location: , 'Thailand year: 2004 source: HSRI

title: A Study of Health publication

abstract: This study consists of five purposes: (1) to survey the states and problems of health publications of Thai publishers, (2) to examine the backgrounds of health information transformers in terms of their status, types of publication work, professional procedures, working process, and related problems, (3) to propose the guidelines for developing and supporting health information transformers, (4) to explore the use of computer and a health publication database as well as to present a health publication database format , and (5) to propose the database format of health information transformers.  The results of the study are as follows: 1. Health publishers generally have 11.95 working staff and publish 8.69 titles per year.  Publication expenses for one title include 10 percents for the copyright cost of an author and 90 percents for publishing, printing, disseminating and marketing. Most of the health publishers prepare the publication layout and original master at the publishing office but employ outside printing work. The health published contents consist of various issues such as disease knowledge, nutrition, self-health care, exercise and fitness, mental health, elderly health care, beauty care, mothers and children, child rearing, drug usage, herbs, bio-organic consumption, yoga, diet, environment, and sex education. These contents are selected in accordance with the authors’ own interest and current problem issues. The objectives of health publishing are to give readers more understanding of health knowledge that they have already known and to provide them new related information as well.   The problems of health publishing are the difficult selection of experienced authors, the high cost of printing, the inaccuracy and unreliability of content, and the limited dissemination of health publications. 2. The health information transformers are averagely 53 years old and are mainly physical doctors. Therefore, writing of health publications is not their main career. Types of their publication work are authors, compilers and editors. By average, they have been working as authors for 10.32 years, with 3.50 books and 7.55 articles since 1997.  Reasons for writing of health publications are to pursue their own interest, use their own health knowledge in practical ways, and follow the social needs. The most serious problem of writing is that the health information  transformers have no time or have limited time for writing or seeking information. Other problems are limitation of health information resources and lack of accurate, reliable, and up-to-date health information. Another problem is related to readers’ attitudes and beliefs that local folk medicines and treatments are much better than modern ones. Also, they believe that illness and death are the ways of life; therefore they pay no attention of their self-health care. 3. The proposed guidelines for developing and supporting health information transformers are providing of consulting health expert teams who can provide some advices to the authors; establishing reliable health information centers; initiating the association of health information transformers; organizing training programs for writing skills and seminars for health publications authors; arranging health publication contests; disseminating of health publications to remote readers; and promoting of self-health care to the public. In addition, private publishers should fairly return to the authors and provide them more funds to disseminate health publications to community as well as support them about writing and research work.  4. The proposed health publication database format is composed of 13 required fields with indexes for information retrieval, and 6 optional fields without indexes. 5. The proposed health publication author database format is composed of 2 required fields with indexes for information retrieval, 6 required fields without indexes, and 7optional fields.


location: , 'Thailand year: 2019 source: HSRI

title: Study of Lactation Consultant’s Services in Health Facilities in Thailand

abstract: Lactation consultant nurses play an important role in the promotion of breastfeeding practices and to ensure optimal age-appropriate feeding of children. Responsible for supporting mothers in overcoming breastfeeding difficulties, they also play a prominent role in providing knowledge, techniques and skills, as well as instructing mothers on appropriate behaviors and building confidence; the critical factors for successful breastfeeding. In Thailand, professional nurses assigned to lactation clinics in health facilities take on the role of a lactation consultant. To date, there have been no studies on service provisions and practices of lactation consultants in Thailand.  This study aimed to understand the situation of lactation consultants working in health facilities, including their roles, knowledge and qualifications as well as the scope of services provided, the challenges faced, and recommendations for improving competency of lactation consultants. A qualitative study was conducted by collecting data from 53 lactation consultants working in public and private health facilities, through focus group discussions and self-administered questionnaires. The results found that lactation consultants had the primary role of providing knowledge and building confidence for pregnant women, mothers and families on breastfeeding, from pregnancy until post-partum period. Lactation consultants’ scope of work was to provide nursing care without invasive interventions which required extensive knowledge focusing on breastfeeding practices, infant formula, maternal nutrition and child development. In addition, they required skills of nursing services, academic and technical skills, as well as communication and administrative capabilities. The large majority of lactation consultants faced difficulties due to their heavy workload, career path uncertainties, and insufficient knowledge of complex breastfeeding complications. These problems were resulted from national and organizational policies, management and the work environment of lactation consultants. Based on these results, in order to improve the capacity of lactation consultants, well-defined national policies and policy implementation on the guidelines and promotion of breastfeeding practices in health facilities, as well as building a network for lactation consultants and developing a mechanism for long-term capacity building and monitoring are recommended.


location: , 'Thailand year: 2007 source: HSRI

title: Factors Related to the Happiness and Stress of Chachoengsao Public Health Officers

abstract: This cross-sectional descriptive research was carried out in January 2007 to study
the factors that affect stress and happiness in 1,426 public health personnel working in
Chachoengsao; included in the study were 1,024 community hospital staff, 59 provincial
public health officers and 343 district health officers. Happiness and stress questionnaires
were used to determine personal factors. The data were analyzed using t-test and
one- way ANOVA. The major findings showed the mean score of happiness of the sample was equal to
that of the general population (mean = 31.49) and the mean score of stress was at a
moderate level (mean = 40.61). Age, education, family incomes, workplace and kind of
services, all were factors affecting the happiness and stress at a statistically significant
level (p <.05). There were no statistically significant relationships between marriage status
and duration of work with regard to happiness and stress.
In conclusion, the sample has the same level of happiness as the general population
and stress was at a medium level. While the workplaces were related to low levels of
happiness and high stress, this factor should be analyzed further and corrected. It is
suggested that raising incomes would increase the happiness and lessen stress for these
officers, resulting in an improved quality of services.


location: , 'Thailand year: 2018 source: HSRI

title: Effects of Socioeconomic Status on Performance of Care in Patients with Diabetes

abstract: Studies from high-income countries observed that health outcomes among individual having access to care still differed based on their socio-economic status (SES). This led to a concern that performance-based payment introduced by National Health Security Office (NHSO) in Thailand would penalize healthcare facilities located in low SES areas where health outcomes would be worse compared to high SES areas, although same standard of care is provided. Patients with high SES would have better health outcomes because they could control themselves better. Those with high SES evidently had higher level of perceived control. Perceived control comprises two important parameters: health locus of control and self-efficacy. This cross-sectional study has been conducted to test whether SES affects health outcomes of Thais who are under the universal health coverage policy. Patients with diabetes (all having access to care) were used as an example. We found no association between SES and treatment outcomes and service-based indicators. CCM-related activities had strong association with health outcomes. SES was, however, associated with perceived control as found in previous studies. Those with high SES tended to have higher perceived control (high self-efficacy and internal locus of control). Perceived control had a tricky relationship with compliance. Those with high self-efficacy had better compliance to diet recommendation, but worse compliance to prescribed medicine. In contrast, those with internal locus of control had worse compliance to diet recommendation, but better compliance to prescribed medicine. The effects were cancelled out; overall, no association was found between perceived control and compliance.


location: , 'Thailand year: 2021 source: HSRI

title: An evaluation of the pilot program on drug-dispensing services in pharmacies to reduce hospital congestion phase II

