location: , 'Thailand year: 2003 source: HSRI

title: Nurses and the health service system at primary care level

abstract: This research report entitled “Nurses and the Health Service System at Primary Care level” aimed at conducting a process to develop concepts, design and a management system at primary care level in a socio - cultural context and the health system reform. Emphasis was placed on proposing nursing as a major tool for the development of a health services system at primary care level. The study was conducted collaboratively by nursing faculties and a nursing department of 6 universities and the Thai Nursing Council. Universities were Khon Khan, Chiang Mai, Mahidol, Burapa, Prince of Songkhla and Walailuk .The study was a participatory action research design employing epidemiological study and a qualitative descriptive approach, focused on stakeholder’s participation. The target sample were health care consumers especially community leaders, members of local authority organizations and health service providers who were nurses and other health personnel. The key informants reflected the current situation of health services for the community. Models of health service delivery systems at primary care level from different settings were critically analysed and synthesized including to roles and functions of nurses in providing health care in communities, especially for the strengthening of the self care capacity of individuals and the self-reliance of communities. Nurses roles and functions included collaboration with local authority organizations in developing health policy and appropriate strategic plans for local health care. Knowledge generated from the findings of the study provides descriptions of health service delivery systems at primary care level which includes health care demands, type of health services needed, type of health personnel required and its management structure. The findings are as follows. The desired primary care service should be a service that should be as a bridge between people and the local health service system. It should be easily accessible, cover all age groups, all dimensions of health, integrated and continuous of care including collaboration with other health services and appropriate referral systems. The service should focus on empowering individuals and families in self-care, the use of local wisdom, and encourage community participation. The structure of the primary care service management could be best designed by considering the potentiality of each setting. The underlying principles for structural design include : health service strategies, health care activities, characteristics and competencies of health service providers, financial management, availability of human resources, health units, quality of service and primary care networks. Conditions contributing to the quality of the primary care service system Government policy should be stated clearly regarding service management that covers all characteristics of the desired primary care services including the establishment of mechanisms for administration, financial systems and human resource development. To achieve the goals of health care at a primary care level, adequate numbers of health professionals should be provided in designated areas. The ideal ratio of health care providers to population should be 1 : 3,000 .Health service providers who are professional must be legally protected by professional legitimization of their practice. There must be standards or guidelines of practice in health care and service, and quality must be ensured. To encourage effective care, the services must collaborate with others institute and organizations in a networking atmosphere. Recommendations for involving authorities. Government must have clear policy and measures on health care finance, resources allocation, laws and regulations, workforce production and development, decentralization and participation in health care. Professional councils mustlegitimize the practice of health care providers. Develop standards and practice guidelines for primary care and develop systems and mechanisms for quality control, audit and assessment including promoting and sharing understanding of concepts and professional roles and functions among its members. Under the current situations of the country health care system, it is proposed that the professional nurse is the most likely person to generate quality of health services at primary care level. There are two strategic approaches to the designs of the system management structure.1). using the existing structure and modifying roles and functions of professional nurses through capacity building.2). creating new structures to implement the appropriate ratio of health service providers and population in designated areas. These two approaches must be pursued under the contracting system for networking services. Collaborative efforts with educational institutes must be made for human resource planning and development of new and existing nursing personnel to be able to provide effective services at primary care level. Health institutions and primary care units should have clear policies and plans for financial management, collaboration with educational institutes and other supporting systems. Professional organizations at all levels must work collaboratively in developing shared visions, concepts and understanding among its members, standards and guidelines for practice, quality management and the enhancing of a network of professional entrepreneurship in community health care.


location: , 'Thailand year: 2020 source: HSRI

title: The Efficacy of Fungal Quorum Sensing Molecules in Treatment of Systemic Scedosporiosis focus on common pathogenic Scedosporium species in Thailand (First-year)

abstract: Scedosporium spp. are human pathogenic fungi causing infections among non-Aspergillus spp. especially in immunocompetent and immunocompromised individuals. Moreover, these pathogenic fungi are highly resistant to standard antifungal drugs whereas effective drugs are highly expensive and give several side effects. Co-treatment drugs have begun to be developed to increase the effectiveness of treatment against Scedosporium infections. One of them is the quorum sensing molecules (QSMs). These QSMs are produced from fungi and play a role in reducing the growth of fungi, especially in the drug resistance group. One of the substances that are increasingly being studied for their role in fungi is Tryptophol (TOH). This research aimed to investigate the role of TOH in the inhibition of fungal infections that were common in Thailand including Scedosporium apiospermum, S. boydii, S aurantiacum, and Lomentospora prolificans. Our study revealed that TOH exhibits an MFC of 8 mM, which is able to stimulate THP-1(Macrophage) and Jurkat cells (T cells) at different time point, 3 and 6 hours post treated respectively. The up regulated cytokines after co-culture with TOH including M1 cytokine , which play a role in the elimination of microorganisms as IL-6 (2, 2.2 folds). T-helper cells cytokines such as คือ IL-17 (4.2, 1.9 folds) and IL-23 (3.8, 2.1 folds), as well as the specific eumycetoma IL-1β (1.7, 2.7 folds), IL-12(3.2, 3.2 folds), IL-37(3.0, 2.6 folds), and IL-35(2.7, 1.9 folds), but not induce apoptosis in both fibroblasts and macrophages. Instead, TOH induced fungal apoptosis as determined using Ethidium bromide/Acridine orange, which corresponded to a 2.2-fold decrease in CARD-9 and a 2.6-fold increase in BCL-2 expressions. After obtaining the laboratory results, our research team began a series of experiments to develop a prototype of neutropenic mouse model of eumycetoma. To produce neutropenic mice, injection of cyclophosphamide at 150 mg/kg were administered. Then, eumycetoma formation was observed in day 3 after intradermal injecting 1x106conidia of Scedosporium spp. at the back of neutropenic mouse. Moreover, our team also developed a prototype emulsion-gel product containing TOH and tested the effectiveness against Scedosporium spp. infection. Our study revealed that the tumor size was reduced after treating with TOH emulsion-gel in infected mice. Moreover, we also expanded our study using an invertebrate in vivo model of Caenorhabditis elegans. Our preliminary results revealed that life span virulence tests and the efficacy of TOH against all four Scedosporium spp. infections exhibited similar promising results to neutropenic mouse model of eumycetoma, suggesting that C. elegans can be used as a powerful alternative model for researchers in microbiology, pathology, and pharmacology in the future.


location: , 'Thailand year: 2021 source: HSRI

title: Survey of public perspectives toward population adherence to COVID-19 mitigation policy following the outbreak in the first half of 2021

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


location: , 'Thailand year: 2008 source: HSRI

title: Evaluation of Hospital Quality Improvement in Mayo Public Hospital by Concept of the Thailand Quality Award

abstract: In order to achieve the standard and effectiveness of care and finally to enhance the quality of life of
people, strategies to improve the quality of services is an important approach for both public and private
health sectors. Mayo Hospital is one of many hospitals that has implemented the TQM/CQI, as recommended
by the Hospital Accreditation (HA) standard for a health promotion Hospital. In addition, Mayo Hospital has applied the criteria for the TQA award in order to evaluate the outcome of implementation.
The purposes of this study were to describe the strategies and outcomes related to the implementation of
quality improvement of services at Mayo Hospital based on the six aspects of the TQA criteria. Both
qualitative and quantitative methods were used in this study. A questionnaire was sent to health personnel
asked about the working atmosphere and organizational environment. In addition, in order to gain
better understanding about the organization’s vision, facilitating and inhibiting factors and lessons learned,
in-dept interviews were held with seven administrative staff and document analysis of a self-assessment
form was conducted. Content analysis was applied for assessing the qualitative data, while quantitative
data were analyzed using percentage, mean, and standard deviation.
The results of this study revealed that, based on six aspects of TQA, leaderships and patient-customer
focused aspects were at the level of improving, while strategic planning and internal process were
at the level of awareness to improving. In addition, the MIS and human resource, development and
administration were at the level of “awareness”.
The strengths of Mayo Hospital were that the administrative team had good understanding about
quality development while the health personnel were involved in determining the directions and goals of
the organization. In addition, patient and customer centered care is their priority of the services. The
coordination among departments was well developed. However, there were areas that needed improvement,
including dissemination of the organizational mission so that it could be transformed into practice,
the information system, the development of practice guidelines or standards of patient-centered care in
all departments, human resources developments, and collaboration and coordination across departments.


