location: , 'Thailand year: 2022 source: HSRI

title: A Literature Review on Utilization of Managed Entry Agreement

abstract: When high–price drugs or new drugs with immature information about their efficacy come to market, will cause uncertainty in the health systems, especially for health–service buyers as the payers in the health systems. Managed Entry Agreement (MEA) is the tools for manage uncertainty that are widely used in many countries such as United Kingdom, two third of OECD member countries, European Union countries. MEA can be divided into two types: financial–based agreement and performance–based agreement. The financial–based agreement aims to limit budget impact through controlling drug costs. It is a simple method, effective in reduce drug prices and limit budget impact, but the details contained in the agreement are confidential, resulting in a lack of transparency. It may give some payers the benefit of such details. It can be implemented at 2 levels: population level and patient level. At the population level, consists of MEA in the model of discount / rebate, price–volume agreement, and expenditure cap. At the patient level, consists of MEA in the model of free initiation treatment and utilization cap that provides individual patient coverage. The performance–based agreement is an agreement based on the actual treatment efficacy. Sometimes referred to as health outcome–based agreement. This agreement is divided in two groups. The first group aims to optimize drug use, known as performance linked reimbursement, which consists of MEA in the model of conditional treatment continuation and pay by result. The second group aims to address uncertainty about drug efficacy with more research studies. This model of MEA is known as coverage with evidence development, or CED. It is a good solution to the problems, but it is complicated to operate, and affect stakeholders in the health systems widely, and high cost in operation. However, the decision–makers in the health system should carefully consider in the selection and implementation of MEA, as each model of MEA has different strengths and limitations, for efficient budgeting and equal access to medicines.


location: , 'Thailand year: 2022 source: HSRI

title: Development of anti-PD-1 antibody for cancer immunotherapy

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


location: , 'Thailand year: 2009 source: HSRI

title: The Study of Information System in Occupational and Environmental Health

abstract: The study of information system in occupational and environmental health is a project under the development of information system in occupational and environmental health project. The aims of the study were to review knowledge on information system in occupational and environmental health field and study the situation of such system in the country. The steps of the study included literature review, information collection, and seminar for information and experience sharing among experts and relevant organizations
 	The results of the study showed that there are 2 issues concerning the study: the information system for occupational health and the other for environmental health. There are at least 2 important databases for both information systems, including environment database and health database. Environment database consists of data from measurement of hazardous levels in various setting such as working environment, or pollution level in communities. On the other hand, health database consists of exposure data in population from health screening and disease information from hospitals and other health service centers. Apart from the database, the proper information system should include data collection, data analysis and interpretation, and dissemination systems.
	In this study, only occupational health information system under the responsibility of the Ministry of Public Health was selected for analysis. The study found that such information systems are mainly responsible by two agencies such as the Bureau of Health Strategy and Planning and the Bureau of Epidemiology. Both agencies have established and developed their own information system, e.g. data collection, analysis, and interpretation. They focus on not only occupational diseases but also general diseases, depending on their mandates.
	Regarding health service centers, several hospitals and health centers throughout the country have provided occupational health services. The occupational health services include pro-active and passive approach (or service at health service stations). The information collected includes data from walk-through survey, environmental assessment, health screening, and disease diagnosis and treatment. Up to now, several health service centers have developed their own occupational health information system to manage information they collected.
	In conclusion, the development of information system in occupational and environmental health is very important for occupational and environmental health service system. However, the system faces many obstacles and problems, such as no information available, data accuracy, data sharing among relevant organizations, and supportive system for system maintenance. Therefore, responsible agencies have to co-operate to tackle the problems and to improve the information system.


