Objective: To study the cultural competency among hospital pharmacists, under the Office of the Permanent Secretary, Ministry of Public Health, Thailand. The findings would serve as an input for cultural competency development plans for Thai pharmacists. Method: The researchers used the online Thai Pharmacists’ Cultural Competency Self-Assessment Scale (TPCCS) developed by the researchers to perform a cross-sectional survey to hospital pharmacists under the Office of the Permanent Secretary, Ministry of Public Health Thailand. Stratified sampling was carried out based on the health service region and the size of the facility. Between March and August 2021, 241 pharmacists responded to the survey (response rate 31.26%). The TPCCS had 16 factors, 92 questions and 5 cultural competency dimensions: 1. cultural awareness, 2. cultural skills, 3. cultural knowledge, 4. cultural encounter, and 5. cultural desire. On a 5-point Likert scale, pharmacists were asked to rate their ability to practice. Results: Thai hospital pharmacists had a moderate level of cultural competency. On the full scale of 5, the mean values for each dimension ranged from 2.39 to 4.24. On average, they had low scores on some cultural awareness dimension. They had the highest score on cultural desire. Conclusion: There was a need to improve pharmacists’ cultural competency, particularly in terms of cultural awareness. A strong desire for cultural competency may be an excellent foundation for continuing growth.


Organizational health literacy [OHL] helps health care organizations achieve high-quality, efficient, and meaningful care to service users, called health literate health care organizations [HLO]. OHL is defined by the Institute of Medicine as “the degree to which an organization implements policies, practices, and systems that make it easier for people to navigate, understand, and use information and its services to take care of their health.” As OHL was a new term in Thailand, there were needs to raise awareness and promote OHL practices at governmental health care organizations. This study was to evaluate the effect of “SASUK OON-CHAI”, a supportive web-based processes for OHL at governmental health care organizations under the Ministry of Public Health. The supportive processes were initiated by the Division of Health Literacy and Health Communication, Department of Health. An evaluative study design was employed to investigate the effects of SASUK OON-CHAI on OHL of governmental health care organizations that registered to participate in interactive online monthly meetings (group 1) and compared with organizations voluntarily chose to self-study the OHL (group 2). The OHL practices were reflected by the staff and service users before and after each health care organization developed and submitted their development plans. The percentages of staff and service users who perceived the OHL practices were compared between the pre-test and post-test using the Wilcoxon signed rank test, and between the two groups using the Mann-Whitney U test. The significance level is .05. Cohen’s D was calculated to indicate the effect size. Results: 455 organizations assessed their OHL practices at least twice with a minimum time interval of one month and their OHL practices were used for the evaluation. 248 chose to participate in the interactive online monthly meetings and 207 chose to self-study. There were statistically significant improvements in the OHL practices of both groups with a small effect size [group 1: pre-test 95.47%, SD = 5.99, post-test 96.95%, SD = 5.51, p = 0.000; group 2: pre-test 96.61%, SD = 6.77, post-test 97.83%, SD = 4.01, p = 0.002). At the pre-test, group 1 had a significantly lower percentage of the OHL practices (p = 0.000), but at the post-test, this percentage was not statistically different from that of group 2 (p = 0.139). Conclusion: Either OHL practices by registering in SASUK OON-CHAI and participating monthly online meetings or self-studying the OHL practices helped improve OHL.


Background: Non-communicable diseases (NCDs) are serious health issues in many countries. This paper aimed to evaluate a wellness center or health promotion program using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework and to investigate financial feasibility of NCDs prevention and promotion program in Thailand. Methodology: A retrospective plus interview study was used in this paper. Data were obtained from two wellness centers in public hospitals, Thailand. RE-AIM model was used to evaluate the program. Financial feasibility was performed with the home exercise and fitness center models based on financial and service assumptions. Results: A total of 217 participants were included in this study. After attending the prevention and promotion program for more than two months, the participants’ body weights and body mass indexes reduced significantly. Regarding the RE-AIM framework, the wellness centers reached target groups and continued providing services in the public hospitals. In terms of a financial feasibility study, the model could break-even in the first year (0.36 year for home exercise, while a fitness center model was 5.44 years with a fee of 4,500 THB per person). For the internal rate of return (IRR), both models showed positive investment. Discussion: RE-AIM model indicated that the wellness centers successfully reached its target groups. The findings provided a positive outcome and positive investment by financial feasibility study despite small sample size. Further studies are recommended to involve more hospitals to improve the generalizability of our findings.


The purpose of this study was to measure the satisfaction of caregivers employed by service units/centers to improve the quality of life of the elderly/local governments to give care to dependent persons in the communities; and to determine the factors that influenced caregivers’ satisfaction with the employment after wage adjustment made since 2017. This was a cross-sectional study in January and February 2022. Data were collected using questionnaires from 563 caregivers who worked under the long-term care funds for dependent elderly from the north, the south, the east, the northeast, and Bangkok. Samples were selected using the simple random sampling method. Data were analyzed descriptively and the relationships between variables were tested using multiple regression analysis. The results showed that the majority of the samples were female (95.4%), age between 40 and 59 years (62.3%), worked as a caregiver for 3 to 5 years (47.2%), and had completed 70 hours of training (89.6%). Regarding employment contracts, 31.3% contracted through service units, 30.6% contracted through local governments, and 17.6% had no contracts. In terms of frequency of payment, 25.8% were paid monthly and 17.9% paid every three months. This study revealed that 48.7% of caregivers experienced late or no payment at all. In this regard, caregivers earned an average wage of 1,620 baht per month (maximum 3,054/minimum 764), but had to pay for travel to work at 214 baht per month (maximum 356/minimum 115). In terms of satisfaction with employment, 51.6% of caregivers had a high level of satisfaction, followed by 26.3% with the highest level. The factors affecting employment satisfaction were quality of work life (B = 1.433, p < 0.01), job support (B = 0.923, p < 0.01), and wages (B = 0.001, p < 0.01). Policy recommendations on wages are: wages should not be lower than the minimum wage, or wages should be increased as step ladder based on experience of the caregivers. If wages cannot be increased, travel expenses, or opportunity losses should be covered. Policies to support the work of caregivers are: equipment such as blood pressure monitors, refresh trainings to improve caregiver knowledge and practices, and caregiver uniforms or team vests, recognition badges, or symbols should be provided to caregivers for public recognition.


The objective of this mixed-method research was to study the lessons learned from organizing health service systems at the tertiary level in the northeastern region of Thailand during the critical pandemic of COVID-19. The study focused on the health care capacity and utilization and the six building blocks frameworks, examining the tertiary hospitals in Khon Kaen, Udon Thani, Surin, and Ubon Ratchathani in the northeastern region of Thailand. The data sources included health region administrators, provincial and hospital managers, COVID-19 committees, medical personnel, environmental workers, and stakeholders from the community. The research was conducted from September 2021 to February 2022, using health-care capacity and utilization assessment tools including in-depth interviews, focus group discussions, and lesson learned extraction. Quantitative data were analyzed using percentages and averages, and qualitative data by content analysis. The research findings plus lessons learned were as follows. 1) The emergency operation center committee’s province played a crucial leadership role. 2) Managers and practitioners collaborated, participated, managed, and took responsibility together. 3) Intersectoral networks supported cooperation and resource sharing. 4) Information and communication technology was used for decision-making by managers. 5) The screening principles for COVID-19 of rapid knowing, detecting, isolating, quarantining, and treating were followed. 6) Preparedness of personnel capacity framework. 7) Competency development of personnel through mentorship, peer support, and networking. 8) Employed SMART principle in management and administration. 9) Enforced seamless referral of patients. 10) Provided knowledge and understanding to practitioners and service recipients. These lessons learned could be effectively applied to tertiary hospitals in future contexts.


The increasing number of COVID-19 patients during the pandemic posed a great challenge for health care services. Nurses have a vital role, not only in providing care, but also in managing other health care services, in regard to the varied hospital resources challenges. This qualitative research aimed to synthesize lessons learned from the COVID-19 crisis experiences regarding nursing competencies and workforce management in Health Region 10 of Thailand. Document analysis, in-depth interviews, and focus group discussions were used to collect data from October 2021 to April 2022. The 293 key informants included the Ministry of Public Health (MOPH) inspector of Health Region 10, representatives of the Thailand Nursing and Midwifery Council, representatives of the Nursing Division of the MOPH, the provincial chief medical officer, a group from the emergency operation center (EOC) committee, hospital directors, heads of nursing departments, physicians, infection control (IC) nurses, and nurses engaged in COVID-19 patient care. The data were analyzed using content analysis. The study revealed that: 1) workforce management in response to the crisis included 1.1) implementation of nursing staff pooled from different units through nurses volunteer co-operation or direct command; 1.2) modifying working hours from 8-hour shifts to 12-hour shifts; and 1.3) assigning head nurses of lower workload units as supervisors to the COVID-19 cohort wards. And 2) strengthening nursing competency focusing on: 2.1 designing educational modules on nursing care for COVID-19 patients with regard to infection control and prevention; 2.2) on-the-job training; 2.3) training self-directed learning skills to nurses to independently online search available COVID-19 knowledge resources; and 2.4) the IC nurses played a major role in infection control competency of the hospital staff, as well as informing the most update COVID-19 practice guidelines. The most common training sessions included the donning (putting on) and doffing (removing) of personal protection equipment (PPE) and the powered air purifying respirators (PAPR), intubation in COVID-19 patients, automatic cardiopulmonary resuscitation (auto-CPR), prone positioning in ARDS (acute respiratory distress syndrome) COVID-19 patients, and mechanical ventilation care. The key success factor for coping the crisis was the collaboration from all partners and stakeholders. The policy recommendations for the present study included setting measures for comprehensive nursing workforce management and essential competency to handle crisis situations, developing the nurse workforce system and mechanisms in order to retain nurses in the system, implementing education and training programs to promote nurses’ competency, continuously, and creating working environments conducive to nurses providing direct patient care professionally.