location: , 'Thailand year: 2021 source: HSRI

title: Proportion, Patterns and Associated Factors of Inappropriate Antibiotic Prescriptions in Acute Upper Respiratory Tract Infection

abstract: Objectives: To study the proportion, patterns, and factors associated with inappropriate antibiotic prescription (IAP) in acute upper respiratory tract infection (ARTI) at the Student Health Center (SHC), Prince of Songkla University (PSU). Methodology: A descriptive retrospective study was conducted by reviewing medical records from the hospital information system (HIS) of Songklanagarind Hospital. Seven hundred and thirty ARTI patients, who met inclusion criteria at the SHC, PSU from 1 January to 30 September 2018 and diagnosed with common cold, acute pharyngitis, and acute tonsillitis under the ICD10 code. Four hundred and thirty-four patients were excluded after medical record review. Descriptive and inferential statistics were employed in the data analysis using the R® 4.0.0. software program. Associations were evaluated via odds ratios with 95% confidence intervals. The level of statistical significance was set at p<0.05 using multivariate analysis. Results: Two hundred and ninety-six participants were enrolled in the study. The proportion of antibiotic use in ARTI was 17.2% (51 of 296). Among antibiotic prescriptions, the proportion of IAP was 80.4 % (41 of 51). The patterns of IAP were as follows: no antibiotics indication 90.2% (37 of 41), wrong duration 26.2% (11 of 41,—a 5 day amoxicillin therapy was the most common 27.2%), and wrong dose 12.2% (5 of 41,—all received amoxicillin in the dose of 2,000 mg/day). The multivariate analysis demonstrated that factors significantly associated with IAP were being a patient with an underlying disease (adjusted OR=4.22, p=<0.001) and a nurse practitioner as prescriber (adjusted OR=10.93, p=<0.001). Conclusion: Antibiotic prescriptions in ARTI at the SHC, PSU did not exceed the 20% rate set in the rational drug use hospital policy for antibiotic prescription criteria. Nevertheless, the proportion of IAP among ARTI patients was high, and the most common pattern was prescribing antibiotics without an indication. Therefore, future research should focus on how to enhance the adherence to antibiotic prescription guidelines to promote appropriate antibiotic prescription, especially among nurse practitioners.


location: , 'Thailand year: 2022 source: HSRI

title: Developmental Evaluation of Payment Methods to Support New Normal Health Care Delivery Outside the Hospital for Patients with Chronic Conditions (Year 1)

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


location: , 'Thailand year: 2020 source: HSRI

title: The Evaluation of Intermediate Care for the Elderly in Thailand according to the Ministry of Public Health’s Policy

abstract: This mixed methods (qualitative and quantitative) study aimed to 1) illustrate the situations of intermediate care for older adults according to the Ministry of Public Health’s policy, 2) evaluate the implementation of intermediate care to older adults according to the Ministry of Public Health’s policy and 3) propose policy recommendations to improve intermediate care in Thailand. Seventeen healthcare facilities providing intermediate care to older adults were multi-stage sampled from the Ministry of Public Health provider sampling frame of 897 hospitals covering 4 regions from the North, Northeast, Central and the South. Key informants comprised 30 executives at the central and provinces, 1,008 intermediate care providers, and 23 academic experts attending final policy meeting. Questionnaires and guidelines for interview including group discussion were the tools used for data collection during September 2019 and June 2020. Quantitative data were analyzed with descriptive (frequency, percentage, mean, standard deviation) and inferential statistics (median test, paired t - test, t - test, Pearson correlation, and stepwise multiple regression). Qualitative data were analyzed by content analysis. The followings are main findings. 1. The hospitals in 8 provinces can be divided based on service data into 3 groups: 1) intensive intermediate care services, 2) moderate intermediate care services, and 3) moderate intermediate care services with limited evidence from questionnaire and individual inpatient data. Group 1 hospitals had longer length of stay (LOS) than other groups in all 3 conditions; stroke 9.2 days, traumatic brain injury 13.6 days and spinal cord injury 26.8 days. The stroke patients in group 1 hospitals showed better patient functional improvement by higher difference of Barthel index (DBI) than in group 2 hospitals (4.0 vs 1.8, independent t-test 3,381 = 12.51, p<0.01). The medical expense had a low positive correlation with LOS (r = .17, p< .01). The DBI has a positive correlation with LOS (r = .17, p<.05) but a negative correlation with age (r = -.04, p<.05). 2. Responses from 1,008 questionnaires gave a fair mean score for intermediate care service to older adults (x ̅ =3.6, S.D.=.5). The highest score was for policy acceptability (x ̅ = 4.0, S.D .= .6), followed by the feasibility of policy (x ̅ = 3.7, S.D. = .6), and lowest for cost support (x ̅ = 3.2, S.D. = .7). By Pearson’s correlation, the policy appropriateness had the highest correlation with the adoption (r=.73, p<.01), followed by the policy acceptability and the adoption (r=.67, p<.01). The sustainability of intermediate care was positively correlated with all dimensions of policy process and years of experience in intermediate care, with highest correlation with policy penetration (r = .57, p<.01). By multiple regression analysis, policy penetration (B = .411, t = 12.603, p<.01), policy feasibility (B = .161, t = 4.833, p<.01), and policy acceptability (B = .134, t = 4.425, p<.01) were predictors of sustainability (Adj. R2 = .367, p<.01). 3. Key success factors of the implementation of intermediate care policy from qualitative methods were listed: 1) executives with visions plan, set clear goal and constantly monitor results, 2) service provider commitment with good multidisciplinary teamwork, and 3) the service system preparedness, efficient resource sharing, shared practice guideline and care models with strong multidisciplinary network. Constraints were lack of staff’s understanding on policy and practice; inadequacy workforce and competent staff; shortage of resources or material including budget, and medical supply; and inefficient patient referral and information system. 4. Policy recommendations include clear policy communications cascading with localization flexibility, integrated seamless care by enhancing the role of family medicine, health workforce recruitment that fits with intermediate care demands, common information platform facilitating referral of data among providers and payers, extension of service scope to more health conditions and age groups, and establishment of appropriate and comprehensive payment systems.


location: , 'Thailand year: 2015 source: HSRI

title: Home Modifications for People with Disabilities and the Elderly: Recommendations from Policy to Practice

abstract: Home and environment modifications are essential to improve quality of life (QoL) of persons with
disabilities (PWDs). Our research aimed to conduct economic evaluation of home and environment modification service to develop the service guideline and address policy recommendations to improve
the services and to suggest how the resources should be mobilized. Sixty houses of PWDs were recruited
based on designated criteria. Capacity building sessions for architects, engineers, local builders, nurses,
physiotherapists and social workers were also conducted. Functions of PWDs before and after modifications
were recorded using the questionnaire based on the International Classification of Functioning,
Disability and Health (ICF). Forty-nine houses were successfully modified. The important findings from
this study were that (1) the home and environment modification service was cost-effective (2) health
personnel and non-health personnel should be involved in the selection process of PWDs who are
suitable to receive the service and (3) PWDs and family members should also be invited to participate in
all construction process. Those with the same impairments may not end up with the same design of the
home and environment modifications because the design depended upon PWDs functions. If the ultimate
goal of services for PWDs is to improve QoL, the home and environment modification is merely one
among other tools to enhance QoL. We recommend that to provide the service, the following procedures
should be considered: stakeholder linkage, resource integration and allocation, decision making based
on functioning data and capacity building. Knowledge management should be conducted to add more
knowledge and understandings.


