Nowadays, adolescents are a group that is targeted by the alcohol industry; and there is an increase of online marketing efforts. However, the main supply of alcohol is via physical availability (e.g., convenience stores, retail shops, pubs, bars). This can be monitored by the “density of alcohol sales licenses” per population. The World Health Organization (WHO) recommends a core set of alcohol best buy intervention strategies. One of them is the “restricted access to retailed alcohol”. This study explored the relationship between the density of alcohol outlets, alcohol sale licences, and alcohol drinking behaviors in Thai teenagers during the last 10 years (2007-2017). We drew data from two data sets. Firstly, alcohol drinking behavior was extracted from the 2007, 2011, 2014, and 2017 waves of the, nationally representative, Tobacco and Alcohol Consumption Survey in Thailand. Alcohol drinking behavior was categorised as: current drinker, regular drinker (≥1 time/week), and binge drinker (≥ 4-5 standard drinks in each time). Secondly, the density of alcohol sales licenses per 1,000 population in each province was calculated by the number of alcohol sales licenses from the Royal Thai Ministry of Finance, divided by the mid-year population number from the Royal Ministry of Interior. In this study, the density of alcohol sales licenses suggested alcohol outlet density. The relationships between the alcohol sales license figures and drinking behavior were analyzed by a heatmap and spatiotemporal mixed model. Our data had two levels. The upper level (i.e., provincial level) featured the density of alcohol sales licenses (spatial effect), years of survey (temporal effect) and the Social Deprivation Index (SDI). The lower level (i.e. individual level) had the demographic data of participants. We found that the density of alcohol sales licenses increased the odds for the current drinker category to be present (odds ratio [OR] = 1.08, 95% confidence interval [CI], 1.04-1.45), especially in male (OR = 1.09, 95%CI, 1.04-1.14). Furthermore, it also increased the odds for the presence of the binge drinker category but only in regards to females (OR = 1.23, 95%CI, 1.05-1.44). The number of alcohol sales licenses from 2007 to 2018 was, on average, nine licenses per 1,000 residents. In 2007 and 2008, the density of alcohol sales licenses was lower than the other years. Meanwhile, in 2015, the density of alcohol sales licenses was higher than the others. It could be concluded that the number of alcohol sales licenses showed quite steady density adjustments and no declines. Based on our results, increasing alcohol sales licenses is associated with a higher proportion of alcohol drinking from Thai teenagers. Thus, it is suggested that government organizations develop and apply strategies towards reducing the number of licenses for the sale of alcohol. Potential examples are: stricter control on the license applications and renewals process, increasing licensing fees, and using the density of alcohol sales licenses as a metric assisting the development of targets in the national alcohol control strategy.


Congestion in large public hospitals resulting in long waiting times to receive services is a chronic problem in Thai health system. This affects the quality of service and patient satisfaction. In 2017, the Ministry of Public Health (MoPH) announced a policy to reduce congestion in large hospitals by using 3 strategies, namely, reducing people's illness, increasing service efficiency, and strengthening capacities of health facilities. One of the measures is to reduce waiting time for medicines at hospitals by allowing patients to bring their prescriptions and receive their medicines at drugstores. This initiative was designed because drugstores are the first point of contact that distribute in different areas allowing better access than public hospitals. In addition, pharmacists in drugstores can apply the knowledge of pharmaceutical care and expand their role in caring for patients. In October 2019, in response to the MoPH, the National Health Security Office (NHSO) initiated a pilot program to allow patients receiving care at hospitals to receive their medicines at community drugstores to reduce congestion in hospitals. In the early phase, the program aimed to develop service systems by piloting in 50 public hospitals and a network of 500 quality drugstores nationwide. Emphasis is placed on dispensing medications to patients with 4 disease groups, namely diabetes, high blood pressure, psychiatric disorders, asthma and other chronic diseases that is not complicated to care for. The NHSO also assigned Health System Research Institute (HSRI) to develop system to monitor and evaluate the pilot program. The monitoring points should cover the assessment of service quality, benefits of the program to patients, service providers and society, and reasonable reimbursement rate for both the drugstores and the hospitals as well as provide recommendations for reducing congestion in hospitals in the next phase. The HSRI has appointed and provided funding to HITAP research team for this work. The objectives are to evaluate the pilot program and develop policy recommendations for the expansion of the pilot program in the future. This study used a program evaluation framework known as the CIPP model, which comprises four groups of assessment issues: assessing project context, inputs, process and the outcomes. The outcomes were divided into three aspects according to the ECHO Framework: economic outcomes, clinical outcomes, and humanistic outcomes, measuring across patients, hospitals and drugstores. In addition, the unit cost analysis of services was performed for both the hospitals and the drugstores. This research is a cross sectional study from October 2019 to September 2020, which collected data using both quantitative and qualitative methods. The quantitative method covered the analysis of unit cost of services, secondary data analysis of NHSO database and hospital database, as well as a survey of patients' satisfaction. The qualitative study consisted of document review and in-depth interviews with key stakeholders. This study collected data in participating hospitals located in 13 health regions by choosing one hospital in each region, except Bangkok, where 3 hospitals participated in the study. The study found that the main objective of the policy was to reduce hospital congestion, which was not yet observed by this study. However, some stakeholders suggested that this policy should focus on improving the quality of drug counseling and pharmaceutical care. The study results showed that the pilot program had some successes such as a joint service model between hospitals and drugstores was developed, collaboration was initiated to provide good care for patients and pharmacists in drugstores expanded their roles in providing pharmaceutical care. Success factors include 1) policy support from hospital-level policy makers 2) knowledge and operational experiences of the program operators both hospitals and drugstores 3) readiness of infrastructure especially the information system 4) the number and distribution of drugstores. In addition, the study demonstrates that patients who received medicines at hospitals had an average waiting time of 41.9 minutes, which was 6 times longer than a waiting time at the drugstore, which was an average of 6.2 minutes. Patients who received their medicines at the drugstore had twice as much consulting time as those who received them at the hospital (7.3 minutes vs. 3.4 minutes). The cost of travel and food for visiting hospitals was significantly higher than that for the drugstores. If patients travelled from home to receive medicines at the drugstores, they could save 41-50 baht on average, or 42-52%, and if the patient went to drugstores, food costs could be saved 54-58 baht, accounting for 81-83 percent. Patients were statistically significantly more satisfied with medicine reception at the drugstores than at hospitals. The issues that were found to be very different were the short waiting time, short travel time and the convenience of travelling to drugstores. In addition, pharmacists were enthusiastic and attentive. Pharmacists used proper speech and manners and the pharmacist explains the drug use information until patients understood. Challenges of the program were 1) The number of patients receiving medicines at drugstores is very low compared to the total number of patients receiving services in hospitals. When considering the overall picture of the country, the coverage of hospitals that patients received medicines at drugstores is low. Only some hospitals have a large number of patients participating in the program. This is caused by many reasons, including a lack of publicity for the project, doctors did not refer patients to drugstores and patients refused to take part in the program. 2) Participating in the pilot program with the current model increased hospital’s workload in screening and inviting patients to participate in the program, coordination and preparation of information to transfer to drugstores, and the logistic of medicines from hospitals to drugstores 3) Information systems in 2020 did not support the transfer of information between hospitals and drugstores 4) reimbursement rate did not reflect actual costs 5) Monitoring and evaluation systems was limited and should be continually developed.


Electronic health data plays a prominent role in the delivery of patient care. It depends upon the management of vital information exchanged among healthcare providers, as such can lead to more appropriate decision-making and improved quality of care and research. Currently, the lack of adequate health informatics standards in Thailand is a major challenge for data stored and sharing. Fast Healthcare Interoperability Resources (FHIR) is a globally important health data standard for information modeling and transfer. This study, thus, explored 1) how data schema of Acute Ischemic Stroke Care Record Summary (AISCRS) can be modeled on FHIR specification; and 2) in how far the data elements can bind with standard medical terminologies (SMTs). The study employed a data mapping technique for information modelling by identifying and mapping corresponding elements between data models, i.e., AISCRS, FHIR, and SMTs. The results demonstrated that the entire content of the AISCRS can be modeled using FHIR. 96% of the content mapped onto core elements, and 4% of the content were modelled as extensions. Furthermore, the FHIR data schema comprehensively supported medical terminology system binding, including SNOMED CT, LOINC, ATC, TMT, HL7, and ISCO-08. Therefore, FHIR proved a suitable model for the entire AISCRS.