location: , 'Thailand year: 2000 source: HSRI

title: National health account in Thailand 1996, 1998

abstract: This was an initiative by local researchers, with an emphasis on putting the NHA system in place.  Two work steps were involved; first, tracking the flow of funds from ultimate sources of finance to financing agencies and second, analyzing the use of funds by financing agencies.  Five ultimate finance sources and twelve financing agencies (7 public and 5 private) were identified.  Use of consumption expenditures was listed under four main categories and 32 sub-categories.	The results from NHA1 in 1994 estimated a total health expenditure of 128,305.11 million baht; 84.07% represented consumption and 15.93% capital formation.  Of total consumption expenditure, 36.14% represented purchasing care from public providers, 32.35% from private providers, 5.93% on administration and 9.65% on all other public health programs.  Public sources of finance were responsible for 48.79% and private sources of finance for 51.21% of the total 1994 health expenditure.  Total health expenditure accounted for 3.57% of GDP (consumption expenditure 3.00% of GDP, capital formation 0.57% of GDP).  However, NESDB estimated 1994 consumption expenditure to be 180,516 million baht or 5.01% of GDP, of which private sources were dominant (82.17%) and the public source played a minor role (17.83%).  The discrepancy of consumption expenditure figures between the two estimates is 2.01% of GDP.  In addition , there is a big gap in the public and private proportion of consumption expenses; 46:54 in NHA1 and 18:82 in NESDB.	From this NHA2 study, the researchers estimated that health care expenditure in 1996 was increasing when compared to the GDP in that year.  But in 1998, health expenditure was decreasing when compared to the GDP in that year.  This was due to the economic crisis in Thailand.  The main decline in health care expenditure was experience by the private sector with a 21% decline., but the expenditure from the government side was still increasing by 10%.  This showed that the government played a big role in protecting people’s health during the economic crisis.  Another finding indicated that individuals tended to spend less on services from both public and private health providers.  They went by themselves to pharmacies and bought medicines to treat themselves.  Although the government increased health care expenditure in general, it decreased its own spending on health prevention and promotion because, due to the economic crisis, the government needed to put more emphasis on treatment and curative services than preventive ones.	In conclusion, a sustainable NHA and utilization of NHA for planning and policy development is a major national objective.  Having a strong NHA structure will enhance the demonstration of how the country’s health resource were spent, what services were provided and who paid for them and will further facilitate international comparison, especially with members of the OECD countries.


location: , 'Thailand year: 2006 source: HSRI

title: A literature review of second opinion and public health information

abstract: Second Opinions is one of the efficient medical procedures to enhance quality and
reliability of health care system, particularly from the patient’s point of view. To be
applied in Thailand, this will provide evidence of our patient’s rights enhancement as
well as consumer empowerment, in terms of allowing consumers to receive better
quality of health care services.
The objective of this study is to review the literatures related to Second Opinions and
people’s access to public health information, with the aim to find out preliminary
information required for a proper development of Second Opinions System in Thailand.
From the literature review, Second Opinions has been initiated and implemented
formally in the USA since 1970s. Initially, Second Opinions was used as a utilization
review technique to reduce unnecessary costs associated with overused and
inappropriate surgeries rather than used as an approach to offer additional information
or other further medical opinions to patients.
Nowadays, in most countries, Second Opinions is adopted and used based on the same
common principle, which regards Second Opinions as a fundamental right of patients to
get reassurance, additional information, as well as other treatment options from health
care service providers, except in the USA where the importance is also given to cost
benefits obtained from implementing the program. It can be seen that, in practices,
there are differences in intensity and scope of regulation imposed regarding the
application of Second Opinions among the studied countries. Some countries have
published state laws regulations to support the implementation of Second Opinions
program. On the other hand, some countries see Second Opinions as a typical issue in
medical ethics that every practitioner needs to follow, thus no need to use law
enforcement.
The methods of obtaining Second Opinions in the studied countries are similar among
each other, but the number of usage and effectiveness of each method are varied
according to various fundamental factors in each country such as education level of
population, technology development, state regulations, and local cultures.
In the present, Thailand has the declaration of patient’s rights as the main mechanism to
move forwards to the establishment of Second Opinions System. However, other
supporting mechanisms still need to be developed in order to ensure the system
effectiveness. The Second Opinions adopted for Thailand should be on a voluntary
basis, giving focus to the patient’s right to make decision, rather than on a mandatory
basis. Under this voluntary basis, patients will have an automatic right to request
second opinion directly from their attending doctors.
The recommended framework for the development of Second Opinions System are as
following 1) Driving: using laws/regulations, documented medical ethics, and public
relation to strive for public awareness; 2) Implement & Control: related public health
assurance units should be assigned to oversee the implementation as well as control the
costs incurred from operating the program; 3) Support: the proper development of
public health information system and coordination units/centers would provide
supporting infrastructure to the adopted system. Under this framework, there are
numbers of involved activities such as regulation amendments, public relation, database
set-up, further study on cost, etc. Then, after the system has been established,
concerned government agencies should relay information to the public through the
effective public relation program and then continually follow-up the implementation
closely in order to evaluate its effectiveness and eliminate the problems occurred.
Although, this report gives preliminary ideas and information required for a
development of Second Opinions System in Thailand, many further studies also need to
be conducted to give full details of pro’s and con’s of having such system prior to
making a go/no-go decision.


