buccal surface were 35.4 and 36.2 in the experiment and control groups. In conclusion, dental nurses were satisfied with SS-Suction both in function and safety. The effectiveness at 15–18 months of SS-Suction was compatible with standard procedure.


Objectives: To report the safety and immunogenicity profile of a protein subunit vaccine (CovovaxTM) given as a third (booster) dose to individuals primed with different primary vaccine regimens. Methods: A third dose was administered to individuals with an interval range of 3-10 months after the second dose. The four groups were classified according to their primary vaccine regimens, including two-dose BBIBP-CorV, AZD1222, BNT162b2, and CoronaVac/AZD1222. Immunogenicity analysis was performed to determine binding antibodies, neutralizing activity, and the T-cell responses. Results: Overall, 210 individuals were enrolled and boosted with the CovovaxTM vaccine. The reactogenicity was mild to moderate. Most participants elicited a high level of binding and neutralizing antibody against Wild-type and Omicron variants after the booster dose. In participants who were anti nucleocapsid immunoglobulin G-negative from all groups, a booster dose could elicit neutralizing activity to Wild-type and Omicron variants by more than 95% and 70% inhibition at 28 days, respectively. The CovovaxTM vaccine could elicit a cell-mediated immune response. Conclusion: The protein subunit vaccine (CovovaxTM) can be proposed as a booster dose after two different priming dose regimens. It has strong immunogenicity and good safety profile


The following study, titled The Mobilization for Inter-Agency Collaboration and Citizen Engagement for Developing a Primary Care System for Provincial Administrative Organizations: A Case of Khon Kaen Provincial Administrative Organization (KKPAO) project, has four primary aims. The first is to study the preparedness of the primary health system of KKPAO in the oversight of primary health services by the Sub-district Health Promotion Hospitals (SHPH) that have been transferred from the Ministry of Public Health (MOPH) to the authority of KKPAO. The model must incorporate the Six Building Blocks of a Health System proposed by the World Health Organization (t.ly/dtPR). This conceptual framework requires more than civic participation as stipulated by the Primary Health System Act of 2019. The second is to study and develop guidelines for promoting cooperation among partner agencies such as KKPAO and citizens in the province. The third is to formulate and propose policy recommendations for the KKPAO. Finally, it offers guidelines for adjusting the roles and responsibilities of the provincial health agencies under the MOPH in supporting and promoting the smooth transfer of HSPH to KKPAO. Data for this study were collected from primary and secondary sources related to health systems within Khon Kaen Province. The primary data were collected by interviewing the providers of health services, administrators, and the Director of the Public Health Division of KKPAO. In addition, focus group discussions were employed to solicit opinions and information about the transfer of SHPHs to KKPAO. Additional information and views were also gathered from organized public forums to maximize the richness and validity of data. The results from the analyses of data follow. All 248 SHPHs in KKP have been transferred from the MOPH to KKPAO. This remarkable success was accounted for by four factors: 1) clarity in the policy direction of the top manager; 2) trust and confidence of personnel of SHPHs and citizens in the management system of KKPAO; (3) personnel who transferred from the MOPH viewed this event as a window of opportunity for professional advancement; and (4) the personnel’s perception of the increased management and fiscal autonomy of SHPHs after the transfer. The transfer of SHPHs from the management responsibility of the MOPH to KKPAO has been in effect since January 2023. It was found that while the SHPHs were able to regularly provide and maintain quality primary care services in their areas, KKPO must view this as a window of opportunity to improve and streamline the health service provision system of SHPHs under its supervision. It is recommended that KKPAO inculcates a culture of services among the health workers and staff of SHPHs. Concerning this, the personnel of the SHPHs need to be trained and informed with the necessary information to 1) maximize the service responsibility of the personnel of the SHPHs; 2) provide recommendations for structural transformation and documentation operations; (3) create a progressive career path for personnel of transferred SHPHs; and (4) dispel any fear and apprehension about the regulative labyrinth of the required process of procurement, the arduous tasks of fiscal management, bookkeeping, coordination with KKPAO, development of performance metrics, establishing amicably inter-organizations relations, intra-organization reporting system, and self-development programs for the personnel. This study also found the indispensable functional roles of village health volunteers (VHVs) as a manifestation of citizen participation in health promotion. KKPAO must capitalize on its long and rich experiences in servicing its community. However, the VHVs we studied feared they would no longer be viewed as a part of the system. It is necessary, therefore, for KKPAO to build a clear understanding and perception among the VHVs that KKPAO recognizes the instrumental roles of the VHVs in health care promotion. This study also provides immediate and long-term policy recommendations for KKPAO. Immediately, the KKPAO should organize professional training courses to give orientation to create more understanding of KKPAO and to impart knowledge and improve the skills of the health workers of all SHPHs’ personnel regarding the management practices, authority, responsibilities, and organizational culture of the PAO. In addition, KKPAO must set up a liaison to provide management consultation for the workers of SHPHs. KKPAO must maintain and improve the skill of both permanent and short-term staff of SHPHs. As a long-term goal, it is recommended that KKPAO set up a specific public health unit to offer more specialized health services. This unit must also coordinate seamlessly between KKPAO and all SHPSs in the province. Moreover, this unit may have additional responsibilities such as developing performance metrics, networking, performance-based budgeting, promoting digital health services, and improving necessary skills to accommodate the new mission.