location: , 'Thailand year: 2000 source: HSRI

title: Persuit of rights and equity in health : social and cultural perspectives for health care reform in Thailand

abstract: Pursuit of rights and equity in health: social and cultural perspectives for health care reform in ThailandThis research is aimed to understand people conceptualization of rights and equity in health from Thai socio-cultural perspective.The research is exploring how people construct meaning of rights and equity in general and how they applied it in issues of health and health care. Numbers of civil organizations are selected based on their local establishment and their concern for local social, health, economics and environmental problems. Members of these organization are selected interview to represent diverse social and economic background of people in the local areas. Focus group interview is applied to bring people opinion,   conceptualization of the terms rights and equity as well as how they see right and equity in health fit their frame of thought.This research try to understand people perception of their current equity in health and their actual needs as well as expectation for better health care. The result of this research is expected to be use in finding direction, patterns or model for health care reform that in concert with human right and equity. Information provided here could be useful for policy implementation and health care reform. This research reveals that civil society/people organization in Thailand has not yet active in raising issues of health as right. When question of right asked people interpret it differently. One set of perspective stress rights of individual. Some groups discussed right of individual provided by law and considered it as to have individual choice. Some groups emphasize the interrelation between individual and community right that "one should have, should be and should receive." Another perspective focuses on rights as social, public, and cultural affairs. However, most people reflex that in the current situation of Thailand, people have not have any right to determined what should be their rights. They have no participation in formulating the right and  do not know what rights they have or granted by the government. They conceived that rights that are provided by the government today are not what common people want. People criticized that government set out rules and regulations without considering social circumstances and cultural tradion of the people. Therefore, many of those rules are not used and sometimes inapplicable. The term equity is too abstract for every groups interviewed in this research. Most people think of it in the same was as equity, particulary when they assess the inequity to health care service.


location: , 'Thailand year: 2019 source: HSRI

title: The Reform of Thailand National Security of Drugs and Medical Supplies

abstract: At present, the management of drugs and medical supplies in the emergency is not very efficient. In addition, Thailand very much relies on the importation of drugs and medical supplies in the normal circumstance. This research study aims to review and analyse the management situation of drugs and medical supplies and to propose the recommendations to reform the management of drugs and medical supplies for Thailand in emergency and at normal situation. This study was designed as a qualitative study. The data was collected using qualitative approaches including the literature review, focus group discussion with stakeholders, in-depth interview with experts and Delphi Technique. The study revealed that to reform the system towards the goal of drugs and medical supplies security in the emergency, the national master plan is needed. There is also a need to assign Division of Public Health Emergency Management (DPHEM), Office of the Permanent Secretary, Ministry of Public Health to be the focal body with the aim to integrate and cooperate with all other related agencies. The Information and Communication Technology Center should be assigned as the main responsible organization in the reform of the IT system. In addition, the study also indicated that the national list of drugs and medical supplies to be reserved, the quantity to reserve should be determined using the scenario planning technique. Moreover, a new law specific to the management of drugs and medical supplies in the emergency should be developed to enhance the efficiency of the management system. Regarding the self-reliant capability, the study indicated that the reform should first start with fast re-structuring of the existing organizations which are responsible for the improvement of drugs and medical supplies industry and reviewing of their roles and responsibilities to put special focus on drugs and medical supplies. The approaches to reform should be performed throughout the entire supply chain. Furthermore, it is really essential to change the budgeting system and unite the working mechanisms among related authorities. Reduction of selling privilege of the Government Pharmaceutical Organization and other organizations which have similar privilege, aiming to create equity and enable real market competition, is one of the main findings from this study. The government should also support the budget to drugs and medical supplies industry to facilitate more efforts and investment in research and development and production, To conclude, the government should place as much emphasis as possible on this reform. Extensive effort should be carried out to facilitate the system reform. The focal authority should be strengthened on every aspect thus the actual integration could be established and the security of drugs and medical supplies of Thailand could be expected.


location: , 'Thailand year: 2003 source: HSRI

title: The Effect of 30 Baht policy in relation to the psychiatric service system : Thailand' overall view and case study of psychlatric hospitals in the Northern Region of Thailand

abstract: According to Thailand’s financial crisis many years ago, Thailand has dramatically developed new budgetary resources allocation system for public health finance through capitation payment for out-patient group and DRG relative weight to purchase inpatient care for in-patient group. However, this new system was likely to create moral hazards. For example, service providers give low quality medical service to patients, or accept only low-risk patients, and reject chronic patients like psychiatric patients. This study has a main purpose to analyze 30 baht service patterns provided by hospitals and taken by psychiatric patients in Thailand. Also, this research shall encompass to its continuing effects and adjustments by hospitals under health department of Thailand’s Northern region during budgetary year 2001-2002.Methodology	This retrospective narrative study collected and collated information from in-patients in all public psychiatric hospitals during budgetary year 2001-2002. Studying tools consist of in-patient data report, 12 file database or other compatible systems, budgetary fund & use report (Sor Jor Ro Ngor 1031), supporting fund  (Sor Jor Ro Ngor 1032), and fund from Sor Por Ro Ngor 102. Data have been analyzed by software programs e.g. SPSS/FW, Visual  Foxpro, Excel, and Arc View. Results This study has been classified into 2 parts as follows: Part I: According to psychiatric Service Pattern during budgetary year  2001-2002, there were 720 and 985 public psychiatric hospitals which have in-patient services in 2001 and 2002, respectively, In each year, there were over 70,000 psychiatric in-patients which mostly use psychiatric services in primary hospitals approximately 57 %, followed by hospitals under mental health department (36%), other hospitals with psychiatric service (6%), and medical school (1%), respectively.	In 2001, there were totally 387 Thai psychiatric doctors who approximately 80% have worked with public sector. Practical psychiatric doctors working with in-patient departments under public sector were only 211 which was accounted for MMM doctor to population ratio of 0.34:100,000 population.	Our finding reveals that psychiatric doctors are imbalance distributed evidencing from over half lived and worked in Bangkok Metropolitan. Additionally, provincial cross services were as high as 30% as public health district cross services were only 14%. Provinces with high psychiatric service record usually the ones that have psychiatric hospitals in the area. Most found diseases are Schizophrenia and Acute Psychotic Disorders, followed by Substance-Related Disorders, Anxiety Disorders, and Mood Disorders, respectively. Part II: From effect & adjustment study of hospitals under mental health department in Thailand’s Northern region during year 2001-2002, there were a total of 3 public psychiatric hospitals: Suan Prung Psychiatric Hospital, Nakornsawan Psychiatric Hospital, and Northern Child Development Center. These hospitals had a proportion of using budgetary fund of 80%-90% as capital return from service change is approximately 14-37%. In board perspective, supporting fund is likely to increase, During this study, budgetary fund support was insignificantly different. Hospitals have been adjusting their systems to 30-Baht policy by tight debt-following policy and diminishing length of stay for in-patients.Discussion	Currently, public health district cross services has recording high. This might come from the following reasons: an inequilibrium distribution of psychiatric doctors and hospital, reputation-lead-people to special hospitals. 30-Baht policy’s implementation drove changes on behavior of service  use & take pattern by pattern by patients and by service providers as follows: primary and secondary hospitals increased number of in-patients, length-of-stay, and individual service charges. Contrarily, number of patients, length-of-stay, and individual service charges in hospitals under mental health department was declined. 	Evidenced from hospitals in Thailand’s Northern Region, financial difficulties have slightly affected due to stable budgetary fund supported in year 2001-2002 even service charges collected from UC program being less in comparison with previous level. More significantly, dig-to earth practical adjustments have been implemented. Minimizing length-of-stay effect has drastically reduced service costs and expenses. However, due to short-period data collection under this study and disease not lead to death soon or immediate cure, so this research cannot be totally concluded at this stage, Further study should be extended and further study in patient’s perspective is worthy for exploration.


