location: , 'Thailand year: 2009 source: HSRI

title: Health Promotion in a Granite Process Factory: A Case Study in Rayong

abstract: This study explored health status, risk factors, and health promotion via occupational health nursing practice concepts, and explored knowledge about noise-induced hearing loss and silicosis, and the practice of using personal protective equipment. This part was a quasi-experiment, with pre- and postparticipatory group process. This study was conducted between March and August 2008. Study subjects
were 47 workers in a granite-processing factory in Muang District, Rayong Province. Data were collected by a walk-through survey form, area air sampling to measure silica dust, sound level meter type I, a health and health behavior interview form, measurement of weight and height, pulmonary function test, audiometer, chest X-ray, questionnaire on knowledge, observation form for health protection behavior, occupational health nursing practice, and participatory group process. Data were analyzed descriptively by number and percentage and inferentially by t-test.
The results revealed major health risks: silica dust above the standard in the gang-saw section (%SiO2 = 7.648) and polishing section (%SiO2 = 6.622); and noise above standard of 90 dB(A) in 4 out of 15 points in the gearing and trimming section (2 points: 97.4 and 102.3 dB(A)) and polishing section (2 points: 91.1 and 99 dB(A)). The results on health status showed that most (78.7%) had abnormal audiograms – reduced high tone hearing (37/47), threshold shift 8.5 percent (4 /47); restrictive lung 6.7 percent (3/47); abnormal chest X-ray requiring surveillance 10.6 percent (5/47), physician observation 2.13 percent (1/47); but none were compatible with silicosis. Regarding health protection behavior, 83.0 percent of workers used ear plugs (39/47), with mean duration being 6.3 hours per day; and nasal masks 55.3 percent (26/47), with mean duration of 6.26 hours per day. Health promotion and counseling were done via participatory group process, demonstration, health education on noise-induced hearing loss, silicosis, and prevention. Before the group process, only 15.38 percent of the workers wore ear plugs correctly (6/39); this increased to 100 percent (39/39) after the group process. Before the group process, workers had knowledge score of 6.52 (SD = 2.12) which increased to 9.81 (SD = 2.60), and the difference was significant (p <0.01).
Silica dust was above standard, but no case of silicosis was detected yet. Audiograms revealed those with abnormality, i.e. 87.23 percent of the total and some areas had noise above the safety threshold. The factory should therefore establish a surveillance program on health and environment and continuing education, especially for new workers. Group process should be deployed to enhance employers’ and employees’ participation.


location: , 'Thailand year: 2019 source: HSRI

title: The long-term management process of caregivers caring for stroke survivors in Muang district, Yala province

abstract: This study applied a Straussian grounded theory to explore the perspectives of caregivers on how they accomplished their long-term management in the process of caring for stroke survivors. Fifteen samples were recruited from the caregivers who had spent at least four hours per day on caring their patients for six months or more, and lived in Satengnok sub-district or Muang municipality, Muang district, Yala province. Data were gathered by using in-depth audio taped interviews, as well as observations, and field notes that enabled concurrent data validation with methodological triangulation. Following coded analysis of the data, the findings showed that the caregivers dealt with stroke and its negative consequences that influenced their patients, themselves, and their families in three stages that were represented by three categories. The first category related to the issue of dedicating care and cure where anticipating that the patient might make a full recovery/could be able to do some daily living activities was a significant condition that motivated the participants’ caring practices. They firstly assisted the patients who could not take/nearly could not take care of themselves to recover in order to limit undesirable effects that affected them and their families, and coupled this with managing their stress, leading to further developments in their caring. The second category, namely preventing deteriorating condition(s) where being concerned about developing complications was identified as the most powerful influence that reinforced the caregivers’care. They attempted to assist the survivors with fluctuating symptoms to continuously maintain their rehabilitation, in order to maintain some degree of recovery as long as possible. They also tried to cope with stresses and strains from the situations they encountered, including beginning to take care of themselves, to regain their power and effort to keep their care going. The final category, labelled as not seeking any treatments but keeping the survivors away from suffering where intending to provide care until the last minute came out as a challenging condition that encouraged the caregivers to sustain their care for their patients although their cure was hopeless. They attempted to make their patients as comfortable as they were able. Also, the participants tried to keep themselves healthier, and maintain their families without more difficulties. Nevertheless, throughout the care period, the caregivers and their families encountered a number of difficulties that challenged their own strength, endurance, and care intentions that they needed to care for their patients from the beginning of the illness to the end; however, they did not give up caring. This led them to reach the process of modifying care and cure based on the patients’ conditions, which emerged as the core category.The noteworthy findings are that the strength, endurance, and full care intention of caregivers encouraged them to develop more likely effective strategies to cope with their dramatically changed lives following the stroke and that would not return to a pre-stroke situation. This required establishing a balance in their “new lives” and in their families. They sought normality in a new way of living little by little, before making an advance to a certain degree that corresponded to the survivors’ conditions and the negative consequences they and their families encountered. Finally, they could still have normal lives of their own depending on their responsibility to sustain the long-term caregiving and probability of other support. The findings could be applied to guide nursing administrators and nursing practitioners about how to manage the provision of corresponding long-term care for stroke survivors, caregivers, and their families when their needs change over time throughout the stroke trajectory.


location: , 'Thailand year: 2019 source: HSRI

title: The mental health care, according to the Islamic way of terminally ill patients : Case Study Muslims Thailand patients in the three southern border provinces.

abstract: From the study of "The process of caring mental health for the patient’s terminal stage following the Islamic way: Thai patients Muslims in the three southern border provinces ". This study is qualitative research. It consists of information from documents by studying from the Quran and the Sunnah. As well as the opinions of accepted Muslim scholars. The information obtained in many languages such as Arabic, Malay, English and Thai. In this study using structured in-depth interviews, participant observation and group discussions. The participants of this study were selected based on the purposive random sampling, the researcher uses their personal judgment to select the sample. The participant’s total number of 39 persons, namely 1) 30 caregivers from 3 provinces 2) 6 Muslim scholars from 3 provinces 3) 3 public health personnel from 3 provinces. The objective of this study to study 1) Knowledge about general health care methods in accordance with Islamic way 2) Islamic mental health care model of terminal stage patients of three Thai Muslims in Southern Thailand 3) compare the knowledge of Islamic path with the real practice of mental health care according to the Islamic way of the terminal stage patient of Thai Muslims in the three southern border provinces and 4) produce a manual for the care and treatment of mental health according to the Muslim way of the patient in terminal stage. From the study, it was found that 1) illness is a condition and pain that occurs with the desire of Allah that was destined to come from various causes whether it is perceived or not perceived all diseases and revival are all destined for Allah. As for the sickness, he will normally give through various causes or factors. Reasonable There are two ways to treat the disease: 1) mentally: healing by reading the verses of the Maruur and reading the Quran, blowing and stroking all over the body. 2) Objects: healing by prevention and control accordance with the nature that Allah has set through the healing process on the basis of the specific cause and regulation that the servant can recognize and study from the academic medicine. The drugs listed in the Qur'an and Al-Hadith are 1) honey, 2) Samsum water 3) Habatus, Sao Dao (black cumin) and 4) date palm. Or other breeds. Islam has forbidden Muslims to treat them with things like pigs, dogs, spirits, and other things that are dirty and etc. Except in conditions that are necessary and have no choice. And do not treat with any type of magic or amulets tied to the neck, wrist, or waist because this is considered a big sin. 2) The caregiver should be giving encouraged with religious principles and remembers Allah every morning and evening by reading al-Fatihahah and 3 Kul including surah alikhlas-annas and alfalaq and recite the Dua and blown down on both palms, then rubbed on the patient's body especially in areas with pain (3 times). Give more often to the patients to read and listen to the Quran or Azkar nabavi from a tape or phone. And persistently saying Tasbiht, tahmid, takbir, and apologizing, etc. All good work, the caretaker will begin by reading the name of Allah and recite the dua by using the right hand regularly except for washing the genitals or washing the penis using the left hand. After completion should thank Allah regularly. And the caretakers should focus on the patient to say Cha-had throughout that "La Ila ha illallah". 3) the actual practice of the caregiver is a) Consolation and encouragement with the principles of Islam. B) Reading the Quran and dua, blowing, and stroking patients. c) Sleeping care and closing food containers and d) off the lamp and closing the window and door before bed and the part that is practised from time to time is the writing the dua put near the patient for often recite. The patient should perform regularly: a) saying "La Ilha Ilallah" b) Reading surah al-fatihah and 3 kul. c) Reading the name of Allah in every action. D) Recite the dua before going to bed and waking up and being patient for every trail. The things that the patient has to do for some time are a) Reading and listening to the Quran or Azkar Nabawi from tapes or phones. B) Saying zikrullah and istigfar in the moment Dawn c) Prayer and fasting in Ramadan. d) Donations and dressing that covers up. E) Sufficient eating and ablution before going to bed and sleeping on the right side of the body and saying, takbir and tahmid before sleeping. E) Recite dua when see sneezing. Handshaking with the visitors and thanking and f) salawatunnabi to praise the messengers (r). 4) The caretakers should try to take care of the patients according to the style of the messengers (r) by doing the following: a) Helping patients to take salat for patients throughout especially for patients with bedridden. B) Consolation by religious principles. C) Recite zikrullah regularly and suggest the patients recite dua according to the chapter on various topics. And helping patient to make tayammum instead of taking a bath for the patients who cannot be watered. D) Read the Qur'an and blow on the palm and stroking around the patient's body. And every time to eat food, medicine and water, speak the name of Allah and use the right hand regularly. F) Flick the patient's mattress, turn off the lights and close the door of the house and window completely. And close the food container when going to bed all the time.