This emancipatory action research with action research aimed to develop essential nursing competencies for COVID-19 and nursing competency development models for primary, secondary, and tertiary health service units through the case study of Songkhla province where strong government management policy existed in collaboration with stakeholders. A total sample of 53 registered nurses (10 from primary, 31 secondary and 12 tertiary health service units) and 6 physicians were recruited. Research instruments consisted of 1) quantitative data collection tools including the questionnaire of essential nursing competencies for emerging infectious disease COVID-19 and the questionnaire of satisfaction on nursing competency development models for COVID-19. 2) Qualitative data collection tools included the behavioral-based interview, the in-depth interview, and the focus group discussion guidelines. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using content analysis. Research results revealed that 1) registered nurses had an overall higher mean score of essential nursing competencies for COVID-19 at each loop of research. Higher mean scores were found on both professional and technical competencies. 2) Nursing competency development model consisted of 3 components including practice guidelines, competency development method, and factors promoting competency development. Practice guidelines consisted of 5 main steps including 1) specification of essential performance competencies; 2) development of monitoring system, support, and empowerment; 3) specification of self-competency development guideline; 4) implementation of the competency development plan; and 5) summarization and report of development result. The competency development method consisted of 6 activities including 1) workshop, 2) on-the-job training, 3) learning from experts, 4) coaching, 5) self-study, and 6) knowledge sharing. Factors promoting competency development included the role of nursing leaders, explicit policy and practice guidelines, and a good attitude towards the profession. Conclusion: research findings could be used as guidelines for the competency development of nursing staff working in primary, secondary and tertiary health service units to have skill and nursing competency for patients with COVID-19 and emerging diseases in the future.


This study was a convergent parallel design mixed methods study collecting quantitative and qualitative data in Yala, Pattani, and Narathiwat provinces. The study aimed to determine the roles of primary care network in screening and monitoring the COVID-19 risk groups. Purposive sampling and quota sampling were used to recruit samples from two districts with the highest infection rate in each province, 2 subdistricts per district, and a total of 6 subdistricts. The samples were consisted of 80 people per subdistrict, including 10 village health volunteers, 10 local government officials, 10 community leaders, 10 religious leaders, and 10 other people, totaling four hundred eighty-one people for quantitative data collection. A questionnaire on knowledge and practice in screening and prevention in risk groups of COVID-19 was the instrument used. The data collection was from January to December 2021. In parallel 270 people provided qualitative data through either focus group discussions or in-depth interviews. Quantitative data were analyzed using frequency and percentage, while qualitative data by thematic analysis. The quantitative results showed that the average scores of primary care network roles for screening and monitoring COVID-19 risk groups were rated as high (mean = 3.19, SD = 0.51). The highest score (mean = 3.33, SD = 0.56) was found for the screening and monitoring of people exposed to COVID-19, followed by the community control of the COVID-19 pandemic and communicating the risk of infection (mean = 3.25, SD = 0.59, mean = 3.22, SD = 0.60 respectively). Findings from qualitative methods were as follows. 1) Village health volunteers played an important proactive role in screening and monitoring risk groups by zoning households under responsibility, and providing communication on risk of infection. 2) Health professionals had the role of health system management based on cultural beliefs, fostering unity among all professionals, and working proactively to control the spread of COVID-19. 3) Local governments supported people’s daily livelihoods and worked with all sectors in the community. 4) Community leaders supervised people to comply with public health measures, took care of safety and shared household responsibility zoning with village health volunteers. 5) Religious leaders directed people based on Islamic principles and practices to implement public health measures to control the spread of COVID-19 at community acceptance level. The outbreak of COVID-19 in the 3 southern border provinces was under control through synergy of cooperation of primary care networks. These collaborations and participations could be important in other areas of community health management.


The COVID-19 pandemic situation has affected health workforce in the public health system, health personnel could not provide care to all infected people. The situations led to home isolation equipped with volunteer health workforce in a telehealth care model. The objectives of this qualitative research were: 1) to analyze the roles and operating procedures of health workforce; 2) to analyze success factors, problems and obstacles in the implementation of home isolation telehealth care model; and 3) to synthesize the home isolation telehealth care model in terms of health workforce in Health Region 12 of Thailand. Data were collected through semi-structured in-depth interviews and online group discussions with 30 volunteers and 50 home isolated patients. Data were triangulation verified at every step of data source check, investigator, and methodology. Content analysis was carried out till interpretation, and conclusions reached. The results revealed that 1) the home isolation telehealth care model was staffed by the combined workforces of health workers and volunteers who helped take care of COVID-19 patients. The volunteers were recruited from lay people, people who had contracted COVID-19 and their relatives. 2) The combined workforces built up shared common goals through group meetings to clarify the objectives and goals of the voluntary work. 3) Training sessions began with forming volunteers’ care attitude ready to be giver to others; followed by the use of language in good communication; knowledge on COVID-19 prevention, care and rehabilitation; tele-patient assessment using information technology and patient database systems to achieve continuity of care. And 4) online patient consultations were operated to reinforce confidence of the combined health workforce. The roles and operating procedures were confined to 4 teams: 1) The central team designed patient database system to assign patients with COVID-19 to patient care team. The databases coordinated and kept track of patients’ symptoms whether they faced severe symptoms, crises, or emergency conditions that required necessary medical equipment support. 2) Patient monitoring team took responsibilities of the assigned patients, making phone calls to assess symptom changes, providing advice, encouraging mental support. This team recorded patient progress in the database. If severe symptoms of COVID-19 were detected, the team needed to notify doctor or pharmacist for appropriate action. 3) The community team was responsible for delivering the actions of the monitoring team to COVID-19 patients, such as providing medical equipment, medicines and food to their homes. And 4) the funeral volunteer team provided necessary ritual ceremony if the patient died. The key factors for success of home isolation telehealth care model included attitude, mindset, and belief in volunteer work, which conveyed peace of mind, complacent feeling and fulfilling in merit making. Problems and obstacles included difficulties of access to the database, communication and tools and the Internet system.


Background and Rationale: COVID-19 control measures impacted on stress, alcohol, and tobacco consumption, including physical inactivity and sedentary lifestyle among populations. As age is a factor in the health belief model that affected individual beliefs throughout life-course, this study aimed to explore health-related behaviors by age groups during the COVID-19 pandemic, compared to the pre-pandemic. Methodology: A cross-sectional study was done among 7,731 Thai people aged 15 years and older, through multistage sampling of the total 13 health regions and proportionate to population size of selected provinces by three age groups (adolescent: 15-24 years, working age group: 25-59 years, and elderly: 60 years and older). Face-to-face interview captured changes in health-related behaviors (increase, no change, and decrease) then analyzed by ordinal logistic regression. Results: During the COVID-19 pandemic 33.3% of Thai people were current drinker, 18.3% were current smoker, 73.5% had sedentary behavior, 6.8% were physical inactive, more than 70% had vegetable and fruit in some meal/day, 77.0% had sugar drink, and 57.7% ate fast-food. Compared to pre-pandemic, 3 out of 8 behaviors were going in positive direction - alcohol consumption (27.0%), sugar drink (11.1%), and fast-food eating (12.7%) - whereas tobacco consumption, sedentary life, physical activity, and eating vegetable and fruit were going in the opposite direction. Negative directions happened among age group 15-24 years the most, followed by the 60 years and older. Taking the 15-24 years as the reference group, the working age and the elderly had less sedentary and physical inactivity, the working age ate fast-food more frequently and the elderly even more than among adolescent group. Also, elderly group had higher risk of eating less vegetable and fruit compared to adolescent group. The 15-24 years had the most 4 highest negative health behavior changes compared to pre-pandemic including sedentary life, less physical activity, more sugar-drink (p < 0.01), and more fast-food. Conclusion: During the COVID-19 pandemic, the adolescent had most negative health-related behaviors, whereas the working age and the older persons had higher risk of having fast-food than the adolescent. Government should further develop interventions specific to age groups. New interventions should create enabling healthy environments to adolescent and the vulnerable groups during the pandemic.


This lesson learned study aimed to review documents and experiences gained from story-telling of 50 executives and practitioners involving with international sports events during COVID-19 pandemic. Key informants were from government and private organizations who agreed to participate in phone and video conference interviews or discussions with an open-ended questionnaire conducted in September 2021. According to research findings, the operations of international sports events with no audiences during the COVID-19 pandemic used quarantine measures called “organizational quarantine type B” provided an opportunity for athletes to be eligible to participate in the Tokyo 2020 Olympic and Paralympic Games. All the authorities involved expressed concerns on challenges of the management of sports events under quarantine. Even though the accomplishments did not have direct economic worth, Thailand had shown the potential of controlling the COVID-19 pandemic internationally. The sports events during COVID-19 with appropriate preventive measures had proved that they promoted social and economic mobility. Combined with other quarantine facilities, the contracted souvenir shops, restaurants and other recreation facilities with disease prevention and control standards, could help decrease stress and distribute profits to the community.