location: , 'Thailand year: 2022 source: HSRI

title: The Lesson Learned of COVID-19 patients journey in Providing Health Care Services in Health Region 9

abstract: The research purpose was to explore the lessons learned of COVID-19 patients journey in providing health care Services in health region 9. Data were collected using mixed methods, starting with a qualitative methodology and supplemented by a quantitative methodology. The sample groups in qualitative research were health care providers and health service recipients selected using purposive sampling: director of the Bureau of Communicable Disease Control, director of the 9th Public Health Region, hospital director, deputy director of Medical Affairs, head of Nursing Mission Group, group head director of Tambon Health Promoting Hospital by choosing two persons per group, a total of 12 persons: plus selecting six persons from each group of doctors, nurses, health workers, EMS, EMT, and health service volunteers from the top two areas of each province in the 9th Public Health Region with the high covid infection: and twenty health service recipients who experienced receiving health care services and recovering from Covid-19. The instrument used was an interview from the sample group in quantitative research who were the health care providers at both administrator and operational levels and health service recipients by purposive sampling, 384 persons per group. Data were analyzed using descriptive statistics, frequency, percentage, mean, and standard deviation, content analysis, and COVID -19 patients journey in providing health care Services in health region 9. The results of the study were as follows: 1) The perception of information from the public health unit for use in family and community disease prevention found the main issues as follows; (1.1) Promotion strategies, the perception of information from public health agencies for preventing diseases in families and communities consisted of the use of digital technology, direct communication with the public, forward authoritative documentation from governments, community leaders and health volunteers knock on the door, and Covid-19 Information Center (1.2) Build awareness of information for sustainable disease prevention, create an understanding not to panic but to be aware, promote knowledge, competence, self-care, creating awareness of information correctly, and creating responsibility for a new norm of life; 2) Access to the first point of receiving health services for patients with Covid-19 infection, operates services in a proactive and reactive form through an integrated network of government, local and private sectors, transferring patients to hometown, proactive in the area, receive health care services at the first pick-up point of the nearest hospital, and receive health services through the call center; 3) Assessment and detection of pathogens of patients with Covid-19 infection, two main types of assessment were carried out for pathogens: Antigen Test Kit (ATK) and RT-PCR, ATK test for initial screening, Confirmation of COVID-19 infection with RT-PCR at provincial hospitals or districts that have only RT-PCR machines, the journey of receiving the Covid-19 testing service is the respiratory clinic, visiting the area to check in the community and referral for infection detection at network hospitals; 4) Receiving care from medical and public health personnel for patients with Covid-19 infection in compliance with the guidelines of the Medical Department; The first wave were hospitalized, and the second wave were divided according to the severity of the disease; 5) Planning for patient discharge to go home follow by providing care information, coordination, referral, preparation of patients and their relatives, and community preparation 6) Ongoing care at home for patients with Covid-19 infection visit in the area public health volunteers follow up to visit areas of responsibility. Local authorities are responsible for the service. Factors contributing to the health services received for patients with Covid-19 infection from the perspective of service providers found that the social media usage like line, facebook, website, were at the highest level (mean = 4.34; SD = .683). Followed by initial screening with Antigen Test Kit or ATK (mean = 4.28; SD = .718), and RT-PCR verified for high-risk groups (mean = 4.25; SD = .722). Obstacle factors of receiving health services for patients with Covid-19 infection from the perspective of service providers reveal that the multi-step process of transmitting information was at the highest level (mean = 3.65; SD = .830). Receiving unfiltered data from social media (mean = 3.65; SD = .931) and receiving rumors from neighbors (mean = 3.56; SD = .918), respectively. Factors contributing to the reception of health services for patients with Covid-19 infection from the service recipients’ perspective like Line, Facebook, and websites were at the highest level (mean = 4.27; SD = .763). Followed by having the patient take a fever test, high blood pressure, and oxygen send information about symptoms during treatment to the staff as scheduled (mean = 4.23; SD = .762). Initial screening with Antigen Test Kit (ATK) (mean = 4.22; SD = .791). RT-PCR assays for high-risk groups (mean = 4.22; SD = .783) and compliance with the Covid-19 treatment guidelines of the Department of Medical Services (mean = 4.22; SD = .798). Obstacle factors receiving health services for patients with Covid-19 infection in the view of the service recipient overall revealed that the multi-step process of information transmission was at the highest level (mean = 3.73; SD = .907). A limited number of personnel to provide health services at the first point of admission (mean = 3.66; SD = .986). The process to access health services is a multi-step process (mean = 3.63; SD = .944). Getting unfiltered information from social media (mean = 3.63; SD = 1.042) and having limited skills in using technology to access and receive news (mean = 3.63; SD = .990), respectively. The results recommended that (1) health services during the Covid-19 epidemic situation should use digital technology to assist in service dimensions of promotion, prevention, treatment, and rehabilitation: (2) There should be an integrated government network with the private and local operation; and (3) Supporting the use of ATK initial screening kits and enhancing health literacy, and creating responsibility for a new norm of life and sustainable lifestyle for the people.