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


location: , 'Thailand year: 2012 source: HSRI

title: Improving Drug Acquisition in Public Hospitals using the Pharmaceutical Acquisition Capability (PAC) Approach

abstract: This study aimed to analyze pharmaceutical purchasing capability of public hospitals using the
Pharmaceutical Acquisition Capability (PAC) Approach. The 2010 purchasing data of public hospitals
was provided by the Drug and Medical Supply Information Center (DMSIC), Ministry of Public Health. the data analysis was done by selecting the drug items that were submitted to DMSIC by more than 3
public hospitals. Total 31 items were included in this study that were categorized into 5 pharmacological
groups i.e. 1) HMG-CoA-reductase inhibitors or Statin, 2) Proton pump inhibitors (PPI), 3) Blood-glucoselowering
drugs, 4) COX-2 selective inhibitor, and 5) Combination of Statin. It was found that a number of
markets held Gini coefficient higher than 0.500. This could be interpreted that purchasers in this market
could buy the product at lower price suggested by PAC-DSS. In addition, high average PAC was also
found in the market with multiple sellers, leading to the recommendation that purchasers could easily
negotiate their price in this market. The study estimated that if hospitals had purchased 31 drug items at
PAC-DSS suggested prices, these public hospitals as a whole would have gained 77 million baht saving.
The standardization and development of data entry system is strongly recommended for better outputs.
The future study on additional invention of feedback information is also suggested to benefit users.


location: , 'Thailand year: 2023 source: HSRI

title: COVID-19 Vaccine Effectiveness in Thailand: a Real World Study (2nd Year)

abstract: We conducted a test negative case control study to assess the Vaccine Effectiveness (VE) of various vaccine regimens for preventing COVID-19 infection and its severity during the period when Omicron was the dominant causative virus in Thailand. All 8,600 individuals, aged ≥5 years, at risk for COVID-19 (Patient Under Investigation, PUI) who presented for nasopharyngeal real time polymerase chain reaction (RT-PCR) testing were prospectively enrolled at Thammasat University hospital during January to June 2022. There were 3,546 cases who were infected. For preventing omicron variant associated infections, the VE increased along with the increase in the number of vaccine dose and the four dose regimen (2 boosters) had the highest but only moderate VE. For preventing severity, the three and four dose regimens (1 and 2 boosters) had comparable high VE and their effectiveness was more durable than the two dose regimens. Significant protective factors to prevent infection were vaccine doses, female and healthcare personnel. Significant risk of infection included elderly, at least one chronic morbidity and household infection. Significant risk of severe COVID-19 was incomplete two dose vaccination, at least one chronic morbidity and elderly. Longcovid condition was prevalent after 6 months of COVID-19. It consisted of multi system symptoms. Weakness and neurological symptoms were the most common manifestations. Risk factors of longcovid condition were female, cough symptom at acute infection and severe COVID-19. Based on the study findings, current mass vaccination programs should focus on reducing COVID-19 severity and mandate at least one booster dose after primary series vaccines. The heterologous boosters with viral vector and mRNA vaccines were highly effective and can be used in individuals who had previously received the primary series of inactivated viral vaccine.


location: , 'Thailand year: 2022 source: HSRI

title: Evaluation of Capacities of Health Systems to Response the COVID-19 Epidemic in Border Area, Chiang Rai Province

abstract: A cross-sectional study was conducted to assess the capacities of COVID-19 prevention and control among healthcare workers and health system under the Ministry of Public Health and Ministry of Interior located in the border areas in Chiang Rai Province: Mae Fah Luang, Mae Sai, Chiang Saen, Mae Chan, Mae Suai, Wiang Pa Pao, Muang, and Chiang Khong Districts. Data were collected by validated questionnaires between April and December 2021. A total of 906 people were recruited into the study. In the aspect of management: healthcare workers working under health institutes belonging to the Ministry of Public Health, local government and health volunteers did not clearly understand the process of work. In the aspect of manpower: healthcare workers under the Ministry of Public Health reported having worked longer hours compared to the period of pre-COVID-19 epidemic, and healthcare workers shortage. In the aspect of communication: line application was favored among government officers. Mobile phones were commonly used among people in a community. In the aspect of materials for the implementation: N-95, PPE and face shield were not sufficient for working among healthcare workers, while the community members reported that masks and alcohol were not enough for them. In the aspect of budgetary: almost all government officers reported that they had a big challenge in the requesting process. Some of the officers did not get the compensation and used their personal money for buying equipment. In the governance aspect: the overload assigned from their director was the major concern. In the aspect of the health system: communities had established several commitments and agreements among them to prevent and control the disease. Moreover, most people followed the agreements. People in a community have good practices to prevent and control COVID-19. Personal and health system capacity related to COVID-19 prevention and control developments are crucial especially to people who are living in border areas. The main focus on improving the capacities are deploying processes of work in crisis situations to make them confident and accurately follow the instructions; the government sector is required to support budget sufficient and medical related materials to healthcare workers. Distribution of essential information to people should be prepared in appropriate languages. Communication channel is also one of the critical points to improve the prevention and control measures in a community. Encouraging people in a community in creating their commitments and implementing them are also very important concerns for improving the effectiveness of disease control and prevention.


location: , 'Thailand year: 2023 source: HSRI

title: Cost-Utility and Feasibility Analyses of Cervical Cancer Screening Using Self-Collected Sample Kit for Human Papillomavirus DNA Test in Thailand

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


location: , 'Thailand year: 2016 source: HSRI

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

abstract: Background: End stage renal disease (ESRD) cause the high morbidity, mortality, and cost in health
care system. The prevention of chronic kidney disease/ESRD is the early recognition and
appropriate treatment of the etiology disease. Glomerulonephritis (GN) is the third most common
cause of ESRD in Thailand comparable to the Western country. The development of qualified
registry and GN network may improve the health care service and accurate epidemiological data
that support the further studies in both clinical and translational research.
Objective: To develop web-based On-line Thai Glomerular Disease Registry for studying the
epidemiology and clinical outcomes of glomerular diseases in Thailand. To develop Thai
Glomerular Disease Collaborative Network (TGDCN) through the country for creating the GN
database and supporting together in taking care of the patients. To perform the clinical
recommendation in GN management.
Methods: TGDCN originally consists of 9 tertiary care centers. We developed the Web-based
Online registry to collect the data from all native kidney biopsy-proven GN patients with aged >
18 years after approval by the ethical committee of each site. We recorded the demographic data
including gender, age, education, native habitat and the laboratory tests including serum
creatinine, albumin, cholesterol, urinalysis, proteinuria, serology tests and the pathological
findings. The clinical outcomes including remission, flare, doubling of serum creatinine, renal
survival, and patient survival were investigated.
Results: We recruited 666 patients performed kidney biopsy during Jul 1, 2014 to Jun 30, 2015.
The female to male ratio was 2.16:1. The mean age, creatinine, albumin, and cholesterol were 42
(18-82) years, 1.4 (0.4-13) mg/dL, 2.9+0.8 g/dL, and 296+118 mg/dL in respectively. The median
proteinuria was 3.2 g/day and ranged 0-22 g/day. The patients presented with 34% of nephrotic
syndrome, 22% of nephritis, 21.7% of nephrotic nephritis, 52% of renal impairment (creatinine >
1.2 mg/dL), and 54.4% of new or aggravated hypertension. The renal pathological findings showed 38% of lupus nephritis (LN), 17.6% of IgA nephropathy (IgAN), 9% of focal segmental
glomerulosclerosis (FSGS), and 8.9% of membranous nephropathy (MN). The mean age of LN,
IgAN, FSGS, and MN were 34, 38, 46, and 50 years. The average creatinine at biopsy of LN, IgAN,
FSGS, and MN were 1.9, 2.4, 2.4, and 1.1 mg/dL. Due to the time limited, the clinical outcomes
were not described at this time.
Conclusion: Our study described the first three common renal pathological findings including LN,
IgAN, and FSGS They were in the working age and presented with the initial renal impairment at
kidney biopsy. This might be the severity of the disease or the delay in performing biopsy due to
limitation of facility in kidney biopsy procedure and referring system. In addition to the data from
Thailand Renal Replacement Therapy (TRT), LN, IgAN, and FSGS were the most common GN
causing the ESRD in our country. Early diagnosis and proper management should be improve the
clinical outcomes among these patients.