This research is an international collaboration among three organizations: the National Science and Technology Development Agency, the Pharmaceutical Organization, and the University of Oxford. Its purpose is to study the potential use of temperature sensor technology in pharmaceutical and medical applications. Temperature sensor technology can measure Thermal Product (TP), a heat property that is specific to each type of substance, and varies with the substance's density, specific heat capacity, and thermal conductivity. The University of Oxford has developed this technology for commercial use in the aerospace industry, specifically for detecting metal contamination in engine oil. We performed a feasibility study for commercial applications in various aspects in this project. The technology is tested in three areas: quality control of pharmaceuticals and raw materials, detection of counterfeit drugs or substandard drugs, and production processes related to medical cannabis. Collaborative research has been conducted to improve the sensor system for more appropriate use. From preliminary experiments, it was concluded that the current sensor system works well with liquid substances and has high sensitivity to detect changes in substance proportions. Therefore, it is suitable for use in quality control processes that require accurate measurement of substance proportions. The system is feasible both technically and commercially for use in quality control processes for drug production and pharmaceutical raw materials. It can help increase efficiency in production by adding real-time quality inspection and control processes during production stages, as the current quality control mainly relies on final product testing. The research team has proposed to install and test the system in the production process of Deferasirox, a pharmaceutical raw material product developed by the Governmental Pharmaceutical Organization (GPO), which is entering the commercial production stage in the middle of 2024. This will be the practical application of research results for commercial use which can also be expanded in the future.


The 2019 coronavirus outbreak has forced many industrial plants to shut down, then negatively affecting to the industrial sector and the economy of Thailand. Serial testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been proposed as a measure for safe factory reopening. This study examines the efficacy of detecting the pathogenic SARS-CoV-2 infection by detecting antigens in saliva samples. It compares the results obtained from the automated machine with the results of the manual antigen detection. The samples used in the study were saliva samples obtained from industrial workers in Bangkok and Nonthaburi provinces between March 2022 and May 2022. A total of 4,364 participants attended the study, of which 85 were confirmed to be infected with SARS-CoV-2. An automated antigen detection using Lumipulse G1200 SARS-CoV-2 Ag detection and manual antigen test kit were compared with RT-PCR. The test results showed that The Lumipulse G1200 SARS-CoV-2 Ag is effective in detecting SARS-CoV-2 infection and results were comparable to confirmation method by RT-PCR with the sensitivity and specificity of SARS-CoV-2 as 87.0% (95% CI 78.0%–93.4%) and 99.0% (95% CI 96.6%–99.9%) respectively. In conclusion, the Lumipulse G1200 SARS-CoV-2 Ag is a capable tool for screening pathogens for SARS-CoV-2 and provide accurate test results when ccompare to the standard test method. The instrument is therefore suitable for use in epidemic situations where large volumes of samples are required to be tested, such as factory or school samples.


At present, the importance of data-driven policy in healthcare is paramount, especially with the emergence of Big Data. Thailand can benefit from diverse data channels to enhance efficiency in primary healthcare services. This study aimed to assess the feasibility of developing a big data system for primary healthcare in Thailand. This includes exploring access and feasibility of relevant data, resource allocation, and assessing potential collaborations among stakeholders. For data feasibility, we reviewed literature and interviewed various data sources. The analysis focused on environmental factors, health resources, individual factors, and behavioral patterns that affect health data. Regarding resource feasibility, we outlined several scenarios for data aggregation from in-depth interviews with experts and relevant organizations, providing direction for maximum benefit from the big data system. Furthermore, focus group discussions were held to discuss collaborative strategies among different agencies. The study results showed the feasibility of important data in environmental, health, and behavioral health aspects. It was found that there is potential data that could be beneficial and comprehensive. Additionally, interviews and focus group discussions emphasized the enthusiasm of organizations to collaborate effectively. However, challenges in data standardization and system interoperability remain. Yet, there's a consensus on the massive benefits of big data. In conclusion, establishing a big data system for primary healthcare in Thailand is not only appropriate but also feasible with robust data. Nevertheless, this challenge hinges on the collaboration of key stakeholders, driven by a shared vision and understanding of its transformative potential.


This research is aimed to achieve this following objectives (1) to analyze and design measures to support and drive health area development of pilot health areas (regulatory sandboxes) including criteria/ indicators to monitor operations and evaluate achievement from developments, (2) to monitor implementation of regulatory sandbox measures in pilot health areas with health area teams, (3) to evaluate results from implementing regulatory sandboxes in pilot health area, and (4) to propose proposal to improve rules and regulations to support area health developments to become integrated and co-responsible development mechanism. This is an analytical, operation, and evaluation research with Health Area 1, 4, 9, and 12 as pilot health areas. Research team worked with ministry of public health executives, health area executives, and other related ministry of public health staffs to draft regulatory sandbox proposal to drive health area development in pilot health areas. The regulatory sandbox proposal covered 5 dimensions of health development building blocks which were (1) leadership and governance, (2) human resource, (3) health financing, (4) information and communication technology, and (5) health technology and innovation leading to delivering expected results in solving national level health agendas (Big Rock). Moreover, the research team also designed monitoring and evaluation framework by setting criteria and indicators for monitoring and evaluations adopting Objectives and Key results (OKRs) concept which allowed all relevant sectors from operators to executives to participate in operations, and express their opinions regarding problem solving, and improving overall operations in health area development to more innovative and creative development. Results of regulatory sandbox evaluation are as follows: 1) Comparative Evaluation between Before and After Pilot Health Area Development: It was found that pilot health areas had progresses in several issues which were leadership and governance, human resource management and development, and health financing as measures in the sandbox allowed easier and faster managements. Regarding information and communication technology, all health areas had significant development leading to faster and more convenience services. However, there was no significant progress nor operation that leads to introducing new investments in financing innovation or health technology that could match what was expected in reform purpose. But if we considered overall achievement of having health areas that could absolutely manage within their areas, we concluded that health area succeeded at their beginning phases, and the ministry level push is needed in improving rules and regulations that were obstacles to expected health area management, as well as integrating health policies with other health related agencies which would lead to absolute health area management. 2) Comparative Evaluation between With (Pilot or with regulatory sandbox) and Without (Non-Pilot or no regulatory sandbox) Health Area Development: It was found that Leadership and Governance: Pilot health areas could achieve all targets in this aspect while most of non-pilot health areas were in processes of appointing health area board of directing committees, and health area board of managing committees. However, non-pilot health areas already had their annual action plans which were guidelines of health area operations. Human Resource: Pilot health area’s integrated management and service mechanism allowed pilot health areas to have management tools to solve human resource management problems of each pilot health area, took shorter time, and had flexibility in human resource management, and allocation as health area board of directing committees were empowered to manage human resources in their health areas. On the other hand, non-pilot health areas still faced human resource management problems such as unclear manpower, and unmatched to health context changes in the health areas. Health Financing: All 12 health areas attempted to integrate sources of funds in health management with other health related agencies within health area such as National Health Security Office, Social Security Office, and Local Government Units. This was a key success factor for solving insufficient resources (especially budgets) in the areas as it would allow the health area to implement and emphasize in activities/ projects that could deal with specific problems or respond to health needs in the area. However, even the pilot health areas had measures from sandbox for integrated service providing and management in the area, they could not enhance the pilot health areas to have absolute financing management. Information and Communication Technology (ICT): In general, the pilot health areas had more concrete actions compared to non-pilot health areas as there were electronic patient health record development, health area database system, and digital transformation planning in hospitals in pilot health area. However, there was significant ICT development in Health Area#8 such as R8 Anywhere to connect all patients’ information in the health areas. Health technology and innovation: Pilot health areas had clearer attempts to uplift their service standards, and resource management, as well as more numbers of projects. However, researchers found significant operations in this aspect in Health Area#8 such as One Stop Service, public health developments for those in jails and foreigners. On the other hand, both pilot health areas, and non-pilot health areas still managed under single source of fund (budget), and had not considered having private sector participate in health service arrangement in the health areas, which might not be enough for solving resource scarcity and sustainable health financing within health areas. Evaluation results also indicated that rules and regulations were one of reasons behind problems and obstacles in health area development as it related to status of the health area office, as well as health area administration. In order to find solutions to clear these obstacles, the researchers proposed approaches to improve laws, rules, regulations, and notices to enhance integrated service provisions., and absolute administration in the health areas to achieve targets as follows: 1) Proposal to improve rules and regulations regarding leadership and governance such as Ministry of Public Health Regulation regarding Health Area Establishment for Health Area Development B.E. … 2) Proposal to improve rules and regulations regarding human resource management such as management within health area office, seeking and appointing people, exemption of rules and regulations in management. And 3) Proposal to improve rules and regulations regarding health financing such as allowing health area office to integrate all funds in the area.


This project aims to (1) search for early warning signs or risk factors related to health impacts associated with the transfer of tambon health promoting hospitals (THPHs), (2) study changes in resource management, health service provision, and public health operations of THPHs that have been transferred to provincial administrative organizations (PAOs), including necessary systemic management approaches, and (3) analyze and synthesize financial, treasury, information, and legal tools to establish an environmental public health system framework for the transferred PHFs to respond to post-transfer health impact situations. The study employs a mixed methods approach, consisting of (1) a qualitative case study conducted in 12 areas across 6 provinces, and (2) a retrospective cohort study with a focus on the first-year post-transfer (fiscal year 2566). It emphasizes baseline data analysis from fiscal years 2561 to 2565 to identify risks and develop measurement sets and information for monitoring future impacts. The project's duration is from September 1, 2022, to August 31, 2023. Key findings from the study reveal that the evaluation framework for health impacts of the THPH transfer should include (1) health outcomes, (2) costs of care, (3) public health outcomes, (4) primary care access, (5) effectiveness or adherence to medical guidelines and timely care, (6) alignment with public health activity frameworks and goals, and (7) resources and management models. This framework can serve as early warning indicators for monitoring post-transfer health impacts. Furthermore, statistical indicators on various aspects of operational differences, trends, and post-transfer changes were identified between transferred THPHs and those that were not transferred, or areas having varying proportions of the transfer. However, it should be noted that certain indicators in the proposed framework lacked data readiness due to limitations in data collection. The surveys with low response rate, despite being conducted by district health officers, might reflect the challenges in executing their existing duties under the new context of decentralized health systems. Additionally, changes in resource management of THPHs transferred to PAOs led to health service reductions, including public health activities. The Ministry of Public Health, the National Health Security Office, the Local Administration Organization Empowerment Committee, the Prime Minister's Office, and the Department of Local Administration, along with relevant agencies, should collaborate to review, plan, and design a monitoring and response system to prevent and address health impacts on the public resulting from the transfer of THPHs to PAOs. This also includes reviewing and re-designing a system for supervising the area-based public health system.