location: , 'Thailand year: 2018 source: HSRI

title: A Utilization-Based Model to Predict Human Resources for Health (HRH) in Secondary Care Services of Thailand 2026

abstract: The present study intended to provide information relevant to human resources for health (HRH) planning in Thailand. The objectives were to analyze and predict requirement for HRH including physicians, nurses, dentists, pharmacists, Thai traditional physicians, Thai traditional physician assistances, physical therapists, and medical technologists in the secondary care setting. We applied the utilization-based model and the approach developed by Segal. The study had 5 steps: (1) collecting utilization data by types of services (the public services under the Ministry of Public Health (MOPH), other public services and the private services); (2) forecasting the requirement for health services in the future using a change in demographics; (3) calculation of the total work hours that each HRH type spending on patients; (4) calculation of full time equivalence; and (5) conducting sensitivity analysis. We found that in 2026 Thailand would require more HRH: physicians 12,432 FTE; nurses 52,392 FTE; pharmacists 5,042 FTE; dentists 5,869 FTE; medical technologists 4,699 FTE; physical therapists 1,795 FTE; Thai traditional physicians 4,202 FTE; and Thai traditional physician assistants 3,043 FTE. However, if we add the other work (not only the health services work), the HRH will require more: an increase in physicians from 12,434 FTE to 14,297 FTE; pharmacists to 7,260 FTE; nurses to 60,251 FTE; dentists to 6,749 FTE; medical technologists to 5,404 FTE; physical therapists to 2,064 FTE; and Thai traditional physicians to 5,463 FTE. The current study confirms that Thailand will need more HRH in the future. It indicates the importance of demographic factor as an increase requirement on elderly health services. An increase in HRH production including financial and non-financial incentive policy options should be studied in details in the near future.


location: , 'Thailand year: 1999 source: HSRI

title: Sexuality and gender relation within family context : implication and strategies for community-based program for sexually trasmitted diseaese and HIV prevantion among rural married women

abstract: Sexuality and gender relation within family context : implication and strategies for community-based program for sexually trasmitted diseaese and HIV prevention among rural married womenThis study was a pilot study which employed anthropological methods. The study site was selected through purposive sampling. A village in Chiang Rai province was selected because this is an area where there is a high prevalence of HIV transmission and a large number of male migrant labourers. The  study sample consisted of married women and their partners who were living in the study villge, as well as well as key informants including health workers at the district level and village leaders. The study obiectives were to describe      	1)meanings and forms of conjugal relations among married rural couples, with a focus on idecology and the practice of gender roles and sexuality, 2)the magnitude and forms of womens sexual negotiation power, 3)perceptions of Sexually transmitted diseases and HIV risk among married rural women and men, and      	4)recommendations for community-based Sexually transmitted diseases and HIV prevention program for rural married couples. It was found that married women played major roles in both the domestic and economic spheres. The sexual division of labor was  not rigid. The meanings of sexuality among married couples included love, emotion, feeling, warmth and reproduction. Sexual communication between couples was non-verbal rather than verbal. The extent to which married women could negotiate within their sexual relations with their husbands varied from one woman to another. Factors which determined married womens sexual negotiation power were 1)women's economic status and roles,      	2)number of years in marriage, 3)age difference between husband and wife and 4)women's personalities. The author reveals that women's sexual negotiation relates to their relative position of power in other domains of life. It was also found that the most effective sexual negotiation strategy with the husband involved asking him nicely about extra-marital sexual activity, leading to a confession extra-marital affairs. From this study, the author describes four factors which exacerbate the risk of married women contracting sexually transmitted diseases and HIV. These are 1)women's low perception of the extra-marital sexual activity of their husbands, 2)the perceived social risk (risk to social relationship, personal identity and status) that influences women's actions/inactions associated with the risk of sexually transmitted diseases and HIV transmission,      	3)the lack of knowledge among married women of early symptomsand appropriate treatment-seeking for sexually transmitted diseases, 4)extra-marital unsafe sex among married women, and 5)the lack of familiarity among couples with the use of condoms in the context of marrisage. Strategies for Sexually transmitted diseases and HIV prevention among rural married couples 1)education women about their own bodies and sexuality as well as about reproductive tract infections and HIV, 2)action research to find appropriate starategies to promote women's sexual negotiation power, by using real case stories of women who face the risk of Sexually transmitted diseases and HIV transmission that match the level of negotiation power that women have, and 3)promotion of sexual  and family responsibility in programs targeted at men, i.e. emphasizing fatherhood for married men and using role model, approaches which model responsible male behaviour.


location: , 'Thailand year: 2003 source: HSRI

title: Thais' ideologies towards universal health coverage

abstract: The 30 baht universal health scheme established by Thai Government in 2001 proposed to provide welfare on health to Thai people. There are controversies whether this policy promotes equity in health.Objective: To study the ideologies of Thai people towards the universal health coverage policy.Method: Qualitative research complemented with quantitative method. Citizen dialogue technique (or weekend meeting) was applied to 100 people randomly selected in each province for the meeting. Participants gave their views in the questionnaires before and after the meeting. The meeting started with small group discussion in the morning and whole group meeting in order to reach consensus wherever possible. The study was conducted in 4 provinces: Sukhothai, Ubonratchathani, Phuket and Samut Sakhon.Results: The turn up rates of participant ranged from 22-80% of the invited guests. They supported the idea of increasing copayment of 30 baht to finance the universal health coverage because they believed that fee increased would provide coverage for more people. They were willing to pay income tax for universal health coverage because they wanted better services. They said the government should not pool in money from the social security scheme to finance universal health coverage. However, some supported that the government should pool in only particular percentage of money from social security scheme to manage the universal coverage policy. Most of participants agreed that the government universal health coverage should not focus on only the low  income people because all people should have equal right to universal health coverage. Furthermore, the government should not increase user fee for those who cross the boundary for services (or against the universal health coverage guidelines), and people whohad an accident or were ill outside their contracted hospitals should not be punished by payinghigh fee. Finally, the universal coverage policy should not limit access to high cost care, they preferred to see the policy as advertised “30 baht for all diseases”. 	Conclusions: These Thais’ Ideologies were mixed between egalitarianism, communitarianism and  utilitarianism. These ideologies represented that Thai people believed in the collective roles of the government to provide health services to all Thai people. Key words: universal health coverage, weekend meeting, egalitarianism, libertarianism, communitarianism and utilitarianism


location: , 'Thailand year: 2023 source: HSRI

title: Lessons Learned from the Operations of International Sports Events during COVID-19 Pandemic

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


location: , 'Thailand year: 2009 source: HSRI

title: Efficiency of Three Laboratories in Detecting Cryptosporidium in Stool Samples

abstract: Cryptosporidium parvum is one of the leading causes of opportunistic infections among HIV/AIDS
patients. Due to the small size of its oocysts, detection of this protozoan requires special staining and
laboratory expertise. In this study, we compare the effectiveness of the three leading parasitology laboratories
in Mahidol University, Thailand. Serial concentrations of Cryptosporidium parvum oocysts from 6 to
1,500 oocysts per 10 μl were added to stool samples and distributed to the study laboratories. Conventional
microscopy and special staining, using dimethyl sulfoxide (DMSO) modified acid-fast stain and
modified cold Kinyoun’s acid-fast techniques were applied. The sensitivity of both techniques was similar.
All three laboratories could detect at least as many as 20 oocysts per 10μl with no statistically significant
difference (p= 0.998). Either staining method could be applied at any laboratories serving HIV patients
with opportunistic infections. However, training laboratory technicians to acquire such expertise
and standardize it is necessary. Effective laboratory diagnosis would be very helpful for physicians, leading
to patients’ appropriate management.


location: , 'Thailand year: 2018 source: HSRI

title: Work Pattern and Job Satisfaction among Thai Physical Therapists in Public and Private Sectors

abstract: In Thailand, health system has increasing concerns on physical therapy (PT) workforce planning for aging population. The workforce projection study should also cover on attrition and retention. To determine work pattern, job mobility, satisfaction of Thai physical therapists and their determinants among public and private sector physical therapists were necessity. During January to April 2013, we conducted a cross-sectional survey on a subgroup of physical therapists (PTs) working in 360 healthcare facilities in 13 provinces of Thailand. A self-administered questionnaire was used to collect variables including socio-demographic characteristic, work status, job satisfaction, and professional mobility. Descriptive statistics such as frequency, mean, median were compared between public and private sectors. Factor analysis was also applied for 10 items of job satisfaction. Plan to leave the PT profession was compared with adjustment for the variables using logistic regression. From a total of 858 active PTs, there were 553 respondents (64.5%) in the study. Working status of private PTs was better than public one in terms of higher incomes, more permanent positions, less work load, and less involvement in prevention and research. However, PTs in the public sector had significantly higher work benefits. Job satisfaction of PTs was influenced by 3 main factors including professional fulfillment, job stress, and physical exhaustion. Within 5 years, one-quarter of the public PTs (23.5%) and one-third of the private PTs (36.1%) had a plan to leave the profession. For longer term, half of the public sector PTs (50.8%) were going to work until retirement. The private PTs were 2.4 times more likely to leave the profession after adjustment for age, income, and all 3 sub-domains of job satisfaction. In conclusion, the national health workforce planning in Thailand should improve the PT’s working conditions in consequence of fulfilling and solving the problem of inadequate PT workforce and high attrition.