location: , 'Thailand year: 2019 source: HSRI

title: Expectations of Community Hospital Directors in Health Region 2 towards the Medical Curriculum of the Faculty of Medicine, Naresuan University

abstract: One of the missions of the Faculty of Medicine, Naresuan University is to produce medical graduates to serve the Collaborative Project to Increase Production of Rural Doctor (CPIRD). The project recruits 145 students who reside in any of the 5 provinces in Health Region 2 annually. After graduation, the medical graduates are deployed to work at rural hospitals of the five provinces. The Faculty of Medicine aims to apply outcome-based curriculum to develop the graduate’s attributes according to the expectations of all stakeholders particularly of the community hospital directors. Thus, the present study was carried out to find the expectations of the community hospital directors in Health Region 2 to provide the basis for developing a medical curriculum satisfying community needs. Method: A cross-sectional descriptive survey was done using a structured and validated questionnaire to all community hospital directors in Health Region 2. Results: Based on the expectations of the respondents, leadership skill and teamwork, patient empowerment, health promotion and disease prevention, patient-centered care, and patient safety were regarded as the top five instructional topics significant to medical practice in community hospitals. Problem-based learning (PBL) was cited as the most beneficial learning approach. On the contrary, the respondents indicated that the medical graduates did not have adequate knowledge on the community health system. Conclusion: The above specified instruction topics and PBL should be incorporated into the learning experience. Moreover, instruction topics related to the WHO 6 building blocks of a health system are useful for practicing at community hospital. As a result, there should be the health system sciences in the medical curriculum aside from basic and clinical sciences in order to produce graduates conforming to the needs of society.


location: , 'Thailand year: 2004 source: HSRI

title: Health seeking behavior and health promotive development model for temporary constructing labors in Samuthrprakarn province (Under UC Health Assurance Policy) Phase I

abstract: This cross-sectional survey was conducted among 457 temporary constructing labors in Samuthprakharn province of Thailand to reveal  the labors migration movement factors and their health status,  health seeking behavior and places, health promotion, health care services utilities, and stake holders brain-storming provision idea for appropriate semi-package model of health promotion. (under Universal Coverage Health Assurance Policy of Thailand)	457 subjects with (UC) golden card provided were proportional  random sampling through  each six districts of Samuthprakhan Province in 2004. Found that most of labors were males(71.33%)higher amount than females(28.68%), major of age range between 21-45 years,  most of them  as the labors constructing in Suwannaphume International Airport(55.80%),  residential real-estate(19.91%),  various type factory/plant(8.75%). The labors educational level  were mostly primary school (Prathom 6 = 41.23%, Prathom 4 = 28.29%) and secondary school level(17.76%).  Most of income range 100-200 bath per day. Major factors of migration movement to be labors is no employment in their home town(48.83%), higher income (33.26%), leave from after agricultural harvested season(20.57%), and motivated(14.14%). Their self health  perception for a year rounded were healthy(73.58%), mild-moderate illness (16.92%) eg. cold, muscle body pain, and headache.  Housing style are single compartment rooms (non separation for bedroom and kitchen) in two level stair row house(55.80%), one level stair with zinc-metal-sheet roofing(33.70%). Residential environment condition still being water sewage flood, smelling, insect and other disease animal vehicles, ambient temperature/air seem to be wormy and less ventilation. Labors self medication and drinking were tonic drink(M-150 and Red bull Brand) (55.36%),  alcohol and alcoholic herb(53.61%), glossary combined medicine(30.42%) and envelop anti pain(salicylic acid)(16.85%). Incase of sickness, mostly hospital utilization(59.4%), health center(21.1%),  other left do the private clinic visiting, and quite unsatisfactory for remedy cost, long waiting time, and less quality of drugs.  Labors nutritional status (Body mass Index) mostly be normal level(71.74%), over nutrition(17.6%), and a few are lower than actual status(11.0%). Breakfast and dinner’s labors were self cooking(63.76% and 69.78%), the left were ready cooked purchasing. Males(49.8%) and some of females(26.9%) eat raw and semi-cooked food for 1-2 time weekly(p=0.03).	Most labors(84.46%)well enough sleeping, and less anxieties(52.52%) with watching television(63.7%). Incase of bad feeling and stress they do nothing(33.9%) almost every day,  go outing to entertainment  place and drinking club and smoking (24.1%). 66.65 per-cent of labors did not do physical exercise but seasonal religion practices(66.52%).  The most of working accident is pierced/tackled by pieces of material(56.52%),  injured by sharpness matters(26.96%), and eye attacked by bouncing matters(12.17%). Their general perception for health services utilization and enable to privilege when being in Samuthrprakhan are Hospital(53.85%), do not know where is(21.10%), village health center(13.19%), but most of them never(78.10%)  vise-versa ever for hospital(15.17%), village health center(6.19%),  all ever subjects had no chance to golden card declaration(44.57%) due to out of area registered, and do not know about this privilege declaration(22.17%).	Brain-storming provision idea among stake-holders by ZOPP Technique session for health promotive modeling and the theme which categorized are :  should be  setting  model of health promotion through all integration sectors and both pertain active and passive activities by counterpart of employer, health services providers, labors, local thambol bureau, social insurance provincial office, and community participatory. The local area status appropriated health promotive modeling  such as : constructing area and labors housing finding and registering system,  health promotion and active environment management welfare system, UC and golden card privilege information  and efficiency communication  system included indicate setting area of health services  place  in case of urgent situation. Finally budget sharing responsibility and fund raising should be responsible with all related sectors above mentioned.


location: , 'Thailand year: 2022 source: HSRI

title: Advanced Clinical Phenotyping and Genotyping of Thai Patients with Familial Hypercholesterolemia (FH) for Clinical Application

abstract: Background and Objectives: Familial hypercholesterolemia (FH) is the most common genetic cause of cardiovascular disease. This study was aimed to examine the Achilles tendon thickness using plain radiograph of lateral heels in FH subjects (diagnosed using the Dutch Lipid Clinic Network [DLCN] score above 3 [possible, probable or definite FH]), non-FH subjects with elevated LDL-cholesterol (LDL-C) >130 mg/dL and subjects with LDL-C below 130 mg/dL. The sensitivity, specificity, and optimal cutoff values with the highest diagnostic accuracy for diagnosis of FH were determined. In addition, the coronary calcium score (CAC) and aortic valve calcium (AoVC) score using computed tomography were also investigated in FH and non-FH subjects. Results: Analysis was performed among 113 FH subjects, 58 non-FH subjects with high LDL-C and 55 subjects with LDL-C <130 mg/dL. The Achilles tendons in FH subjects were significantly thicker than those in the other 2 groups. Men had thicker Achilles tendons than women, but not significantly different. The cutoff thickness values ≥6.875 mm gave the highest diagnostic accuracy of 74% with 70% sensitivity and 78% specificity. For CAC scores among 112 FH subjects and 58 non-FH subjects, the proportion of FH subjects who had CAC >0 AU was not significantly different than that of non-FH subjects but the proportion of FH subjects who had AoVC > 0 AU was significantly higher that that of the non-FH subjects (10.7% vs. 1.7%, P= 0.029). CAC scores were significantly associated with age, LDL-C burden and Thai CV risk score Conclusions: Measurements of Achilles tendon thickness by plain radiographs in 133 FH subjects showed that cutoff values of ≥6.875 mm gave 74% accuracy with 70% sensitivity and 78% specificity. The proportion of FH subjects with CAC >0 was not significantly different than that of non-FH subjects but the proportion of FH subjects who had AoVC > 0 AU was significantly higher that that of the non-FH subjects.