This present study has five main objectives: 1) To develop a digital community-led health impact monitoring tools on the mobile platform application; 2) To establish communication channels for both horizontal and vertical communication within and between communities, as well as with relevant organizations and public communication regarding community-led health impact monitoring of transboundary pollution; 3) To create citizen reporters who can produce in-depth content on community-led health impact monitoring; 4) To develop a prototype public learning space for community-based health impact monitoring; 5) To utilize the research findings from the program “Development of Community-led Health impact Monitoring System in Nan Province, Thailand: A Case Study of Transboundary Pollution from Hongsa Power Plant, Lao PDR” to produce video documentary reflecting the research process, methodology, and context related to community-led health impact surveillance to mobilize knowledge to communities experiencing similar health risks. The participants consisted of teachers and students from 8 schools in Chaloem Phra Kiat District, one school in Thung Chang District, and orange farmer group in Thung Chang District. Both qualitative and quantitative research methods were used in data collection and analyses. As a result of this participatory research project, various tools and communication channels were developed to enable teachers, students, and community members in the affected areas to record, report, and communicate health impact monitoring information through the C-site mobile application developed by the Public Media Network Department, ThaiPBS. The tools and communication channels include an interactive map on the C-site communication platform, comprising 37 layers of data, including 16 GIS layers, such as administrative boundaries, forest area data, Nan river basin data, village coordinates from Khun Nan to Huai Kon, and data from four other organizations (mobile towers, Office of the National Broadcasting and Telecommunications Commission, PM2.5 dust measuring device API from the Faculty of Science, Chiang Mai University, SO2 and NO2 measuring devices from the Faculty of Engineering, Naresuan University, and community maps from the Faculty of Arts, King Mongkut's University of Technology Thonburi, as well as 14 additional survey-based data layers, such as indicator data collection, location-based storytelling in the style of users-generated contents from nearby citizen reporters, and emergency reporting. The community survey conducted in the 8 communities led to the development of community indicators that cover health and the environmental dimensions. In terms of health, two digital surveys on physical and mental health were developed, in terms of environment, monitoring surveys for water quality using the benthic macroinvertebrates, and monitoring surveys for agricultural produce for both general agricultural groups and orange farmers were developed. Two 3-day training sessions were delivered in October and December 2022 aiming at installing skills of using the C-site application, Mobile Journalism for Citizen Science or MoJo4CitSci, and riverine detective activities. The first training session was Training of Trainers (ToT) including teachers, students, local volunteers in Chalermprakiat district, and orange farmers from Thung Chang district. In the first training session, participants were extremely satisfied with all three activities. The participants showed highest satisfaction with using the C-site application for data collection (x̅ = 4.87, S.D. = 0.35), followed by nature detective activities (waterway) (x̅ = 4.86, S.D. = 0.37), and using Mobile Journalism for citizen science (MoJo4CitSci) (x̅ = 4.83, S.D. = 0.39), respectively. In the second session, participants reported that they were very satisfied with all three activities. The highest satisfaction was with nature detective activities (waterway) (x̅ = 4.13, S.D. = 0.78), followed by using Mobile Journalism for citizen science (MoJo4CitSci) (x̅ = 4.12, S.D. = 0.82), and using C-site application for data collection (x̅ = 4.04, S.D. = 0.75), respectively. The communication of health impact monitoring manifested in two important forms: horizontal communication involved knowledge transfer about using necessary knowledge and tools for monitoring, and risk communication within the community; and vertical communication, which started from bottom-up communication, where the flow of communication was facilitated by the open structure of ThaiPBS based on participatory communication. It is evident that this communication ecology is like weaving and connecting communication networks to support the community-led health and environmental impact. If this system is further developed and integrated with the national emergency communication system that may occur in the future, it will significantly enhance the efficiency of caring for the health of vulnerable population who are at risk of being affected by transboundary pollution.


Background: Childhood is an important age for growth and continuing development. Early investment, especially during pregnancy increases quality antenatal care and can prevent complications, providing the child with their highest health potential for the future. In Thailand, pregnant women will receive the maternal and child health handbook (MCHH), a comprehensive guide used for recording and communicating important health information between the pregnant woman and health care provide (HCP), from pregnancy till the child is 6 years old. Despite the potential, not so many people read the MCHH, many hold the misunderstanding that the MCHH is for communication between HCPs. As a hardcopy, the MCHH bears a printing cost, once provided to the user, the content and functions cannot be upgraded simultaneously, and is at risk for wear and tear or loss of the book. KhunLook mobile application (KhunLook app) was developed in 2015 for parents, childcare providers, and HCPs to use as an interactive electronic MCHH intended to assist parents in child health supervision from 0-18 years. The content can be easily updated, data can be backed, minimizing the risk of loosing data. KhunLook application is found to be well accepted and easy to use. Using KhunLooK application can also increase parent health literacy. Currently, KhunLook app has been downloaded more than 550,000 times. KhunLook yields potential for further development of a maternal mode for pregnant women, for even more potential of Thai people. Objectives: We aim to develop the maternal mode of KhunLook app for promotion of Maternal and child health then to pilot the use of the application at the antenatal clinic in 2 groups of users, pregnant women, and HCPs. Methods: This study has 2 phases 1) Development of KhunLook maternal mode and 2) Pilot use of KhunLook maternal mode at the antenatal care clinic. The study was conducted during August 2021 to May 2023, we studied user requirements and incorporated feedback from pregnant, post partum women and HCPs who provide antenatal care. Content was developed and verified by maternal-fetal medicine specialist. Then the final application was piloted at the antenatal care clinic Srinagarind hospital and the Faculty of Medicine, Khon Kaen University. Ethics approval for this study was obtained from the Research Ethics Committee, Khon Kaen University.Results: Development of KhunLook Maternal mode. After brainstorming within the team for a prototype, the prototype was presented to participants for user requirements and feedback. Eighteen pregnant and post-partum women, and 27 HCPs participated in this phase of the study. The functions within the app and the content were well accepted for usefulness and understandability, the app was easier to use than the MCHH. The content was rated good to very good by the specialists. We incorporated the suggestions and feedback to develop the final application and tested it for functionality. The final application had a family, gestational age, information, health records, and a summary page. Pilot use of KhunLook maternal mode at the antenatal clinic. Forty-five pregnant women and 13 HCPs participated in this phase. The pregnant women’s mean age was 30.1 (20-40) years, and 33.3%, 31.3% and 35.6% were in their 1st, 2nd and 3rd trimester of pregnancy. The HCP’s mean age was 44.4 years. All the participants rated the functions and content to be very good and good. The app was rated easier to use than the MCHH on all items, with statistical significance on all items for pregnant women, and for some items for the HCPs. Users rated the app 9.0 and 8.7/10 versus 7.5 and 7.9/10 for the MCHH, which was statistically significant in both user groups (p=0.000, p=0.0205). KhunLook is intended to be complementary to the MCHH, but if only 1 mode was to be chosen, 86.7% of pregnant women and 30.8% of HCPs chose KhunLook app over the MCHH. Pregnant women stated that they preferred KhunLook due to the ease of use, completeness, and understandability of the content, and since they already have a mobile phone, there is no hassle of carrying a book around. Those who weren’t sure which mode to pick stated that they were worried that the information could be lost and preferred to use both methods together. All HCPs would introduce KhunLook app to their patients because it has quality information, it is very useful, convenient, easy to use. The maternal mode of KhunLook app is well accepted, in pregnant women and HCPs. We suggest using it in complementary of the MCHH. More promotion is needed for its use to reach potential.


Background: Chronic kidney disease (CKD) is prevalent in Thialand that incure high healthcare expenditure. Screening for high risk CKD is recommended to contribute benefit. Aging is one of a CKD risk factor, though this service is yet excluded from the Universal Coveragre Benefit Package (UCBP). Objective: To propose a recommendation for elderly CKD screening to be included in the UCBP by performing economic evaluation, budget impact analysis, and feasibility of delivery such a service. Methods: A cost-effectiveness analysis (CEA) of six screening methods was carried from societal and provider perspective. Decision-tree and markov model were used to simulate screening and CKD health states. Screening methods included Serum creatinine (Scr), Proteinuria dipstick (Pro), Microalbuminuria dipstick (Micro), Albumin-to-creatinine ratio (ACR) dipstick (ACRdip), combined Pro+Scr, and combined Micro+Scr. Parameters were reviewed and analysed by meta-analysis. Sensitivity and threshold analysis were performed to identify uncertaintity of the CEA results. Budget impact analysis was conducted to estimate 5-year budget for NHSO. Feasibility of service delivery was explored by qualitative approach using telephone interview. Results: Under Thailand’s willingness to pay of 160,000 baht/QALY, the six screening methods were cost-effective. CKD screening incurred additional cost and effectiveness. ICER of the six methods were between 16,878.73 - 24,245.37 and 13,844.74-20,503.14 baht/QALY for societal and provider perspective, respectively. Protienuria dipstick had the lowest ICER and exhibited a 5-years-budget of 5,653 million baht for screening and treatment, however treatment budget was the major proportion of the budget (97-99%). Primary care practitioners agreed the benefit of CKD screening and suggest to implement a screening method that ease to use. Preparing for CKD screening before implementation should concern: human resources, training about screening, CKD related services and referral system, educate elderly about CKD to increase compliance to screening and treatment. Conclusion: Annual CKD screening for elderly is cost-effective. Although protienuria dipstick incures the lowest budget to NHSO for screening and treatment. However microalbuminuria dipstick should be selected because of its highest cost-effectiveness. Elderly CKD screening is feasible for primary care but need some prepations regarding healthcare resources: human resources, CKD related services and referral system. This study recommends that CKD Annual CKD screening for elderly should be included in the UCBP.