This study aimed to serve three principal purposes, first, to review lessons learned in administering health security for migrant workers and non- Thai within the international and local contexts; second, to critically analyze the roles and responsibilities toward health security system governance of central- coordinating agency and finally to synthesize the alternative model of central coordinating agency to ensure organization accountabilities in formulating applicable and accessible health security in Thailand. The study was undertaken by using qualitative research, relevant literature review, detailed semi-structured interview, and group brainstorm session for the data collection process. The study results revealed that socio- economic integration and expanding globalization have substantially influenced upon public health administration for migrant workers and non-Thai nationals, both global and regional contextualization. However, multi- stakeholder alliances in the healthcare system and departmentalism have resulted in problematic situations in governing health security for non-Thai. These four unsolved problems were: first, lack of working integration between political authorities, policy implementers, and responsible agencies; second, conflict of law and overregulation including ambiguity in non- Thai national’ s legal rights to access health security system; third, lack of integration between levels of management across the external organization and inefficient segregation of duties, together with inharmonious relationship between the regulator, user, and service provider in the healthcare system, finally, inefficient service from the unclear guideline on the multinational customer, triggering higher additional cost. Based on previous problem statements, this study presented five options under two frameworks as the solution approaches to establish a central- coordinating agency that governs the health security system for foreign workers and non- Thai nationals. The mentioned frameworks consist of; Framework No. 1: adjusting responsible departments or agencies within the Ministry of Public Health, first option: Promoting Division of Health Economics and Security to be Central Collaboration Office, administering health security system for migrant workers and non-Thai. Second option: Establishing a new division within the Office of the Permanent Secretary, Ministry of Public Health to mainly operate as Central Collaboration Office, working together with the Division of Health Economics and Security as a finance department. Framework No. 2 Promoting organization structures and legal frameworks for related government agencies governing health security systems for migrant workers and non-Thai. First option: Establishing multinational fund as an independent entity working under a government agency or public organization. Second Option: Drafting National Health Security Act for non-Thai nationals. Third Option: Reinterpreting the Law that recognizes the rights holder specified in section no. 5 of National Health Security Act, B. E. 2545 to cover all Thai citizens, including Stateless and People with Citizenship Problems.


The development of integrated information system (registration and utilization information system as a repository for common use) for health should be based on the conceptual framework of value-based healthcare (VBH). The proper structural measures compatible with patient database along with the completeness and accuracy of the database are the focus of the present study to monitor and evaluate the VBH. The study of diabetes based on the 52-file standard datasets expected to see a high number of Thai people with diabetes that caused high costs and disease burden. The present study employed mixed methodologies to study the appropriate indicator structures in relation to the patient databases. The quantitative data from October 2017 to September 2018 from the primary care units in Lopburi (A) and Phetchabun (B) were analyzed. The results showed that A had 170 patients with 24.1-97.1% data completeness and 92.3-100% data accuracy; while B had 8,836 patients with 0-81.4% data completeness and 67.9-100% data accuracy. The qualitative research based on interviews with 10 relevant workers in the PCUs led to similar conclusion that duplicate data and wrong data formats were common data errors and affected the monitoring of quality of the full range of services. The development of the continuity of care and outcome reporting system would help improve the completeness and accuracy of health


This research aimed at examining costs of intermediate care among patients with cerebrovascular diseases hospitalized in a tertiary hospital in fiscal year 2018. This study was a cross-sectional descriptive study collecting data from July to December 2019. Seventy patients with cerebrovascular diseases were recruited accruing 179 admissions and 1,417 admission days, average admission day per case equaled to 7.9 days. Research findings showed that 71.4% of participants were the universal coverage scheme (UCS) beneficiaries, 25.7% were beneficiaries of the civil servant medical benefit scheme (CSMBS) and 2.9% were members of the social security scheme (SSS). The full internal cost of intermediate care was approximately 2,293,622 baht. The highest cost was routine service cost (RSC) at 1,484,988 baht, followed by medical care cost (MCC) at 807,472 baht, while the capital cost (CC) was the lowest at 1,163 baht. Among different health insurance schemes, variation of full cost of each health scheme was marginal i.e. the UCS at 1,604, the CSMBS at 1,656, and the SSS at 1,716 baht per admission day. The full external cost of intermediate care among patients with cerebrovascular diseases was 4,722 baht per case consisting of 4,182 baht of direct non-medical cost per case, and 350–1,490 baht per case for opportunity cost. Cost analysis using cost-bearer criterion into internal costs borne by providers and external costs borne by patients/families could guide health service planning integral to efficient financing at the heart of health system strengthening to improve health of the population, and achieve equitable access to essential health care service with efficient use of health resources.


National Health Security Office (NHSO) lump sum pays a service unit for orthodontic treatment 48,000 baht per cleft patient’s lifetime even the orthodontic treatment is ongoing. When some patients have to relocate and be treated at other service units, they are charged for the remaining treatment. This descriptive cross-sectional study aimed to perform costing based orthodontic fee and payment schedule. Itemized full cost was calculated according to activity-based costing. Two workshops with dental personnel of 15 regional hospitals in 9 health regions were conducted to collect data on itemized service time, and the material and non-drug medical supplies of the budget year 2020. The national data on average renumeration per minute of specialist dentist, dental technician and dental assistance; and depreciation cost of building and dental equipment were obtained from the Ministry of Public Health. The indirect cost was added at a 20% of the total direct cost and the future development cost was a 25% addition on the full cost. Itemized dental lab fee (if any) was finally added to be the final fee for reimbursement from the government payer. The study was performed during February to December 2020. The full cost and final fee of orthodontic treatment were 47,311 and 56,320 baht per patient lifetime. The payments of 3 treatment phases conforming with cost of dentition by age were 3,583 (for primary dentition of pre-school age) 18,158 (for mixed dentition of primary school age) and 34,580 baht (for permanent dentition of secondary school age). If based on final fee, the required budget for reimbursement should increase by 8,320 baht per patient lifetime. According to the 2013 NHSO’s 48,000 baht rate, the payments should be 3,054; 15,475 and 29,471 baht respectively.


Background and Rationale: Treatment discontinuation and medication non-adherence are critical problems in caring patients with schizophrenia; this could cause recurrence and serious consequences of schizophrenia. A multidisciplinary team in Donmoddaeng district, Ubonratchathani province developed a home health care, proactive approach, to promote patient care and treatment continuity. This study aimed to determine outcomes of home health care in patients with schizophrenia provided by a multidisciplinary team in Donmoddaeng district, Ubonratchathani province. Methodology: A randomized controlled trial was conducted in 60 schizophrenia patients (30 in study group and 30 in control group). All patients received usual care at the hospital. The patients in the study group received three visits of home health care by a multidisciplinary team and brief motivation counseling by a pharmacist. This study was a 6-month trial, run during July – December 2019. Clinical outcomes and quality of life were measured together with problem-solving results and patients’ satisfaction pertaining to home health care. Results: Most patients were male (study group 60% vs. control group 63%), aged above 30 years (93% vs. 67%), single (47% vs. 63%), with primary school education (67% vs. 53%), employed (57% vs. 57%), living with family (77% vs. 90%) and had disease longer than 5 years (73% vs. 53%). After brief motivation counseling, the follow up rate with doctor increased from 87% to 100% in month 1 and 2 (p = 0.043), the medication compliance rate also increased from 87% to 100% in month 1 and 2 (p = 0.043). Patients were very satisfied with home health care (4.37±0.49). At month 6, the recurrence rate of schizophrenia in the home health care group was 0% vs. 17% in control group (p = 0.020), and hospitalization due to the recurrence was 0% in the home health care group vs. 13% in the control group (p = 0.038), with average length of stay of 0 day vs. 0.60 ± 1.85 day (p = 0.040). No significant difference in quality of life scores was found (11.00 ± 10.86 vs. 9.50 ± 9.13, p = 0.7). Conclusion: Home health care by multidisciplinary team in patients with schizophrenia was effective. Healthcare facilities should support this proactive approach in order to improve efficiency and effectiveness of schizophrenia patient care.


The National List of Essential Medicines (NLEM) category E(2) was first announced in 2007 to be the drug
list for specific groups of patients to provide equitable access to high-cost medicines regardless of
health benefit schemes. The selection of medicines to the category E(2) was managed by the NLEM
subcommittee under the National Drug System Development Committee. Since 2007, the selection
process has been evolved leading to an increase number of medicines to the E(2) list. This study
aimed to describe the selection process of medicine to the NLEM category E(2), including responsible
organization, process, definition/selection criteria, outcomes, as well as barriers and enablers. A
qualitative approach was employed comprising document review and semi-structured interviews with
policymakers and stakeholders of the selection process. Data were analyzed using a content analysis
approach. The results revealed that the number of medicines in the NLEM category E(2) increased every
3 years according to the serving term of the committees, resulting in 32 medicines approved for treating
40 indications in 2018. Barriers to efficient work procedures were addressed as follows: 1) limited budget
and skilled workforces; 2) limited frequency of call for drug submission to the NLEM; and 3) different
interpretation of the definition and enlistment criteria of NLEM on category E(2). In addition, the present
study found that giving high priority to the selection of medicines to the category E(2) and reviewing
barriers, enablers of the selection processes of the subcommittee would lead to a more efficient
selection process. The present study recommends performance improvement plans through
organizational structure including recruiting highly skilled staff, improving work processes, and a
monitoring and evaluation system to achieve the efficient selection process.


The objectives of this study were to: 1) studying the causes and factors of success/loss, lack of financial liquidity of the hospitals management, and 2) proposing financial management guidelines for the hospitals. The sample comprised 8 financial managers, working at the health region level and ministerial level. Data collection were collected by in-depth interviews, using structured interview forms. Data analyses was carried out using content analysis. The results found 8 themes of causes and success factors in hospital financial management: 1) nationally, set aside 10 percent of the money for management 2) adaption 3) leadership 4) provide additional income, reduce expenses 5) accounting software 6) reduce labor costs and adopt information systems 7) e-bidding procurement system and 8) Planfin preparation. There were found 10 themes of causes and factors of financial management failure: 1) inadequate budget allocation 2) capitation 3) allocation of the universal health coverage scheme budget downturn 5) incapability of hospital administrators 6) lack of leadership 7) labor cost 8) material cost 9) incorrect accounting information system and 10) operating expenses do not meet the fiscal plan. The policy recommendations for financial management guidelines are as follows: financial administration should be more decentralized to health regions and provinces; changing the method of budget allocating by excluding salary from the health capitation; setting a sharing fund to help hospitals with problems; increasing budgets for health regions; joint management using virtual accounts; and increasing joint financial management within health regions.