location: , 'Thailand year: 2021 source: HSRI

title: Developing a Fast Healthcare Interoperability Resources (FHIR)-Based Electronic   Medical Records for Acute Ischemic Stroke Patients

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


location: , 'Thailand year: 2010 source: HSRI

title: Determination of Health Policy and Systems Research Topics in Thailand

abstract: Health policy and systems research (HPSR) is crucial for strengthening health systems. In cases
where resources are limited, research topic prioritization is an important process to ensure the effective
use of available resources and to help identify research topics that are relevant and also address stakeholders’
concerns. In foreseeing the benefits of introducing a prioritization process, the Health Systems
Research Institute (HSRI) and its affiliates organized the HPSR topic prioritization seminar 2010, which
was aimed at preparing a list of national prioritized research topics, in the hope that the list will be used to
support policy decisions in Thailand.
This is a research and development study which employed participatory observation, brainstorming,
and questionnaire surveys. A total of 247 organizations were identified as stakeholders, 90 of
which participated in the prioritization process. At the beginning of the process, 120 HPSR topics were
proposed by 66 organizations. Of these topics, 15 were prioritized. It was found that topics that are related
to (a) disease with a high burden and (b) service delivery are likely to be included in a priority list. In
addition, results from a self-administered survey demonstrated that 93 per cent of the stakeholders strongly
supported the process and expressed their interest in participating in similar events if conducted in the
future.


location: , 'Thailand year: 1999 source: HSRI

title: The evaluation on social welfare services to develop the quality of life of the elderly in Thailand

abstract: The Evaluation on Social Welfare Services to develop  the quality of Life of  the Elderly in Thailand	The study of  “the evaluation of social welfare services to develop the  quality of life of the elderly in Thailand”  has the purpose to evaluate the purpose, target, efficiency and effectiveness of the social welfare services by the government in 4 areas I.e. Homes for the elderly, the allowance, social services in the community (emphasizing the village welfare Assistance Center)  and the funeral welfare services.  The procedures in doing the research are both quantitative and qualitative research. The examples of study are the elderly in  four regions and the peripheral provinces.  The methodology in the quantitative study are the enquiries of the elderly, and the tools used in the qualitative study are the methods of interviewing, case studies, focus grouping with the elderly, observation in the village and community  concerned.  The  statistics of the study is the percentage, the mean, chi-square and the analysis of  variation.	In  this study it is found out that the context evaluation particularly the purpose of the social welfare for the elderly.  The government has the concept to manage mainly the service for the poor elderly without the relatives and supporters, by using the occupational means-test by screening them who qualified to receive the  social welfare.  The main concept of social welfare for the elderly is the concept of public assistance  except the funeral welfare services is as   the welfare services with the specific purpose in organizing the funeral for the elderly which is the welfare assisting the elderly in the community.  The result’s evaluation of the purpose of services found that the funeral welfare services is the only  welfare that giving concern the value and dignity of elderly as far as the elderly are concerned themselves and voluntary involvement of their relatives in guaranteeing for the elderly in the society, while others services  the government arranged for the elderly  has been directed through  the top-down policy	In the assessment the spending  social  resources for social welfare projects for the elderly, it is found out that the cost for Homes for the elderly is yearly high as  34,500  Baht per person, the allowance for the elderly  in  communities is 2,400 Baht  a  year (200 Baht per month in average) the cost of operation in  the village Welfare Assistance Center   in the early stages is 25,000 Baht.  While the funeral welfare the government does not allocate the budget but collects from the elderly and their families by collecting from the community’s members including the elderly 5-50  Baht per dead person.  The funeral welfare is the service concern with the dignity of the elderly and mainly counted as the cost of the community, thus the dependence on the government budget  become less.  The procedure of using the funeral welfare is flexible and adapts to the elderly’s qualification.  Thus, the potentials of social welfare services for the elderly of the organization therefore mainly depends on the strength of the community.	According to the result of this study is found out that the mechanics of the government organizations are  not so efficiency, that reflects the mechanism of the governmental organization from the evaluation of the qualified elderly, the criteria of selecting the elderly to be admitted to the Village Welfare  Assistance Center the elderly and receiving the allowance lower than the standard that will guarantee the social justice for the elderly,  lacking the suitable means-test that will lead to unfair allocation of the government budget.   The government lacks the process of  assessment, investigating, monitoring and evaluating system to accomplish the social welfare projects for the elderly efficiently, as they face the problem of disembursement process of the allowance and fund of the Village Welfare Assistance Center. The mechanism have been created according to the bureaucratic system, not by the representatives of the elderly in the community.	The result of evaluation of the effectiveness of social Welfare Services find out are the following.the operation of Homes for the elderly can respond well the the physical needs of the elderly but cannot respond spiritually.  There are enough governmental welfare Homes for the elderly, but unfair as far as the elderly with the high and medium income can be admitted to the facilities as same as the poor elderly.The system of the Allowance is divided into 3 groups as following.the poor elderly has the opportunity to get the highest allowancethe elderly with their descendants not so poor, with medium income but has good relations with the committee of the village will get the next high allowanceThe  miserable, living alone (or without relatives) elderly has the  opportunity to get the less subsistence because they are “marginal groups”  in the community.  The social welfare in terms of the allowance of the officials is intervened by the political mechanismThe  Allowance and the village Welfare Assistance Center is discentralized in terms of quantity.The official and unofficial funeral welfare services (natural groups)  responds to the elderly’s needs of the community more than other social welfare services of the government.	The  evaluation of projects of social welfare for the elderly shows that the social welfare by the government is not so functional and justice as far as the poor elderly, without relatives, cannot get access to the social welfare services because of the selection process is nepotic and unfair.  The target groups of the elderly cannot enjoy such welfare as they cannot protect their own rights as they are not participated in the management process which leads to the sustainable welfare and activities, cannot strengthen the elderly and the community for long. As far as managing the service separately i.e. handling the government welfare Homes for the elderly separately from the family and community.  Even the welfare is good but lacking the  improvement of management to develop the potentials of elderly for self-dependence, stabilization in the society, lacking the spiritual development of elderly for a long period, thus the elderly lead a “surviving-existing” rather than “well-doing” style of life.


location: , 'Thailand year: 2000 source: HSRI

title: Health expenditure model

abstract: Health expenditure model	This report presents the findings of the research "Health Expenditure Model" which consists of a review of related literature and the health expenditure model. 	The review of related research work identifies 3 groups of study on health care expenditures: group A measures and estimates health care expenditures of countries by developing national health accounts (NHA) showing sources of financing for health care. Group B analyzes the difference in health care expenditures among countries at a macro level, utilizing regression analysis of cross section data. The findings from such studies using data of developed countries indicate that national income is the most important factor determining aggregate health care expenditures. Group C studies health expenditures at a micro level, using cross section data from surveys of household income and expenditures in a regression analysis to find the relationship between household health care expenditures and household income and other socio-economic variables. It is found that income is not a very important determinant of household health care expenditures as in the macro study.When comparing the 3 groups of studies, it can be concluded that group A or NHA studies can identify the size of the society's resources used in health activities either in the public or the private sector, in consumption or investment, but it provides a picture at a certain point in time. It does not serve as a tool for forecasting future health expenditures, nor for explaining the changes in health expenditures resulting from external factors and government interventions.	Studies in Group B which construct a model and use a regression analysis can provide an explanation of factors determining health expenditures and of differences in health expenditures among countries, but they cannot say much about health policy directions and health budget determination.	Group C studies on household health care expenditures are studies at a micro level which derive different findings and conclusions from those derived from a micro study.When comparing the 3 groups of studies, it can be concluded that group A or NHA studies can identify the size of the society's resources used in health activities either in the public or the private sector, in consumption or investment, but it provides a picture at a certain point in time. It does not serve as a tool for forecasting future health expenditures, nor for explaining the changes in health expenditures resulting from external factors and government interventions.