Introduction: Non-communicable diseases (NCDs) constitute significant contributors to global morbidity and mortality, with Thailand being no exception. Adhering to prescribed medications plays a pivotal role in the treatment and management of these diseases. Nevertheless, more than half of the patients encounter difficulties in adhering to the recommended treatment regimen. This not only affects patients in terms of complications, disability, premature mortality, but also leads to escalated healthcare costs attributed to the care of patients with complications and disabilities. In the Thai healthcare context, there appears to be a dearth of understanding regarding the definition and significance of medication adherence among healthcare providers, alongside policy-level factors linked to this crucial aspect of treatment. Previous studies have primarily concentrated on patient-level determinants. Specific objectives: 1) To synthesize knowledge regarding the definitions, meanings, and policy factors that influence medication adherence of patients with NCDs, based on relevant documents and research studies both domestically and internationally. 2) To analyze the definitions and meanings of medication adherence among patients with NCDs attending community hospitals under the Ministry of Public Health of Thailand. Additionally, to investigate the policy factors affecting medication adherence through expert consensus. Method: This study synthesizes knowledge related to the definitions, meanings, and policy factors influencing medication adherence in patients with NCDs, employing Cooper’s literature synthesis method (2007). This acquired knowledge is subsequently utilized to formulate the initial set of questionnaires, encompassing the definitions and meanings of medication adherence, as well as policy factors. The questionnaires are further assessed for expert consensus using the Delphi technique, gathering opinions from 21 experts, divided into three distinct groups. The first group, consisting of five experts, is responsible for decision-making, involvement, and oversight of medication policies. The second group, comprising twelve experts, focuses on implementing policy responses related to medication and its usage. Finally, there is a group of four academic experts. Data is collected in two rounds to solicit opinions from these expert groups. In the second round, the same questionnaire is employed, enriched with median values, interquartile ranges, and reference points, allowing experts to provide self-assessments and evaluate their responses in comparison to the group's collective input before finalizing or revising their answers. The data analysis encompassed an examination of responses from questionnaire rounds 1 and 2. The median and interquartile range were used to gauge the significance of the identified factors. Experts exhibited consistent responses (median ≥ 3.5, interquartile range ≤ 1.5), though a 12.02% variation indicated divergent views. Consequently, the researcher finalized the questionnaire and summarized the findings. Round 1 data was collected from December 15, B.E. 2565 (2022), to March 18, B.E. 2566 (2023), and round 2 data was collected from April 15, B.E. 2566 (2023), to May 15, B.E. 2566 (2023). Results of the Study: 1) Definition and meaning of medication adherence in patients with NCDs in Thailand, Experts are highly to most highly agree, and have consensus across all six dimensions and 18-item checklist includes items ranging from 3.77 to 4.88 (IR = 0.61-1.38). 2) National drug-related policy: This encompasses both the national drug policy and the main national drug formulary, the Public Procurement and Supplies Administration Act B.E. 2560 (2017), as well as the policies and core regulations concerning the rights and costs of treatment and medication for chronic disease patients. Experts agree these impacts on the management of chronic disease medications in hospitals and the prescription of medications by physicians, ranging from a high to the highest level of impact and consistency across the two dimensions. Additionally, an 8-item checklist with items ranging from 3.78 to 4.63 (IR = 0.94-1.41). 3) The policy of the Near-home Medicine Pick-up Project, which allows patients with chronic illnesses to obtain medications from nearby over-the-counter pharmacies, has an impact on medication adherence. Experts agree that the policy shows a high to the highest level of impact and consistency across the six dimensions of the 16-item list (MD = 3.68-4.12, IR = 0.61-1.26). 4) National Policy on medicines, the National List of Essential Medicines Government Procurement and Supplies Management Act 2017 and universal health coverage policies and regulations related to rights and expenses for treatment and medicines of patients with NCDs, experts do not agree.


Medication adherence is crucial for managing the progression of chronic non communicable diseases among patients. Promoting medication adherence at the operational level serves as a significant mechanism for both treatment and enhancing patients' quality of life. This research employed a mixed method approach, beginning with qualitative data collection through in depth interviews involving 11 patients with chronic non communicable diseases and 12 healthcare personnel. The findings then served as a conceptual framework for the subsequent quantitative research. Quantitative data were collected via questionnaires distributed to 76 healthcare personnel working in the Non communicable chronic disease NCD) clinic of a community hospital and primary service units within the network The research findings indicated that patients perceived journey through the service process as having five steps: 1) registration, blood examination, and blood pressure measurement; 2) waiting for the examination; 3) receiving treatment; 4) waiting for medication; and 5) receiving medication. Conversely, healthcare professionals perceived their role during the examination waiting period and medicine waiting period as involving health assessment services, addressing disease complications, and health education to improve patient self care behaviors The health service systems related to patients with chronic non communicable diseases lacked clear guidelines for promoting medication adherence. Healthcare personnel, however, actively engaged in promoting medication adherence across three areas: 1) assessing medication adherence, 2) communication for effective treatment, and 3) clinical decision making to support adherence Various factors and conditions influencing medication adherence, categorized into three areas: patient factors, personnel factors, and system factors The study of healthcare providers' promotion of medication adherence revealed that they practiced the most in communication for effective treatment, whereas assessing medication adherence received the least attention. Operation through communication for effective treatment was robust across all dimensions Fill Refill, Understand, Organize, Take, Monitor, and Sustain). On the other hand, assessing medication was moderately rated, and overall clinical decision making scores was high. Notably, Take’ was the most assessed dimension, while Organize’ was the least assessed. Communication was highest in the dimension of Fill refill’’, while the Understand dimension received the least attention. Clinical decision making to promote medication adherence was highest in the dimension of Understand’ dimension and lowest in the Fill refill’ dimension The analysis of the relationships between personal factors, patient condition factors, healthcare personnel factors, and system factors with the promotion of medication adherence, utilizing Point biserial correlation statistics and Spearman's rank correlation statistics, indicated several significant relationships. Notably, related training exhibited a significant relationship (rpb = .32, p < .01). Patient factors, including the feature of medications (rs = .21, p < .05) and the patient's self care potential (rs = .24, p < .05), as well as healthcare personnel factors, particularly personnel's understanding of disease, medication, and adherence (rs = .24, p < .05), demonstrated statistically significant relationships with the promotion of medication adherence


Non-communicable diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, and Diabetes Mellitus, contribute significantly to global illness and mortality rates, including in Thailand. Collaborative efforts are crucial for effectively managing these diseases and ensuring patients' adherence to medication. However, over half of the patients struggle with following the prescribed treatment regimen, leading to complications, disability, premature death, and increased healthcare costs. Existing knowledge on medication adherence for chronic non-communicable diseases is primarily derived from foreign social and cultural contexts, which may limit its applicability to Thai patients. Additionally, there is a lack of in-depth studies on medication adherence from the patients' perspective in the Thai community. Therefore, this study aims to explore and understand the meaning and experiences of medication adherence in Thai patients with chronic diseases, as well as the conditioning factors that influence adherence. This research applies qualitative methodology to study at chronic disease and psychiatric clinics at Wang Thong Hospital and Nong Phra Subdistrict Health Promoting Hospital. Data collection involves in-depth interviews, observations, and studying medical records of 24 registered patients. Inclusion criteria include 1) patients with high blood pressure [hypertension: HT], and/or abnormal blood lipid levels [dyslipidemia: DLP], and/or myocardial infarction [MI], and/or chronic heart failure [CHF], and/or stroke, and/or diabetes [DM], and/or chronic obstructive pulmonary disease [COPD], and/or depression. 2) have received treatment for chronic diseases for at least one type of medication from either the Chronic Disease Clinic or the Psychiatry Clinic at Wangthong Hospital or Nong Pra Hospital continuously for a minimum of one year. 3) able to communicate in the Thai language. 4) voluntarily participate in the research study after receiving informed consent. This study interviewed 8 repeat informants, totaling 32 interviews. Data analysis utilizes Colaizzi's method (Colaizzi, 1978 cited in Sanders, 2003) and ensures trustworthiness using Lincoln and Guba's framework (Lincoln & Guba, 1985). The study identified five themes regarding experiences of medication adherence in patients with chronic diseases in the community. The first theme is patients' expectation for better life through treatment and medication adherence. Patients follow doctor's instructions to recover or alleviate symptoms and return to normal life. However, when treatment outcomes, including the effects of drug use, are unsatisfactory or when side effects occur, patients may engage in non-adherent behaviors. This means that the treatment and medical regimen recommended by physicians do not meet their expectations or needs. They may also seek additional treatment methods, such as visiting private and reputable clinics and using supplements. The second to fifth themes involve conditioning factors that affect medication adherence within the Thai context. These themes cover concerns about consistent medication adherence, self-management, family support, and building relationships with healthcare professionals for effective treatment, as well as addressing specific sub-issues.