location: , 'Thailand year: 2002 source: HSRI

title: The monitoring and evaluation of universal health coverage in Thailand, first phase 2001/02

abstract: This report summarizes major findings and recommendations from the research project “The Monitoring and Evaluation of Universal Health Care Coverage in Thailand, First Phase 2001-02.” The universal coverage of health service in Thailand consists of four major schemes, namely: (1) Civil Servant Medical Benefit Scheme (CSMBS), (2) Social Security Scheme (SSS) and Workmen Compensation Fund (WCF), (3) 30 Baht Scheme, and (4) Car-accident Compensation Scheme. Both WCF and the Car-accident Compensation Scheme could be considered as supplementary schemes where funds are collected from those who liable for the workplace or traffic accidents. The study employs a mix of methods that range from gathering and analyzing secondary data from various sources—including the data that come through reporting systems, review of previous studies, in-depth interviews and focus groups, content analysis of medias, observing meetings of committees, working groups, participating in seminars organized by various groups, and field works that include using questionnaires and analyzing hospital and patient records. The findings of this study are summarized as follows:	CSMBS provides health care benefit to government officials and their dependents (parents and up to three children). The payment mechanism is retrospective fee-for-service. During the past 13 years (1988-2001), the program cost has increased by six-fold, averaging 15 percent per annum. A reform was implemented in the late 1990s that cut down certain benefits such as limiting uses of private hospitals to emergency cases only, cutting lengths of stay at public hospitals and covering only medicines in the Essential Drug List. After the reform, the program cost subdued temporary, then rebounded back to the original trend. The present reform—based on an HSRI research which was approved by the cabinet in 2000, aims primarily at changing the payment mechanism to pay the inpatient cost according to the Diagnostic-Related Groups (DRG). This new payment mechanism is scheduled to be in full force in 2004, provides a gradual four-year transition that involves IT development and setting up the Central Information Center. At present, the reform is undertaken but is about 1.5 year behind the schedule due to the late start.	SSS is primarily a compulsory scheme that covers private employees in the formal sector. The scheme is based on the Social Security Fund where the main revenue comes from social security taxes that are imposed on employers, employees, along with by-law contribution from the government. At present, SSS provides six benefits to the employees—one of which is health benefit that covers cares for illnesses that are not work-related. Health care costs for work-related accidents and injuries are paid for by the Workmen Compensation Fund (WCF), which is also administered by the Social Security Office (SSO) and collects premium solely from the employers. Each employee in SSS could choose a listed hospital as the main-contractor. SSS pays the main contractors prospectively, mainly per capitation. (WCF pays any hospitals on fee-for-service basis, but with a ceiling per accident or injury). Each main contractor in the SSS could arrange with smaller hospitals or clinics to serve as its subcontractors and with larger hospitals to be its supra-contractors. To date, SSO appears to leave these arrangements to the main contractors, which, at times, leads to having unqualified subcontractors. In some provinces, the private hospitals that are SSS’ main contractors are blacklisted by their supra-contractors because of poor payment record. This could prohibit the insured to get quality care when needed. Since April 2002, all employees in the formal sector are required to enroll in the SSS. Thus far, only one-fourths to one-fifths of the newly-required workers has enrolled. As a result, more people would be covered by the 30 Baht Scheme than the number of the truly eligible. This would have negligible fiscal implications, however, since the burden the government shoulder for both programs are almost the same for this group of workers in the FY 2002.	The 30 Baht Scheme is a new scheme that covers the rest of population who are not under CSMBS or SSS. Thus far, the Ministry of Public Health (MOPH) has been the administrator of this scheme. The scheme started as a pilot project in six provinces in April 2001 and then expanded to 21 provinces in June. Since October 2001, the scheme has consolidated all existing health insurance programs undertaken by the MOPH—including the Health Welfare Program for the Low Income and Disadvantaged and the (voluntary) Health Card Scheme (better known as the 500 Baht Health Card for Family). While the phrase “universal coverage” and the slogan “30 Baht fee for curing every disease” have been high in the government’s discourse, the major reform that affects the health care providers most in the past year has been health care financing reform with the aim to redistributing resources, and thence physicians, to the deprived areas on a more equal basis. The financing reform allocated three-fourths of the MOPH budget based on capitation, resulting in having more money go to highly-populated and under-staffed hospitals in rural areas. Larger hospitals in major cities that used to attract most physicians in the past have found themselves in trouble, as their costs are rather high compared with the budget received and they are not allowed to charge the patients the way they used to. Hospital-based data suggest that, during the first six-month of the full-scale 30 Baht Scheme, number of outpatient visits has increased substantially from the same period last year. Number of inpatients has been in line with in the past few years. Hospital death rate has decreased. However, inpatient death rate increased slightly in the first half of FY2002. There have also been concerns on effects of payment mechanism (such as inclusive capitation) on delayed treatment or referral. Contrary to popular beliefs, thus far the 30 Baht Scheme has not cost the taxpayers dearly. In FY 2002, the scheme added about 10 billion baht to the MOPH regular budget (approximately 16 percent increase from 60 billion baht in FY 2001) while providing health coverage to additional 25 million people. The outlay is expected to increase only slightly in the FY 2003, even less than the increment in the SSS. It is unlikely that the three major health insurance schemes would be merged in the near future. This has caused concerns on equity and overlapping coverage. Part of the overlapping coverage is due to incentive problem, i.e., multiple cardholders still benefit from having more than one card as there has been no one dominant scheme under which the benefit package is better than other schemes in every aspect. One plausible measure to solve the incentive problems is to elevate certain benefits under the CSMBS that are still below than those of the SSS and the 30 Baht scheme and also elevate certain benefits of the SSS that are still below that of the 30 Baht scheme. In addition, reform on payment mechanism is needed to curtail health providers’ incentive that could lead to double/multiple standard in taking care of patients under different schemes.


location: , 'Thailand year: 2014 source: HSRI

title: Setting reimbursement prices for pharmaceuticals: Cases of outpatient referral, disability, accident, and emergency for Bangkok-region National Health Security Office