Background & Rationale: The previous format of data collection to formulate an action plan had many problems and obstacles. While the features of Google Sheet as a tool in Google for Education on the cloud system are fascinating. The purpose of this research was to develop an application for importing budget plan data on projects for the preparation of the annual fiscal action plan of the Sirindhorn College of Public Health Chonburi for the faculty of Public Health and Allied Health Sciences. Methodology: The process of system development life cycle (SDLC) was applied in 6 steps. 1. Google Sheet application development meeting was first launched to the planning and strategy committee of the college administrators (planning). 2. Set the scope of the system in detail covering the system requirements in terms of access and security of the system and data management functions to allow the system to collect and export data (defining). 3. Detailed information of the program was analyzed to design the work order and verify data integrity at the system boundaries (designing). 4. Created the database in Google Sheet as designed in the action plans with HTML, CSS, and JavaScript languages (building). 5. Evaluated the usability and functions of the program to improve the program (testing). 6. Installed the program, created user manuals for hands-on training, trained and evaluated user satisfaction for the final improvement of the system (deployment). Result: The developed web application had user interfaces for data import, data processing, data storage, and result presentation. The program used the Google Apps Script language that needed no installation of servers and database systems to the server. However, users were able to access it and collaborate simultaneously at any location with Internet connection. The overall satisfaction rating was high (average 4.1) for the efficiency of using Google Sheet to deliver the action plan of the College. Conclusion: The Google Sheet made it easy to import data, update and edit project plan information to create an action plan for Sirindhorn College of Public Health Chonburi. The process was simple, suitable, reduced duplicate work, and done with the same database consistent with the digital policy of the Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute.


The objective of this study was to review policies related to the health care and well-being of urban refugees and asylum seekers in Thailand (URAS). The qualitative approach was exercised. Data collection comprised a review of academic documents from both domestic and international sources, multi-lateral agreements or international covenants, and domestic laws related to human rights and health of URAS. The acquired data were analyzed by means of content analysis. The findings revealed that there were three main health issues faced by URASs in Thailand: (i) disease screening, (ii) mental health, and (iii) other health issues. In terms of international covenants, Thailand has not yet been a signatory of the 1951 Refugee Convention. However, in 2019, the Government endorsed the ‘Regulation of the Office of the Prime Minister: Screening Process for Aliens Entering the Kingdom of Thailand and Incapable of Returning to Their Home Country’. There have no tangible changes of healthcare policies for URASs after the Regulation was promulgated. The present study recommends that, the Regulation should be used to create a concrete set of committees to expedite the issuance of subordinate laws or orders that can be exercised at the local level. Moreover, there should be additional studies on the extent to which the Thai Government should become a party of the 1951 Refugee Convention and should withdraw a reservation to ratify Article 22 of the 1989 Convention on the Rights of the Child. A thorough investigation was recommended to estimate benefits and drawbacks of becoming a party of these international agreements.


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the novel virus that causes COVID-19, which was initially found in China and had spread rapidly worldwide. Patients with COVID-19 have had a wide range of respiratory symptoms which elderly patients with underlying diseases have a greater risk of developing acute respiratory distress syndrome and death. Currently, there is no vaccine and no specific treatment for COVID-19. Plasma donation from individuals who have recovered from the COVID-19 with a high level of SARS-CoV-2 antibodies is another potential adjunctive therapy for patients infected with SARS-CoV-2 National Blood Center (NBC) is responsible for providing patients with blood products for the treatment and producing human plasma-derived medicines. Therefore, this study aims to produce COVID-19 convalescent plasma (CCP) ready for adjunctive therapy and to study the factors involved antibodies to COVID-19 production in patients. Additionally, Hyperimmune globulin products are prepared from the convalescent plasma with a high titer of SARS-CoV-2 antibodies, called COVID-19 intramuscular immunoglobulin (CIMIG). This study started from April 2020 until July 2021 which 1,676 individuals recovered from COVID-19 registered via the pre-registration platform on the NBC website, of which 838 participants met the donor's criteria by phone and made an appointment for pre-screening. Then 451 participants were selected to participate in the CCP donation project, most of them are aged 31-45 years, and the proportion of males is higher than females. This project was divided into 2 phases according to the pandemic situation. For phase I, 155 individuals donated the CCP around 477 units, of which 348 units with neutralizing titer > 1:160 were used for adjunctive therapy 188 units and CIMIG production 160 units obtained 826 vials (NT titer of 1:5,120). For phase II, 296 individuals donated the CCP around 723 units, of which 668 units with SARS-CoV-2 Ig anti-RBD levels > 132 U/mL were used to transfuse the patients. A total of 1,712 doses of CCP from phase I and II were transported to hospitals and used to adjunctive therapy in 892 patients. The hospitals comprised 16 government hospitals and 33 private hospitals. For the factors related to the SARS-CoV-2 antibodies production, older people and symptom of pneumonia were significantly associated with the antibodies to SARS-CoV-2 level (p-value < 0.001). Besides, it also found that males were able to donate CCP longer than females (p-value <0.05). In addition, CIMIG was tested for efficacy and safety of clinical trial phase I in 10 participants. One had an adverse effect such as rash and low-grade fever, while low levels of SARS-CoV-2 antibodies were found to persist in all participants for approximately 3 weeks after injection. In summary, although the study limitations, our results have shown the association between SARS-CoV-2 antibodies levels and CCP donors characteristics, such as age, sex, and symptom of pneumonia, that were useful for further studies. Furthermore, this study documents Thailand's experience on the CCP production provided to transfused covid-19 patients and CIMIG production, which may be another way of covid-19 treatment in an emergency use setting. However, it needs further information from clinical research for standard treatment protocol.


At present, The Pharmacy council has launched the notification on Guidelines for Telepharmacy, with some additional details required to be stated for the setting of continuous and efficient operating in telepharmacy, while conforming current changes of society and technology. This study aimed to conduct the standard of telepharmacy and guidelines for pharmaceutical care and to develop data architecture which supports and facilitates the operating of telepharmacy. This study was designed in accordance with development research, in which it was divided into 2 phases. The first phase, literature review was done from guideline/standard of practice of foreign references and acceptable standard transportation requirements which was primarily analyzed for the suitability in consistency of context. Team on synthesis research has drafted the guideline of telepharmacy and guidelines for pharmaceutical care. Summary of the guidelines was obtained according to the group discussions of stakeholders and opinions from pharmacists. In the second phase, the draft of data architecture for supporting the telepharmacy was conducted in accordance with information from phase I. Additional suggestions from stakeholders were obtained, prior to the summary of data architecture. Phase I study result provided the basic guideline for telepharmacy that was consisted of minimum dataset (composing of patients’ information, prescription, dispensing, pharmaceutical care service, and drug transportation); the basic guideline for telepharmacy (in which it contained 8 components i.e., location, customer service approach, information technology, transportation, etc.); and guidelines for pharmaceutical care (including prescription analysis and pre-dispensing for remote prescription, drug transportation, and remote counseling. The result of phase II study provided the draft of data architecture using HL7-FHIR for standard messaging and standardizing the database which contributes to the data exchange among organizations and leads further to better outcome in patient care. Finally, this study proposed the Pharmacy Council of Thailand to implement the guidelines, standard data set, and capacity building for community pharmacist on telepharmacy service.


Background: Thailand is among the 30 countries with high tuberculosis (TB) prevalence. Cases of TB in Secondary schools have been reported and aggregated adolescents in school are at risk of TB transmission. Children with latent TB may develop TB diseases later on. Nevertheless, studies of TB diseases and latent TB prevalence in schoolchildren in Thailand are scarce. Method: We did an observational cross-sectional study in Secondary school children grade 7-12 in a school in Bangkok and a school in another province of Thailand. We used the Symptoms scoring questionnaire developed by the Bureau of Tuberculosis and Chest radiography to screen for pulmonary TB to identify the TB prevalence. And we used tuberculin skin test (TST) at a 10 mm. cut-off to identify latent TB infection in grade 7 students. Also, 80 students were undergone QuantiFERON® TB Gold (QFT) blood test together with TST. Furthermore, we did a survey on knowledge, attitude, and practice (KAP) of TB in school among personnel of the 2 schools using a structured questionnaire. Results: A total of 1,005 from 5,113 students from 2 schools were enrolled, 496 from Nawaminthrachinuthit Bodindecha School in Bangkok and 509 from Chonburi Sukkhabot School in Chonburi province. Three hundred and fifty-four, 176, 154, 176, 141, and 153 students were from Grade 1, 2, 3, 4, 5, and 6 respectively. The mean age was 14.6±1.8 years. Forty-six and 21.8 percent had the household incomes of 20,000-40,000 and less than 20,000 Thai Baht per month. Twelve percent had the history of TB exposure in the past. The screening with Symptoms scoring questionnaire and chest radiography revealed no TB disease in this survey. Meanwhile, 270 first grade students were screened for latent TB and 13 were positive, resulted in latent TB prevalence of 4.8% (95% Confidence Interval (CI), 2.3-7.4%) Of them, none developed TB disease during the 1-year follow-up. The TST at 10 mm. cut-off had the sensitivity 50% (95% CI 6.8-98.2) and specificity 98.7 (95% CI, 92.9-100%) compared to QFT. Furthermore, the results of KAP survey among the school personnel showed lower percentage (11-39%) of correct answers to knowledge of TB symptoms in children, transmission, and prevention of TB in community. Most personnel had positive attitude to learn about TB and help students to receive treatment (78-99%). However, 55% tended to separate students with TB from others even the students already receiving treatment and 29% would not be a personal tutor for students with TB after the treatment. Conclusion: The prevalence of TB disease and latent TB in Thai school children is not high. The routine TB screening in Thailand may target other population groups with higher TB rate. However, the protocol for reporting and investigation should be put forward for schoolchildren who develop TB diseases along with school personnel education on TB transmission and prevention.