location: , 'Thailand year: 2002 source: HSRI

title: Health status researcher network project : health status measurement for Thai people

abstract: The Health Status Researcher Network Programs, one of the Health Intellegence  Network programs, are immensely supported by Health Systems Research Institute, Thailand. The objective of this programme is to generate linkage among researchers, health experts and those who are interested in interlinked network collaboration, but organize independently, on the basis of data characteristics and their applications.	The program, initiated in July, 2001 is of reviews for selecting suitable health status measures for Thailand. Further developing these indicators for use at the local and national levels is the program’s next step.	It is proved that the importance of measures for assessing health status of population becomes ever greater. Firstly, findings from the process for preparation of REPORT on HEALTH of THE NATIONS,Thailand  2000 ,clarified that data were available but these scattered data are not systematically well-organized for shared usage. Data generation and analysis, besides data collection, is relied mainly on each individual organization or researcher’s interest, which leads to lack of overall consistency and reflection. Secondly, Thailand is currently in the midst of transitional environments such as devolution and health system reforms. Inevitably, such changes  affect on national, provincial and local restructuring that encourages operational mechanisms of such levels to be more autonomous. The decision making process, therefore, requires locally specific data in order to manage to its fullest capacity. Also, preparing provinces or other subnational-levels for sufficing their own data for measuring health status, disease burden and system performance is needed. Lastly, standard concepts and definitions, most importantly, applied in the context of health care reforms, are needed to make a clear aligned understanding in describing or measuring health systems, health promotion or disease and injury prevention, which, in various countries, are currently adjusted for policy efforts. For instance, health promotion has become a critical procedure in monitoring public policies. In the new health systems, new tools are needed for making development at both national and local levels. The objectives of this program are toSearch for indicators measuring health status of Thai populations utilized appropriately at the  national and provincial levels.Establish researcher networks for developing a consistent and sustainable system of population’s health status assessment.Develop local- area researchers through capability buildings and establish extensive networks at all levels.Generate a health status assessment manual that is for use at the provincial level.Disseminate health status and related reports periodically.The first phase of this program centers on reviews of global and national health status indicators, having consistently been developed, thereby, presenting proposed indicators that are appropriate for Thailand at the provincial and national level application. Moreover, such measures can be used for inter-country comparisons for overall and sub-level reflections by age and geographic distribution.Such reviews include 1) consideration of concepts, theories, definitions, advantages and disadvantages of each indicator used for measuring health status of the population, problem prioritization, cost-effectiveness, and equity. 2) consideration of data sources in respect to systematization and reliability. 3) consideration of feasibility of the indicator application at the local level.  Based on researcher team’s expertise and indicator characteristics, the reviewed measures are broadly classified into 3 categories; namely, Basic Demographic Measurement, Negative Health Measurement and Positive Health Measurement.Basic Demographic Measurement, of which is not only themselves the fundamental indicators in directly reflecting the health state of population, but also the basis for calculating rate and other substantial health status indicators, in particular applied for use at sub levels such as the health service area or the provincial area. Quantitatively, ample data gathered from each sub area will be further aggregated into the national measures. Difficulty of sub-area measurement is a lack of data quality and reliability; therefore, development of database together with data generating agencies, such as Central Registration Office and National Statistics Bureau, is tremendously urged. Proposed indicators include number of population classified into size, age- sex structure , life table, infant mortality rate, maternal mortality rate, age-sex-specific-mortality rate, birth rate,total fertility rate, which are all presented at the provincial and national level.Negative Health Measurement defined by World Health Organization encompasses many different dimensions of health and functioning, and complex interaction with environment. At present, dynamic environmental transformation has brought greater evolution from single indicators to composite index and summary measures of population health, broadening area of health measurement. These measures are reflection of the unfinished health agenda and identify area where health gains can be made. This assists the national, as well as sub-level policy makers to make use of health policy and planning, including further determination of proper intervention. Proposed indicators regard cause-specific-mortality rate by age and sex, Year of Life Loss(YLL), incidence rate, prevalence rate, case-fatality rate, duration of disability, and natural courses of diseases and Year Loss due to Disability(YLD). Disability-Adjusted Life Years, the aggregate measure of YLD and YLL, and Disability-Adjusted Life Expectancy are included. 3. Positive Health Measurement mirrors the dimension of positive health in response to a paradigm shift in health system reforms from “cure-oriented health” to “promotion-emphasized health”. Life Expectancy or life longevity is not sufficient to measure life with good health. As a result, World Health Organization proposed Healthy Life Expectancy; that is, DALE or HALE in World Health Report 2000. In addition, developing indicators for measuring good health state of Thai persons at the individual level is necessarily encouraged in light of fully reflecting well beings covering physical, mental, social and spiritual dimensions, and, more importantly, being optimal for Thai society. This will result in accomplishment of health promotion policy. These developed measures are eventually called Healthy Thai indicators.The next step of this programme is to develop and test the proposed indicators, to develop health information system database in the targeted provinces, to establish local researchers and create extensive networks, to disseminate reports and data for interrelated communications among researchers and health experts, and to  institutionalize of knowledge pools of measurements for assessing health status of Thai population.


location: , 'Thailand year: 1995 source: HSRI

title: Criteria, guidelines and evaluating tools for the promotion and transfer of public health civil servants(administrative personnel level 8-10 and technical personnel level 9-10)

abstract: Criteria, Guidelines, and evaluating tools for the promotion and transfer of public health civil servants (Administrative personnel level 8-10 and technical personnel level 9-10)The recommendations propose strategies for personnel  assessment based upon the meri system whereby the scope of application will be limeted only to administrative personnel level 8-10 and technical personnel level 9-10. The proposed  merit system encompasses 4 components as follows : 1.criteria, qualifications and career ladder ; 2.procedure of assessment ; 3.responsible agency for evaluation ; and 4.assessment tools. The first three components could be readily put into action  while the last one or the assessment tools suggest experimental  models which could be further developed in detail for future  application. The salient feature of the recommendations could  be summarized as follows : 1.criteria for assessment and career ladder are clearly designated to spell out the basic qualifications of the personnel to be assessed and steps of professional growth 2.open opportunity for concerned personnel to submit their work history and future plan propused to implement in the desired position, including open opportunity to apply for recruitment in the desired position. 	3.existence of an agency to screen essential information and data before submitting to policy makers for consideration through the 3 essential steps : step 1 : the evaluation committee considers the evaluation forms and grades them on a regular basis ; step 2 : the searching committee screen out unqualified  personnel, evaluate the applicants and makes recommendations for futher      consideration ; step 3 : the selection committee proposed the short list of appropriate applicants to be considered by the responsible policy makers. The Permanent Secretary and Director General will take part in the selection process as well as designate policy for the three  foresaid committees. 	The overall recommendation were made under close cooperation of high level administrators, expens and  technicians concerned and they were proposed for open critique and comment by health personnel level 8-10 who will be directly affected by this undertaking in a consultative meeting before final submission. This paper is in short the recommendations for establishing a sound merit system in personnel administration which proposed detailed guiding principles for implementing the system in its early stage. It is noteworthy that the establishment of the merit system requires continuing endeavours in organizational development, interdepartmental cooperation, development of tools and database for personnel assessment which, in the long run, could be evolved into an effective Personnel Assessment Centre.