Patients in critical care are at risk of clinical deteriorations such as congestive heart failure, when the heart muscle could not pump the blood as good as it should be, and sudden cardiac arrest, which is caused by the disruption of the heart’s pumping function These clinical deteriorations often appear without any warning. They can cause patients losing consciousness, having clinical complications, or death. A timely treatment is necessary after such complications. The early detection of clinical deteriorations can both improve patient outcomes and reduce the utilization of healthcare resources. Many early warning scores (EWSs) are designed to identify patients at risk of deterioration. The Modified Early Warning Scores (MEWS), for example, utilizes patient data including blood pressure, heart rate, respiration rate, body temperature and patient’s responses in order to identify patients according to their severity. Clinical staff can use the MEWS score as a guide to monitor the patients and give help immediately if needed. This research focuses on the development of machine learning algorithms for the identification of deteriorating patients in intensive care wards with physiological parameters acquired from the hospital information system and the central patient monitoring system. In contrast to other studies in which the algorithms were developed only on public datasets, our study utilizes both public datasets and local clinical dataset from Songklanagarind’s Hospital with an aim to make our algorithms work in local narratives. In the first part, we proposed a data-driven framework for predicting the risk of mortality that combines high-accuracy recurrent neural networks with interpretable explanations. Our model processes time-series of vital signs and laboratory observations to predict the probability of a patient’s mortality in the intensive care unit (ICU). We investigated our approach on three public critical care databases: Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III), MIMIC-IV, and eICU. Our models achieved an area under the receiver operating characteristic curve (AUC) of 0.87–0.91. Our approach was not only able to provide the predicted mortality risk but also to recognize and explain the historical contributions of the associated factors to the prediction. The explanations provided by our model were consistent with the literature. Patients may benefit from early intervention if their clinical observations in the ICU are continuously monitored in real time. In the second part, we used the recurrent neural network (RNN) model to predict the risk of occurrence of clinical conditions. Our results varied with an area under the receiver operating characteristic curve (AUROC) of 0.55-0.73 depending on the clinical condition. Our model can provide interpretive data to explain the influence of model prediction parameters and increase confidence in the model. The clinical staff was informed before the clinical conditions and could determine the treatment plan to achieve a better outcome for the patient.


Digital chest x-ray images are the most widely used medical diagnostic tool Nowsaday. They helps in the diagnosis of diseases such as pulmonary tuberculosis and lung cancer. There are millions of chest radiographs produced by hospitals each year. But only less than 10% of the images were interpreted by radiologists. The rest of the images are often interpreted by general practitioners. But interpreting results by general practitioners is likely to be wrong. Several studies have shown that general practitioners may have chances to misinterpret the results including misdiagnose or missed diagnose up to 20-50% of the images with lung cancer lesions. In addition, the interpretation of results by a single radiologists still has a 5-9 percent chance of error. Artificial intelligence (AI) may be an option to assist in the screening of chest radiographs with lesions or abnormalities that must be reinterpreted by a radiologist. In this study, a database of chest radiographs from the tuberculosis and lung cancer database was created. For the development of AI systems using U-Net and SegNet neural networks, it was found that the SegNet model network yielded satisfactory screening results. Sematic segmentation using the SegNet model and using pre-tutorial VGG19, which added a dropout with a probability value of 0.4. After designing and teaching the network with various patterns until the level of accuracy is satisfactory. The AI was tested with testing images. For the test with 17 images, Small1I lesions was best identified by the AI with an average IoU accuracy of 90.23%, followed by cancer lesions with an average IoU of 89.45%. The lowest correctly classified lesion was cavity with an accuracy of only 5.71%. The AI was further tested with a set of 26 images with cancer lesions. The AI did not detect 4 malignant lesions. When tested with 10 images without lesions the AI incorrectly identified a couple of lesions in 2 images. From the results, this artificial intelligence should be implemented in the form of a Triage to screen images before consulting a radiologist. This can reduce the workload of radiologists and general physicians and thus may be of economic value in terms of radiologist and general practitioner wages and time.