Concurrent use of rifampicin (RIF) and dolutegravir (DTG) reduces DTG exposure, thus, DTG 50 mg twice-daily is currently recommended. Food increased DTG concentrations in healthy volunteers by 33 – 66%. We therefore investigated the effect of RIF on DTG exposure when dosed at 50 mg once daily with food, which would be more convenient than 50 mg twice daily in resource limited settings, where generic fixed dosed combination of TDF/ 3TC/DTG (TLD) is widely available. Method: We conducted a single-center, randomized control trial study in Bangkok, Thailand to evaluate efficacy, safety and pharmacokinetics of dolutegravir 50 mg once daily with food versus dolutegravir 50 mg twice daily in HIV/TB co-infected patients receiving rifampin based antituberculosis therapy. TB/HIV coinfected adults, ART naïve, stable on RIF containing regimen for drug-susceptible TB were randomly assigned to receive DTG 50 mg OD with food (study arm; TLD 1 pill/day) or DTG 50 mg twice-daily (control arm; TLD 1 pill plus additional DTG). Intensive PK was scheduled at week 4. Blood samples were collected pre-dose, 1, 2, 4, 6, 8, 12, and 24-hour post-dose (by study arm). HIV-RNA, liver and renal function tests were monitored. DTG concentrations were determined by validated LC-MS/MS. PK parameters were estimated (nonparametric; WinNonLin). The primary endpoint was DTG geometric mean ratios (GMRs) of DTG 50 mg QD vs DTG 50 mg BID (90%CI) and percent of participants with DTG minimum concentrations (Cmin) above the required protein-adjusted 90% inhibitory concentration (IC90) of 0.064 μg/mL. Results: Totally 20 study arm and 20 control arm participants completed PK analysis. The majority were male (87.5%); with median age 35.6 years, and median body weight 57.5 kg. At baseline, median CD4 was 170 (IQR 45.5-302) cells/μL and median HIV RNA was 4.96 (IQR 4.23-5.61) log10 copies/mL; 43% had HIV-RNA> 100,000 copies/mL. GMR (90%CI) maximum concentration (Cmax) and area under curve (AUC0-τ) not within the bioequivalence range of 0.8-1.25: 0.84 (0.57-1.25) and 1.07 (0.72-1.59), respectively (Table 1). Cmin GMR was 0.3 (0.18-0.49); however, the geometric means in both arms were above the required IC90: 0.18 (0.11-0.28) in study arm and 0.59 (0.44-0.79) in control arm. At week 12, 83% and 83% of participants in study arm and control arm, respectively had HIV-RNA <50 copies/mL. At week 24, 83% and 100% of participants in study arm and control arm, respectively had HIV-RNA <50 copies/mL Both arms were well-tolerated. Conclusion: Although there were substantial reductions in DTG concentrations when co-administered with RIF, Cmin levels were mostly above the protein-binding-adjusted IC90 of 0.064 μg/mL and majority of participants had high efficacy and >85% had VL suppression at week 12 and 24. Dolutegravir based ART can be used safely with rifampin based antituberculosis.


Tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) are the major public health issue in Thailand. Previously, it was found that treatment coverage rates of TB and MDR-TB in Thailand were low as a high number of TB-infected persons (>40%) were either undiagnosed or unregistered treatment. The national strategic plan (NSP) for TB (2017-2021) has been launched to eliminate TB in Thailand by 2035. To respond to the NSP, in particular, strategy 5: research and development of novel diagnostic innovation, our research aimed to evaluate the effectiveness of the molecular methods formerly developed to diagnose TB and MDR-TB in clinical samples. This study will lead to a decrease in TB diagnosis turnaround time and an increase in the efficacy of TB and MDR-TB treatment and control in Thailand. This project is divided into two phases; the first phase was the evaluation of MDR-TBD-II and INH-RD using M. tuberculosis (Mtb) DNA samples based on multiplex real-time PCR and high-resolution melting curve analysis in TB and MDR-TB diagnosis. The second phase focused on evaluating of the immunomagnetic separation (IMS) using monoclonal antibody against the Mycobacterium Ag85B antigen combined with PCR with confronting two-pair primers (PCR-CTPP), MDR-TBD-II and INH-RD to directly diagnose TB and MDR-TB using clinical sputa. All results will be compared with Xpert MTB/RIF, standard laboratory culture and identification, and DNA sequencing technique. The MDR-TBD-II assay exhibited high performance for TB diagnosis. When it was evaluated with Mtb DNA samples (n=130) against standard culture method, the 100% concordance was achieved. According to the standard proportional method for TB drug susceptibility testing (phenotypic DST) and DNA sequencing method, the specificity of the MDR-TBD-II in identifying RIF-susceptible isolates were as high as 96.7% (58/60) and 98.3% (58/59). In addition, it could detect mutations at codons 531 and 526, the most commonly mutated codons in the rifampin-resistance determining region (RRDR) of rpoB gene in 93.3% (28/30) and 83.3% (10/12). However, this assay had limitations to diagnose the resistance amomg phenotypically RIF-resistant Mtb isolates containing the following genotypes, i) no mutation in the rpoB gene, ii) class-3 SNP or class-4 SNP mutations, and iii) rpoB mutation at codons 516 and 522, which are relatively rare among RIF-susceptible Mtb in Thailand. Diagnosis of isoniazid (INH) -resistant and -susceptible Mtb isolates (n=166) using INH-RD assay showed high concordant results to the phenotypic DST at 98.1% (105/107) and 94.9% (56/59), respectively. This assay could also detect the most commonly found mutations responsible for INH resistance. The katG mutations at codon 315 were detected at 97.9% (95/97) and all mutations of the inhA promoter among tested isolates were detected at 92.3% (12/13). In addition, the results obtained with INH-RD assay were highly in concordance with DNA sequencing method when it was tested with isolates with katG and inhA promoter non-detected mutation (wild type) at 94.9% (56/58). The performance of PCR-CTPP and MDR-TBD-II combined with IMS for direct diagnosis of TB from 259 sputa was evaluated against the culture method. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PCR-CTPP and MDR-TBD-II were 80.0, 82.4, 84.2, and 77.8%, respectively, and 70.7, 91.6, 90.8, and 72.7%, respectively. Although, the Xpert MTB/RIF and AFB smear conferred a higher sensitivity (97.9% and 93.6%), Xpert MTB/RIF gave a lower specificity (81.5%) than PCR-CTPP และ MDR-TBD-II. However, the Chi-square testing showed that the detection of TB by PCR-CTPP, MDR-TBD-II, Xpert MTB/RIF, and AFB smear is significant different from the culture method (x2=100.11, p-value=0.0064; x2=102.47, p-value=0.0062; x2=170.96, p-value=0.0037; x2=155.92, p-value=0.0041, respectively). In addition, Cochran’s Q test revealed that among IMS-CTPP, MDR-TBD-II, Xpert MTB/RIF, and AFB Smear, there is at least one assay that conferred different results for TB diagnosis (Cochran’s Q=24.32, p-value=0.0000). In comparison to phenotypic DST, the detection of RIF resistance by MDR-TBD-II showed sensitivity and specificity at 70.0% and 69.8%, which were lower than Xpert MTB/RIF (84.85% and 98.57%). The statistical analysis showed that the detection of RIF resistance by MDR-TBD-II is not different from those obtained by phenotypic DST (x2=5.75, p-value=0.11). In contrast, detection of RIF resistance by Xpert MTB/RIF is significantly different from DST results (x2=67.97, p-value=0.0094). Compared to phenotypic DST, the detection of INH resistance by INH-RD showed sensitivity and specificity at 83.3% and 74.2%. The statistical analysis showed that the INH-RD results are not different from the phenotypic DST results (x2=8.94, p-value=0.0709).The results indicated the potential in applying these molecular assays for identification and drug-susceptibility testing of clinical Mtb isolates. However, the application of these methods combined with IMS is limited for the direct diagnosis of TB and drug-resistant TB from clinical specimens. A decreased sensitivity and specificity observed in all methods suggested that the quantity and quality of extracted DNA may be insufficient. Modification of methods for direct extraction of DNA from specimens is, therefore, necessary to reduce the turnaround time (TAT) to as little as 1-2 days. This TAT will be comparable to diagnosis using the Xpert MTB/RIF and TB-LAMP, and faster than the line probe assay. The cost of MDR-TBD-II and INH-RD is inexpensive, approximately 250 bahts per 20-μl reaction (the cost of DNA extraction kit, real-time PCR reagents, and consumables were included). In addition, as high as 96 samples can be tested simultaneously using a 96-well PCR plate. Nevertheless, the asasys require a real-time PCR machine and skilled operators. PCR-CTPP is easy to use, can be used to confirm TB, and is inexpensive (150 baht per 25-μl reaction), but still requires gel electrophoresis to determine PCR results. Therefore, research and development of these methods are essential to build up a prototype technology for TB and MDR-TB diagnosis at the point of care and lead to a sustainable resolution of TB burden in Thailand in the future.