location: , 'Thailand year: 2023 source: HSRI

title: A Study of Workplace Health Promotion and Non-Communicable Disease Prevention Roles and Support Among Organizational Leadership and Human Resource Executives

abstract: In Thailand, the Cabinet has outlined the national reform plan (public health) for the year 2021, which emphasizes the concept of "Health Promotion" in alignment with the sustainable development goal of the United Nations, specifically Goal 3: Good health and well-being. The plan focuses on policies and measures within the workplace, setting a goal to establish "workplace health policies". Despite this, there is presently a paucity of research on management, implementation, and workplace health promotion, and Thailand has yet to establish a national policy framework. This study aims to investigate the management and implementation, as well as provide policy recommendations at both organizational and national levels, by organizational leaders and human resource executives, concerning health promotion and non-communicable disease prevention in workplaces. Methods This study employs a cross-sectional study to procure data from personnel in the human resources domain across organizations situated in Thailand during the period spanning January to March 2023. The collection of data encompassed a questionnaire, featuring three distinct sections addressing organizational demographics, health promotion execution, and health promotion policies. The acquired data were analyzed via the application of advanced statistical techniques including descriptive statistics, bivariate analyses, and multiple linear regression. A qualitative study, specifically an exploratory research design, utilizing conventional content analysis with an inductive approach was undertaken. The interviews were conducted from May to November 2022. The data for analysis were collected through in-depth interviews conducted with senior-level executives from prominent organizations and human resource managers affiliated with influential bodies such as the Federation of Thai Industries (FTI), the Thai Chamber of Commerce and Board of Trade of Thailand (TCC & BoT), the Thai Bankers’ Association (TBA), the Personnel Management Association of Thailand (PMAT), industrial estates, and various workplaces. The data collection for this study involved conducting interviews with key informants, totaling 35 individuals, representing 27 organizations, units, and businesses. Results In this quantitative study, the implementation of health promotion initiatives within the workplace demonstrated a statistically significant association with key factors including organizational operations exceeding 19 years and the allocation of financial resources for health promotion. The workplace health promotion policy exhibited a statistically significant correlation with various budget allocation factors across all domains. These factors encompassed collaborative decision-making within the workplace, a conducive physical work environment, psychological well-being in the workplace, employee engagement and trust, effective leadership and supervision, job design, as well as monitoring and evaluation practices. In the qualitative study, the findings of the study can be categorized into four main categories. The first category, "Management," consists of organizational policies and guiding principles. The second category, "Implementation," includes budget allocation, activities, and operational tips. The third category, "Barriers," comprises operational challenges and individual factors. Lastly, the fourth category, "Groups, Clubs, Associations," encompasses collaborative policies and joint activities. Conclusion The findings of this study indicate that the duration of organizational operations, the size of the organization, and the allocation of budgetary resources for health promotion play crucial roles in determining the successful implementation and feasibility of workplace health promotion policies within organizations. This study has outlined strategies for management and operational measures to enhance workplace health promotion and synthesized policies for health promotion in Thai workplaces. These policies encompass both monetary and nonmonetary approaches.


location: , 'Thailand year: 2018 source: HSRI

title: Human Resources for Health Requirements Projection: Crucial Baseline to Support Human Resources for Health Planning

abstract: Effective human resources for health (HRH) planning require evidence-based information to support the decision making. HRH requirement projection in line with desired health service system could therefore be compared with HRH supply projection in order to identify gaps. Gap analysis leads to the development of the HRH plan in order to solve those problems. HRH requirement projection could be carried out both at national level as well as at health facility level. The approaches used to forecast the HRH requirements at national level are: population ratio method, health needs method, health demand method, and service target method. Each approach has its strengths and limitations. At health facility level, the HRH forecast emphasizes on task and functional, skill mix, productivity, etc. Approaches used for the HRH projection include: skill mix, workload indicators of staffing need (WISN), task and functional analysis. Recommendations to strengthen HRH requirement projection to support effective HRH planning include: 1) HRH projection should be revised often to be in line with the changing context, 2) HRH information to support HRH projections should be updated, 3) HRH requirement projections should be done at national level as well as at facility level, 4) HRH requirement projections should not be done separately by each profession, but should be rather forecasted interrelated among health teams, 5) choosing appropriate method of HRH projection.


location: , 'Thailand year: 1998 source: HSRI

title: Outstanding enterprise for operative well-organized health promotion : a case study of the Uniliver Thai Holding Co., Ltd.

abstract: Outstanding enterprise for operating well-organized health promotion: a case study of The Unilever Thai Holding Co.Ltd.	This study aims to elaborate process and success of an outstanding enterprise for operating well-organized health promotion programs as a case study for other workplaces to develop their health promotion activities. The Unilever Thai Holding Co.Ltd. was selected as a case study for this purpose since it has been well-recognized for the  company’s health promotion programs especially its smoking-free policy. Additionally, the study describes the systematic factors and conditions of success including recommends for policy, management, and basic infrastructures that are necessary for all enterprises or their health promotion organizations to setup their own health promotion programs. Qualitative research methodology was used for the study. Most of information gathered from literature review of relevant reports and documents including structured questionnaire a part of program’s participants. The data was analyzed by using organizational analyzed by using organizational analysis that emphasized specially on organizational structure,  work system, strategies and personal as well as the Ottwa Charter conceptual framwork for health promotion. The study found that 	1.  The Unilever Thai Holding Co, Ltd. is a larg-scale enterprise that started its health promotion program from the success of the “Smoking-free Program”. Since, the company has developed other health promotion activities more systematically  e.g. acceptation of new comer who is non-smoker, not-fat and health including developed programs to follow-up the workers’ health.	2.  The success of the aforementioned was supported by the company’s policy that emphasized on health prevention and promotion rather than curative activities, consisting with the company’s high-level executive has high-level of concern to the medical advisor’s capability as the company practical leader for health. These are important factors and well-guaranteed for success of the company’s health promotion implementation. 	3.  Implementation of the Unilever’s Smoking-free Program has been enforced successfully by using policy as its supportive factor especially during the period of conflicts between the supportive and negative group of workers. Practical implementation of the program was conducted step by step and allow the  workers to learn, participate, adopt to perceive the program.	In the other word, the program used the workers’ participation as a strategy to foster the program’s   success and use social movement to make change and perception as an important social force. 	4.  Implementation of any health promotion program can initiate from any activities without framework of health promotion as a whole for example, it can initiate from making awareness of  adverse-effect of smoking and then develop to other learning process of other health promotion activities. 	5.  Building of supportive environment is a crucial factor of success especially the external social movement for smoking-free made good opportunity for change and make less negative pressure to the program as well as get more participation from non-smokers. The company’s internal supportive environment was also important.