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


location: , 'Thailand year: 2017 source: HSRI

title: The Performance of Village Health Volunteers in the Midst of Change

abstract: The purposes of this review article were to determine situation changes affecting performance of
village health volunteers. The data were collected by reviewing documents and related research and then
synthesized data in accordance with the objectives. The results showed that from the past to the present,
there are many changes, from policy, finance, social and information technology. These changes affected
the performance of village health volunteers and community health. Managing community health problem,
governments could not manage alone. They needed participation of public sector, especially village
health volunteers who were the mainspring of the public sector because they have lived in the community
and known the background of their area, therefore, they have received the trust of the community. The
recommendations concerning increasing operational effectiveness of the village health volunteers included
the following: promoting income generation, strengthening information technology skills, and building
up the coordinator or community mentoring role.


location: , 'Thailand year: 2011 source: HSRI

title: Preliminary financial assistance under section 41 and civil litigation

abstract: Since the section 41 of the National Health Security Act B.E.2545 has been enforced, requests for the
preliminary financial assistance under section 41 were increasing every year, but the civil litigation rate is
undetermined. The main purposes of this descriptive research are to examine the relationship between
preliminary assistance and the rate of civil litigation and to study preventable damage from medical errors.
The author retrospectively reviewed all documents related to sub-committee meeting to decide the
request for preliminary financial assistance between the year 2004 and 2010 and interviewed the relevant
personals. Data were analyzed with frequency, percentage, and Fisher’s Exact Test. The results showed
that 37 cases were included in the study, 28 cases were eligible for payment of preliminary assistance. Two
cases in Lamphun and 43 cases (0.93%) in Thailand filed a civil lawsuit against the Ministry of Public
Health. The rate of civil litigation in cases who did not receive money compared to those received in
Lamphun were not different (p-value = 1), but different (p-value = 0.031) at the national level. In conclusion,
the payment of preliminary assistance in Lamphun had no effect on civil litigation, but the filing rate
significantly reduced at the national level owing to this measure. Health care providers should review the
service process, which the most common causes were in the communication and the referral system, to
prevent any damage that may occur repeatedly in the future.


location: , 'Thailand year: 2003 source: HSRI

title: Quality indicators of administrative data and hospital characteristics

abstract: The study of quality indicators of administrative data and hospital characteristic aims to test the 45 indicators of quality assessment of the administrative data in the US whether they can be applied with the existing administrative data in Thailand.Can they use and compare the result of the services in various aspects such as year,region comparison. Will  they be possibility of using some indicators to monitor the quality of services in Universal Coverage of health care scheme (UC)  in the future? 	The methodology is cross sectional study of reimbusement data from 2000-2003.It is two parts of analysis.First,the data is assesed by sampling from year 2001 hospital data to audit the chart with central data.Second,administrative data of three years are test with 45 HCUP(Health care cost and utilization project)  indicators.There are two groups of those indicators provider level and area level indicaor.The provider level consist of 6 Volume, 5 Utilization, 6 inpatient condition mortality  and 7 inhospital procidural mortality indicators. While the area level consist of 4 Utilization and 16 Avoidable hospitalizations and Ambulatory care sensitive condition (ACSC) indicators.The comparison between the various characteristics are studied in this research.	The result of this study showed that the 70% of data was corrected in diagnosis and 62% in procedural coding.The data can rather use for analysis of indicator.For the volume indicator,it can not be evaluated from data because those operations are less in Thailand,Thus,the mortality form them can not be compared as well.   	The utilization indicator which can be analysed in this study was Caesarean section rate while incidental appendectomy among elderly and Laparoscopic cholecystectomy can be used by combining data from three years due to the small number of cases.The useful inpatient condition mortality were Acute myocardial infarction mortality,Congestive heart failure mortality,Pneumonia mortality and Stroke mortality while another two indicators, Hip fracture mortality and GI hemorhage mortality were required to use the total data of several years for assessment. 	For the area level indicators, the service rate of Hysterectomy and Laminectomy can be used while CABG and PTCA  cannot because of the inadequacy of data. Most of the Avoidable hospitalizations and Ambulatory care sensitive condition indicators can be used except for uncontrolled diabetes mellitus since there is no coding in ICD 10. However,some provinces had few data compare to area population so the indicators cannot be evaluated.	Because they are no composite index of indicator,each of them can be applied separately,Using various years of data makes the reliable result of assessment especially mortality indicators. Some of indicators are main indicators for presenting the result of hospital services for example;  Caesarean section rate because there were adequate data in each year and such result of services can be used for comparison. For the area level indicators, this study showed that some provincial area might have less population so the reliability of the indicators might be questionable. This  can be solved by expanding area into regional area.   	Applying these indicators 	in Universal Coverage scheme presently is not likely to be possible because of two factors;the correctness of data and the suitability of the indicators in Thailand data.Moreover, there are many factors involved. For example, cause of illness, treatment or operation and health service system between Thailand and other countries are different. In order to tell which province or which hospital is good quality in inpatient services providing, there must be the development of indicators for Thailand, particularly, the standard of selection of indicators using statistic method. Besides, low standard of care caused by the monitoring organization would make the result of indicator assessment for comparison more meaningful.


location: , 'Thailand year: 2013 source: HSRI

title: Disease prioritization for inclusion into Thailand’s population-based screening benefit package

abstract: Population-based screening is a large-scale process of identifying apparently healthy people for disease
risks. Some health screening programs in Thailand have been introduced without scientific evidence.
This paper details the experience gained from a systematic and participatory prioritization of health problems
to be screened in Thailand. A consultation meeting with three rounds of anonymous votes was conducted.
Participants included technical officers in the Ministry of Public Health, medical practitioners,
representatives of non-governmental organizations and lay people. We identified the primary list of 31
health problems for their contributions to disability-adjusted life years (DALYs) in Thailand. A set of
information depicting the burden of diseases and availability of screening techniques were provided to
participants prior to the meeting. The prioritization process was conducted with a modified Delphi technique.
The final list of high-priority health problems was determined by researchers using inputs from
round three and overall aspects: ischemic heart disease and stroke, diabetes, alcohol dependence, cirrhosis
and liver cancer, anemia, cervical cancer, HIV/AIDS, asthma, tuberculosis, nephritis and nephrosis,
breast cancer and traffic accidents. They will be investigated further on the appropriate screening program.


location: , 'Thailand year: 2003 source: HSRI

title: By pass problems experienced by patients obtaining public health's services in Phukhieo hospital, Phukhieo district, Chaiyaphum province