The 5th Health District's coronavirus (COVID-19) study aims to study the impact on mental health and factors affecting the mental health of people in the 5th health district from the covid-19 pandemic. Qualitative research studies from 4 groups of informants: patient groups, relatives of patients, Medical profession and Non-Communicable diseases patients The 5th health district is Kanchanaburi, Suphan Buri, Nakhon Pathom, Ratchaburi, Samut Sakhon, Samut Songkhram, Phetchaburi and Prachuap Khiri Khan. The results of the study were as follows: 1. Impact on mental health on covid-19 pandemic Coronavirus 2019 patients and relatives was found in the cognitive to be shocked, scared and believed that when infected with coronavirus, it would die. The patient's relatives do not blame the patient, but they are encouraged and want the patient to go with the flow of life. In the emotion part, both patient and relatives are worry about their physical and mental state as they feel undervalued, disgusted and stigmatized by family members and surrounding society, which patients choose to switch off their communication channel to avoid the shame that could be received. Moreover, in the part of behavior: patients and relatives adapt their daily life with exercise to keep themselves healthy. In the part of relationship, the result showed a decrease in family interaction. There has been an increase in the risk of developing psychiatric disorders. Patients are at risk of depression, relatives have insomnia and need to take medication, and feel like dying. A Non-Communicable diseases patient found that in the cognitive part, they believe that once infected, they are more likely to die. Having a congenital disease is easier to get infected. When they are going out, they will get infected and will be disgusted by the surrounding society. In the emotional part, they were depressed when they see COVID-19 patients detained as people who have no kith and kin. They felt angry and blamed those who bring the infection into the village, and being stigmatized by others. In the part of behaviors, the reforming of daily life has been adjusted by wearing a face mask, eating healthy food and washing their hand regularly. In the part of relationship, there was a decrease in meeting in person. It is not possible to come to visit normally. However, for healthcare worker, they are still in the relationship. This group of patients are well adapted and stay strong. Nevertheless, there were some patients who already got mental health. Therefore, being stressed and thought of suicide were obtained by those patients. For medical profession, in the part of cognitive, they are concerned because this virus is a new incidence that has spread rapidly and terribly. They need to be more careful when taking care of patients and take care of themselves. The working patterns has been changed, such as wearing hot protective equipment. By working harder than normal and having limited human resources during the pandemic, they emotionally feel exhausted, fear, anxiety, stress, paranoia and alienation from society, being shown to behave disgusted, stigmatized both to themselves and their families. In the part of behavior, their behavior has been changed to ensure safety and prevent themselves to get infected. In the part of relationship, the study found that they need to live separately with their families. For example, they could not return to their home. However, they still got help and understanding from their families. From this study, there is no sign of metal health in this group of people. 2. Factors affecting mental health changes in the situation of the spreading of COVID-19 1. Assistive factors among people infected with coronavirus 2019 were found to be expressed with disgust with the assistance, lack of intimateness and inappropriate communication. Patients are requiring assistance, such as the practice when they are quarantine and when they are back to normal lifestyles also treatment guidelines and effective communication channels with patient’s families and relative in groups. In the group of relative, the patient receives help of their colleague neighbors, public health volunteers, local administrations. They are encouraging each other so they got cheer up among themselves. Among patients with chronic non-communicable diseases, they received the help from King Vajiralongkorn, creating the delight from people. The government has a policy of grants. Compensation for the people who are not able to work. There's a health authority, volunteers are assisting in various areas of healthcare workers, supported by family members, government. An organization has donated protective items during the duty. 2. Social environmental factors among people infected with coronavirus 2019, there was a lack of understanding of the disease and treatment guidelines. Therefore, people are anxious and afraid of getting the disease, and received information online that create the lack of understanding about the diseases. In a group of relatives, they get a disgusting stance from neighbors. Social media is a funnel of misinformation. Among patients with chronic non-communicable diseases. It found that communities in society are also generous to each other, especially volunteer in the village. They provide help to the public, provides useful advices of how to use face masks, washes hands, gives out masks and alcohol. Hence, it makes people feel that they are not abandoned. In the medical profession group, there are families and associates who are supportive. There's a media network, headman, but there are still people who do not understand to act disgusted. 3. Occupational/economic factors, all 4 groups are affected in income. There was a decrease in income among people infected with coronavirus 2019 and relatives were left out of work, closing down the business and there is no income. 4. Access factors to the health service system, receiving the medicine by mail has been introduced and at the general practice for the non-communicable diseases patient and providing the staffs from NHS to take care the patient closely with continuous receiving of medicine and more convenience. 5. Educational factors are indirect factors caused children to study online, causing patients with non-communicable diseases to take care of themselves, thus increasing difficulties to everyone. 6. Legal and Order The government or institute are concerned and value the work of healthcare workers by providing COVID-19 insurance to healthcare workers.


Migration is a global phenomenon. Thailand is currently the destination country with the largest population of migrant workers in ASEAN. Urbanization has attracted large numbers of migrants to cities and/or metropolis. Three main urban health challenges are infectious disease outbreaks due to overcrowded housing, chronic NCDs due to unhealthy urban lifestyle, and accidental injuries due to work risks. The Urban Migrant Health Survey and Enhancing Private Sector Role in Migrant Health System Development research project aims to develop the health service system that meet the health needs of migrant workers in urban areas, and promote the participation of private sector. The research methodology was a combination of quantitative and qualitative with documentary research. It consists of an assessment of migrant workers' health problems in Bangkok Metropolitan region, interviews, focus groups, and literature review. The data collection include face-to-face surveys from 432 migrant workers, 54 entrepreneurs and 81 health service providers, interviews with 20 migrant workers, 49 entrepreneurs, 3 health service providers, and 3 government officials, as well as 3 focus group meetings among expert and 2 future scenario meetings among entrepreneurs. Literature review emphasizes on six building block of migrant health system in developed countries and Bangkok Metropolitan. The documentary research findings are that the core idea underlying established migrant health system in developed countries is allocating migrant health rights according to their level of economic and social participation. Two major obstacles of migrant health system in Thai metropolis are the lack of migrant health policy in urban development policy and bias towards migrant workers in policy processes and health service provision. Therefore, it is necessary to tackle both by establish the share vision of an urban health system integrating migrant workers and promote the paradigm shift towards migrant workers integration as a participant in the urban economic and social development. In parallel, policies on proactive health service provision to cover dense urban migrant communities and health finance that covers all groups of migrant workers are introduced. These are supported by systematic management of migrant health database management system and enhancing the participation level of employers and migrants in the inclusive urban health system development.


Cancer is a major cause of death in Thailand. Apart from surgery, chemotherapy, radiation, and hormonal therapy, cancer immunotherapy became the most promising treatment in the era. Immune checkpoint inhibitors (ICIs) act as immune stimulators to reactivate exhausted T cells to harness cancer cells. Programmed cell death protein 1 (PD-1) is the most potent immune checkpoint molecule, and PD-1-targeted ICIs have been approved by the U.S. FDA for cancer immunotherapy for over 30 indications. In Thailand, ICIs need to be imported for cancer treatment, and the cost of this drug is very expensive, and most cancer patients cannot access this kind of therapy. So, the development of this drug in our country is urgently needed to make it cheaper and increase the chance of patients to access the treatment. This study successfully developed a novel humanized anti-PD-1 monoclonal antibody (humanized anti-PD-1 CUSB1936) using mouse hybridoma technology and characterized its physicochemical and biological properties. The result showed that the humanized anti-PD-1 CUSB1936 could bind to PD-1 protein with high affinity in the sub-nanomolar range and neutralize the PD1/PD-L1 interaction with EC50 values 375.2 - 613.5 ng/mL. In addition, the anti-PD-1 CUSB1936 VH3+VL2 variant could induce T cell activation via IFN-gamma and IL-2 secretion in vitro better than the benchmark antibodies (Keytruda and Opdivo). Then, the anti-PD-1 CUSB1936 VH3+VL2 variant was transiently expressed using the Expi293 expression system. The purified anti-PD-1 CUSB1936 VH3+VL2 variant was then characterized and evaluated in vivo anti-tumor activity in MC38/hPD1 allograft mice model. The results exhibited that the anti-PD-1 CUSB1936 VH3+VL2 variant at 10 mg/kg could significantly inhibit tumor growth compared with IgG antibody control and showed similar antitumor efficacy compared with benchmark antibody. These findings prove that the anti-PD-1 CUSB1936 VH3+VL2 variant exhibits high anti-tumor efficiency and could be further developed as a novel PD-1 targeted ICI in Thailand.