location: , 'Thailand year: 2023 source: HSRI

title: Developing a Model of a Primary Care System for Provincial Administrative Organizations (PAOs): A Case of Rayong Provincial Administrative Organization

abstract: Current literature raises caution against the indiscriminate application of decentralization and advocates careful formulation of decentralization measures to prevent the unintended perverse consequences. In 2021, Thailand has embarked on a large-scale decentralization reform that resulted in the transfer of 33.21 % of subdistrict health promoting hospitals (SHPHs) to 49 provincial administrative organizations (PAOs). SHPHs serve the important function of providing primary care services as stipulated in the 2017 Constitution. In Rayong—a province along the eastern coast of Thailand, 40 SHPHs were transferred from the Ministry of Public Health (MOPH) to Rayong PAO in 2022. This research sought to understand the problems and obstacles facing Rayong PAO after it became responsible for 40 SHPHs and their primary care function. The research also attempted to analyze how Rayong PAO has managed to solve these problems and planned for the future challenges of primary care. The World Health Organization’s (WHO) six building blocks of a health system was used to guide our research. Data were collected by interviews and focus group discussions. A total of 62 key informants participated in this study. This research found that after decentralization, SHPHs experienced severe staffing shortages, particularly the shortages of physicians and dentists. However, these staffing shortages were chronic organizational problems that existed in the Thai health system prior to decentralization. Confusion arose immediately after SHPHs were transferred to Rayong PAO, as the Thai government did not provide adequate financial resources and clear guidelines on medicines and medical supplies, population health data management, and primary care service provision. Despite all these shortcomings, Rayong PAO demonstrated a coping capacity that enabled it to use all the available resources and networks to ensure the proper functioning of SHPHs. The salient elements of Rayong PAO that contributed to its coping capacity included: (1) the comprehensive health promotion strategy, (2) effective solution for staffing shortages, (3) clear plan for SHPH development, (4) experienced and skilled advisory team, (5) efficient area-based health committee, and (6) strong relationship with the family medical doctors in the area.


location: , 'Thailand year: 2021 source: HSRI

title: Cost Analysis and Factors Affecting Treatment Cost of HIV/AIDS at Phra Thong Kham Chaleom Phrakiat Hospital

abstract: This study was a retrospective descriptive study. The objectives were to determine the costs and formulate the cost function due to HIV and AIDS treatment from a provider perspective for the fiscal year 2018 at Phra Thong Kham Chaloem Phrakiat Hospital, Nakhon Ratchasima province. Descriptive statistics were used to summarize demographic characteristics and costs. Stepwise multiple regression was employed to construct the cost function. Ninety-six patients with complete cost data were analyzed. Male and female was equal. More than sixty-nine percent aged higher than 40 years old (mean age 42 years). The total treatment cost was 1,652,314 baht, or an annual average of 17,212 baht per person. Based on the fitted regression model, the significant explanatory variables included drug resistance, the number of out-patient visits, age, and adherence to treatment. The model could explain fifty-seven percent of the cost (Sig. F<0.001). In conclusion, the present study provided a description of costs of HIV and AIDS treatment. It also explored factors affecting institutional costs. These data can assist financial and efficiency management.


location: , 'Thailand year: 2020 source: HSRI

title: The synthesis of political suggestion for the development of Accredited Drugstore Co-working with Family Medicine Clinic

abstract: Introduction: The work of the Family Medicine Clinic (Primary care cluster) is limited, that is, the pharmacist is not enough. Pharmacies as a co-service unit should therefore complement a complete pharmaceutical system. Method: Participatory action research in the area of Khon Kaen, Phetchabun Phitsanulok and Songkhla under the project to reduce hospital congestion by the drug store mechanism. The study period consisted of 3 research phases in Phase 1 to develop a model for the pharmacy that is a unit in conjunction with a family medicine clinic and establishing guidelines. In phase 2, putting them into practice in the area. And the research in phase 3 is to evaluate the outcome of drug use problem management. Satisfaction and opinions of pharmacists, patient and health care provider in the family medicine clinic and economic results. The objective is to develop a service model of a pharmacy that is a joint unit with a family medicine clinic. Evaluating the management of drug problems of the people who come to the pharmacy. Evaluate the satisfaction of patients and healthcare workers with the developed models and assess the economic results of the developed models. Results: The service model of quality pharmacies and GPP pharmacies as a joint service was developed. Additional pharmacy services which developed in this study are Medication therapy management (MTM) as well as waste drug management and health promotion for patients who come to receive services in the project to reduce hospital congestion by the drug store mechanism. The results of the development have resulted in the management of drug use problems. Behavioral problems, and residual medicine, found a total of 14,211.22 baht, most of which cause 55.03% of patients who did not comply in drug use, followed by 38.48% of over prescription. Most common drug related problem is noncompliance and the most common health behavior problem is diet problem. For the results of assessing the satisfaction of the clients in various areas, a full score of 5 found that the clients were satisfied at the highest level in all aspects. Both the service procedures, which consisted of the appropriateness of the service procedures by community pharmacists (4.77 ± 0.46) and the appropriateness of the duration of service from community pharmacists (4.77 ± 0.47). Pharmacists, which consisted of service etiquette of pharmacists (4.88 ± 0.33) and pharmacists, can help resolve drug use problems of patients (4.81 ± 0.44). Knowledge of disease and self-received drugs (4.72 ± 0.51) applied knowledge gained from community pharmacists to apply for self-care (4.75 ± 0.48) and reduce the time to wait for service compare with hospital (4.86±0.37) and overall satisfaction (4.87±0.36). The results of the satisfaction assessment of pharmacists were the highest (4.27 ± 0.69). Except for the appropriateness of compensation which was satisfied at a high level (3.84 ± 0.86). It was found that the total cost per time of service in the model 1 was 104.24 baht per time of service. It can be seen that the cost of drugstores in Model 1 is greater than the remuneration paid by the NHSO to the pharmacy, which is 70 baht per time of service. In addition, when the cost per item of drug is 31.03 baht per one item of medicine dispensed by the pharmacist and giving advice on drug use. For model 2, it was found that the cost per time of service was 176.73 baht per time, it can be seen that the cost of Model 2 is 106.73 baht higher than the remuneration paid by the NHSO to the pharmacy. Conclusion: The drugstore in the project to reduce hospital congestion by the drug store mechanism should be provide Medication therapy management (MTM) and health promotion services to patients, in addition to prescribing and giving medication advice because people are benefiting and satisfied. The National Health Security Office should increase the remuneration for pharmacists in Model 1 to at least 100 baht per visit and Model 2 to at least 170 baht per visit and to develop the potential of all pharmacies in the project to be able to provide services to manage drug use problems and health promotion to the patients.


location: , 'Thailand year: 2023 source: HSRI

title: Approach and Feasibility for Transfer Pharmacy Service from Hospital to Community Pharmacy

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


location: , 'Thailand year: 2008 source: HSRI

title: Thai Pharmacistsû Job Satisfaction, Organizational Commitment and Intention to Quit

abstract: This research was conducted to determine the relationship between job satisfaction, organizational
commitments and the intention to quit among Thai pharmacists, and to compare the influence of latent
variables in the model between pharmacists working in government service and private organizations. A
literature review was carried out in order to develop the assumption model. The study population comprised
pharmacists whose names were retrieved from the Pharmacy Council documentary system and
who had worked as a professional pharmacist for either the government service or private organizations.
The questionnaires, Cronbach alpha 0.63 - 0.94, covered individual dimensions, job satisfaction, organizational
commitment and intention to quit. A total of 542 pharmacists completed the questionnaires. Descriptive
statistics were used to analyze the data collected and t-test was used to compare the average
means. The LISREL program (version 8.72) was used for model testing and multi-group analysis. It was
found that the pharmacists who worked for private organizations had a higher level of job satisfaction and organizational commitment. The relationship model consisted of individual factors, job satisfaction,
organizational commitment and intention to quit; organizational commitment showed the highest correlation
with the intention to quit. The model accounted for 45.0 percent of the variance in intention to quit
and there was invariance across groups.