abstract: The objectives of the research: by pass problems experienced by patients obtaining public health’s services in Phukhieo hospital, Phukhieo district, Chaiyaphum province, were to show the causes of this: (1) the factors of by pass problems experienced by patients obtaining public health’s services, (2) the problems occurring to the patients both inside outside of the hospital occupying when they obtained the by passed public health services and (3) to study a referral system and it’s problems for standard management of the hospital. The study focused on the qualitative research method. Data were obtained from document review, in-depth interview and focus group, and also the participant observation and non-participant observation. The study covered the period of February to September, 2003.The results of this study showed that: 	1. The factors leading to the bypassing experienced by the patients obtaining public health services were the inconvenience in transportation, inreliance of the clinical  service quality, the seriousness of the disease, the character of the servant, the contact and information obtaining from the service, service system, mode of clinical service right, the clinical referral, and the non-understanding of the card holders under the universal coverage insurance. 	2. Most of the patterns and conditional problems were described as following items: (1) an economic problem was caused of the loss of time, the cost of transportation, food, and health’s care. These charges had to be paid by the patients because the universal coverage insurance cannot be used. This was caused by unused referral system, (2) the physical problem was occurred from the inconvenience and no safety of life and (3) the mental problem was occurred because they were not satisfied of the service quality because of the non-understanding of the referral management system between the patient and the relative of the servant. 	3. The quality and standard of health care and referral system management in Phukhieo hospital were revealed that: (1) there was small amount of doctors that the ratio of doctors to patients was low score, general practice and most of them were funded and just graduated. They always move to several areas. So their knowledge and experience were not enough, and the inspiration to improve service system was lacked, (2) the strategy for the referral system management depended on the universal coverage insurance policy that the patients were commented to use the first register service. The patients with over cured disease) will be immediately and safely referred to higher efficient hospital, (3) the referral strategy always improved following the policy of referral system) of Chaiyaphum province,(4) the standard and quality of referral sys tem were shown that the patient was not treated in the referral standard from most doctors. The patients who can cure themselves were referred, while the patients with over cured disease were allowed to care themselves until they were coma and then were referred the secondary care, (5) Since running on the 30 baht policy, the referral system was limited by a payment. If it was not necessary, the patient was not referred because of the necessity to decrease the payment. This was differ from the previous service system and (6) The communication problem to refer the patient arise between general practice and specialists. Most general practice was graduated so far or funded. So they were not confident to ask the special doctor and they cannot contact to consult specialists when they have the problems. 	4. The policy suggestion was that, the alternate strategy for the persons relating to consider the policy was the patient choice for register with the health care service depending on their convenience. This was independent from the geographical or occupied dividing areas to solve the patient’s problem.  	5. The developmental suggestions indicate that: 		5.1  The patients should obtain the information from the various choices such as the community deputy meeting, the village health volunteer ’s meeting, civic groups and home health care, or the data will be obtained from family folder observation by the personnel’s health in the following mentions. (1) the patients are commented to obtain service from the specific health care and for the case of by passed patients, the charge of health care have to been paid by them, (2) the sheets describing healthcare efficiency of all hospital levels should be distributed to all personnel’s health of all department  and sub-district health. These are the data for the communication to the patients about the health care efficiency and for patient deciding, (3) There should be the communication to understand about the right of the universal coverage insurance, referral system and the rules of the health care obtaining in Phukhieo hospital for either government service right patients or life insurance patients. 		5.2  For the servants personnel’s health,  the improvement of the health personnel’s health is important. The strategies of this are that, (1) the seminar of services behavior should be always established and performances according to the patients’ rights  (2) services behavior should be used to consider progression and (3) the finding out and pronounce of the excellent personnel’s health should be done monthly or yearly. In the other case, there should be punishment when there are the complains about the improper service, and also the service system and personnel improvement should run to obtaining the patient’s trust. 		5.3  The service system revealed that, the quality and service system need to be developed, especially the out patients department (OPD.) that a lot of time was used for waiting to see doctor. Possession of nurse practitioner is a method that can help to increase the service efficiency. Case study showed that, there was the referral standard problem. The referral audit between doctors and all servants should be set up once a month or two months to improve the referral standard, communication between the referral concerned servants, and increase the occasion of communication between general practice and specialists. In addition, the quality of secondary care in the hospital has better be corrected, for example; conference, seminar, the deficient specialists to be the consultant once a week or two weeks. This is to develop the doctors’ knowledge and efficiency, inspire doctors to work in the hospital for a long time, therefore the service quality will be developed and the bypassed patients from Phukhieo hospital will be decrease.


location: , 'Thailand year: 2021 source: HSRI

title: Cost of Palliative Care for Cancer Patients of a Community Hospital in Khon Kaen Province

abstract: Palliative care is crucial care for cancer patients, especially those who are moving toward the end-stage. The World Health Organization states that palliative care is low cost. However, a cost analysis of such care is limited in Thailand. This study aimed to perform a cost analysis of palliative care for cancer in a community hospital. The analysis was conducted based on two perspectives: the health care provider’s and the patient’s. Cost data of 42 palliative cancer patients were recorded from January 1 to December 31, 2018. The cost of the provider’s perspective included labor and material costs from three departments: outpatient, inpatient, and home-visit, whereas the patient’s perspective covered the direct medical cost, direct non-medical cost, and opportunity cost. Results show that the average cost of the provider’s perspective was 16,525 ± 14,979 baht per patient: from outpatient 4,309 ± 7,103 baht, inpatient 10,915 ± 11,704 baht, and home care 1,301 ± 1,977 baht. The cost on provider’s perspective was mainly born by medical materials (68%). The average cost on the patient’s perspective was 38,707 ± 32,943 baht per patient: 5,262 ± 5,571 baht for outpatient, 6,231 ± 7,355 baht inpatient, 20,806 ± 20,454 baht home care, and 6,408 ± 17,336 baht for seeking other healthcare. The patient cost was predominantly opportunity cost (69%). The Ministry of Public Health and the National Health Security Office should consider the budget plan for palliative care.


location: , 'Thailand year: 2022 source: HSRI

title: Impact and Adaptability Through Behaviors Change for Prevention COVID-19 Among the Hill Tribe Populations Living in Borders Areas, Chiang Rai   Province, Thailand

abstract: A cross-sectional study aimed to assess the impacts from the COVID-19 pandemic and adaptability to prevent and control the disease among the three groups (students, general population, and the elderly) of the hill tribe people lived in border areas in Chiang Rai province, Thailand. Validated questionnaires were used to gather information from participants. Data were collected between April 2021 and December 2021. A total of 2,208 participants were recruited into the study. Among students, their had got moderate level of the impact. Several barriers access education during the pandemic were detected such as inaccessible to internet and no educational technologies and materials available. The ability of their adaptations to follow COVID-19 prevention and control measures was found in moderate level. In general population, majority were impacted in moderate level. Several impacts were detected such as leaving job without compensation, salary reducing, not met the qualification from the national policy of compensation from the COVID-19 pandemic due to no Thai identification. Moreover, a large proportion had increased their family debt during the pandemic. The ability of their adaptations to follow COVID-19 prevention and control measures was found in moderate level. The elderly, a large proportion were working in agricultural section, and had got the impact in moderate level in particular their job and income. The main problem was unable to sell their agricultural products. The ability of their adaptations to follow COVID-19 prevention and control measures was found in good level. National educational policy should be focused on educational materials and technologies supported to children and schools. Creating and seeking markets and supply chains for general population and the elderly should be urgently executing. Moreover, the policy related to support prolong living environmental under the COVID-19 pandemic is crucial particularly those who are living in poor education and economic status.


location: , 'Thailand year: 2000 source: HSRI

title: Health secter reform: experiences in ten countries

abstract: Health sector reform: experiences in ten countries	This report aims to synthesize lessons derived from health sector reform experiences in ten countries, namely, Germany, United Kingdom, Australia, New Zealand, Japan, Republic of Korea, Republic of China (Taiwan), Singapore, Malaysia, and the United States. The main source of data for the synthesis comes from reports on health sector reform of these ten countries commissioned by the Health Systems Research Institute. Other sources include journal articles and discussion with academicians from some countries. 	Analysis of the structural aspect of reform addresses 1) overall structure of the health system, 2) benefits and choices available to, and burden borne by the consumers/ patients, 3) provider characteristics and payment mechanisms, 4) insurer/ fund characteristics, sources of fund, number and roles of insurer, and 5) intermediate system outcomes. Policy process model is used as the framework for comparative analysis of reform process. Lessons on the policy processes in each of the following policy stages are compared and contrasted: 1) agenda building, 2) policy formulation, 3) policy adoption, and 4) policy implementation. 	Experiences from these ten countries indicate that countries succeeded in instituting universal coverage of health care all employ compulsory insurance. While systems managed by a single insurer or insurance fund are often found to be less responsive to client needs, those managed by multiple insurers suffer from problems such as cream skimming, distribution of risk among insurers, and system inefficiency. Appropriate rules are needed to ensure overall equity, quality, and efficiency of insurance system(s) in a country. Insurer should be a prudent purchaser, playing active roles in selecting, negotiating with providers, and monitoring quality of care. Payment mechanisms can be designed in such a way that overall costs are controlled, while health promotion and preventive services are promoted. 	Health sector reforms taken place in these countries in the past century had two main objectives: expansion of insurance coverage and cost containment. Reform processes in most countries culminated in the enactment of laws. Experiences in some countries show that simply passing insurance laws does not always lead to the desired outcome. Implementation of policy is no less important than policy formulation and adoption for the accomplishment of reform objectives. Factors affecting the success of reform process include the degree the reform initiatives are in accordant with societal values, whether a comprehensive or a piecemeal approach to reform is employed, economic condition at the time reform movement took place, relative political power among the various stakeholders, political mobilization of the movement, development of technical capability for implementing reform, and the effectiveness of policy communication.