The COVID-19 epidemic situation is affecting health and managing to cope with the global population crisis. The primary health care system is the key system that connects the people and the public sector in health management. This research aims to 1) explore the situation of problem management in the COVID-19 epidemic in the primary health service system. 2) investigate the outcomes and consequences of COVID-19 epidemic management in primary health care systems; and 3) synthesize COVID-19 epidemic management policy proposals in primary health care systems. The study was conducted on the primary health service system at the subdistrict health promotion hospital in the Public Health Region 11 to cope with the COVID-19 epidemic. The concept of primary health care roles and functions in relation to the public health systems and community networks, integrating the core concepts of 1A4C and utilizing qualitative research methodologies, was implemented in this research. Researchers used multi-stage sampling and in-depth interviews by group discussion, structured in-depth interviews, participant observation, and study information from documents/guidelines of the area. Qualitative content analysis was used to examine the data. Data triangulation allows for data validation at every stage of the study. Conclusions are reached through content analysis and interpretation. According to the findings, The geography of the 11th Health Area is divided into 1) island areas and tourism. 2) Border areas, border borders, and international entry and exit channels 3) Agricultural and industrial areas Primary health care systems play a part in managing problems in the COVID-19 epidemic situation. It was ordered under the order of the provincial disease control committee. to the district level, sub-district level, and village level by participation of all sectors in the community and to develop additional relevant personnel, such as Hotel Public Health Volunteers and Foreign Public Health Volunteers in order to provide thorough and comprehensive management for both people both inside and outside the area. tourist and foreign workers
Management approach of primary health systems The actions were as follows: 1) Educating the public Health Volunteers and people in the area and develop the potential of related personnel 2) Health care services based on the DMHTTA principle with a one stop service treatment process 3) Taking care of chronic disease patients (NCDs) in the whole group receiving treatment at the host hospital and those who received treatment at the STD hospital used technology to care for the patients and for communication. Provide care and provide additional educational information during appointments. remote consultation Health services delivery platforms
Community surveillance measures are 1) setting up screening points in the area 2) closing the area 3) screening before entering the community. Local administration is based on participation from all sectors in the community. Quarantine can be either home quarantine or local quarantine. Hotel quarantine (Alternative Local Quarantine) and 4) management of migrant workers in the area in the service sector, agriculture, fishery and factories. Recommendations for the management of the primary health care system include: 1) Information management should be provided by using an epidemic control model and database that can be linked across the entire system. 2) Strengthen the manpower framework and response plan to assist in the management of emerging disease cases. 3) For patients to receive continuity of treatment, there should be a person who is primarily responsible for 2-way communication coordination between the referral hospital and the subdistrict health promotion hospital. 4) Local government organizations should have a standard system to manage vehicles for the pick-up and delivery of COVID-19 patients and risk groups. 5) Before disseminating information to the public, there should be a system for screening information and knowledge sets should be a channel for distributing information from various knowledge sets to make it easily accessible to the public. 6) As part of community systematic management, subdistrict health promotion hospital should implement the guidelines for controlling the epidemic in a tangible and explicit way. This should be enhanced by participation from all sectors of the community and should enhance communication and leadership skills for the team to perform. 7) Regulations in the category of emergency money for the control of developing disease epidemics should be established by local government/municipal organizations. 8) In the operation of epidemic control operations, the relevant authorities should consider the safety of workers at high risk of infection. 9) A home visit tracking app with two-way communication should be available to provide caregivers with confidence in their ability to care for patients consistently. 10) Caregivers' knowledge and skills in caring for the disabled, the underprivileged, the elderly, and bedridden patients can be enhanced through manuals or online learning resources. And 11) Numerous studies have revealed many agencies' engagement and help in the management of network partners in co - management with primary health care units in the COVID-19 outbreak. Participation with network partners is a major driving factor.
Policy Recommendation: 1) The Public Health Region 11 should create and develop a health information platform that connects all 7 provinces to be able to access the system for both personnel and people from all sectors. and publicize them all around. 2) The Public Health Region 11 should have a policy to develop a telemedicine system to manage, control and supervise vulnerable groups. high-risk exposure and COVID-19 patients including the care system for chronic patients in the community. 3) The Public Health Region 11 or the Provincial Public Health Office should organize a training course for developing health leaders in the area with the target group being a network and volunteering in the community to develop competency in community operations 4) The state should establish a clear working policy to protect workers in surveillance, prevention, control and care for COVID-19 patients. both in terms of the adequacy of personnel, duration, protective equipment and budget for management. 5) The state should have a policy for every local government organization to have a public health work group that directly accepts those who have graduated in nursing or public health. To link health operations in the community with understanding, access, speed and pertinence. 6) The Department of Health Service Support should organize training and develop public health volunteers with a curriculum that keeps pace with changes in both subject matters. Emerging diseases, chronic diseases, epidemics and care at all ages 7) The state should establish a system and mechanism for creating and developing network cooperation at the community, district, province and health zone levels with participation of people in all levels and sectors in order to Accuracy, clarity, convenience, speed in practice and encourage volunteers in the area to participate in physical, mental, social and spiritual dimensions.


Utility value is an important outcome for cost-utility analysis (CUA). The EQ-5D is used to elicit the utility values for economic analyses recommended by the Thai health technology assessment guideline. Therefore, this literature review was to establish the dataset of utility values for Thai patients with liver, lung, colorectal, breast, cervical, ovarian and hematologic cancers in various stages in Thailand.
This study reviewed all relevant studies by searching international databases such as PubMed and Scopus, and national databases including health intervention and technology assessment program (HITAP), health systems research institute (HSRI) and Thai LIS-Thailibrary integrated system (ThaiLIS) Study was included if 1) report utility values for Thai cancer patients and 2) identify the type of instruments used to elicit utility values. Moreover, quality scoring and assessment were performed for all included studies based on the adapted National Heart, Lung and Blood Institute guideline.
Of total 4,432 studies identified, 30 studies were included for literature review. Utility values were elicited from direct methods (Standard gamble; n=3 and mixed direct methods: Standard gamble, Time-trade off and Visual analog scale; n=1), indirect methods (n=14), mixed direct and indirect methods (n=3), mapping techniques (n=3), indirect method and retrieved from published papers (n=3) and unidentified methods (n=3). Within indirect methods, the EQ-5D questionnaire (n=17) was used in which the EQ-5D-3L (n=13) was the most frequently used. However, none of the included studies reported the psychometric performance of the instruments used to elicit the utility values.
This review establishes the dataset of utility values for Thai cancer patients with various stages. Both direct (SG, TTO and VAS) and indirect methods are used to elicit the utility values. The utility values decline in patients with metastatic stage (Stage IV) compared to the earlier-stage (Stage I-II). However, the utility values are mostly the result from chemotherapy or surgery for cancer treatment, so the utility values is directly uncomparable among the included studies. Therefore, further studies investigating the differences of utility values derived from direct and indirect methods among Thai patient cancers with various stages should be encouraged. Furthermore, the EQ-5D-5L with hybrid model should be used to elicit the utility values for economic analyses based on Thai health technology assessment guideline.


Background The Coronavirus disease (COVID-19) pandemic was emerged in 2020 and continue to third wave in 2021. Social measures and personal preventive measures were rolled out, which includes COVID-19 vaccine allocation and distribution strategy. This study aims to assess public adherence to personal preventive measures and perception of COVID-19 vaccine. The findings will further communicate and translate into policy recommendations.
Methodology Online survey was performed by Google Forms service and communicate through the village health volunteers channel throughout the country. Sampling method was the convenient sampling. Questionnaires were adjusted around every two week throughout the survey period from 15 February to 15 August 2021, with the total of 12 questionnaires sets. The analysis was performed by STATA software.
Results Total 422,479 respondents were included in this survey and around 79.4% was female with an average age of 46 years old. Majority of the respondents were graduated in high school or lower level (80%) and were in the argricultural field (38%). Respondents were euqlly distributed in all health regions. Wearing face mask was the highest compliance behaviour, while avoid touching face, nose, eyes and mouth received the least compliance. Overall personal protective behaviours were still high of around 91.1% in the 1-15 August 2021 survey period. In the latest survey period found that vaccine acceptance in the 15-59 years old was higher than the 60 years old and above group of 73.0% and 61.0%, respectively. Correlation analysis revealed positive correlation between higher risk perception and vaccine willingness of adjusted OR 3.45 (95% CI 3.38-3.53, p value < 0.001). Infodemic data revealed that public still misperceive about vaccine management system and some may still misunderstood about vaccine effectiveness. However, around 70% of the respondents reported that information from media has no effect on their decisions.
Conclusion The public still compliant with personal protective behaviours, especially when the epidemic has not subside. Willingness to vaccinate was influent by media at some level, however, the most affected factor was own risk perception. Therefore, the government shall monitor and control the infodemic situation and establish vaccine literacy with social measures concurrently