This study was conducted to evaluate 1. diabetes and hypertension service delivery, including both curative and preventive approaches, and 2. human resources in health management and coordination between hospitals and other stakeholders in the community using a mixed method study. 8 and 16 high-performance district and sub-district hospitals across four provinces in Thailand were chosen for the study. Quantitative data from questionnaires were analyzed using descriptive analysis where categorical data were reported as number (percent), and numeric data were reported as mean (SD). For qualitative analysis, content analysis was used to identify and summarize three domains as follows
1. The similarities and uniqueness of service deliveries between each health providers
2. The comparison of the job descriptions in district and sub-district hospitals by occupation
3. Human resources in health management focused on the adequateness of the human workforce and methods used for retaining health personnel. All hospitals included in this study were selected appropriately. In 2021, all hospitals recruited in the study received better scores than the country average in multiple diabetes and hypertensive indicators in preventive and curative domains proposed by the Ministry of Public Health. In order to achieve high quality of care. In addition, this study evaluated diabetes and hypertensive services using the framework from the handbook of integrated, people-centered health services in new normal diabetic and hypertensive clinics, a guideline endorsed by the Department of Medical Services, Ministry of Public Health. All hospitals provide almost comprehensive care according to the recommended guideline. Varieties of health professionals performed specific tasks to increase patients' health literacy, stratify patients based on their clinical risks, register patients in the database for continuity of care, reorient the care model according to patient health status, and assess patients when there were changes in blood pressure or blood sugar control. However, most hospitals could not achieve the self-monitoring domain due to insufficient equipment compared to patients' demands. Due to the limited amount and types of health professionals working in sub-district hospitals compared to district hospitals, health professionals working in sub-district hospitals need to be more flexible and perform multiple roles outside their trained professions. In contrast, health professionals in district hospitals only worked on specific tasks they excelled. Therefore, multiple sub-district hospitals asked for temporary pharmacists and dieticians' support from district hospitals which were crucial for operating non-communicable disease clinics but were not regularly stationed in sub-district hospitals. The support could improve the quality of care where patients receive services from trained professionals, and additional support could relieve partial workloads from health professionals in sub-district hospitals. Moreover, village health volunteers were one of the significant human resource components in providing quality diabetes and hypertensive preventive and curative care, especially in sub-district hospitals, where limited human resources in health affected the staff workload. Village health volunteers provided various kinds of support, including performing basic tasks in the clinic, giving preliminary health advice, delivering medicine, and acting as the bridge between patients and health professionals in the community. Furthermore, they also played a significant role in preventive measures. Village health volunteers were the major players in performing diabetes and hypertension screening in the general population every year. Hence, training specific non-communicable disease competencies for village health volunteers to work on more sophisticated tasks with additional financial incentives could maintain sustainable community-oriented diabetes and hypertensive service deliveries.
Lastly, health technology adaptation could play a significant role in increasing the efficiency of care. Telemedicine is the most familiar technology and could be integrated into diabetes and hypertensive consulting services between multiple levels of providers. In addition, personal health records, accompanied by an increase in patients' digital health literacy, could be a potentially significant improvement in diabetes and hypertensive care. The combined technology and knowledge could help patients better understand their current health situation. Hospitals could use integrated information between providers to monitor and determine the best treatment plans for patients continuously.


Objective: To investigate the reactogenicity and immunogenicity of the fourth dose mRNA vaccines after different three-dose regimens, followed by a comparison between the 30 μg BNT162b2 and 50 μg mRNA-1273 groups. Methods: The prospective cohort study was performed between June and October 2022. The self-recorded reactogenicity after 7 subsequent days following a fourth booster dose was evaluated. The binding antibodies and neutralizing activity to the Omicron BA.4/5 variants were determined. Results: Overall, 292 healthy adults were enrolled and received either the BNT162b2 or mRNA-1273. The reactogenicity was mild to moderate and well-tolerated within a few days. Sixty-five individuals were excluded. A total of 227 eligible individuals received the fourth booster dose of BNT162b2 (n=109) and mRNA-1273 (n=118). Most participants, regardless of different previous three dose regimens, significantly elicited a high level of binding antibody and neutralizing activity against the Omicron BA.4/5 at 28 days after a fourth dose. The neutralizing activity against the Omicron BA.4/5 between the BNT162b2 (82.8%) and mRNA-1273 (84.2%) groups was comparable with a median ratio of 1.02. Conclusion: The findings indicated that the BNT162b2 and mRNA-1273 can be used as a fourth booster dose for individuals who were previously immunized with any mix-and-match three-dose COVID-19 vaccine.


Objective: To compare the reactogenicity and immunogenicity between the two-dose mRNA COVID-19 vaccine regimen and one or two doses of inactivated vaccine followed by an mRNA vaccine regimen in healthy children between 5-11 years of age. Methods: A prospective cohort study was performed at King Chulalongkorn Memorial Hospital in Thailand between March to June 2022. Healthy children between 5-11 years of age were enrolled and received the two-dose mRNA COVID-19 vaccine (BNT162b2) regimen or the inactivated (CoronaVac) vaccine followed by the BNT162b2 vaccine regimen. In addition, healthy children who received two doses of BBIBP-CorV between 1-3 months prior were enrolled to receive a heterologous BNT162b2 as a third dose (booster). Reactogenicity was assessed by a self-reported online questionnaire. Immunogenicity analysis was performed to determine binding antibodies to wild-type SARS-CoV-2. Neutralizing antibodies to Omicron variants (BA.2 and BA.5) were tested using the focus reduction neutralization test. Results: Overall, 166 eligible children were enrolled. Local and systemic adverse events which occurred within 7 days after vaccination were mild to moderate and well-tolerated. At one-month, post-two or post-three doses, children vaccinated with two-dose BNT162b2 (GMT 2872 BAU/mL), CoronaVac/BNT162b2 (GMT 3021 BAU/mL), and two-dose BBIBP-CorV followed by BNT162b2 (GMT 3269 BAU/mL) elicited similar levels of anti-receptor-binding domain (RBD) IgG (ns). However, the two-dose BNT162b2 and two-dose BBIBP-CorV followed by BNT162b2 groups elicited higher neutralizing activities against Omicron BA.2 and BA.5 variant than the CoronaVac/BNT162b2 group. Conclusion: The heterologous, CoronaVac vaccine followed by the BNT162b2 vaccine, regimen elicited lower neutralizing activities against the emerging Omicron BA.2 and BA.5 variant than the two-dose mRNA regimen. A third dose (booster) mRNA vaccine should be prioritized for this group.