location: , 'Thailand year: 2009 source: HSRI

title: Primary Prevention of Hepatocellular Carcinoma

abstract: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death in the world; it
causes 600,000 deaths globally per year. Most cases of HCC occur in Asia and developing countries. The
major risk factors for the development of HCC are viral infection (chronic hepatitis B and hepatitis C),
cirrhosis from consumption of alcohol, and the intake of aflatoxin as well as iron overload, obesity and
diabetes mellitus type II. Prevention of infection with hepatitis B and C viruses and avoidance of risk
factors are the key strategy for reducing the incidence of HCC. This communication describes a summary
of interrogatory questions frequently compiled for potential research study.


location: , 'Thailand year: 2017 source: HSRI

title: Operational Actions of the Thailand Antimicrobial Resistance (AMR) Containment and Prevention Program in Response to the World Health Organization (WHO) Global Action Plan on AMR

abstract: The Thailand Antimicrobial Resistance (AMR) Containment and Prevention Program, utilizing a One Health approach, has been implementing the following 10 operational actions in accordance with the World Health Organization (WHO) global action plan on AMR since 2013. They are: 1) estimate the national AMR burden; 2) determine the AMR prevalence and AMR chain in Thailand; 3) develop a national AMR containment and prevention governance structure; 4) develop laboratory and information technology systems for surveillance of AMR, antibiotic use and hospital-acquired infections; 5) regulate the use and distribution of antibiotics in humans and food animals; 6) design AMR containment and prevention campaigns; 7) generate local evidence to promote responsible antibiotic use and infection prevention and control practices; 8) create the AMR campaign packages; 9) implement the AMR campaign packages in selected communities; and 10) conduct research and development of AMR surveillance, diagnostics, and therapy and prevention of AMR infections. The major outputs, outcomes and impacts of the Thailand AMR program are: the magnitude of the AMR burden in Thailand was established; AMR campaign packages for health professionals and laypeople were developed according
to the established AMR chain and AMR prevalence in Thailand; and locally-generated evidence on the responsible use of antibiotics and infection prevention and control (IPC) is available. Implementation of AMR campaign packages in 4 pilot communities revealed their effectiveness in terms of improved awareness and understanding of AMR, responsible use of antibiotics, and compliance with IPC practices. Many containment and prevention measures from the Thailand AMR program have been adopted as national policy and implemented nationally.


location: , 'Thailand year: 2008 source: HSRI

title: The Outcomes of Anti-HIV Treatment in HIV-infected Patients at Wanghin Hospital, Srisaket Province

abstract: This descriptive research study was aimed at assessing the progress of antivirus
treatment, the difference in CD4 related antivirus treatment formulation before and after
treatment. The sample population comprised cases of HIV/AIDS who were treated at
Wanghin Hospital, Srisaket Province in the period from 2003 to July 31, 2007. The study
used secondary data on 89 cases of HIV/AIDS. Data analysis was carried out by using a
computer program. The mean difference was calculated by chi-square, t-test and paired
t-test. The samples comprised male patients (52.8%), female patients (47.2%); and 56.2 percent of the samples were aged 31-40 years. The CD4 counts in the five-year period
exceeding 200 cells/mm3 were 35.5, 40.0, 60.7, 65.5 and 84.4, respectively. There were two
antivirus treatment formulas, i.e., GPO vir, which was used in 80.9 percent of the cases,
and the formula of D4T, 3TC and Efavirenz in 19.1 percent of them. There was no difference
in the CD4 count between the two drug formulations, but the differences were significant
at the 0.001 level between, after and before treatments. CD4 cells exceeding 200
cells/mm3 were found in 93.8 percent of the female patients and in 75 percent of the male
patients, which was significantly differnt (p< 0.05). Based on the present research, it is
recommended that the patients should receive drugs continuously and follow-up, evaluation,
and patient care should be provided continuously.


location: , 'Thailand year: 2018 source: HSRI

title: Evaluation of Laboratory Quality and Service Standard in Primary Care Unit According to Ministry of Public Health Standard 2014-2016

abstract: The quality and primary care standard system (PCS) is consisted of eight main topics with a checklist of 40 items. PCS has been used as guidelines to implement and organize service systems and develop the laboratory work of the primary care units to meet quality and service standards. This study aimed at collecting and analyzing data in order to sort the frequency of unmet quality requirements of 7,452 primary care units (80.89%) assessed by network laboratories in fiscal years 2014 – 2016. The highest nonconforming requirement was Item 3 concerning the unavailability/insufficiency of materials, solutions and instruments at primary care units (such as blood glucose test with glucometer, pregnancy test, urine strip test for glucose and protein and hematocrit). The findings of this study revealed areas for improving quality and primary care standards. In addition, involved agencies should use the data to formulate policies and guidelines for improving quality and service standards focusing on the parts that the primary care units were unable to accomplish in order to improve the quality of the laboratory services at the primary care units. This will result in a decrease of service congestion at major hospitals in addition to promoting efficient treatment, prevention and disease control.


location: , 'Thailand year: 2017 source: HSRI

title: Evaluation of Financial Management for Health Promotion and Disease Prevention under the Universal Health Coverage: From Design to Implementation

abstract: This study focuses on four parts of health promotion and disease prevention budget under the Universal
Health Coverage, including budget for solving specific health problems in the area or provinces,
benefit packages, community health promotion and budget for promoting, monitoring and evaluating the program. Therefore, the objectives of the study are to evaluate the allocation in terms of sufficiency
and budget implementation, as well as monitoring and evaluating process in healthcare facilities during
2014-2015. Two provincial case studies were selected and retrospective method was employed by reviewing
related primary and secondary data. In-depth interviews of healthcare executives and focus group
discussions with healthcare practitioners were conducted. The results showed a number of challenges
due to the dynamic budget allocation that could lead to difficulties in budget management. Also, it was
unable to explain whether budget in each area was sufficient due to no separated budget for P&P. Furthermore,
lay people might not be aware that they were entitled to receive personal benefits from the Health
Promotion and Disease Prevention Fund. Most healthcare facilities did not portray evidence-based manner
to carry out and create activities regarding monitoring and evaluation program effectiveness. Therefore,
the National Health Security Office should estimate the budget to meet the requirement and strengthen
public relations to increase service utilization, and also set up mechanisms to verify accuracy of data in
order to plan the service provision. For health facilities, the P&P budget should be explicitly separated
and evidence-based academic should be used to support the implementation.


location: , 'Thailand year: 2021 source: HSRI

title: Completeness and Correctness of the 52-File Standard Datasets for Value-Based Healthcare Indicators in Diabetes Mellitus

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


location: , 'Thailand year: 2013 source: HSRI

title: Cost-Effectiveness of generic Alendronate and brand Risedronate for Primary Prevention of Fractures in Postmenopausal Women with Clinical Risk Factors

abstract: This study analyzed the cost effectiveness of Alendronate (generic product) and Risedronate (original product) for the primary prevention of fractures in postmenopausal women with clinical risk factors, including rheumatoid arthritis, long-term use of oral glucocorticoids, a parental history of hip fracture,
high alcohol consumption and current cigarette smoking. A Markov model with nine health states was
applied to estimate total costs and effectiveness for eight age-groups (45, 50, 55, 60, 65, 70, 75 and 80 years
and above) under the healthcare provider perspective. The model used a 10-year time horizon and assumed
the 5-year duration of medication with a linear efficacy reduction after stopping the medication,
and 50% medication adherence. Epidemiological data on natural history of disease, clinical efficacy, cost
and utility data were obtained from literature review. An increased risk of fractures in patients with the
risk factors was adjusted according to the relative risks, which were estimated using the FRAX® model
under the conditions of the bone mass density (BMD) t-score of -2.5SD and body mass index of 24 kg/m2.
The results showed that incremental cost-effectiveness ratio (ICER) of Alendronate and Risedronate for
the primary prevention of fractures in the postmenopausal women who had no clinical risk factors was
equal to 801,353-7,012,743 and 1,727,023-13,967,461 Baht/quality-adjusted life year (QALY), respectively.
The ICER was higher than three times of gross domestic product (GDP) per capita. When clinical risk
factors were considered, the use of Alendronate was cost-effective for women who were 75 years or above
and had the parental history of hip fracture (ICER, 202,089 Baht/QALY) or had the long-term glucocorticoid
use (ICER, 473,821 Baht/QALY). Risedronate was cost-effective for women who were 80 years or
above and had the parental history of hip fracture (ICER, 399,114 Baht/QALY).