Coronavirus - 19 outbreak situation is a significant problem affecting population globally in all dimensions. Older people are a vulnerable group due to age- related decline and a weakened immune system; these led older persons prone to have chronic conditions known as non-communicable diseases that require continuing care. The main aims of this study were to 1) examine changes in health dimensions including physical activity, physical frailty, social frailty, life-space mobility, depressive symptoms, and quality of life among older persons with non-communicable diseases prior to the COVID-19 pandemic (the first wave), during the pandemic (3 months before and during the current wave), and new normal (last week), and to inform health policy recommendations.
This longitudinal study was composed of two phases: the first was to test the psychometric property of the 4 translated measures including the Rapid Assessment of Physical Activity: RAPA, the Frail Scale, Social Frailty Index, and the Life- Space Mobility Assessment Questionnaire: UAB LSA. The second phase was designed to investigate health dimensions in older persons. The sample was older persons with non-communicable diseases who met the inclusion criteria were selected by convenience sampling from 5 regions including the Northeast (Roi-Et), North (Phrae), Central (Samut Prakan), South (Surat Thani), and East (Prachin Buri). The multi-stage sampling was used to select the settings. One hundred and fifty participants were recruited to participate in the first phase of the study and 2,000 participants were enrolled to the phase 2. Data were corrected from June to November 2021 by trained research assistants. The participants responded to study tools including 1) the Demographic and Health Questionnaire 2) the Rapid Assessment of Physical Activity: RAPA, 3) the Frail Scale , 4) the Social Frailty Index, 5) the Life-Space Mobility Assessment Questionnaire: UAB LSA), 6) the Thai Geriatric Depression Scale- 15: GDS-15, and 7) the EQ-5D-5L. Mplus was employed to analyze data for the content validity index, confirmatory factor analysis, and reliability of Cronbach’s alpha coefficient and Kappa coefficient of the first phase. Regarding the second phase, one-way ANOVA, Kruskal-Wallis H test, and path analysis were used for data analysis with the Mplus program. A significant level was set at p < .05.
Results revealed that a total of 2,000 participants aged rang 60 – 89 years with a mean age of 65.13 years (SD = 4.62 years). Most of the participants were females (63.7%) and had top-five chronic conditions including diabetes (62.45%), hypertension (37.5%), dyslipidemia (18.6%), knee pain (12.5%), and cardiovascular diseases (6.8%), respectively. For the psychometric property testing of four measurements, all measures were acceptable for validity and reliability. Regarding changes in health dimensions in the older participants during the COVID-19 pandemic, findings indicated that the prevalence of low level of physical activity, physical frailty, social frailty, life-space mobility limitation, and depressive symptoms were 94.65-95.65%, 2.3 – 3.2%, 42.00-47.05%, 29.95 – 36.20%, and 4.85 – 5.45, respectively. The quality of life assessed by participant perceptions of their health state and their satisfaction with health state showed that older participants perceived their health and were satisfied with their health state when facing the COVID-19 outbreak. The older participants showed downward trends in decreasing satisfaction; the other health dimensions were quite stable, but there was a significant difference among participants living areas Results from a path analysis indicated that physical frailty was the strongest direct power on quality of life (DE = -.39) following by depressive symptoms (DE = -.219), and life-space mobility (DE = .116), respectively at the time of COVID-19 first outbreak. When considering a total effect of dependent variables on quality of life, physical frailty, depressive symptoms, and life-space mobility were also strongly influent on the quality of life (TE = -.464, TE = -.219, and TE = .116, respectively).
The main conclusion that can be drawn from this study is an essential finding to a better understanding and raise awareness of health dimension trajectory among older persons with non-communicable diseases during the COVID-19 outbreak. Monitoring and managing changes in health dimensions, particularly physical frailty, depressive symptoms, and life-space mobility, which impact the quality of life, is suggested to promote active aging and maintain a good quality of life in this population, specifically living areas.
Health Policy Recommendations
The findings of this study highlighted that the policy response to COVID-19 seems beneficial for transmission control, but health problems that require long-term care have significantly increased, particularly in older adults. The COVID-19 restriction policy may generate poor health outcomes—decreased physical activity or daily mobility, increased risk of developing physical frailty, social frailty, and depression—resulting in poor quality of life, increased healthcare needs, and costs of care for older adults.
Based on the research findings and in-depth interview, the essence of policy recommendations for government organizations and other partners in line with complex care needs in older adults, for enhancing elder care quality and improving specific management either during the pandemic situation or at other events are as follows:
1. Monitoring older people's health with specific assessment tools for this population is highly recommended. The Ministry of Public Health should initiate monitoring older people's health policy with specific assessment tools to healthcare personnel. Applying specific assessment tools—the Frail Scale, the Social Frailty Index, and the Life-Space Mobility Assessment Questionnaire—are essential in early identifying health problems and tracking health status changes in older adults, which is beneficial for gaining information to enhance both preventive policy announcement and effective continuing care.
2. Safe areas in the community or senior’s hours allowance older people is recommended for promoting health, social interaction, and quality of life. The Ministry of Interior, Ministry of Social Development and Human Security, Provincial Administrative Organization, Subdistrict Administrative Organization, Hospitals or Primary care settings, community resources, or others should provide additional support for promoting physical activity and daily life and social interaction in older adults during controlling pandemic policy. Establishing a zoning permit for older people in the communities or local temples is essential in maintaining health and socialization within local contexts. Moreover, creating senior hours (early morning or evening) for older people for grocery shopping, religious rituals, and exercises is significant for maintaining bodily function, spiritual well-being, and quality of life.
3. Visualized health information focusing on caring for older persons or vulnerable population is imperative for enhancing healthy practice and providing easy-to-access care during the pandemic. The Ministry of Public Health, the Ministry of Information and Communication Technology, and other related organizations should provide visualized practical information for an older person regarding health practice, transmission prevention, vaccination, and resources. All valid health information should be available for access via broadcasting on television or media outlets, local announcement, and posting at communities or local temples, which is indispensable for improving the confidence of individual self-care, family members, village health volunteers (VHVs), and caregivers (CGs) further to strengthening easy-to-access care.
4. Precise, up-to-date, professionals’ health information focusing on an older person is imperative for enhancing the confidence and competence of healthcare teams. The Ministry of Public Health, the Ministry of Information and Communication Technology, and other related organizations should provide precise practical information for an older person regarding health practice, transmission prevention, resources, referrals, and others to the frontline health personnel. The reliable real-time health information should be available for access via authorized websites/official line applications, targeting media outlets, and posting at communities or primary care settings, which is indispensable for enhancing better care and improving the confidence and competence of healthcare teams both professional and non-professional personnel.
5. Providing transportation support for managing healthcare services is more crucial than using telemedicine/telehealth to maintain health and enhance proactive care equity, particularly in rural contexts. Older people require regular health assessment, but mostly may not be affordable for using smartphones to access high technological care. The Ministry of Public Health, local administrative organizations, hospitals, primary care units, and other local authorities should provide effective transpiration—mobile geriatric clinic by geriatric nurse practitioners, medical distribution by VHVs, and safety vanpooling for in-hospital services or medical appointments by local authorities—to promote health equity and quality of care.
6. Geological tracking or location mapping is highly encouraged to provide better care and full precision support for vulnerable older adults, particularly those with long-term care needs, bedridden, continuous ambulatory peritoneal dialysis (CAPD), or living alone/with no family support. The Ministry of Public Health, the Ministry of Information and Communication Technology, and other related organizations should integrate tracking location technology to communicate with healthcare teams in providing effective, timely care as needed in each geographical area. Remarkably, further research is required to better understand technology acceptance and barriers for monitoring healthcare needs in older adults living in rural areas.
7. Trained and educated non-professional healthcare personnel is highly recommended for better care and preventing the burden of health personnel shortage during the pandemic. The Ministry of Public Health, the Ministry of Higher Education, Science, Research and Innovation, School of Nursing, and other related organizations should provide short course training or specific education support to non-professional healthcare personnel—volunteers, family members, teachers, and caregivers (CGs)—for enhancing efficient care collaboration during the pandemic. Moreover, blending folk wisdom or local community beliefs with scientific knowledge may improve holistic care covering multidimensional of health in older adults.


Background and Rationale: Acute ischemic stroke is a major public health problem in Thailand. Treatment decisions are based on the national clinical practice guideline (CPG). However, the guidelines are in the form of publications or pdf files, generating several barriers to implementation. Adopting clinical decision support (CDS) technology will increase practice effectiveness. This study intends to develop web application-based stroke guideline for physicians and teams in health care area 7. Methodology: Health professional team from health care area 7 convene for a discussion. We determine clinical practice gaps based on Thai CPG, develop a web application, evaluate user satisfaction, and track key performance indicators (KPI) after using the web application. The project has a one-year operating period. Results: This study structures guideline suggestions and converts evidence synthesis into executable knowledge for web applications via a multilayer framework (https://strokenetwork.kku.ac.th). The National Institute of Health Stroke Scale (NIHSS) is used to classify stroke subtypes. It is a clinical decision support (CDS) tool that assists physicians in making treatment decisions. CPG was separated according to the hospital's potential level. A list of hospitals consists of details necessary to assist physicians in planning patient referrals. The satisfaction of the health care teams was assessed. The CPG for health care area 7 in web application is appropriate: 40% strongly suitable, 60% suitable. NIHSS assessment are appropriate: 40% strongly suitable, 53% suitable. Easy to understand and convenient to use: 20% strongly agree, 40% agree. Web application will benefit actual clinical practice: 13% strongly agree, 73% agree. The KPI for stroke patient treatment at Srinagarind hospital demonstrated that specific indicators have potentially improved after the web application's implementation: increase of stroke fast track notification rate, increased rate of receiving intravenous thrombolytics, decreased rate of intracerebral hemorrhage with death post intravenous thrombolytics, shorter duration of receiving intravenous thrombolytics, increase proportion of patient with improved outcome, and decreased time of hospitalization. Conclusion and discussion: We demonstrate how to develop web application for physicians and healthcare teams. The web application guideline was appropriate, simple to understand, and easy to use. There are numerous potentially improved KPI. Web apps should benefit health care teams and have ability to improve in the future.