location: , 'Thailand year: 2021 source: HSRI

title: Anti-dengue virus drug screening of purified natural products and their detivatives using computational simulation to dengue envelope protein and cell-based verification

abstract: Dengue virus infection is a global threat for which no specific treatment has not been established. Previous reports suggested chrysin and flavanone derivatives were potential flaviviral inhibitors. Here, we reported two halogenated chrysins, abbreviated FV13 and FV14, were highly potent against DENV1-4 and ZIKV infectivities with the FV13 EC50 values of 2.30 ± 1.04, 1.47 ± 0.86, 2.32 ± 1.46, 1.78 ± 0.72 and 1.65 ± 0.86 μM; and FV14 EC50 values of 2.30 ± 0.92, 2.19 ± 0.31, 1.02 ± 0.31, 1.29 ± 0.60 and 1.39 ± 0.11 μM, respectively. The CC50s to LLC/MK2 of FV13 and FV14 were 44.28 ± 2.90 μM, 42.51 ± 2.53 μM, respectively. Mechanism of drug action studies suggested multiple targets but maximal efficiency was achieved with early post infection treatment. Computational study suggested the target at viral envelope and further optimized the pharmacophore to the stronger binding affinity. Pharmacophore models were generated using trajectories obtained by molecular dynamics (MD) simulations of the dengue envelope E protein complexed with the active inhibitor, flavanone (FN5Y). Subsequently, compounds presented in various drug databases were screened using the LigandScout 4.2 program, molecular docking, followed by extensive MD simulations. The highest-ranked compound from this procedure was then synthesized and tested on its inhibitory efficiency by experimental assays. Moreover, we synthesized two halogenated flavanones, dibromopinocembrin and dibromopinostrobin, and tested against dengue serotype 2 at the EC50s of 2.06 ± 0.75 and 5.86 ± 0.51 μM with at the CC50s of 67.21 ± 0.97 and >100 μM, respectively. Flavanones are more aqueous soluble than flavones therefore they are more suitable for further in vivo experiments. Computational studies suggested the potential target be likely the NS5 methyltransferase. Since flavones and flavanones inhibited viral translation and replication potentially with multiple targets. A flavone was chosen for alkyne addition to the B-ring, resulting in an alkyne-tagged apigenin. The alkyne serves as a chemical tag for the alkyne-azide cycloaddition reaction for subcellular visualization. The compound located at the perinuclear region at 1 and 6 h after infection corresponded to a previous report that apigenin-fixed bead pulled down a ribosomal protein S9. Interestingly, the compound signal started shifting to vesicle-like structures at 6 h and accumulated 24 and 48 h after infection. Moreover, the drug treatment in dengue-infected cells showed that the compound restricted the viral protein inside the vesicles, especially at 48 h, where the dengue envelope proteins spread throughout the cells. The alkyne-tagged apigenin showed stronger efficacies than the originals at the EC50 of 2.36 ± 0.22, and 10.55 ± 3.37 μM, respectively. The cytotoxicities were similar at the CC50 of 70.34 ± 11.79, and 82.82 ± 11.68 μM, respectively. Therefore, the newly synthesized, alkyne-tagged flavone did not interfere with the anti-dengue efficacies and was found in cytoplasmic vesicles inside the cells targeting a previously reported ribosomal protein S9 protein. Molecular docking predicted two RPS9-binding sites of both apigenins with similar affinities. The interaction should attenuate dengue productivity by interfering with viral translation and suppressing the viral proteins from trafficking to the cell surface.


location: , 'Thailand year: 2015 source: HSRI

title: The Effects of Health Behavioral Adaptation Program on Weight Loss among Overweight Secondary School Students in Hat Yai District, Songkhla Province

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


location: , 'Thailand year: 2019 source: HSRI

title: Reliability and Validity of the Physical Activity Questionnaire for Pregnant and Lactating Women

abstract: This study aimed to develop the physical activity questionnaire for pregnant and lactating women (PAQ-PL) and to assess its reliability and validity. The PAQ-PL was developed based on the modification of the previous physical activity questionnaires for pregnant women from Thailand and other countries. The developed PAQ-PL was initially tested to determine the feasibility and acceptability for health care service by interviewing pregnant and lactating women as well as health care service providers. The reliability was assessed by administering the PAQ-PL twice within a 7-day interval (N=212) and the validity was assessed based on the correlation between the PAQ-PL and the accelerometer (N=86) in pregnant and lactating women who visited the Health Promotion Hospital, Health Promotion Center Region 5, Ratchaburi Province. The developed PAQ-PL was in the table format and consisted of 21 items of physical activities (PA) that were appropriate for Thai pregnant and lactating women context. It had good reliability on the time spent (minutes/day) for total PA, moderate-to-vigorous PA (≥3.0 metabolic equivalents, METs), and sedentary- to-light PA (<3.0 METs) [intraclass correlation coefficient, ICC = 0.79, 0.84, and 0.77, respectively (p-value <0.05)]. Its validity was acceptable when used for assessing the time spent on vigorous-to-moderate PA [Spearman’s correlation, rs = 0.21–0.37 (p-value <0.05)]. In summary, the developed PAQ-PL had moderate to good reliability and acceptable validity, especially when considering the assessment of moderate-to-vigorous PA. Hence, it may be feasible to use the PAQ-PL to assess the PA of pregnant and lactating women in the public health service system.


location: , 'Thailand year: 2020 source: HSRI

title: Area-based Network Allocations: A Solution to Mitigate the Shortage of Health Workforce

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


location: , 'Thailand year: 2008 source: HSRI

title: Treatment Outcome among Astthma Patients in the Asthma Clinic, Kanthararom Hospital, Srisaket Province

abstract: A study was conducted to determine the outcome of treatment following the GINA
(Global Initiative for Asthma) guidelines 2006 on asthmatic patients visiting Kanthararom
Hospital, Srisaket Province. The guidelines stressed the reduction of bronchial hyperresponsiveness
and treatment of bronchospasm. A total of 128 asthmatic patients (having
340 visits) during the period January 1 to July 31, 2007 were interviewed and the peak
expiratory flow rate (PEFR) measured by experienced nurses. The patients were then
treated according to the guidelines. Of the total cases, 61.72 percent were female. The
mean age of the first asthmatic attack was 35 years. The admission rate within one year of
the interview was 30.47 percent and the incidence of acute severe symptoms (ER visit)
was 76.57 percent. The drugs used in the patients comprised inhaled corticosteroid (ICS)
35.15 percent, oral corticosteroid 5.45 percent, B2-agonist combined with corticosteroids
inhalant 18.75 percent, and ICS combined with long-acting B2-agonist 12.50 percent. These
patients made visits to the asthma clinic an average of 2.65 times in four weeks. The
results of treatment producing total asthma control were 12.94 percent, good control 30.58
percent, and poor control 56.47 percent. Since a significant number of treated cases remained
in the poorly controlled category, it is reasonable to conclude that the increased
practice of ICS may be effective in reducing ER visits and hospitalization.


location: , 'Thailand year: 2021 source: HSRI

title: Policy Recommendation for Primary Care Management among COVID-19 in the Public Health Region 11

abstract: 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.


location: , 'Thailand year: 2020 source: HSRI

title: Information Technology for Emergency Medical System (ITEMS): A Study of its Use and Problems