Currently, lung cancer treatment has been developing in several approaches such as; conservative chemotherapy, immunotherapy, or novel targeted therapies which increase the overall response rate, survival rate with good quality of life for the patients. This study aims to explore the whole genome sequencing profile and omics profile in non-targetable advanced non-small cell lung cancer both in tissue and in liquid biopsy. The results of this research project will lead to developing of screening, diagnosis, personalized therapy, and monitor of treatment in this group of patients. We will explore the data according to Thai population which might be different from the other ethnicity and this will lead to developing the new drug for Thai lung cancer patients. This research project composed of 7 sub-research projects which we completed the first-year aim. The first, second, third, fifth, and seventh sub-research projects will continue the research for the consecutive years. Furthermore, the first, second, and the seventh subresearch projects are in the process of preparing for Next Generation Sequencing (NGS) for the second-year proposal aim. In the first year, we could prepare the good quality of DNA and RNA as our purpose in order to proceed in NGS. Regarding the third, fourth, and fifth subresearch projects we found the initial result in potential biomarkers for predicting of treatment response. We also explored the clinical characteristics of 17 locally advanced and advanced non-small cell lung cancer (NSCLC) patients. Majority of patient were male, former/current smokers, adenocarcinoma with the high prevalence of PD-L1 expression (TPS = 1-49%: 23.5 % and TPS ≥ 50%: 35.8 %). In conclusion, the study of molecular alterations in Thai lung cancer patients is very important for drug development in order to drive the innovative lung cancer treatment. However, the other important issue and concern is exploring the whole genome sequencing profile and omics profile in non-targetable advanced non-small cell lung cancer. Our research team hope the results of this research project will lead to developing of screening, diagnosis, personalized therapy, and monitor of treatment in this group of patients.


There are many health information systems in Thailand and various project indicators. Many of them are redundant and unable to integrate both the reporting system and the medical expense reimbursement. has not yet been fully utilized This study is an analytical study. To study and find a suitable management model and approach for the whole ecosystem that affects the drive of the digital health system. It was carried out in three parts: 1) digital health system review; The study found a digital health governance model requires collaborative governance. have a strong leadership, has authority and constantly in position There is a central agency that drives the development of digital health systems. and to focus on the standardization of the health data system There are good examples of Australia, England, Finland, and India. 2) Developed prototype tools of personal health information system; Personal health data from multiple database sources is integrated and automatically linked directly from the hospital to the central, can display health information through mobile applications and link between hospitals to use in medical treatment and 3) synthesize recommendations; to reform data management from Silo Base to Authority Base for sustainable. Therefore, there are proposals in 5 mission and it is necessary to have an agency directly responsible for the digital health system. There is a proposal for an action plan to establish National Digital Health Authority.


The sequential embedded mixed-method research consisted of two phases. In phase 1, the qualitative phase was aimed to explore the experience, barriers and supports of the pharmacists in the primary care cluster. Focus group discussion was conducted with 24 pharmacists from 6 provinces of the health region 6. Findings of content analysis comprised three main themes: barriers and supports from the policy; colleagues; and the pharmacist. The barrier was the health information access and incomplete data flows from the primary care cluster to the hospital and vice versa. Effective patient care needed inter-professional teamwork in receiving updated medication knowledge from the part-time pharmacist in the primary care unit. Communication skills helped the pharmacist provide effective resolutions to drug-related problems (DRPs). In phase 2, the prospective, quasi-experimental study aimed to examine DRPs, blood pressure control, and physician acceptance to pharmacists’ roles, as well as, to examine relationships of patient’s or pharmacist’s factors with the effective resolutions to DRPs. Data collection form of DRPs was adopted from Cipolle et al’s classification. Quantitative data collection was performed on 1,471 hypertensive patients who were attended consecutively 3 visits by the pharmacists participated in the phase 1. Of all 379 DRPs identified, the highest problem was 164 of non-adherence (43.3%). After the primary pharmacy care, the DRPs were significantly decreased by 33.2% and 32.4% (c2(2)=46.78, p < 0.001) at visit 1 and 2, respectively. Blood pressure was unchanged. Physician acceptance rates to pharmacists’ roles were 77.8%, 70.3% and 68.4% consecutively. The factor related to the effective resolving non-adherence was the physician acceptance (rs = 0.18, p = 0.020), consistent to phase 1’s findings. This sequential embedded mixed-method research provided linkages of all findings which clearly illustrated the overview duty of primary care pharmacy.


Background and rationale: Chronic kidney patients with renal replacement therapy were at risk of COVID-19. During COVID-19 pandemic with social distancing practices, hospitals postponed patient’s appointments. Methodology: The purpose of this mixed-method study was to develop and examine the effectiveness of telemedicine model in caring for peritoneal dialysis patients from lessons learned during the COVID-19 pandemic. The samples included 2 nephrologists, 6 pharmacists, 10 peritoneal dialysis nurses, and 80 peritoneal dialysis patients. Purposive sampling was used to select the participants. The study comprised 3 phases: phase 1 situation analysis; phase 2 design and development of a model of telemedicine service for peritoneal dialysis patients; and phase 3 result study of the telemedicine model by comparing the treatment time, cost and satisfaction. The research instruments covered a semi-structured interview guide, feasibility questionnaire of telemedicine model, cost record form, and satisfaction questionnaires for multidisciplinary team and peritoneal patients and caregivers. The quantitative data was analyzed using descriptive statistics, Wilcoxon signed-rank test, and paired t-test. Results: 1. During COVID-19 pandemic, patients and their caregivers have difficulty getting to the hospital as scheduled, the continuity of taking medication and the limitation of home visits. Patients and multidisciplinary teams suggested that during COVID-19, the methods of care should be adjusted, using telephone online platforms, such as Line application, to provide patients and caregivers the knowledge to promote self-care. The applications should be downloaded onto a mobile phone for immediate communication with the doctor and nurse when abnormal symptoms and problems were found. 2. According to patients and care providers, the feasibility of a telemedicine model in caring for peritoneal dialysis patients was moderate at the beginning. The model was rated highly by the multidisciplinary team, patients, and caregivers at the conclusion of the intervention. 3. Three patterns of patient journeys of peritoneal dialysis patients were identified based on clinical status of the patients: a well-controlled, a moderate control, and an uncontrolled symptom group. and 4. medication management of erythropoietin (EPO) and other medications for chronic kidney disease and co-morbidities were delivered through a nearby client hospital network. Discussion and conclusion: The cost of telemedicine model incurred higher capital costs at periphery. The higher number of services should lower the unit costs. Telemedicine was proved to be a feasible model of providing care among patients who had good disease progression control and reducing hospital visits. Therefore, the health service may develop and expand the results of this study to other chronic diseases. The provider should combine telemedicine with outpatient service.