Stroke has been regarded as an important health problem that produces a great impact on an annual healthcare expenditure, quality of life of the population, and the productivity of the country. However, the therapeutic efficacy is still limited because abundant of the stroke survivors live with the disability. Therefore, the efforts to reduce and to prevent the disability in the stroke survivors is essential and required. Our primary data in an animal model of stroke reveal that an anthocyanin-rich mulberry fruit can decrease brain infarcted volume, and brain dysfunction so we hypothesize that a consumption of an anthocyanin-rich mulberry fruit as an adjuvant therapy with the current therapy should decrease disability and dependency in the stroke survivors. The aim of this project is to proof this concept and to determine the consumption safety in the stroke volunteers. In the development of mulberry capsules for the application in volunteer testing, the product developed had a high humidity of 11.32%. It is slightly above the norm for most herbal products that should not exceed 10% except for some herbs because it is easy to have a microorganism accumulation in the high humidity condition. However, no contaminants were found, and the qualification of the developed mulberry product achieves the requirements according to the notification regarding to herbal pills of the Ministry of Public Health. In the developed mulberry capsule, anthocyanins especially cyaniding-3-glucoside (755.240±6.78 μg/g sample), were found in the highest amounts, followed by cyaniding-3-rutinoside (285.440±1.26 μg/g sample). In addition, chlorogenic acid (236.220±0.34 μg/g sample), gallic acid (108.500±0.24 μg/g sample), and quercetin (15.700 ±0.02 μg/g sample) also present, but in much smaller amounts. The developed mulberry capsule reveals the biological activities associated with stroke, especially the antioxidant, anti- inflammation, and neurotransmitters enhancement activities. When evaluating the storage time, the reduction of the phytochemical content, especially anthocyanin, and bioactivity when stored at 4 °C less were less than those at room temperature. Over a period of 3 months, the reduction of important phytochemicals and bioactivities remains in the range of about 20-25%. However, the longer they are stored, the lower their levels and bioactivities. Therefore, the process of extending product life must be developed in the case of commercial development. In the study regarding to the effect of mulberry capsule consumption in cerebrovascular disease subjects, the project is accredited by the Human Research Council, Khon Kaen University (HE631600), and it is registered in the Thai Clinical Trials Registry (TCTR) under the reference number TCTR20201222006. The research model is a three armed, randomized, double-blind, placebo-controlled experimental study. The volunteers are patients at the age between 18-85 years old with transient and ischemic stroke patients in the last 5-10 days that had weakness in one side of the body. All subjects are divided into 3 separated groups as following; the placebo group, and the groups that received mulberry fruit capsules at the doses of 1,000 mg, and 2,000 mg. Prior to the consumption of mulberry fruit capsule, and at 2 and 6 weeks of consumption, all volunteers are subjected to the assessments of the flowing parameters; body mass index, electrocardiography, blood pressure, respiration, clinical signs, and stroke severity with NIHSS score assessment. The assessments of hematological changes, and clinical chemistry are also performed to monitor the consumption safety of mulberry fruit capsule. The assessment of serum biomarkers consisting of MMP-9, S100β, vWF, and VCAM1 are performed prior to the consumption, and at a period of 1 and 6 weeks of consumption whereas the assessment of lactic acid producing bacteria which is regarded as probiotic bacteria particularly Lactobacillus spp and Bifidobacterium spp. In feces is performed prior to the consumption and at a 6 week-consumption period. The current results demonstrated that at 2 and 6 weeks of consumption, the Modified Rankin Scale (mRS) after stroke of volunteer in both placebo and mulberry fruit capsule show the significant reduction in mRS. However, the rates of change in mRS of the mulberry consumption groups both at 1,000 and 2,000 mg per day are significantly higher than that of placebo group. It has been revealed that the volunteers in a mulberry fruit consumption at a dose of 1,000 mg per day show a significant improvement of mRS only at 1 week after consumption whereas the volunteers in a mulberry fruit consumption at a dose of 2,000 mg per day show a significant improvement of the mentioned parameters after 1 week of consumption and this change is observed throughout the study period. In addition, the volunteers in the mulberry fruit treated group at a dose of 2,000 mg per day show the significant reduction of VCAM1 after 1 week of consumption, and the reduction of both VCAM1 and MMP9 are observed at 6 weeks of consumption. The current results suggest that mulberry fruit capsule at a dose of 2000 mg per day shows the good potential to reduce mRS in stroke and the underlying mechanism is partly associated with the reduction of VCAM1 and MMP9.


Background: The district is an important strategic point in the development of the health system based on the concept of area-based and people centred. It is consistent with the principles of Primary Health Care (PHC) in the Alma Ata Declaration 1978 and the Astana Declaration 2018. Key components of PHC include people-centered services delivery of essential primary health care, multi-sectoral policy and actions, and empowering people and community for self-care. District Health Board (DHB) or “Por Chor Or” (in Thai) is a model and mechanism that expedites health and improves quality of life of local people. The mechanism was initially introduced as a few pilot districts in B.E. 2558. Later, in B.E. 2559 and B.E. 2560, participating districts were increased to 73 and 200 districts respectively. In B.E. 2562, this management model was implemented nationwide. This study aims to assess how Por Chor Or is implemented in different districts and whether it follows the IPCHS concept as well as propose policy recommendations for future development. Method: The study employed mixed-method study design. Purposive sampling was used for selection of study areas in 8 provinces including Chumporn, Nakhon Panom, Nakhon Sawan, Nan, Ratchaburi, Srisaket, Songkla, and Saraburi. Three districts categorized in each province were selected according to a suggestion from responsible health officers at provincial level who categorized each of the proposed districts into three implementation levels: ‘good’, ‘moderate’, and ‘initiating’. For qualitative research, in-depth and focus group interviews were conducted with 891 participants using semi-structured interview guidelines. Thematic analysis was used for qualitative data analysis. For quantitative research, 8,562 participants answered online questionnaire adapted from WHOQOLBREF. One-way ANOVA was used for quantitative data analysis on SPSS. Results: Qualitative data analysis showed that Por Chor Ors in ‘good’ and ‘moderate’ implementation levels demonstrated learning organization features including building multi-sectoral collaboration, shared ownership, and co-implementation of Por Chor Or’s policy. In terms of working process, ‘good’ and ‘moderate’ Por Chor Ors emphasized on informal monitoring, regular and two way communication, and creating structures or bodies that linked policy implementation from subdistrict to village level. They also had integrated health services that shared Por Chor Or’s policy emphasis including focuses on health promotion and disease prevention as well as enhancing quality of life. This work had been implemented through Sub-district committee on quality of life improvement or “Por Chor Tor” (in Thai), a sub-district mechanism for Por Chor Or’s policy implementation. Also, leadership to implement the policy was stronger in other sectors outside public health. Locals in ‘good’ and ‘moderate’ Por Chor Ors also had better perception and participation in health development and quality improvement related activities. For ‘initiating’ Por Chor Ors, they relied on bureaucratic working system to implement Por Chor Or’s policy. Multisectoral collaboration and co-ownership of Por Chor Or’s policy implementation was scarce or unclear. Public health sector remained leading sector in policy implementation. However, public health services were shifting towards health promotion and disease prevention in ‘developing’ Por Chor Ors and locals had minimal perception and participation in health development and quality of life related activities. Quantitative findings showed that overall quality of life score was the highest in ‘good’ Por Chor Ors (97.1, S.D. 11.1); followed by ‘initiating’ Por Chor Ors (96.0, S.D. 11.8) and ‘moderate’ Por Chor Ors (95.8, S.D. 10.6) respectively. Enhancing factors for Por Chor Or’s success included competency and leadership of District Chiefs and Por Chor Or’s secretary teams, particularly for District Health Officer, multi-sectoral participation, clear working structures that linked policy implementation between district and sub-district levels, supports from provincial administrative bodies, and visits from provincial and regional health bodies to empower Por Chor Ors. Additionally, the study showed that using UCCARE for Por Chor Or evaluation might not accurately reflect the mechanism’s level of implementation or development due to ambiguity of criteria interpretation of UCCARE by the stakeholders. Conclusion: District Health Board or Por Chor Or is a mechanism that encourages multi-sectoral and local individual collaboration to empower health management and self-care that leads to an improvement of individual’s quality of life. The success of Por Chor Ors comes from integration of bureaucratic administration and ‘bottom-up’ approaches which can explore and respond to people’s health needs. The change is galvanized by District Chiefs and other stakeholders whose leadership and understanding of local needs can support a work culture of learning organization. All Por Chor Ors work in consistent with policy and health system development which is based on primary health care principle and concept. Further improvement of system and tools to support Por Chor Ors needs to align with capacity, amount, difficulties, and strategic issues of each Por Chor besides having existing tools for self-assessment. The success of implementing those tools will result in more effective strategy formulation and better development for Por Chor Ors.