location: , 'Thailand year: 2021 source: HSRI

title: Evaluation of Molecular Technique for Diagnosis of Tuberculosis and Multidrug-Resistant Tuberculosis, Year 2

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


location: , 'Thailand year: 2005 source: HSRI

title: The Flow of Health Personnel in Public Hopitals

abstract: The study looks upon recent changes of the health personnel situation in public hospitals in Thailand. The study covers four professions-physicians, dentists, pharmacists, and nurses. More emphasis is placed on physicians and dentists, the two scarcest health professionals, and those that public hospitals have faced the most problem retaining.	The recent years have seen increasing number of resignation, and many blame this on the 30 Baht Scheme. A recent study found, however, that resignations usually determined by joint factor such as work burdens, remuneration, and further training opportunities-all of which are similar to determining factor in the past. The state of economy is important, as it affects the relative compensation between the private and public sectors. Not many physicians cited political induced factors such as the 30 Baht Scheme or Article 41-42 of the National Security Act as the main factor. However, it would be prudent not to dismiss the possibility that dissatisfaction with the 30 Baht scheme might add some weight that tip the scale on their final decisions. The number of dentist training has increased at a slower pace than those of physicians and, in most cases, is resulting from founding a new dentistry department in a new university rather expanding the existing departments. In most dentistry departments, the number of graduates fluctuates significantly from year to year. The main reason is that many first-year dentistry students would reapply to a medical school and would withdraw from the dentistry department if they were admitted to the medical school. Pharmacists used to be considered a scarce health profession in which graduates were required to work for the MOPH after graduation. Such a requirement was abolished years ago and the public hospitals usually do not have problem filling the pharmacist position, although the legal requirement to have pharmacists working in drugstores could still not be enforced. Like other health professions, Bangkok and the Central Region has more pharmacists per capita than the rest of the country, but their distribution is better than those of physician and dentists. Nurses were also considered a scarce profession in which the graduates were required to work for the MOPH after graduation. Such a requirement was abolished even before the pharmacist case, partly because the government was not willing to hire all graduated nurses. Although some public hospitals still complain that they don’t have a sufficient number of nurses, the issue isn’t of great concern for the public or politicians.   	If we compare the number of health personnel with the standard that was set for the Primary Care Unit (PCU) in the 30 Baht scheme, we would find dentists to be the scarcest profession. In the Northeastern Region, even if all dentists are spread evenly throughout the region (which is currently not the case), there still would not have enough dentists to satisfy the standard requirement. While other professions could meet such a standard, it should be kept in mind that the standard itself is a bare minimum. Under such a condition, and given the situation that the 30 Baht Scheme has not successfully attracted private providers, to retain a sufficient number of personnel in public hospitals would be crucial to the success of the universal health coverage program in Thailand.


location: , 'Thailand year: 2007 source: HSRI

title: Factors Affecting Treatment Outcome of New Pulmonary Tuberculosis Patients in Pannanikhom District, Sakhon Nakhon Province

abstract: Factors affecting treatment outcome of new pulmonary tuberculosis patients in
Pannanikhom District, Sakhon Nakhon Province.
The study focuses on the relationship between predisposing factors, reinforcing factors
and enabling factors in a cohort of new pulmonary tuberculosis patients registered at
the tuberculosis clinic of Praarjanphun Arjaro Hospital in Pannanikhom District Sakhon
Nakhon Province during the period October 2004 - September 2006. The data were collected
using an interview form and analyzed by using retrospective study statistics, Chi -
square, Fisher’s exact test and correlation coeffcients.
The predisposing factors significantly associated with treatment outcome in new
pulmonary tuberculosis patients were age, marital status, education and economic factors
(p < 0.05).
The reinforcing factors were no cigaratte smoking or drinking of alcohol while under
the care of their doctor, during introduction and while reserve care from family, and
observers. Consultants explained the DOTS strategy to the pulmonary tuberculosis patients,
observers, Medical packing, checking and allergy drug (p < 0.05).
The enabling factors were distance and convenience of transportation (p < 0.05).


location: , 'Thailand year: 2023 source: HSRI

title: The Development of Health Care Delivery Model in New Normal Era in Sub-district Health Promoting Hospitals on the Island

abstract: This study aimed to develop health care delivery model in new normal era in subdistrict health promoting hospitals (SHPH) on the islands. The research and development were a method for this study. Data were collected by in depth interview and using the questionnaires in health care personal and people who came to receive care services at 53 SHPHs on the island. Focus group interviews were conducted among policy makers in 10 provinces to receive information related to structure, process, and care services. The preliminary analysis and the first draft prototype of health care delivery model in new normal era in SHPH on the island and the proposed policy were presented to local policy makers from 3 health zones to receive feedback and more recommendation. This process was conducted to make the health care delivery model and proposed policy relevant to each SHPH’s context and local people health need. The result of the study revealed that in Thailand, there are 58 SHPHs on the islands. During data collection process, the researchers were not allowed to collect data in 5 SHPHs in the southern part due to Covid-19 pandemic. In this study the report is based on 53 SHPHs on the islands including 50 SHPHs, 1 sub-district health station and 2 village health stations. About 87% of SHPHs were size S. the majority of people in the 6th health zone were Buddhists while the majority of people from the health zone 11th and 12th were Muslim and uses local dialogue to communicate. Local people were fishermen and agricultures while people from other places and living on the islands were wage workers. There were 201 health care personnel, 72.14 % were female with the ages ranged from 22 to 60 years (mean = 35.56 years). About 53% were community health personnel while 26.08% were professional nurses. In regard to work experiences in the studied SHPHs, the range of year were varied from less than 1 year to 30 years with the mean of 8.36 years. The majority of their responsibilities focused on providing primary medical care (86.34%), caring of people with chronic illnesses (85.30%) providing medical care procedures for patients with chronic illnesses at home. Work process barrios were staff shortage in particular nursing profession, communication with other health care staffs outside the islands, difficulty commute between islands and mainland and inadequate budgets. Work process facilitators were collaboration from local people and strong community network. All health care personnel stated that the workload was exceed manpower in SHPHs, they had to work overtime almost every day especially during the week ended and long holidays. In the famous tourist islands, health care personnel had to carry 3-4 folds of their workload during the holidays because of the large crowds of foreign and Thai tourists. After covid-19 pandemic, while Thai government encourage tourist business to booster country economic tourists flooded all famous tourist islands. In regard to their perception on work, they were very satisfying with their work because they realized that people in the community can rely on them. However, they were dissatisfying with their career advancement. Regarding the transferring of SHPHs from Ministry of Public Health to Provincial Administration Organization, all health care personnel had learned about this issue but most of them did not understand about the guidelines and did not assure their career advancement after the transfer. There were 642 people who come to receive care service and were invited to join in this study. The majority of them were female (78.66%) with the ages ranged from 20 to 90 years (mean = 49.80 years). Majority of them graduated from primary school, had chronic diseases, and received continuing care from SHPHs. Almost all of them stated that numbers of health care personnel should be increased and in every SHPHs nurses are main profession. During data collection we found that there was not a nurse in 16 SHPHs. High technology equipment was needed as well as the need for prompt emergency medical care while they have emergency and critical illnesses. Similarly, the local policy makers stated that people on the islands should receive standard care relevant to their health needs. Health equity is their right and access to health care services should be similar to ones who live on the mainland. In conclusion, in new normal era care services provided in SHPHs on the islands should be advanced the level of services up to the level of community hospitals. Three prototypes of SHPHs on the islands were developed based on the context of the islands including; SHPHs on the main tourist attraction island, SHPHs on the non- tourist spot island and SHPHs on the big island with a community hospital. The expected outcomes emphasize on rescuing patients with emergency and life-threatening illnesses and providing comprehensive care services for people living on the islands. The policy proposals from this study include, drafting the new standard for SHPHs on the islands using the 3 aforementioned prototypes, encourage people and community engagement, embed travel medicine in the foundation of SHPHs on the islands and allocate 2-3 emergency nurse practitioners for each SHPHs on the islands. Moreover, to make smooth transferring process of SHPHs to Provincial Administration Organization, definite guidelines should be announced to make all health care personnel become certain about this process.