This mixed-method study aimed to investigate the impacts of the coronavirus pandemic on occupational therapy (OT) services in Thailand and to explore the feasibility of adapting international service models into the Thai context from OT’s perspective. One hundred fifty-three occupational therapists were asked to complete the questionnaires, and 45 OTs were invited to participate in focus group discussions. The lockdown measures and the increasing number of COVID-19 patients in Thailand meant that rehabilitation services were classified as non-urgent. Many patients endured irregular service for an extended period affecting their recovery and performance. Three types of OT services were developed to deliver services in the “new normal” situation: on-site; telehealth; and hybrid. OTs redesigned the services according to patient demand and need: orofacial motor skill training; outcome measurement and follow up; home program counseling; screening and history taking; functional assessment and telephonic monitoring; Line application; material or equipment delivery to home; social skills group training as a hybrid service; and educational video production. OT telehealth remains a challenge for efficiency implementation. Policy recommendations include developing clinical practice guidelines for efficacious and cost-effective OT telehealth services. Upskilling and reskilling training courses should be available to occupation therapist. The government should provide telecommunication infrastructure for equal access to OT services to all who need.


The purpose of this mixed-method study was to synthesize policy recommendations on nursing workforce development: production, distribution, and retention during the COVID-19 pandemic. The quantitative data were collected from 396 samples through the questionnaire on actual and expected workforce retention operations due to the COVID-19 pandemic. The qualitative data were collected from 120 subjects through in-depth interviews. The findings were as follows: 1) Pre-pandemic situations of production, distribution, and maintenance of nursing workforces relied on the production plans of educational institutions. The teaching style and the distribution of nursing profession were based on big hospital setting, and the maintenance of nursing workforce as a whole was inappropriate to workload. 2) During the pandemics, the production plan did not change. However, a variety of functions and skills needed to deal with changing situations were delivered through on-line and in class to learners to solve the skill shortage problems. The movements of trained nursing workforces to cover high nursing care needs at the primary, secondary and tertiary levels of field hospitals in the community up to the intensive units in hospital. Retention measures were found in various compensation plans appropriate to the increased burdens and risks. 3) Post-pandemic policy proposals for nursing workforce were on the production, distribution, and maintenance. On the production side, long-term production plans should take account of the actual needs of the country’s health service system. In terms of distribution, there should be a review and planning the distribution of nursing staff in health care facilities at the ministry level, regional health systems and health care facilities at all levels systematically to have appropriate number of workforces according to geographical contexts, population health needs and levels of nursing services complexity. In terms of workforce retention, guidelines should be developed for building nurses morale and motivation.


In the situation of the COVID-19 pandemic, people were stressful due to the impact on social, economic and health situation from the pandemic. As a result, the number of people with mental health problems and the burden of mental health problems has been increasing. Recognizing the importance of mental health issues during the COVID-19 pandemic, Thailand proposed a mental health preparedness and response for the COVID-19 pandemic as the agenda of the 148th session of the World Health Organization Executive Board and played a leading role in developing a decision on this issue with supports by many countries. Thailand’s movement on mental health was the result of close collaboration between different organizations, continuous investment on capacity building of potential global health personnel and a strong network with countries and the WHO. Therefore, what Thailand has gained from driving mental health issue on the global platform is building a positive role and image of Thailand, incorporating Thailand’s interest into a decision and adapting lessons from other countries on mental health into Thai context.


The National Health Security Office (NHSO) has encouraged the free treatment of patients with acute ischemic stroke with thrombolytic treatment starting in 2008 only at university hospitals in Greater Bangkok. Subsequently, the aforementioned treatment services have been expanded to all areas in Thailand. The challenge of such treatment is that the time from the patient’s neurological symptoms until receiving thrombolytic treatment must be within 270 minutes as soon as possible. A shortage of neurologists in the provinces challenged the development of stroke service network. Using the principles of NETWORK (N: national standard, E: engagement, T: teamwork, W: wisdom, O: organization, R: reach target, K: knowledge management) and STANDARD (S: seamless, T: timeliness, A: awareness, N: network, D: drug available, A: ability, R: referral system, D: district health system) enabled nationwide service expansion in 2011. The current rate for acute ischemic stroke patients with thrombolytic treatment was approximately 8%.