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


location: , 'Thailand year: 2008 source: HSRI

title: Effectiveness of the Self-care Health Promotion Program for the Elderly in Khamsakaesang District, Nakhon Ratchasima Province

abstract: OPD reports from hospitals and health centers in Khamsakaesang District in 2007
  showed that 52.78 percent of the outpatients were in the age group 60 years and older; of that
  proportion of elderly patients, the cause of their seeking medical care in 62.53 percent of the
  cases was improper self-care behavior. The objective of the present quasi-experimental research
  study was to assess the effectiveness of the self-care health promotion program for the elderly.
  The study samples were selected from the total database population numbering 5,252 persons.
  Using multi-stage random sampling, 60 cases were identified for this study.  The descriptive
  data were analyzed by the STATA program, version 10, to obtain percentages, means and  standard deviations; paired sample and independent sample t-tests, with statistical significance at
  the 0.05 level, were used for the data analysis. The qualitative data were analyzed according to
  the content of the questionnaire interviews on self-care behaviors for health promotion, together
  with observations and personal discussions. The results showed increased statistically significant
  behavior in the control groupûs test, i.e.,  the patientsû paired sample t-tests showed mean
  differentials of 0.49 ± 0.05,  t = 48.00.  A comparison between the groups showed that the
  control group acted more properly than the comparison group (t=40.32, p value 0.001).
  Qualitative data showed that family lifestyles, and economic and traditional beliefs influenced
  their behavioral change. The results of this study could be used to integrate and adapt care for
  the elderly and other patient groups in primary care or clinic promotions. At least they could be
  used to increase efficiency in protecting the elderly against untimely illness and from
  developing complications from improper self-care behaviors.


location: , 'Thailand year: 2019 source: HSRI

title: Development of an Instrument for Non-Invasive Hemoconcentration Measurement for Monitoring and Treatment of Patients   with Dengue Hemorrhagic Fever

abstract: Dengue hemorrhagic fever (DHF) is one of the critical public health problems in Thailand. During the disease progression, DHF patients will enter the critical phase in which hypovolemic shock potentially occurs and might lead to death. The shock in dengue is caused by substantial plasma leakage from blood circulation. Plasma leakage potentially leads to hemoconcentration, insufficiency of blood plasma, and ultimately hypovolemic shock. Thus, current guidelines on management of dengue fever/ dengue hemorrhagic fever recommend monitoring patient’s hematocrit levels by performing invasive blood collections every 2-4 hours during the critical phase. hematocrit levels are then used to adjust intravenous fluid replacement in DHF patients to prevent hypovolemic shock. This project aims to address two main research questions, including 1. the feasibility of using a noninvasive hemoglobin monitoring device (Masimo), already approved for medical used, for monitoring hemoconcentration instead of collecting patient’s blood through conventional methods and 2. development of a non-invasive prototype measuring hemoconcentration with a comparable or higher level of efficiency compared to the commercialized noninvasive device (Masimo). The prototype has been designed to be affordable for public hospitals in Thailand and to potentially replace expensive commercialized devices (Masimo). For the first research question, hemoglobin levels were measured in 154 patients with dengue fever (from 336 patients in this study) using the commercialized devices. Data were analyzed for the relationship between hemoglobin from noninvasive device and hematocrit from blood collection. The analysis revealed that hematocrit levels obtained from venipuncture or fingertip prick and hemoglobin levels from the Masimo device tended to change in the same direction. However, the incidence rate of dengue infection was very low over the course of the data collections. In addition, the majority of dengue patients in this study had dengue fever (DF) that does not have a critical phase seen in DHF. Thus, the overall variation of hematocrit levels observed in patients in this study was small due to the lack of data from the critical stage. Hence, our proposed model for the relationship between hemoglobin and hematocrit was not sufficiently tested with patients during the critical stage. In order to apply our model to routine hematocrit monitoring, an interface extension from Masimo was built to receive signals from the Masimo device, analyze the signals using our proposed mode, and convert them to hematocrit. In addition, we also proposed a new guideline for monitoring patients with dengue infection before, and after, reaching the critical stage using the developed interface and Masimo device. For the second research question, we adopted AFE4490 Integrated Analog circuit and Nellcor ds100a probe for non-invasive hemoconcentration measurement prototype. This prototype used Arduino DUE as a processor. We have designed the real-time algorithm and auto alert system calibration by weight average technique using signals from red and infrared sensors. The data were collected by a computer connecting to the Arduino processor. The prototype was calibrated with FLUKE Index 2 pulse Oximeter simulator. We found that the signals read were accurate. A comparison of data from the prototype and the Masimo device suggests that the correlation between REDDC signals from the prototype and SpHb values from the Masimo is very strong although accuracy of measurement from the prototype is not as high as the Masimo. Initially, the prototype was also used to monitor hemoconcentration of 73 patients with thalassemia (with about 70% of accuracy) after they received blood transfusion. The prototype will be further improved to increase its accuracy in measurement of hemoconcentration through laboratory tests and model adjustment.


location: , 'Thailand year: 1999 source: HSRI

title: The muscoloskelatal pain behaviors and a model for solving the problem in the community : study in 2 villages, Northeast Thailand

abstract: The  Musculoskeletal  Pain  Behaviours  and a Model for Solving the Problem  in  the  Community: Study  in  2  Villages,  Northeast  ThailandThe study aimed to investigate the behavior of the people who got experienced from musculoskeletal pain (puad - muay) in 2 villages (Ta Poo and Ta Ma-daur), NE Thailand.  The study group was 15 years and over and voluntarily interviewed by structured questionnaires to compare between 2 villages (N=101 and N=100). The study found that most of the respondents perceived musculoskeletal pain as recurrent, work ralated and work problems (71.2 and 78.0 percent). Waist was the highest percentage in both area. Occasionally treatment and no treatment in Ta Poo 57.0 and 27.0) was higher than Ta Ma-daur (37.0 and 20.8) which were significant differences (p <0.05). The locus of control of general health and musculoskeletal pain was assessed using a forced 6 point scale with a conbach' s alpha coefficient 0.5426 in the pilot study. The samples were selected by systemetic sampling (N=175 in Ta Poo and N=165 in Ta Ma-duar). The result showed that in both villages the respondents was internal control for health prevention but external control if they were already sicked. The external control referred to others (doctors). The control of the beliefs for musculoskeletal pain was internal in both villages. The motivational orientations by health team were designed through educational programme for the health officers and the people. Thai massage practicing and exercising was includes in this programme. 6 months after training programmes, the massage and self-help groups were collaborated in one village. The other village was developing in the preparatory step. The were regular meetings between the health officers and the health volunteer to communicate about musculoskeletal pain issues. 	The conclusion was that the people in both villages had the capability to solve musculoskeletal pain by themselves if they got the reliable information and was motivated by the knowledge health officers.


location: , 'Thailand year: 2020 source: HSRI

title: Feasibility and Budgetary Impact Study on PET/CT Service at 2 Government Hospitals in Thailand

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


location: , 'Thailand year: 2010 source: HSRI

title: Iodine Status in Populations in Chiang Mai,Lamphun, Lampang, and Mae Hong Son during FY 2007-2009

abstract: Iodine deficiency has several effects on health, particularly concerning brain development in the
fetus and in early childhood. With regard to the past few decades, the situation was mitigated when considering the total goiter rate in children. A mild deficiency produced no obvious physical effect, but
did impair mental function. In this regard, the northern and northeastern regions comprised the highest
risk areas. This descriptive study was aimed at reviewing the iodine status of populations in Chiang Mai,
Lamphun, Lampang, and Mae Hong Son by analyzing secondary data during Fiscal Years 2007-2009 and
was framed under the WHO manual entitled “Assessment of Iodine Deficiency Disorders and Monitoring
Their Elimination.”
It was found that a proportion of the households using adequately iodized salt was progressively
over 90 percent in every province except Mae Hong Son. Thyroid function was assessed by screening
TSH levels in newborns that were over 11.2 mu/L; in Chiang Mai, Lamphun, Lampang, Mae Hong Son
the levels were 12.73, 7.84, 10.29, and 15.83 percent, respectively, and the incidences of thyroid hormone
deficiency were 1:2,297, 1:1,665, 1:2,468, 1:3,058 respectively. The total goiter rate was below 5 percent in
every province. The level of iodine in urine in pregnancy in Mae Hong Son was equally insufficient at
50.89 percent; in primary school pupils in Lamphun it was 52.38 percent, that is, equally more than adequate.
In conclusion, four provinces indicated mild iodine deficiency areas, but their situation had gotten
better. Iodine deficiency prevention requires more attention from policymakers. Proper development of
intellectual quotients by adequate iodine intake should be designated as one of the national strategies on
childhood capacity-building. Correct knowledge-building on the benefits of proper iodine intake should
be encouraged. Salt producers need to show social responsibility as well; legal measures are necessary, if
they do not do so.