location: , 'Thailand year: 2007 source: HSRI

title: Northeastern Migrant Labor : Situation and Health Issues

abstract: Outstanding labour migration has been reported in the northern region
of Thailand leading to changes in physical and social aspects.  Subsequently effects on health status at individual, household and eventually community level
shall be witnessed.  This article was aimed at presenting situation, recommended
research issues and strategies in order to develop preventive measures and reassurance of adequate health services accordingly.
Presently, labour is classified as formal and informal.  Whereas, the latter
is not yet entitled to legal protection and benefits of the social security scheme.
These discriminations exist among some industrial labors undergoing unfairly a
series of probation periods.  As such, the phenomena calls for research related to
situation and pattern of employment; classificaiton of labor and required health
care/insurance; their health behaviors and proper health promotion measures.
Safety regulations and guidelines in working place, particularly in small,
and medium enterprises have often been neglected and the premises can avoid
monitoring of the public sector.  It may critically call for strong participation of
community and local health facility.  Research effort should, then, be made on;
development on tripartite monitoring and surveillance on safety work place,
labor protection system by community, and labor in home industries, guideline
for labor protection from occupational health risk, guideline on rehabilitation of
vulnerable labor with participation of family and community, an of health status
and safety of labor in service sector.
Haphazard movements of labor on provincial, regional and national
levels do not accommodate registration, provision and coverage of health care
and insurance with respect to their health needs.  Further development of health
care system, hence, should focus on accessibility.
Health and safety regulation information should also be disseminated.
The research issues should cover on an effective model for disseminating health
and safety regulation information at community level, life skill for adapting in
cross cultural environment, community and health facilities roles and functions
on surveillance on health, and self-care empowerment of labor Based on information synthesis and brain storm of experts and stakeholders, research strategies and issues were formulated as follows: strategic I promotion health of labor at community and strategic II self-care empowerment of migrant labor.  The research issues of strategic I include situation of labor health,
classification of labor based on health care system, effect and impact of Free Trade
Act (FTA) and new production pattern on health, monitoring and surveillance
on safety work place and labor health problem, labor protection at community
industries, health protection and rehabilitation of labor with high risk, and perception on labor’s right at community.


location: , 'Thailand year: 2012 source: HSRI

title: Health promotion and disease prevention policies and priority setting on health problems for children aged 0-5 years in Thailand

abstract: Health promotion and disease prevention (PP) policy has played a critical role in the Thai health care
system for a period of time. However, the implementations of such policies were still fragmented without
a clear strategic plan and goals. The development of PP policy focusing on certain age group in a systematic
manner was expected to help tackle those barriers. Children aged 0-5 group was selected as a pilot
group for the development of PP policy recommendations for relevant PP agencies in Thailand. Extensive
document reviews and deliberative process which involved the participation of stakeholders was employed
in the health problems prioritisation process. This article aimed to share experiences and findings
from the review and prioritisation process.
Child health related policy and law were completely available in Thailand and covered almost all
aspects of health determinants. Those policy and law were under responsible of varied agencies; however,
a well-coordinate initiative at a national level was not observed. According to the prioritisation process,
three health related problems that stakeholders expressed as high priority were problems related to carers,
child development, and antenatal care. The identified problems were also categorised according to
type of problems and responsible agencies. Problems related to physical and mental health were mostly
taken care by the National Health Security Office (NHSO), meanwhile problems concerning health and
well-beings were under other agencies, i.e. the Ministry of Social Development and Human Security and
the Thai Health Promotion Foundation.
Experiences from this study affirmed the importance of priority setting for policy development process.
Although most of the stakeholders of the priority setting process were from health sector, prioritised
problems were not solely focused on physical health. Proposed problems also included other societal
aspects as well as environmental factors that might affect well-beings, e.g. teenage pregnancy, quality of
child development centres, lack of parental knowledge of carers. In addition, the stakeholders also aware
of an importance of child development as this would affect quality of the population and their quality of
life in the future. Obviously, these social and well-being concerns have never been included in the benefit
package for health promotion and disease prevention under the NHSO. Challenges included identification
of effective interventions to tackle those prioritised problems in order to develop decent policy recommendations
for the NHSO and other responsible agencies.


location: , 'Thailand year: 2015 source: HSRI

title: Situational Analysis of Difficulty in Discharging Inpatients from Tertiary Care Hospitals and Development of Guideline to Facilitate Discharge Processes and Downstream Referrals; Phase1

abstract: Background: Patient referral to tertiary hospitals is currently problematic and faces many obstacles. At large state hospitals and teaching hospitals, consistently high inpatient occupancy rates limit the ability of the hospitals to admit new patients, including referral patients. Since the issues with high inpatient occupancy rates partially stem from patients not being ready to leave hospital care at the time of discharge and prolonging hospital stay, it is important to understand the reasons why this happens.
Methodology: The study focused on cases of difficult discharges at a large tertiary hospital by analyzing the situation around the discharges and other relevant factors on the part of the hospital, the patients, their families and societal attitudes. It is divided into four parts, each with different methodologies designed to give a comprehensive view of the issues from various stakeholders: 1) compilation of consensus opinions of medical experts, 2) a survey of difficult discharges, 3) in-depth interviews, and 4) a knowledge exchange workshop.
Results:
Part 1: The first part of the study looked at the opinions of medical personnel towards difficult discharge cases. A multidisciplinary panel viewed the issue from two perspectives, patients with prolonged length of hospital stays and those with difficult discharges. The main difference between the two was that difficult discharge cases resulted in feelings of anxiety for the patients and other involved. The panel classified the main factors affecting difficult discharges into six categories: medical, patient, family, social, organization and health care system.
Part 2: The second part of the study looks at the magnitude of the problem at one teaching hospital in the Bangkok metropolitan area. A survey found that difficult discharges occur in about 10% of all cases, with the majority of patients being over 65 years of age and required some form of assisted living. Most were general medicine patients with cancer or circulatory system disorders and are part of a healthcare program where hospitalization costs can be reimbursed. About 50% of the difficult discharge cases still had active medical conditions, while 70% no longer needed to be treated at a tertiary hospital. The factors contributed to anxiety for medical staff in dealing with these cases include the patient’s inability to care for themselves independently, and the fact that their families are not ready to care for the patient at home. For patients and their families, their concerns stem of a lack of confidence in their ability to care for the patient at home.
Part 3: The third part of the study focuses on the perspective of the patients, their families and society at large towards hospital stays and discharges. It was found that Thai society in general places high expectations on hospitals, with many holding the view that hospitals are able to treat and cure all ailments and is their primary healthcare provider. Subsequently, when faced with situations where medical conditions are not curable, patients and their families are not able to cope with the bad news. At the time of discharge, patients tend to disagree with the recommendations of the medical staff because of their dependency on hospital care. In addition, the Thai public lacks knowledge about palliative care and there is a general shortage facilities for alternative care such as nursing homes, hospices and chronic care facilities.
Part 4: The last part of the study was a knowledge exchange workshop on the issue of difficult discharges and potential solutions for tertiary hospitals in the Bangkok metropolitan area. The workshop was conducted with representatives from the hospitals and from the staff of 12 health districts under the Ministry of Public Health. Some of the major findings from the workshop was that: 1) the participation of family members in the patient’s treatment plan helped to make the discharge process easier, 2) hospital systems working in close cooperation in each health district resulted in a more efficient discharge and referral process and 3) for Bangkok, a major problem was the lack of secondary care institutions that were acceptable for patients and their families and the family not being ready to care for the patients at home.
Conclusion: The issue with difficult discharges from tertiary hospitals is widespread throughout large hospitals in Thailand. Many complex and overlapping factors contribute to the issue, including medical, patient, family, social and larger health care system factors. The solution to the problem needs coordinated steps that tackle all facets of the problem and requires further study to develop discharge protocols that can be practically applied by each hospital.