Health maintenance organization (HMO) is one of interesting models for responding to Social Security Office’s (SSO) medical service developments. Therefore, feasibility and acceptability of stakeholders were needed to be studied for further planning decisions. Methodology: This policy research study was to assess the feasibility and acceptability of three proposed HMO models with the SSO transforming into supervisory and monitoring roles. Model one was the HMO through a large private hospital network; model two, HMO through the public health insurance or regional health system; and model three; HMO through a private insurance company. Four key informants groups were selected by using purposive sampling including 1) policy executives serving as HMOs, 2) service providers, 3) service users, and 4) executives or experts with relevant roles. Qualitative data were collected, and content analysis was performed. Results: HMO model two was the most feasible model regarding service area coverage, economies of scale, experiences of management and credibility, etc. However, there were other challenges such as regional health system capacity. Stakeholders concerned that insurer’s overhead cost would take away the desirable benefits of service users, especially in private HMOs that might have a for-profit culture. Some opinions suggested on more precise improvements of the current system instead of establishing HMOs. In addition, they disagreed on the sub-district health promoting hospital acting as gatekeeper at primary care level, as this would deprive user’s rights and create barrier of access to health services. Conclusion and discussion: Although the proposed HMO model two was considered the most possible, skeptics were on limited competitions within the HMOs. HMOs might not reduce the health expenditures because of overhead cost and long-term investment in primary care system. Further study should consider possible competitive HMO models or other HMOs in Thailand such as medical schools network.


This study focuses on establishing health workforce data sharing platform between health professional councils and the Ministry of Public Health. Minimal dataset adopted from WHO’s recommendation was created. This standard dataset was agreed by all health profession councils according to Thai’s context. This essential data for each health profession is basically required for planning and management for national and organization level. International definition was kept in mind for future global comparison. Essential personal data includes personal identification number, name and surname, birth history information, current address, contact information, and a professional license. Certification of education and training, employment status, and address of the place of employment. Moreover, the centralized platform has been created to facilitate the collection of data for supervision, monitoring, evaluation, and research between related sectors particularly health professional councils and the Ministry of Public Health. Establishing of a data link and personnel registration system Establishment of a system for registering professional personnel It complies with several operational standards regarding hardware equipment, software, and adequate vocational training. And data storage is mandated by law. The main result aims to strengthen the national health workforce core indicators to facilitate policy makers to establish proper plan, effective management, and good monitoring system on health workforce both national and sub-national level


This study aimed to study attitude of health workforce toward primary health care management to examine, synthesize, and develop appropriate model of people public private partnership (PPPP) for managing primary health care. Quantitative and qualitative methods were used in this study. Data collection was conducted in two study areas namely Kuchinarai district, Kalasin province and Dansai district, Loei province. Samples in this study included 61 participants for quantitative and 44 participants for qualitative data collection. They were from community, private and government sectors. Nonetheless, they were identified as executives, implementing staff and common people. The result revealed that samples had relatively high positive attitude toward partnership among people, public, and private sectors. The samples thought that contributing factors of partnership model for primary health care management included 1) national policy, 2) strong health leadership, 3) homogeneous and closerelationship community, and 4) natural and man-made environment capitals and social capital. While hindering factors that the samples figured out were 1) the red-tape system, and 2) lack of resources (human, money, material and knowledge). Processes of developing PPPP for primary health care management included 1) developing relationship among partners, 2) building trust and safety zone of working together, 3) having continuing knowledge communication, 4) empowering each other, 5) strengthening and expanding network, and 6) working together under the rules, regulations and committees. The samples believed that this partnership model could contribute to four dominant outcomes including 1) health outcome (not only access to services in the community), 2) economic outcome, 3) environmental outcome, and 4) learning and knowledge outcome. To materialize the model in other areas, the following two broad recommendations are proposed: 1) integration of the partnership model in the district health system (DHS) that could benefit primary health care in terms of human resource, budget and other resources efficiently; 2) all related stakeholders and their staff should acquire knowledge, skills and positive attitude toward partnership model among three sectors for primary health care management.


This study aimed at analyzing the level of system governance of the participatory health region and the committee roles on system governance; and categorizing system governance of the participatory health regions at national level. Mixed methods of both quantitative and qualitative studies were used. The study covered 13 health regions. The study population consisted of 638 committee members and secretariat teams. Quantitative data were collected by self-administered questionnaires designed according to United Nations’ good governance criteria, and analyzed by descriptive statistics and exploratory factor analysis. Qualitative data were collected by in-depth interview, focus group discussion, report review and observation, and analyzed by content analysis. The study took 15 months from October 2018 to December 2019. Quantitative analysis showed that the participatory health regions had high system governance level since all components got scores greater than 2.5. The top three highest scores consisted of following the rules of law (score 4.01), equity and inclusive coverage (score 3.91) and transparency (score 3.81). The three least scores included efficiency and effectiveness (score 3.65), accountability to people (score 3.66) and responsiveness to target population (score 3.72). Qualitative data analysis revealed 20 important committee roles on the system governance. Holistic care provision and regular meeting reporting got the same highest levels (score 4.04) while the least achievement role was on fulfilling the setup plans (score 3.48). By factor analysis, two categories of system governance were found: the planning and the implementation process. The present study suggests that the network governance can be used to strengthen both the National Health Security Office’s area health and the regional health of the Ministry of Public Health. Public relations, experience sharing in working with soft power, and building collective leadership are recommended for improving system governance. The weakness of the present study was the lack of impact evaluation.