Objectives: (1) to examine prevalence of medication non-adherence (2) to investigate the factors contributing to non-adherence to medication treatment among elderly patients with non-communicable diseases receiving treatment as outpatients. (3) To evaluate the value of unused medication resulting from non-adherence to medication treatment among elderly patients with non-communicable diseases. Methods: This was a cross-sectional descriptive study. Participants were selected from the electronic hospital database using random sampling. Data will be collected through a developed interview questionnaire based on the study objectives. Study setting in rural area was NongPhra district Health Promotion Hospital, Phitsanulok; in urban area was Rajvithi hospital, Bangkok. Data analysis was performed using descriptive statistics, employing SPSS version 21. Results: In rural area, from 214 participants, overall prevalence of medication non-adherence in older adults with non-communicable diseases patients was 98.1%. Prevalence of non-adherence patients for each step were as followed; refill 43 (20.1%) understand 185 (86.4%) organize 174 (81.3%) take 175 (81.8%) monitor 181 (84.6%) sustain 175 (81.8%). The total of unused medicine was 11,007.5 pills. The economic impact of unused medicine was 10,027.63 Baht and average 63.07 Baht per person. Medication for treating cardiovascular diseases were mostly involved in medication non-adherence. In urban area, from a sample of 286 elderly patients with non-communicable diseases, the prevalence of medication non-adherence in elderly patients with non-communicable diseases was 29.72%. For the factors associated with non-adherence using chi-square and Fisher exact tests, no significant differences were found between the two sample groups. When calculating the quantity and value of unused medication for the entire sample group, it was found that there were 11,341 remaining medication units with a total value of 46,339.14 Baht, averaging 545.16 Baht per patient. Atorvastatin 40 mg was the medication with the highest value of unused medication, amounting to 12,337.50 Baht, while Metformin 500 mg was the highest quantity of unused medication with 11,141.50 medication units. Conclusions: Medication non-adherence is prevalent, especially in rural area. Effective and easy interventions should be in place for dealing with medication non-adherence.


Background: The previous study, entitled “The Development of Multi-Sectoral Approaches to End TB in Municipality and Central District (year 1)" was conducted in Chiangrai province in 2019 and 2020 revealed private pharmacies and clinics contributed to 25% tuberculosis (TB) detection rate (6 of 24 referred cases). Subsequently, this project was extended and implemented in 8 provinces of the Health Region 1 amid the Covid-19 pandemic. The project was coordinated by 8 operational researchers (OR) who are government health staff in provinces. The study aimed to develop a model involving pharmacies/clinics to screen and refer persons with TB risks and to investigate factors contributing to the implementation outcomes among 8 provinces. Methods: Developing two digital innovations, i.e. TB-Refer, a web-application for TB screening and referral and a TB online training course. The data were collected for 9 months and analyzed database of TB-Refer. The qualitative methods included in-depth interviews with OR, provincial TB administrators (Mr.TB), hospital staff and the pharmacies/clinics with and without referral cases. Results: The participation rate of pharmacies in 8 provinces is 50.4% (143/284) with a range of 12.7%-100% participation. Participation from clinics is only 4.6% (11/240) with no-participation in 2 provinces. Of the 143 pharmacies, 19 (13.3%) pharmacies screen and referred 37 persons with TB risk to the hospitals, while 2 out of 11 clinics screen and referred 2 cases made up to a total of 39 referred cases (38 symptomatic cases and 1 asymptomatic contact case). Only 19 referred persons arrived the hospitals and received TB screening and one pulmonary TB with sputum positive (AFB 3+) was detected. Fifty-seven pharmacists and five clinics doctors/staff enrolled and completed this training. The median scores of drug stores were increased from 16 (IQR = 4) to 23 (IQR = 2) (p < 0.001) while the mean scores of clinics were increased from 17.8 (SD 4.5) to 21.8 (SD 2.3) (p = 0.034). Drug stores and clinics completing the course had higher proportion of TB screening and referral cases to the hospitals than those without training (22.6% vs 7.6%, p=0.008). Among 8 provinces, only one province demonstrated regular referral and continuity of communications between OR and pharmacies/clinics. The OR of this province is a staff of disease control department who received excellent support from the department of consumer protection and public health pharmacies (CPHP), including supports from Mr.TB of the hospital and the provincial health office, particularly establishing a hospital’s fast track for referred patients. Conclusion and recommendations: It is feasible to involve drug stores and private clinic to screen and refer persons with TB risks to the hospital. The best model is the project’s coordinator should be a staff of disease control with good support of CPHP and provincial health authorities. Personals of drug stores and clinic should attend the TB online training course.


Objectives: (1) To develop a new 20-item medication adherence questionnaire (MAQ-20) including test the psychometric properties; (2) To develop a medication adherence questionnaire for specific medications used for treatment of non-communicable chronic diseases (NCD); (3) To develop digital innovations for measuring medication adherence in patients with NCD. Method: This study was designed as research and development research. Part 1 The development of the MAQ included four steps: 1.1 Item generation-based on literature review and the medication self-management model as a theoretical framework; 1.2 Operationalization of the identified domains into items; 1.3 Content validity of the draft version 1 was assessed based on the item-objective congruence (IOC) by three experts; and 1.4 Reliability was evaluated by Cronbach’s alpha. Part 2 The development of medication adherence questionnaire for specific medications by experts in pharmacokinetics/pharmacokinetics: if a population pharmacokinetics/pharmacokinetics study for a specific medication is available, Monte Carlo simulation is performed for possible pattern of missed doses; if population pharmacokinetics/pharmacokinetics study for a specific medication is unavailable, pharmacokinetics/pharmacokinetics profiles of a specific medication is reviewed and determined a missed dose affecting therapeutic level by the expert group. Part 3 The development of the digital innovation comprised of 5 steps: 3.1 design of the application is based on concept of user friendly; 3.2 development of database for storage the server; 3.3 vigilance system for database security through Hypertext Transfer Protocol Secure: HTTPS and Secure Socket Layer (SSL); 3.4 database management system for preventing loss of data; and 3.5 basic test of the application’s functions and performance by experts.
Results: Part 1 The final version of questionnaire namely the MAQ covers 20 items rated on a 3-point Likert scale (“Always,” “Sometimes,” and “None”) organized into six domains: Refill, Understand, Organize, Take, Monitor and Sustain. The range of the IOC was from 0.67 to 1.00. In a pilot study (n=40), the MQA is easy to complete (mean completion time = 9.0 min). The reliability of questionnaire was 0.657, indicating acceptable internal consistency. One item deletion in the draft version 2 resulted in an increase Cronbach's alpha. Part 2 the medication adherence questionnaire for specific medications composed of 40 items according to the scope of medication list used in primary care healthcare settings. They were simply rated on 3 choices based on pharmacokinetics/pharmacokinetics profiles of a specific medication and expert opinion. Part 3 Web-based application namely MAQ plus© comprised of 4 main menus: home menu described the project details; medication adherence questionnaire developed from this study part 1 and 2; user manual; and frequently asked questions. The application was approved for basic functions and performance. Conclusion: The first version of the MAQ-20 has acceptability of validity and reliability. The medication adherence questionnaire for specific medications and the MAQ plus © web-based application were approved for basic quality by expert group. Future studies should examine the psychometric qualities (construct validity, criterion validity, and test–retest reliability) in larger populations and usability test of MAQ plus© web-based application with available similar applications.


Background Non communicable diseases (NCDs) require continued use of medications for life. Medication adherence is an important factor for successful achievement of therapeutic goal. Objectives (1) To synthesize knowledge from projects in the upstream, midstream, and downstream phases of the Medication Adherence Research Network for Rational Drug Use in Thailand. (2) To develop an integrated medication adherence community model for patients (3) To examine the efficacy of a new integrated medication adherence model for improving medication adherence in patients with non communicable chronic disease. Methods: This study is a mixed method research consisting of: (1) a qualitative method to synthesize knowledge from upstream, midstream, and downstream research results of a series of medication adherence projects; (2) data analysis of knowledge shared in exchange meetings with providers, patients, and caregivers to develop the drafted prototype; and (3) the application of a cross-over randomized clinical trial. Study sample size was calculated to include 72 patients who did not adhere to medication use and attended the clinics of non communicable diseases at Wangthong hospital. Group 1 examined the prevalence rate of patients with medication adherence before and after receiving the new service system model in a group of 36 patients. This group of patients attended a current service model for 1 month, then were assigned to a new service model for another 1 month, and Group 2 examined duration of continued effect from the new service model in another group of 37 patients. This group of patients were assigned the new service system model for 1 month, then attended the current service model for another 1 month The Medication Adherence Questionnaire 20 items (MAQ-20) was a tool for evaluating medication adherence and data was collected through patient interviews. The data was analyzed using McNemar Test and Wilcoxon Signed Ranks Test to compare the two related groups and Mann Whitney U Test to compare the differences between the two independent groups, via SPSS version 21. Results Experts reached a consensus on the definition and meanings of medication adherence consistent with the 6 steps of medication self-management according to Bailey et al. (2013). This covers activities along the patient service path in the hospital. Proportion of patients who adhere to medication use was significantly higher after receiving a new service model in overall process of medication use p < 0 0001) and especially in the step of organizing medication p 0 046)), the step of taking medication p < 0 0001). The effect of the new service model continued for at least 1 month after returning to the current service model judging from the proportion of patients with medication adherence remained the same during and after receiving the new service model. p value = 0 063)). Comparison of the effect of these 2 systems for each time period was also performed. During the first month, a statistically significant difference in medication adherence between the new system and the routine system was observed. (p-value < 0.001). The proportion of patients with medication adherence in the new system was higher than that in the routine system. During the second month, a statistically significant difference in medication adherence between the group that switched to the new system and the group that switched to the routine system was also observed. (p-value < 0.002). The proportion of patients with medication adherence in the group that switched to the new system in 2nd month increased compared to that in this group when receiving the routine system in 1st month. In contrast, the proportion of patients with medication adherence in the group that switched to the routine system in 2nd month decreased compared to that in the group when receiving the new system in 1st month. Conclusions The new service model helped to improve medication adherence in patients with non communicable diseases and the new service model had continued effect on medication adherence for at least 1 month. In the future, implementation of this new service model should be tested in other hospital settings.