location: , 'Thailand year: 2009 source: HSRI

title: Art Therapy 2: Theory

abstract: Art therapy is a form of expressive therapy that uses art materials, such as paints, chalk and markers.
Art therapy combines traditional psychotherapeutic theories and techniques with an understanding
of the psychological aspects of the creative process, especially the affective properties of different art
materials. Its psychotherapeutic modality is based on the disciplines of “art” and “psychology” involving
Sigmund Freud’s psychoanalytic theory, relying on the human person’s symbolic expression as a
means of communication as an alternative to verbal communication.
The term was coined by Margaret Naumburg in 1947 in the United States of America (some have
mentioned that Adrian Hill did so in Britain in 1945). Art therapists have generated definitions of art
therapy split into two categories. The first involves a belief in the inherent healing power of the creative
process of art making, embracing the idea that the process of making art is therapeutic, which is referred
to as “art as therapy” (Edith Kramer’s theory). The second definition of art therapy is based on the idea
that art is a means of symbolic communication, referred to as “art psychotherapy,” emphasizing the products
– drawings, paintings and other art expressions – as helpful in communicating issues, emotions, and
conflicts. The art image becomes significant in achieving insight, resolving conflicts, solving problems,
and formulating new perceptions that in turn lead to positive changes, growth, and healing. In reality,
both approaches are used together in varying degrees.