location: , 'Thailand year: 2017 source: HSRI

title: The development of tool for diagnostic and monitoring patients with Parkinson's disease

abstract: Purpose: To study pattern of tremor symptoms in Parkinson’s disease patient for differential diagnosis from other symptoms, including related movement disorder and study measure parameters of tremor and create the system to collect the data with wireless internet. Method: This study particularize 2 periods 1) To develop assisted device for detect tremor symptoms, including tremor assessment device with tremor analysis software and spiral drawing 2) To enroll population who have tremor symptom 100 sample and manufacture 40 device give to 20 hospital for test this device. Results: This study during in period 1, to design and develop tremor device for diagnostic and monitoring patients with Parkinson's disease. This device include hardware that can detect accelerometer 3 axial and gyroscope 3 axial and tremor analysis software that show angular rate, angular rms, peak rate, peak frequency and other parameters and can save the data by notebook or android technology. Tremor device was designed modern form, small sensor board as a wristwatch and can take pulse rate. This device can set time to test. In part of the signal made stably and reduce to send error signal. Conclusion: In the part of develop tremor device in episode1 and 2 focus on practical use of medical device, that save the data from user and have to design with regard to available use in daily, safety , smart and technology is more modern.


location: , 'Thailand year: 1999 source: HSRI

title: The survey and baseline data processing about 0-6 years child care centres in Thailand

abstract: The Survey and Baseline Data Processing about 0-6 Years Child Care Centres in Thailand		The purpose of this study was to explore Thailand’s child care centers for children aged 0-6 so as to bring the data as inputs to improve the child care centers. Secondary data were mainly used while some data were collected by interviewing responsible staff and asking a number of foundations and private organizations which had the child care centers.  The data collection process was carried out between December 1998 and February 1999. All of the data were analyzed and categorized into general information e.g. administrative, educational, nursing and information system of the child care centres. The research team also developed the computer program for database management so called Relational Database Management System composed of menu, tools for processing data, operational options, reporting and object creation in forms of table, questionnaire and texts. The team recommended Thailand’s child care centers be initially developed the less complicated system for example the children’s information system, the teachers’ information system, the inventory system and the budgeting system. Each database system should be free from each other. Tools for developing the database management system could be Microsoft ForPro, Microsoft Access, Lotus Approach. More importantly, the staff involved should be trained to be familiar with the use of various kinds of information technology.


location: , 'Thailand year: 2019 source: HSRI

title: Development of detection of circulating tumour cells in peripheral blood using magnetic cell isolation method in   combination with fluorescently labeled antibodies to detect cancer cell antigens

abstract: The present study was aimed to develop a method to detect cancer cells in venous blood of cancer patients, either for screening for following-up. Heparinized venous whole blood of about 10 milliliters from the subjects were processed for red blood cell lysis and white blood cell depletion. The cells remained were cryo-fixed and stained using commercially available reagents claimed to give a good morphology of the fixed cells that could be stored for many months. Blood samples were collected from 25 colon cancer patients and 12 subjects who were negative for colon cancer screened by colonoscopy. Early in the study, blood samples from 2 breast cancer patients, 5 hepatocellular carcinoma patients, 1 cholangiocarcinoma patient, 1 lung cancer patient and 1 osteosarcoma patient were also collected. Antibodies against vimentin, cytokeratin, CD45, CDX2, CD31 and CD34 were used. Due to a technical problem on red blood cell lysis and staining temperature, a few weeks were spent to solve it and later cells could be fixed and stained at low temperature. Other optimizations included low temperature handling steps and concentrations of antibodies. The immuno-stained cells appeared mostly to be white blood cells of good morphology. A pathologist had investigated the stained samples and found that there were only 2 cases out of 25 colon cancer patients that seemed to have some abnormal/cancer cells. These were larger and their neclei were also bigger than the nearby white blood cells. They were especially positive for CK 20 and CDX2, the latter being reported to be specific for adenocarcinoma. However, the size of many abnormally stained cells found in many cases was similar to white blood cells, it may be concluded that in this present study abnormal cells could be found in blood samples of colon cancer patients but perhaps with a very low sensitivity. Also owing to quite a high cost of reagents for cell isolation and low temperature processing, this method at the moment could not be used as a routine colon cancer screening.


location: , 'Thailand year: 2014 source: HSRI

title: Factors associated with Streptokinase failure in the treatment of STEMI patients: a retrospective study

abstract: ST Elevated Myocardial Infarction (STEMI) is a life-threatening condition that requires immediate
medical care; treatments include thrombolytic therapy e.g. Streptokinase. The objective of this study was to explore the characteristics of STEMI patients associated with medication failure in the use of Streptokinase.
Method: A retrospective study was conducted in STEMI patients who were admitted to Suratthani
Hospital from 1st January 2011 to 30th June 2013. Failed Streptokinase is defined as ST resolution (STR)
<50% and ongoing chest pain >90 minutes after receiving medication. Data, including age, sex, door-toneedle
time, wall of infarction, smoking status, Killip classification, and underlying diseases such as hypertension,
were collected. Multiple logistic regression models were used to explore the association between
these covariates and failed Streptokinase, as well as each of the criteria used to define failed Streptokinase,
with a significance level of 0.05. A total number of 93 STEMI patients were identified, with a
mean age of 58. Factors significantly associated with STR <50% after 90 minutes are hypertension (OR
2.913, 95%CI: 1.014, 8.369), Killip class >1 (OR 3.057, 95%CI: 1.053, 8.878), and having anterior wall infarction
(OR 7.018, 95%CI: 2.219, 22.199). There is an association between ongoing chest pain after 90 minutes
and having anterior wall infarction (OR 5.09, 95%CI: 1.297, 19.973). Failed Streptokinase is associated with
Killip class >1 (OR 3.652, 95%CI: 1.032, 12.921) and having anterior wall infarction (OR 6.602, 95%CI 1.498,
29.089). Despite its advantages, STEMI patients with hypertension, anterior wall infarction, and Killip
class>1 may be less likely to be beneficial from using Streptokinase.


location: , 'Thailand year: 0 source: HSRI

title: Assessment of Population Health Impacts Subsequent to the Transfer of Tambon Health Promoting Hospitals (THPH) to the Provincial Administrative Organizations (PAOs) in the Fiscal Year 2566: Phase 1 Warning Signs on Potential Health Impacts

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


location: , 'Thailand year: 2015 source: HSRI

title: Thai Elderly People’s Experiences of Moving through Journeys of Dependences in Long-Term Care Facilities

abstract: As older persons moving through the stage of dependence and seeking for help, some of them needed
to receive care in long-term care facilities. This transition period can be very emotional and stressful event.
This qualitative study aimed to examine the experiences of Thai elderly (n = 19) focusing in their adaptations
in the transitional period in long-term care facilities. Participants (≥ 60 years old) who moved to the
long-term care facilities for at least 6 months and had partially impaired of IADLs or ADLs, were interviewed
using open-ended questions. Example of the questions included: “How do you make the decisions
of moving?“, “What were your experiences before moving?“, “How do you feel about the new place and
come up with?” Qualitative results were analyzed by content analysis. The analysis was made to find the
similarities and differences between the experiences of participants. The results showed that the elderly
experienced their transitional period differently. Key determinant was the extent to which they were able to
control over the decision to move to long-term care facilities. Participants who preserved their autonomy
learned to adapt and accepted the transitional period better than the participants who lost their control.
Meanwhile the elderly who were forced to move and had family conflicts, tended to have depression. Facing
death and functional decline, some elders gained the concepts of life cycle and became more calm and
motivated to modify their behaviors for maintaining their capability of livings as long as they could.