Objective: To assess the immunity status against vaccine-preventable diseases in the Expanded Program on Immunization (EPI) program, including hepatitis B, measles, mumps, rubella, diphtheria, tetanus and pertussis, along with other important diseases or vaccine-preventable diseases in the EPI pipeline (hepatitis A, hepatitis C and varicella) in Thai individuals residing in Chonburi Province, Thailand. Methods: A cross-sectional descriptive study was conducted in Chonburi Province between October 2022 and February 2023. The subjects in this study consisted of the population living in Chonburi province from birth to 80 years of age. Participants were grouped into age categories based on ten-year intervals. The level of immunity against hepatitis A, B, C, measles, rubella, mumps, varicella, diphtheria, tetanus, and pertussis. Results: A total of 1,459 subjects met the selection criteria and were enrolled. Seroprevalence rate against hepatitis A (anti-HAV IgG) were low in individuals below 40 years of age. The overall trend showed an increase in seroprevalence with age. For immunity against hepatitis B, children and young adults who were born after implementation of infant universal Hep B vaccination in Chonburi Province in 1988 had seroprevalence of HBsAg less than 1%, anti-HBc less than 3%. The anti-HBs levels were highest in children under 5 years of age. These findings are consistent with the integration of Hep B vaccination into the EPI. For anti-HCV, seroprevalence rate was 1%, with the majority of seropositive individuals being adults and elderly. Seroprevalence against measles, mumps and rubella in 657 individuals across all age groups showed that individuals between 11-20 years old possessed the lowest immunity. Older adults and elderly possessed high levels of immunity against measles and mumps, whereas children under 5 years of age and the elderly possessed high levels of immunity against rubella. Results of anti-diphtheria toxoid IgG (anti-DT IgG) in 657 individuals across all age groups showed that 65.4% of individuals were seroprotective as defined by anti-DT IgG ≥0.1 IU/mL. The lowest seroprotection rate for anti-DT IgG was found in 31–40-year-old age group (48.9%), followed by 51-60-year-old age group (50.5%) and 41-50-year-old age group (56.9%). Regarding the anti-tetanus toxoid IgG (anti-TT IgG), 95.1% of individuals were seroprotective with the lowest seroprotection rate found in 60-70-year-old and ≥ 70 year-old age groups. In contrast, the geometric mean titers against pertussis toxin were highest in children under 5 years due to recent vaccination. The results of anti-varicella IgG shows that the seroprevalence increases with age, starting at 20 years old. Conclusion: The immunity status against hepatitis A, B, C, measles, rubella, mumps, chickenpox virus, diphtheria, tetanus and pertussis showed that the seroprotection rates are under achieved in the following diseases: diphtheria, pertussis, measles, mumps, rubella, in different age groups as described. After the COVID-19 pandemic has subsided, revisions of the vaccine policy should be performed in order to prevent the outbreak of vaccine-preventable and other relevant diseases. The study's findings are preliminary for one province, but they provide valuable data on the immunity status against vaccine-preventable diseases. This will help guide the vaccine policy development for Thailand in the future.


Background: Cervical cancer is the third most common cancer in Thai women. Despite the national health benefit coverage of cervical cancer screening, its incidence and mortality rates are still high. The success of the screening policy is restrained due to various barrier factors that minimize the screening rate. Self-screening is one of the promising strategies that could reduce barriers to screening in Thai women. This study aimed to conduct (1) a systematic review of efficacy or effectiveness, cost-effectiveness, and acceptability; (2) cost-utility analysis; (3) budget impact analysis; and (4) feasibility analysis of cervical cancer screening policy by using a self-collected sample kit for HPV DNA test in Thailand. Methods: (1) A systematic search was conducted in 3 medical databases, i.e., Embase, MEDLINE, and PubMed on October 12th, 2022. The studies related to efficacy or effectiveness, cost-effectiveness, and acceptability or feasibility of cervical cancer screening by using a self-collected sample kit for HPV DNA test were included in the systematic review. (2) A cost-utility analysis of 3 options, i.e., (a) additional self-screening, (b) clinician screening only, and (c) no screening policies, was performed using a societal perspective. (3) budget impacts of the additional self-screening policy were calculated from a provider perspective. Lastly, (4) a feasibility study was done by in-depth interviewed medical professionals involved in cervical cancer screening and women who were the target group. Results: (1) Among 1,326 studies, 16 were included in the systematic review. There were 6 studies that reported screening performance of self-collected sample HPV DNA tests. Overall, the accuracy of screening by HPV DNA test using either self-collected or clinician-collected samples was similar, with approximately 74-91% sensitivity and 84-99% specificity when compared to the results of colposcopy at CIN2 or worse. There were 7 economic evaluation studies, all of which reported that self-screening was cost-effective. In addition, 3 feasibility studies found that majority of Thai women preferred self-screening to clinician screening. (2) Our cost-utility analysis revealed that the additional self-screening policy was the best-buy policy when compared among the three option. (3) The average budget impact per year of additional self-screening policy was around 723 million Thai baht. (4) Medical Professionals and the target group mostly accepted self-screening method. However, women who were at-risk or had gynecological symptoms should be examined by a clinician. Conclusions: In context of Thailand, additional self-screening policy for cervical cancer prevention was cost-saving compared to clinician screening only policy. The benefit of additional number of screened women predominated the incremental cost. Policy-makers should consider this evidence in the policy optimization process.


Introduction: Peritoneal dialysis (PD) is a common renal replacement therapy for most children with end stage kidney disease (ESKD). Automated peritoneal dialysis (APD) is a method of PD using a cycler machine, suitable for overnight use during sleep, allowing minimal disruption to the daily activities of both children and caregivers. This is in contrast to continuous ambulatory peritoneal dialysis (CAPD), which necessitates daytime self-administration and can impact the quality of life for children receiving renal replacement therapy. Objectives: To investigate and compare the quality of life among pediatric ESKD patients undergoing APD and CAPD. Additionally, to explore and compare the incidence of infection-related complications associated with peritoneal dialysis, alterations in blood pressure, sleep problems, and changes in electrolyte balance within the body during APD and CAPD. Methods: This is an open-label randomized controlled trial conducted across 11 institutions. Volunteers include ESKD pediatric patients aged 1 to 18 years who are eligible for treatment under the national health security system. Patients undergoing long-term peritoneal dialysis were selected. Specifically, participants needed to reside in locations with electricity access and have proficiency in the Thai language. A total of 40 volunteers were required for each group. The study involved a 48-week follow-up of participants in both the APD and CAPD groups. Clinical data were collected. Quality of life was assessed using the PedQL, and health utilities were evaluated with the EQ-5D. Results: The study involved 30 volunteers in each of the APD and CAPD groups, with average ages of 10.5 (SD, 4.3) and 12.3 (SD, 3.1) years, respectively. Participants had been on peritoneal dialysis for an average of 14.9 and 15 months in the APD and CAPD groups, and gender distribution was similar in both groups. The most common cause of ESKD was renal hypoplasia (18.3%), followed by reflux nephropathy (15%). Of the participants who completed the study, 12 withdrew. Using the PedsQL, assessed by parents, there were no significant differences in the quality of life between the two groups in all aspects. However, self-reported assessments found that the social dimension scores were significantly higher in the APD group than the CAPD group at week 16, with statistical significance. Both groups exhibited a notable improvement in social, emotional, and overall scores at the end of the study but no significant differences were nevertheless found in other aspects of quality of life. The EQ-5D, assessed by both parents and patients themselves, did not reveal any significant differences between the two patient groups. The mixed-model repeated measure analysis did not find statistically significant differences in changes in both quality of life and benefits between the two groups. The study found a peritonitis rate of 0.34 cases per year, and there were no significant differences between the APD and CAPD groups. Blood chemistry changes and blood pressure changes over 48 weeks showed no differences between the two groups. Notably, the CAPD group had more hospitalizations for hypertensive urgency and/or emergency (12 cases) compared to the APD group (3 cases) (p < 0.01). In week 16, patients aged 6-12 years in the CAPD group had a significantly higher rate of excessive sleepiness (40.7%) compared to the APD group (16.7%) (p < 0.04). By week 48, patients aged 13-18 years in the APD group had longer daily sleep duration on both weekdays (10 hours) and weekends (10 hours) compared to the CAPD group (8.5 hours and 8 hours on weekdays and weekends, respectively) (p < 0.03). Discussion and conclusion: Quality of life score changes showed no statistically significant differences between the APD and CAPD groups. However, clinically significant improvements in quality of life scores were observed in the social, school, and overall dimensions for the APD group, as assessed by parents and self-assessment. These improvements exceeded the minimal clinically important difference for both PedsQL and EQ-5D in dialysis patients. In contrast, the CAPD group showed some improvement in scores but not to a statistically significant degree. The lack of significant differences in quality of life changes may be due to the limited sample size. It's worth noting that EQ-5D was not designed to evaluate children's quality of life and did not encompass school and social dimensions. Treatment with APD and CAPD did not differ significantly in the incidence of peritonitis due to infection. Changes in kidney function, blood chemistry levels, and blood pressure complications showed no significant differences between the two treatment methods. Nevertheless, hospitalization incidents for severe high blood pressure were significantly more common in the CAPD group than the APD group. Most patients experienced sleep problems, with significantly higher rates of excessive sleepiness in the CAPD group compared to the APD group, at 2.4 times higher. Also, the APD group had longer daily sleep hours on both regular and weekend days in patients aged 13-18 years compared to the CAPD group, which may be attributed to clinical significance.