location: , 'Thailand year: 2023 source: HSRI

title: System Governance Factors influencing the Implementation of Participatory Health Region of Thailand

abstract: This study aimed at analyzing the level of system governance of the participatory health region and the committee roles on system governance; and categorizing system governance of the participatory health regions at national level. Mixed methods of both quantitative and qualitative studies were used. The study covered 13 health regions. The study population consisted of 638 committee members and secretariat teams. Quantitative data were collected by self-administered questionnaires designed according to United Nations’ good governance criteria, and analyzed by descriptive statistics and exploratory factor analysis. Qualitative data were collected by in-depth interview, focus group discussion, report review and observation, and analyzed by content analysis. The study took 15 months from October 2018 to December 2019. Quantitative analysis showed that the participatory health regions had high system governance level since all components got scores greater than 2.5. The top three highest scores consisted of following the rules of law (score 4.01), equity and inclusive coverage (score 3.91) and transparency (score 3.81). The three least scores included efficiency and effectiveness (score 3.65), accountability to people (score 3.66) and responsiveness to target population (score 3.72). Qualitative data analysis revealed 20 important committee roles on the system governance. Holistic care provision and regular meeting reporting got the same highest levels (score 4.04) while the least achievement role was on fulfilling the setup plans (score 3.48). By factor analysis, two categories of system governance were found: the planning and the implementation process. The present study suggests that the network governance can be used to strengthen both the National Health Security Office’s area health and the regional health of the Ministry of Public Health. Public relations, experience sharing in working with soft power, and building collective leadership are recommended for improving system governance. The weakness of the present study was the lack of impact evaluation.


location: , 'Thailand year: 2014 source: HSRI

title: An evaluation of the public health officers at subdistrict health promoting hospital, Buri Ram Province

abstract: This study was a cross-sectional descriptive research. The purposes were to study motivation and
organizational support affecting an evaluation of the public health officers at subdistrict health promoting
hospitals in Buri Ram Province. Population size was 324 persons and a sample size of 207 persons was
selected by systematic random sampling. The research instruments were the questionnaires. The Cronbach
coefficient of instrument was 0.97 and validity was checked by 3 experts. The 207 questionnaires and The
12 in-depth interviews were collected by a research assistant during 1 February 2014 to 28 February 2014.
The data was analyzed by SPSS for windows program to acquire a percentage, mean, standard deviation,
percentile, Pearson Product Moment Correlation Coefficient and Stepwise Multiple Regression.
The findings revealed that most males (53.6 %) with the average age of 40.80 years. The marital
status was 67.1%. The educational degree was a Bachelor’s degree or equivalent for 87.9 %, Duration of
working as public health officers, at subdistrict health promoting hospitals was averaged at 10.35 years.
They were used in 60.4% of practice in evaluation programs. It was revealed from the study that The
overall motivation was in a high level at an average 3.68 (S.D. = 0.42). The organizational support at high
level averaged 3.64 (S.D. = 0.52). And an evaluation of the public health officers at subdistrict health
promoting hospitals in Buri Ram Province at high level, average 3.79 (S.D. = 0.54).The motivation factors
and hygiene factors, also an organizational support, were positive influence on an evaluation of the public
health officers (r = 0.649, p-value < 0.001; r = 0.575, p-value < 0.001; and r = 0.779, p-value < 0.001, respectively).
Six factors that could predict an evaluation of the public health officers at subdistrict health promoting
hospital in Buri Ram Province including Organizational Support in management, Company policy
and Administration, Responsibility, Organizational Support in Time, Organizational Support in Technology
and Job Security with a level of statistical significance (68.9%). The main problem from the study was
the Organizational Support in human resources for 37.21%


location: , 'Thailand year: 2007 source: HSRI

title: Adaptation to Illness of Tuberculosis Patients and Recommendations for Family and Social Support of Patients