The objectives of this research study were to (1) examine the type 2 diabetes patient journeys and (2) synthesize recommendations on communication campaign contents to reduce the number of new type 2 diabetes patients. Two qualitative methodologies were applied in this study. First, 26 purposive samples from 8 provinces in different regions of Thailand were recruited for in-depth interviews. Second, focus group discussion was employed to collect data on the contents of the communication campaign. The results revealed that the type 2 diabetes patient journeys were divided into three stages. In the initial stage, the risk group exhibited habits that contributed to diabetes in terms of consumption and physical activity. The under 35-year-olds also lacked access to diabetes screening and had misconceptions about type 2 diabetes causing them less aware of the risk of developing the disease. The second stage was the beginning of treatment. Patients chose to come for screening after seeking advice from their family member, village health volunteer, the mass media, and after they themselves faced physical conditions interfering with their daily lives. The beliefs in high blood sugar findings and doctor’s advice were the driving force for seeking treatment. Additionally, patients started seeking more information on diabetes through various means. The third stage was to live with diabetes. Patients acknowledged having disease, yet often reported feeling stressed when they were unable to control their blood sugar levels or encountered diabetes-related problems. There were two main categories of content suggestions for developing communication strategies for lowering the number of new cases. The first was the hygiene content for regularly delivery, such as, food and drink risk behaviors, and physical exercise. The second was the hero content to increase awareness on dangerous complications of the disease.


Although the Pharmacy Council has launched the Guidelines for Telepharmacy, it required additional details for implementation. The present study aimed to develop the standard practice for telepharmacy and guidelines for pharmaceutical care and to design data architecture that supported and facilitated the operation of telepharmacy. This developmental research was designed into 2 phases. The first phase combined literature review, focus group discussion, and stakeholder hearing with the aim of developing the basic guidelines for telepharmacy and guidelines for pharmaceutical care. Minimum dataset consisting of patient data, prescription, dispensing, logistics, and guidelines for pharmaceutical care was an output and recommendation of phase I study. The results from the first phase were inputs for stakeholder consultation of the second phase. The output of phase II study was the telepharmacy data architecture compliance to HL7 FHIR (health level 7 fast healthcare interoperability resource) for telepharmacy data sharing consisting of patient personal information, health data, treatment history, and logistic statistics. The recommended data architecture of the phase 2 study was named “Thailand Telepharmacy Profile”. Finally, this present study proposes the Pharmacy Council of Thailand to implement the guidelines and standard data set.


Background: The COVID-19 pandemic has caused immense health and financial loss globally. Standard health precautions, including mask-wearing reduced its spread. Compliance with these measures varied between countries, depending on the culture, the public awareness and the policies enacted by the government. A higher rate of mask-wearing was thought to be more effective in limiting the spread of the disease and methods of monitoring mask-wearing would be useful for campaigns to increase mask-wearing. Although the mask-wearing rate has been estimated with questionnaires and episodic counting studies, there were very few reports visually documenting the rate of mask wearing sequentially over time. In the present study we developed an artificial intelligence (AI) system to analyze images from public CCTV (closed-circuit television) to document the rate of mask wearing in Bangkok, Thailand, and correlate the rate with public health policies and COVID-19 events and determine factors related to improper masking. Methodology: Public CCTV cameras in the Bangkok Metropolitan Area (BMA) were selected in view of their location and camera viewpoints. Every week, 9 hours of video clips from each of these cameras were downloaded and sent for analysis by an AI that had been trained to detect mask-wearing using pictures with and without masks from public databases. A number of the images was also visually checked for accuracy. The rate of mask-wearing was analyzed and correlated to public health measures and COVID-19 infections using panel regression analysis. The images of faces without masks were reviewed to understand factors related to not wearing masks. Results: 39 cameras were selected for weekly data download from 1 April to 15 November 2021. Of these 15 were validated fortnightly by humans. Important COVID-19 events over 8 months of the study included the announcement of the mask mandate and the peak infection of the 4th wave of infection in Thailand. The overall average rate of mask-wearing across BMA in the mobile population increased after the mask mandate from 89% (SD 10%) to 92% (SD 9%) but this did not reach statistical significance (p = 0.3). However, comparing the mask-wearing rate from the mask mandate to the start of the 4th wave, and from the start to the peak of infections of the 4th wave, the mask-wearing rate increased significantly from 92% to 96% (p = 0.0039). Statistical analysis also revealed that the reported number of infections in the prior week, weekends, time of day, and type of location were significant factors associated with the mask-wearing behavior. Analyzing the images showed that males were approximately 3 times more likely to be seen without proper masking. Conclusions: The use of public CCTV and mask-detecting AI can be used for public monitoring of mask-wearing in the real-world. Bangkokians had a high mask-wearing rate in public areas with an 89% mask-wearing rate before the mask mandate. Although mask wearing increased after the mandate to 92%, the maximal rate of mask wearing (96%) correlated with the peak infection in Bangkok. Factors related to improper masking included the reported number of infected people in the prior week, weekends, time of day, and location type. These factors, as well as other factors seen from the CCTV images may be good targets for campaigns to increase proper mask wearing in the future.