location: , 'Thailand year: 2013 source: HSRI

title: Distribution and utilization of antibiotics in health promoting hospitals, private medical clinics and pharmacies in Thailand

abstract: A mismatch between available antibiotics in the healthcare outlets and limited medical and microbiological
capacities of these outlets can lead to irrational use of antibiotics and subsequently worsens
bacterial resistance situations. The study aims to investigate (a) patterns of antibiotic distribution and
utilization among health promoting hospitals, private medical clinics, and pharmacies; (b) opinions on regulation regarding antibiotic distribution and use; and (c) terminology used by health professionals to
explain to patients about antibiotics. A cross-sectional survey using self-administered questionnaires was
conducted in 27 districts of 9 purposely sampled provinces during April-May 2012. The response rate was
53% (601 questionnaires); 276 of them were from health promoting hospitals, 107 from private medical
clinics and 218 from pharmacies. The results showed that,of the 47 antibiotics surveyed; 25, 35 and 37
items were available at health promoting hospitals, medical clinics and pharmacies, respectively. The
most commonly found antibiotics were amoxicillin (98-100%), norfloxacin (93-99%) and dicloxacillin (85-
99%). Private medical clinics and pharmacies had higher rates of antibiotic utilization for potentially selflimited
diseases than those in health promoting hospitals (40-60% vs. 20-30%, correspondingly). Most
physicians in private medical clinics (77%) agreed with the prescription-only measure for all antibiotics.
Fewer nurses and other health professionals in health promoting hospitals and pharmacists in pharmacies
(24% and 5%, respectively) agreed with such measure. The terms “antimicrobial agents” (36-55%) and
“anti-inflammatory agents” (19-25%) are used more often than the term “antibiotics” (11-28%). The observations
from this study indicate that the regulation of antibiotic distribution should be more restrictive
and such regulatory measures, together with measures to promote rational use of antibiotics, should be
implemented simultaneously.


location: , 'Thailand year: 2019 source: HSRI

title: Improvement of Clinical Outcome in Kidney Diseases via On-line Thai Glomerular Disease Registry: 3rd Year

abstract: Background: End stage renal disease (ESRD) affects the quality of life and causes the high cost in health care system. The prevention of ESRD is the early recognition and appropriate treatment. Glomerulonephritis is the third most common cause of ESRD in Thailand. Thai Glomerular Disease Collaborative Network (TGCN) was established to evaluate the epidemiology and clinical outcomes in the glomerular diseases and helped to promote the good system to taking care of these patients. Methods: TGCN originally consists of 9 tertiary care centers and expands to 37 hospitals. We conducted a prospective cohort study in the adults’ native kidney biopsy proven glomerular diseases between July 2014 and Mar 2019. The clinical and laboratory parameters at the time of biopsy, pathologic findings, treatment regimens and clinical outcomes were recorded via on-line registry. This year, we interested in the secondary glomerular disease causing by hepatitis B, hepatitis C, and HIV including the rare and poor prognosis disease such as deposit disease. Results: We recruited 2,755 patients performed native kidney biopsy during Jul 1, 2014 to Mar, 2019. The adequate data for analysis were 2,132 cases. The average age, creatinine, albumin, and cholesterol were 44+16 years, 2.15+19 mg/dL, 2.9+1.2 g/dL, and 290+138 mg/dL in respectively. The median proteinuria was 3.68 (0.02-42.03) g/day. The renal pathological findings showed 34.5% of LN, 13% of IgAN, 11.4% of FSGS, 7.9% of membranous nephropathy (MN), and 7.4% of minimal change disease (MCD). In our data, we found HCV-ATN 2 cases and HCV-associated GN 37 from 1,871 cases performed HCV testing including diabetic nephropathy 9 (24.3%), MPGN 5 (13.5%), FSGS 5 (13.5%), MCD 3 (8.1%), IgA 3 (8.1%), ANCA 2 (5.4%), and MN 2 (5.4%). Regarding the rare Paraprotein-related kidney diseases, we found only 22 cases mostly with 18 amyloidosis, 3 light chain deposit disease, and 1 heavy chain deposit disease. Conclusion: Our study described the common renal pathological findings including LN, IgAN, FSGS, MCD, and MN. we have performed the recommendation for management in glomerular disease, FSGS and MCD in adult Thai patients 2018 and IgA, MN 2019 in this report.


location: , 'Thailand year: 2018 source: HSRI

title: Distribution of Infectious Diseases in Health Data System by Dasymetric Mapping

abstract: This particular research aimed to analyze spatial distribution of infectious disease patients using dasymetric method comparing with areal interpolation technique. This study used infectious disease patient statistical data between 2014 and 2016 provided by subdistrict health promoting hospital (HPH) located in Phlaichumphon, Banklong, Chomthong, Bankrang, and Watchan subdistricts. Land use was classified into 4 categories including residential, agricultural land, forest, and water resource. Furthermore, spatial infectious cases data was utilized together with classified land use data in order to investigate the infectious disease distribution using dasymetric method and areal interpolation method. The results showed that the rate of infectious patients in residential area was 25.75 per 1,000 inhabitants and the rate of non-residential area was 24.92 per 1,000 inhabitants. The highest rate of infectious disease was found in the residential area of Chomtong district. Moreover, the comparison of coefficient of variation (CV) between dasymetric and areal interpolation techniques showed significant difference. The dasymetric method had significantly lower average rate of infectious disease than the areal interpolation.


location: , 'Thailand year: 2010 source: HSRI

title: Revealing the Mental State of Prison Inmates using Art

abstract: This research was intended to discern the adverse mental state of prison inmates based on their
expression of art images. Thirty inmates, 20 males and 10 females aged 24-57 years, were subjected to
psychoanalysis by two psychologists, and interpretation of their drawings by the art investigator.
Results obtained by the psychology group and the art educator were then compared, discussed and
a conclusion reached. It became evident that in the present project the drawings did not demonstrate
revelations as expected in the objective nor were they in accord with the psychologist’s findings; the
outcomes of both groups denoted only the prisoners’ present mental state, reflecting their factual situation
as prisoners. In realizing that the present study included subjects who were prisoners because of
having committed crimes that were not so serious, mental state was similar to that of normal persons.
Therefore, the researchers decided to carry out further research on persons convicted of committing more
serious crimes, which theoretically might be reflected in a more severe innate mental status.


location: , 'Thailand year: 2008 source: HSRI

title: Chronic Care Model

abstract: Although effective treatment of and care for some chronic diseases exist nowadays, the majority of
patients with such diseases still do not receive appropriate treatment. This is due to: (a) the rapidly rising
number of patients in parallel with the increasing age structure of the population, which exceeds the
ability of the existing health-care system; (b) the health-care system falling short in its ability to translate
knowledge into routine medical practice; and (c) the health-care delivery system being designed for acute
patient care; it is poorly organized for providing the full complement of services needed by people with
common chronic conditions. The chronic care model (CCM) was developed in the 1990s, based on the
premise that effective chronic illness care can be delivered by prepared provider teams who engage productively
with an activated, informed patient. The six dimensions of CCM that enhance this productive
interaction include the following: (1) self-management support; (2) delivery system redesign; (3) a clinical
information system; (4) decision support; (5) health-care organization; and (6) community policies and
resources. To date, CCM has been applied for patients with diabetes, cardiovascular disease, chronic
respiratory diseases and asthma, depression and HIV infection. Evaluation results, particularly for diabetes,
show that the implementation of CCM improves the process and immediate outcomes of care. However,
its long-term impact on patients’ longevity is still undetermined.