location: , 'Thailand year: 2018 source: HSRI

title: National Health Literacy Survey 2017, Thailand (Phase 1)

abstract: Health Literacy refers to individual competences to access, understand, appraise and apply health information and services to make appropriate health decisions. Studies show that health literacy has crucial influence on one’s health status. For Thailand, there is no a standard tool to assess health literacy at the regional and national level. The present study aimed to develop and validate a Thai health literacy questionnaire for Thai people aged 15 years and above for assessing health literacy at the regional and national level. A cross sectional design was employed to collect data with a developed questionnaire in six provinces. The provinces were Chiang Mai, Nakornsawan, Nakornratchasima, Bangkok, Chonburi and Nakornsrithammarat. The questionnaire was drafted based on Nutbeam’s and European Health Literacy survey framework. It was pre-tested for plain language with experts and 35 general people. For the validation, the questionnaire was administered through face to face interviews. Focus groups were conducted for qualitative analysis. The internal consistency reliability was confirmed by the Cronbach’s alpha. The construct validity was confirmed by the confirmatory factor analysis. Correlations between health literacy scores and health outcomes were also explored. There were 722 people participating in the study. The Cronbach’s alpha was .88 for access, .86 for understanding, .90 for asking and .79 for deciding. All the Cronbach’s alphas are above .70 which indicates a satisfactory internal consistency reliability for the whole questionnaire. The confirmatory factor analysis also shows a good construct validity. Health literacy scores also correlated significantly with health outcomes which included having a chronic disease and metabolic syndrome. Those health outcomes were more prevalent among people with lower health literacy. The Thai Health Literacy Questionnaire (THL-Q) is thus appropriate to assess health literacy at the regional and national level.


location: , 'Thailand year: 2005 source: HSRI

title: Institutional preparation and capacity building for Thailand's adoption of Clean Development Mechanism (CDM) Project

abstract: Research Title	Institutional preparation and capacity building for 	Thailand’s adoption of Clean Development Mechanism (CDM) 	ProjectResearcher 	Suthawan Sathirathai, et al.Funding	Health Systems Research InstituteYear	2004AbstractThe objective of the research report entitled “Institutional Preparation and Capacity Building for Thailand’s Adoption of Clean Development Mechanism (CDM) Project” is to present Thailand’s strategy for implementing the CDM project especially in the field of laws and regulations. This will be used as the main database for negotiations and a basis for decision-making concerning the selection of the projects for the benefit of the people and country. To carry out the study, the researchers organized fora for the exchange of views and knowledge on CDMs both in the public and private sectors. Other research methods used consist of the review and analysis of related laws as well as the collection of data on CDMs in industrialized countries.  	The outcome of the study shows that the implementation of CDM has enabled Thailand, which enjoys great potential for attracting foreign investments, to increase her capability of achieving sustainable development in line with the requirements of the Kyoto Protocol. Two main issues to be considered are, firstly, the fact that Thailand may have legally-binding targets for reducing greenhouse gas emissions in the future; secondly, the country may also lose other opportunities, should it expedite the implementation of CDM without careful consideration. It is therefore imperative to establish a basic guideline relating to the selection criteria for CDM projects to ensure that there are sound modalities and procedures as well as clear rules on the rights to issue Certified Emission Reductions (CERs) as far as national entities and CDM project owners are concerned. Besides, these rules should enhance the reliability and transparency of the CDM implementation process as well as provide the CDM process with institutional mechanisms to check the performance of related agencies and organizations.


location: , 'Thailand year: 2007 source: HSRI

title: Seasonal Climatic Variation and Dengue Hemorrhagic Fever in Uttaradit Province

abstract: The purpose of this study was to explore the trends of dengue hemorrhagic fever on
the disease’s occurrence and its association with ambient temperature, rainfall and relative humidity. Information was collected retrospectively from secondary data related to the occurrence of dengue hemorrhagic fever and meteorological data, reported from January 1, 1996 to December 31, 2006.  Data were presented in frequency, and an association
was analyzed with cross-sectional time-series regression.  The results revealed that the
rate of dengue hemorrhagic fever varied from 120.62 to 277.6 per 100,000 population between epidemic years.  There was a tendency for the population to be affected by the
disease every two to five years.  Ambient temperature, rainfall and relative humidity
were positively associated with the occurrence of the disease (p<0.001, p<0.001 and
p<0.001, respectively).
Based on the results of this study, the author would like to suggest that the Ministry
of Public Health should continuously increase the people’s awareness of the occurrence
of dengue hemorrhagic fever.  The provincial health office should coordinate with the
provincial meteorological center, requesting meteorological data related to dengue hemorrhagic fever for preparation of early warning systems for the prevention and control
program.


location: , 'Thailand year: 1998 source: HSRI

title: Status and role of Thai people in health Promotion

abstract: The objectives of the study were (1) to study the situation of Thai-people health promotion (2) to study the role and the development of health promotion in popular sector, and the relationship between government sector and non-government sector (3) to analyze and to suggest the policy recommendation on the contribution of health promotion. The methods of this study were document review method, indepth interview and informal interview. 	The finding of this study was: in general, life expectancy at birth has lengthened substantially, Thai people was facing a changing pattern of health, the pattern of morbidity and motality have changed, non-communicable diseases were increasing. The Thai’s lifestyle was changing to urban lifestyle. Thai people mostly eat Thai food, but they increasingly eat saturated fat and decreasingly eat fiber foods. Thai’s daily activities are 8-9 hours of work, 6-8 hours of sleeping, watching television. Lack of exercise and inappropriate self-medication; and some people drink alcoholic beverages and smoke cigarettes. And, Thai people were coping with the stress problem and lack in the coping skill and the life-skill in the modern society. The study also concluded that Thai people were interested in ill health or illness. For the community-based health promotion, the government have had the policy of the community participation and health development for two decades, but the communities were induced by the health personnel. However, the non-government organizations and some government organization contribute the community’s initiatives, decision-making, control and health development. Some community organizations/groups were initiated the health promotion activities by themselves. If was recommended that (1) MOPH should increase the individual health potential; using the variety of methods and the appropriate methods (2) MOPH should promote community organizations and contribute the community’s initiatives, decision-making and health development (3) MOPH should promote the health personnel skill of mediation, enabling and advocacy in the health promotion process (4) MOPH should formulate the long-term master plan of health promotion.