Background: Transferring the mission regarding primary care services at Chaloem Phrakiat Health Center (CPHC) and the Tambon health promoting hospital (THPH) to the local government organization (LGO), resulting in fairness, equity and equality. The mechanism for allocating resources and budgets with primary care is one of the keys to transforming the health care system for reducing inequitable accessibility to health care services. Objectives: 1) to study the situation of health insurance fund management and expenditure allocation for public health services from the health insurance fund of the contracting unit for primary care (CUP) to CPHC and THPH 2) To compare the proportion of expenditure allocation for public health services from the health insurance fund of the CUP to CPHC and THPH 3) to develop the policy recommendation on health insurance fund management and expenditure allocation for public health services from the health insurance fund of the CUP to CPHC and THPH. Methods: This study was a mixed method research under provider perspective that considers a top-down approach that includes tangible costs and intangible costs of the CUP to CPHC and THPH in the fiscal year of 2022. The four study sites were included in this study based on purposive sampling of the CUP with two of CPHC or THPH those has been transferred to the LGO during 2008 and 2012 and two of those do not transfer. The process of this study consisted of 3 steps; step 1, we conducted in-depth interview of 16 key informants and content analysis was employed, step 2, we compared the proportion of expenditure allocation for public health services from the health insurance fund of the CUP to CPHC and THPH and step 3 we developed the policy recommendation on health insurance fund management and expenditure allocation for public health services from the health insurance fund of the CUP to CPHC and THPH. Results: 1) The allocation models depend on the agreement of the District Coordinating Committee. There are various of allocation models regarding to the context of the CUP. The National Health Security Fund budget has a form of money allocation. The expenses of pharmaceutical, non-pharmaceutical supplies and equipment were included in the Outpatient (OP) budget and the payment was a Fixed cost. Most of the CUP allocated the OP budget regardless to the number of health care service output provided by the CPHC and THPH. While the P&P budgets were allocated based on the number of health care service output provided by the CPHC and THPH. However, there are some studied sites those allocate the P&P budget regardless to the number of health care service output provided by the CPHC and THPH. For other health insurance funds, the allocation models depend on the context of each health insurance funds. 2) The proportion of expenditure allocation (in cash: in kind) for public health services from the health insurance fund of the CUP to the CPHC and THPH and the transferred CPHC and THPH were 73.05:26.95 and 54.78:45.22, respectively. The ratio of expenditure allocated (in cash: in kind) to the CPHC and THPH was 2.23 times compared to the transferred CPHC and THPH. The highest expenditures were for providing OP and P&P (UC) services. The OP and P&P (UC) expenses of the CPHC and THPH and the transferred CPHC and THPH were 1,5085,019.85 Baht (95.35%) and 6,670,911.35 Baht (93.03%), respectively. The proportion of per capita budget for providing OP and P&P (UC) those allocated to the CPHC and THPH were higher than to the transferred CPHC and THPH. The global budgets cover the cost for providing public health services of the CPHC and THPH and the transferred CPHC and THPH were come from the same source which were ranged between 50.32% and 52.52%. Labor costs were the highest cost covered by the global budgets (51.57%-65.27%). Material costs were the highest cost covered by the maintenance budgets (67.99%-70.10%) followed by the expenses from the CUP (22.27%-29.49%). The cost of treatment activities provided by the physicians were ranged from 0 Baht (no activity) to 319.34 Baht. Finally, the cost of treatment activities provided by other health care personnel were ranged from 27.27 Baht to 1,454.48 Baht. 3) Management and budget allocation model for public health service should be sufficiently allocated to any kind of services in health center and health promotion hospital which should include those did not transferred and transferred hospital to subdistrict and provincial administrative organization. This is for the fairness of the allocation option 1, in case that the original Contracted unit of Primary care (CUP) (no paid) in the context of editing Ministry of Public Health’s maintenance allowance. Option 2, in the case that original CUP (no paid) with directly allocated to health promotion hospital in the context that no editing of Ministry of Public Health’s maintenance allowance. Option 3, in the case that new CUP (With paid) with the directly allocate to health promotion hospital.


Diabetic retinopathy (DR) is one of the most common microvascular complications in diabetes patients as well as one of the most important causes of blindness worldwide. Therefore, DR screening is vital for health care system to prevent blindness. Although, in Thailand, we utilize the percentages of diabetes patients who undergone DR screening program as an indicator of effectiveness in eyes health services, this indicator is not directly reflect the number of diabetes patients who truly go to see retinal specialists for proper management. As a result of the problem mentioned above, this prospective study aimed to compare referral adherence of diabetes patients screened by artificial intelligence (AI) with integrated system group with diabetes patients screened by health care personnel (manual or conventional group). In this study, we screened DR using fundus camera which connected with digital health platform and divided diabetes patients into artificial intelligence (AI) group and manual (conventional) group week by week for 8 month period. However, fundus photo in AI group were reviewed by retinal specialist (overreader) from tertiary hospital and mismatch cases were contacted. Furthermore, referral information was recorded by nurse at tertiary hospital to evaluate referral adherence. Total 1,454 patients included for our analysis (708 patients were screened by AI and 746 patients were screened by manual). Referral adherence of patients diagnosed as referral diabetic retinopathy in AI group was more than manual group and even more than manual group who referred from uncertain fundus images (89.15%, 72.7% and 70.73%, respectively.) Moreover, screening health care personnel’s satisfaction increased after deployment of AI. In conclusion, implementation of an integrated system of artificial intelligence in real clinical setting may improve efficiency in DR screening and also increase referral adherence of diabetic retinopathy patients.