location: , 'Thailand year: 2016 source: HSRI

title: Appropriate Roles and Options of the Ministry of Public Health After 10 Years of Health Care Decentralization

abstract: Over the past 10 years, the Ministry of Public Health (MOPH) has transferred her seven responsibilities
and more than 30 health centres to local governments. The ministry faced both successful and failed
experiences. It was necessary for the ministry to review what should be the appropriate roles and options
for decentralization. This study was a qualitative research. It aimed at analyzing appropriate roles of the MOPH and her
sub-organizations together with the National Health Security Office (NHSO) in linking disease prevention
and health promotion in local areas and the overall system governance. Research methodology used
both literature review and brain storming as well as in-depth interview. The interviewees included 22
experts who were representatives from the MOPH, non-governmental organization, local government
and the NHSO. The gathered data was analyzed by using content analysis and the results were presented
by thematic analysis.
Results of the study showed that public health, disease prevention and health promotion were direct
responsibilities of the local government for improving the quality of life of local people and these roles
ought to be transferred to local authorities. But the prevention of serious disease epidemic should be
remained the command of the MOPH at the central level. Other ministerial sub-organizations together
with NHSO should play supportive roles of the health policies issued by the MOPH. Local government
could be an arm-length extension of the MOPH to bring policies into practice. Options for decentralization
should encourage stakeholders’ participation in disease prevention and health promotion. The area
health model became a more preferable solution because it could help align the fragmented health system
and create better networking governance.


location: , 'Thailand year: 2015 source: HSRI

title: Nutritional Status Changes after Denture Treatment among Elderly in Royal Denture Bestowed Project : A Case Study of Second Health Services Region

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


location: , 'Thailand year: 2007 source: HSRI

title: Fluoride in Drinking Water and Dental Fluorosis in Panomsarakham District, Chachoengsao Province ; Problem Solved by Community Participation

abstract: Objective: The purposes of the study in Panomsarakham District, Chachoengsao
Province, were as follows: 1) to survey the quantity of fluoride in drinking water sources;
2) to determine the prevalence and severity of dental fluorosis in district elementary
schools, and its relationship to the presence of fluoride; and 3) to encourage community
participation in solving the dental fluorosis problem.
Method: 1. Collection of 426 water samples from 87 villages; these were sent for
fluoride detection by ion-specific selection method (electrode); 2. a cross-sectional study
was conducted on 2,281 elementary students in grades 1-6 resident in Panomsarakham
district, for the presence of fluorosis and caries;  and 3. resorting to community participation with local authorities.
Result: Highly fluoridated drinking water was found in 13 of 81 villages, and the
levels were especially high in Bansong, Nongyao, Kaohinsorn and Tatan villages.  The
dental fluorosis prevalence rate was 35.9 percent among students from highly fluoridated
villages, and only 12.7 percent among those from villages where the level of fluoridation
is low.  The severity of dental fluorosis depends on the concentration of fluoride in drinking water, with statistical significance being p=0.000.  The mean DMFT was 1.46 in a
highly fluoridated village while it was 1.42 in a village where fluoridation was low.  It
was noticed that the highly fluoridated area still had higher rates of dental caries compared with the area with a low level of fluoridation, which is contrary to the findings of
other reports; this aspect requires further study in the future.
Conclusions: High levels of fluoridation in drinking water were found and its presence directly related to the prevalence and severity of dental fluorosis.  Therefore, the
problem should be solved by stakeholders [government, communities and politicians],
i.e., the communities concerned should take responsibility for a campaign to change  the
source of drinking water; politicians should provide a budget for intervention and the
government should support surveillance and the provising of data.


location: , 'Thailand year: 2008 source: HSRI

title: Health Care Decentralization in the Philippines

abstract: Decentralization has fully materialized in the Philippines over a period spanning
almost two decades. In Thailand, decentralization was initiated as early as 1932, but
materialized only in 2007. However, decentralization process in the health sector has been
delayed in the devolution of health service facilities from the central to local government
levels.
Lessons learned from the Philippines, which has fully implemented decentralization
for 17 years, will be very valuable lessons for learning about the positive and negative impacts
arising from decentralization in order to provide policy options for Thailand so that it
can avoid negative impacts and follow successful policy measures in support of the decentralization
process of health services to the local government level.


location: , 'Thailand year: 2017 source: HSRI

title: Progression and outcomes of CKD in Thai SEEK population

abstract: Chronic kidney disease (CKD) is one of the major public health problem in Thailand. The Nephrology Society of Thailand was granted the community-based cross-sectional survey study using stratified-cluster sampling method to represent population from all region of Thailand called Thai SEEK (Screening and Early Evaluation of Kidney Disease) study during 2007 to 2008. The overall prevalence of CKD from Thai SEEK was 17.5% which increased awareness of CKD burden and lead to deliver strategic planning for CKD prevention and management programs. However, study about the natural history of CKD progression, particularly among Asian and Thai population which might useful for the estimation of health cost and strategies prioritization for slow CKD progression stills limited. Moreover, we still lack of information of the incident of CKD using a standardized method for GFR estimation in representative Thai adult populations. So the research committee of The Nephrology Society of Thailand was conducted this follow-up study from Thai SEEK population.


location: , 'Thailand year: 2021 source: HSRI

title: Research for evaluating the impacts of medical marijuana policy in Thailand, Phase I

abstract: The medical marijuana (MMJ) system has been established for the first time in Thai history since February 19, 2019, according to the Narcotic Control Act 2019 (7th edition) . This study aimed to find essential research questions regarding the implementation and impacts of and design the monitoring and evaluation system for the MMJ policy in Thailand. Research methods employed include a literature review, 22 in- depth interviews with key stakeholders, two focus group interviews covering nine service providers and patients, and a participatory observation in the MMJ clinic at the Ministry of Public Health. Our crucial findings cover: (a) the Thai MMJ system is complex, consisting of the sub-systems: modern medicine, Thai traditional medicine, and local community medicine. These three sub- systems are not harmonized. Patients could not access and benefit from the whole system, resulting in many of these patients having to use illegal marijuana products. ( b) MMJ is a new matter in Thailand and could provide both benefits and drawbacks for the Thai society; hence it is essential and urgent for Thailand to have an MMJ related knowledge generation system and an MMJ policy impact monitoring and evaluation system. (c) MMJ movement in Thailand has attributes like “political economy,” which means the MMJ policies may be driven by benefits rather than medical rationale. The proposed policy recommendations include follows. (1) Establish an advisory committee containing various capability dimensions and socially accepted, and have no conflict of interest. (2) Strengthen the MMJ service system in a way incorporating the advantages of all three MMJ sub-systems. (3) Urgently invest in the policy impact monitoring and evaluation system, including evaluating the supply, service utilization, and short-term and long-term consequences. (4) Promote Thai people’s health literacy regarding MMJ is crucial to prevent them from being victims of false information of the illegal MMJ providers. (5) Study the efficacy and the cost-effectiveness of various MMJ products in Thailand using the Thai culture-relevant, modified scientific method. And (6) study future MMJ policies for Thailand to inform policy decision making guided by scientific evidence.


location: , 'Thailand year: 2021 source: HSRI

title: Integration of genome sequencing in the diagnostic process for Thai infants with infantile cholestatic jaundice

abstract: Integration of genome sequencing in the diagnostic process for Thai infants with infantile cholestatic jaundice co-operated by Faculty of Medicine, Prince of Songkhla University and Health Systems Research Institute, Ministry of Public Health. To discover new genetic susceptibility of infantile cholestasis, next generation sequencing was implemented to operate in our study together with clinical finding and investigation. Focusing on biliary atresia, a half of cases had successful bile drainage from the hepatoportoenterostomy. According to similarity of clinical finding, the poor prognosis with naïve liver may be miss diagnosis from other cholestatic jaundice disease. Genetic biomarker became an important application to help discrimination of isolated biliary atresia and the others, improve post-operative outcome and delay queuing for liver transplantation. In our study, 64 individuals with cholestatic jaundice were included together with consent for blood sampling and genomic investigation under standard operation procedure of Genomic Thailand Consortium. All of retrieved samples and metadata information were processed at Translational Medicine Research Center (TMRC), Faculty of Medicine, Prince of Songkla University and delivered to Department of Medical Science, Ministry of Public Health. For the leftover specimens, whole exome sequencing was undergone to intensively discover pathogenic variants related to the cholestatic syndromes. Annotated exome sequences were comprehensively reviewed and discovered 45 possible deleterious variants. Moreover, genetic association was performed for SNPs located in ADD3 and EFEMP1 genes (rs2501577, rs17095355, rs6761893 and rs727878). The statistical appraisal of susceptibility shown significant association of first three SNPs with the disease together with additive biological interaction between both genes. In summary, we purpose that our study will be a beginning of implementation of high-throughput sequencing and genetic biomarker in pediatric surgical diseases.