Zika (ZIKV) is emerging and re-emerging arboviral diseases. These viruses are transmitted to humans through the bites of Aedes mosquitoes. Recently, ZIKV infection has been described as an emerging disease in Thailand and many countries, especially in tropical and sub-tropical areas. The specific drugs and vaccines against these infections are unavailable; therefore, effective disease control relies on vector control measures only. To understand the transmission cycle of these viruses, mosquito vectors and human. This study is designed 1) to determine seasonal ZIKV infection rates in mosquitoes for prediction the outbreak of ZIKV infection, and 2) to develop and validate a Zika-RT-LAMP (SYBR). The present studies detected very few positive samples of ZIKV and chikungunya viruses in mosquitoes by hn-RT-PCR, collected from 4 provinces which were proposed. However, we detected the chikungunya virus in mosquito samples collected from the outbreak areas in Bangkok, and we successfully performed whole genome sequencing with these samples. The Zika-RT-LAMP (SYBR) assay showed high sensitivity and specificity. The detection limit of the ZIKV-RT-LAMP assay was 10-6 ffu/ml and detected the Asian lineage of ZIKV RNA without cross-reactivity with other arthropod-borne viruses. In addition, the researchers used dengue fever data as a prototype to test the developed model by applying ontology to enhance the classification efficiency of decision tree algorithms. These findings have provided information regarding pathogen-pathogen interaction in host cell. The data from this study could be used for future development of more effective prevention, control strategies, and predict outbreaks of ZIKV in Thailand.


Introduction: Currently, continuous ambulatory peritoneal dialysis (CAPD) has been included in the Universal Health Coverage (UHC) benefit package, whereas automated peritoneal dialysis (APD) which is more expensive has not been included in the benefit package, yet. Economic evaluation of APD in pediatric patients has not been studied before. Objectives: We aimed to assess the cost-utility and budget impact of APD versus CAPD in pediatric ESKD patients using a Markov model as well as to study the social impact of APD and CAPD from the perspectives of patients and caregivers. Methods: Cost-utility and budget impact analyses were applied using the Markov model based on a social perspective. The results were presented as the incremental cost-effectiveness ratio (ICER). Budget impact analysis was evaluated based on a governmental perspective. In addition, the social impact was assessed by qualitative and descriptive researches which collected the data from patients and caregivers for patients receiving APD and CAPD using in-depth interviews. RESULTS: Based on a social perspective, compared to those receiving CAPD, patients receiving APD had an ICER value equal to 3,063,598 baht per QALY gained and APD increased the budget in average by 54 million per year compared to CAPD. Kidney dialysis in pediatric with ESKD had social impacts on both pediatric patients and their caregivers. It is different from ESKD adult patients in that dialysis affects patients themselves. APD was satisfactory and a positive social impact was found among ESKD pediatric patients and their caregivers. Discussion and conclusions: If the societal willingness to pay in Thailand equal to 160,000 baht per QALY gained, APD would not be cost-effective. Compared with CAPD, when considering the social impact on pediatric patients and caregivers. It is clear that APD can help both pediatric patients and their caregivers carry out their daily activities during the day and the inclusion of APD can result in an increase in annual budget of 54 million baht. Therefore, we recommend to include APD into the benefit package for UHC. However, the government should offer social support methods for pediatric patients and their families.


Currently, there are no epidemiological studies in Thailand on type 1 diabetes and diabetes diagnosed before the age of 30 Long-term studies in Thai children and adolescents have been published periodically. less 5 years ago. Recent evidence has shown that the ratio of type 2 diabetes in Thai children has increased as well as type 1 diabetes. The etiology and clinical features of diabetes in children and adolescents are tendency to change according to environmental factors and lifestyles. The study of type 1 diabetes in all ages and diabetes diagnosed as young as 30 years old consists of two sub-projects: Sub-project 1: Basic patient data collection for registering diabetic patients who are admitted to network hospitals nationwide. Basic laboratory data from the patient's blood was analyzed. Epidemiological analysis and measurement of autoantibodies against 3 islets antigens, GAD65, IA2 and ZnT8 in the laboratory to know the incidence of type 1 diabetes. Subproject 2 Study molecular genetics of diabetics diagnosed before the age of 30 years by studying patients with clinical characteristics compatible with NDM and MODY together with negative autoantibodies results. The prevalence of T1D, NDM and MODY diabetes in the Thai population can be used to diagnose and treat diabetics, especially personalized medicine. A total of 4,749 people registered for type 1 diabetes and diabetes diagnosed before the age of 30 in Thailand from 84 network hospitals across Thailand, and 1,337 specimens were obtained from 1,337 diabetic patients diagnosed before the age of 30, with clinical diagnosis of diabetes divided into type 1 diabetes 868 cases (64.9%), type 2 diabetes 314 cases (23.5%), 72 cases of MODY diabetes (5.4%) and 83 cases (6.2%) of unspecified diabetes. In the study of autoantibodies against three types of islets antigens, namely GAD65, IA2 and ZnT8, 868 patients with type 1 diabetes tested positive 529 cases (60.9%). Autoantibodies tests in type 1 diabetes patients showed 449 GAD antibody positives (51.7%). 301 IA2 antibody positive cases (34.7%) 267 cases (30.8%) were positive for ZnT8 antibody. Patients with clinical characteristics compatible with MODY diabetes, where diabetes is transmitted in a distinctive family and no autoantibodies were found in 29 islets antigens. Based sequencing analysis by exome sequencing revealed gene variation associated with previously reported diabetes. Another 20 MODY patients have not found a previously reported pathogenic gene (MODYX). This study, systematic nationwide, is a preclinical and scientific study that directly contributes to Thailand's cognition related to diagnosed diabetes under 3 0 years of age in Thailand. It can be used as an empirical reference and may lead to the formulation of appropriate public health policies related to diagnosis. Treatment and prevention of diabetes in young people in Thailand as well.


The two research projects used similar study designs and data collection methods but differed in the interventions being tested. Chao Phraya Abhaiphubejhr Hospital study site used herbal product produced by Chao Phraya Abhaibhubejhr Hospital (a powdered form of herbal medicine) while Saraburi Hospital used Andrographis paniculata extract, a product of GPO. Therefore, the data cannot be analyzed together, particularly when it is known that the absorption of powdered form has less bioavailability. Conducting clinical research during a rapidly mutating COVID-19 global pandemic with varying species and symptoms is challenging. Changes in treatment policies by the public health authority further complicate research efforts to prove the efficacy of Andrographis paniculate. Using a pragmatic trial design with GCP concepts during a pandemic may be more responsive to policy decisions and worth investing in. The studies were conducted under the concepts of GCP with intensive safety monitoring which resulted in ethically and scientifically reliable research. The research found that the use of Andrographis paniculata, whether in powder or extract form of more than five days, can lead to abnormal liver function. This emphasizes the importance of quality data from proper study design and good monitoring throughout the trial. Issuing treatment policies with evidence from poor study design and inadequate or no monitoring of the study conduct, together with publicizing the use of herbs on a large scale to the public will do more harm than good. The establishment of a data and safety oversight committee and preliminary statistical analysis from the beginning of research projects will help to speed up the research process, reduce risks to patients, and lower research costs. Designing the research project by planning ahead for a data and safety oversight committee and preliminary statistical analysis during the research can hasten the development process and will reduce the risk to patients as well as the costs of conducting and monitoring research. Health Systems Research Institute (HSRI) should provide training for personnel to increase the number of study monitors. In the case where HSRI is unable to do so on its own, sufficient budget should be provided to hire external clinical monitors to monitor data recording and reporting during the research, overseeing the management of data recorded in the computer system. This is an important role of research sponsors according to good clinical research practice standards to ensure accurate data recording and reporting. In addition, HSRI should provide or support budgets for a computerized data management system that can automatically verify accurate data recording. Examples of research data management programs are Redcap or NCRC program for accurate data analysis, the system can check for corrections during the research until the completion of the research project. This is in order to raise the standard of clinical research in Thailand. In the future, it is desirable for the public health service agencies to prepare health information in a standard format such as HL7 FHIR13, so that the hospitals can share patient health information between hospitals. Data from different hospitals can be analyzed for various forms of treatment, comparing Andrographis paniculate treatment with other types of treatment, it can lead to decisions that respond more appropriate to the COVID outbreak situation. Good example is the big data link of the United Kingdom during the COVID-19 outbreak which has led to the establishment of data for national research14 Using big data for research purposes has the potential to provide valuable insights. The HSRI should play a role in promoting the creation of knowledge and understanding of big data research and providing budgets for big data research to personnel involved in such research, whether it is a researcher, Research Ethics Committee, Hospital administrator or officials of the institute to support such research that concurs with the mission of the HSRI and further development of medical and health innovations in the country.