abstract: The objective of this qualitative study was to study the adaptation to illness of tuberculosis patients and develop recommendations for family and social support of the
patients. Purposive sampling was carried out by in-depth interviews of registered AFBpositive pulmonary tuberculosis patients who were treated in Chaingyuen Hospital and
lived in Chaingyuen district.  It also included in-depth interviews of the families, neighbors, and health volunteers, as well as the local governor, and health officer. Focus group
discussion was conducted among three groups of neighbors, families and cousins of tuberculosis patients; there were four cases of non-participatory observers in the patients’
families. The results of this study show that, in the first two months of treatment, the
patients required physical and psychological adaptation because of worring disease progression and drug side effects, which made them reduce their activities.  They also needed
support from others, which lowered their self esteem.  After the first two months the
patients felt better owing to their improving health, and the normal activity which gave
them confidence in the treatment and boosted their self esteem.  Although most of the
patients could adapt to the role-functioning aspects, they still helped themselves and
sought the support of others appropriately.  One-third of the patients sought alternative
treatment, especially with Thai herbs, without addressing financial problems.  For social
support most patients were given good care and love by their families and the community with regard to finance, work, using utensils and providing information on the disease, all of which helped the patients.   The patients were satisfied with the treatment
service received from  the national health insurance system despite the lower number of
homevisits allowed under related guidelines. The health officer therefore followed up by
telephone instead of making homevisits, which showed that local government authorities can play a role in homevisits.  Based on this study, we recommend that the authorities
involved should consider develping community networks and creating a referral system
for patient support, providing knowledge about tuberculosis to the community through
appropriate channels, for example, community radio, and developing a home visit system to meet establihed standards, and make continuous evaluation.


location: , 'Thailand year: 2000 source: HSRI

title: The characteristics of problem in health service utilization under different health insurance schemes

abstract: The characteristics of problems on health service utilization under different health insurance schemesThis research aims at analyzing conditions and problems of health service consumers under current five insurance programs and of a group of consumers who are not covered by the systemproblems of health service delivery affecting the consumermode of health service utilization of the consumers who are not insured problems caused by weaknesses of the five schemes and the quality of service andproposing guidelines and machinery leading to the development a national health service system. The research in both quantitative and qualitative. The quantitative study involves the interviews of 2,400 consumers consisting of 400 each from the five different schemes and another 400 from non insured group in 4 provinces namely Samutprakarn, Chiengmai, Pattani, and Srisaket. The qualitative study involves the administration of 9 focus groups, 12 case studies and interviews with 9 resource persons. The objectives of the research are hereby responed: Problem encountered by all groups of consumers in clouding the non-insured are the lack of promptness on part of public providers; the long waiting for the doctors, the limited time spent for the examination and diagnosis with no explanation on symptoms of the illness; difficulty to commute to and from the designated health centers.Problems relating to the implementation which affect the consumers are lacks of sufficient information on benefits under the schemes by the insurers and lack of good      coordination among them; inappropriate subsidization for the free medical care consumers; moral hazard and adverse selection; refusal to receive reffered patients due to reimbursement difficulty; and inefficient service due to unreasonable financial incentives managed by central      administration. 3) Only the non-insured minority are capable to pay for their own medical expenses. In case of minor illness, the non-insured would go to the drug stores or private clinics. Their utilization of hospital service is less compared to all of the insured groups. Most of them can depend on themselves for out-patient charges. Most of them can depend on themselves for out-patient charges. Non-insured patients with high cost of expenditures are sometimes advised by the nurse to buy health card or to consult with hospital social workers for appropriate assistance. The number of the non-insured could be much decreased upon efficient health campaigns. Each of the health insurance schemes has its strengths and weaknesses. Collectively speaking, the duplication as well as the discontinuation of rights undermine the reliability of the data used for effective planning. Insufficient subsidization has and impact on the important factors determining provider's behavior. Good accessibility to free service enhances the beneficiaries to overuse the service. 5) The researchers have some reservations over adopting one single insurance system for the "health for all" policy. We might not be able to adopt the system that has been proved successful in many developed countries due to our people's limited ability to pay tax on the one side, and the eddiciency of tax collection on the other. The authorities should timely consider the introduction of pay mechanism by which all consumers receive free essential service and pay only for non-essential service.


location: , 'Thailand year: 1998 source: HSRI

title: Networking and processes for road accident policy

abstract: Networking and Processes for Road Accident Policy	Road accident cases in Thailand were on the rise since 1983 to 1991. Road users were increasingly injured by 60% and 38% more death rates found during this period. Despite the availability of road accident prevention policy e.g. compulsory use of motorcycle helmet and safety belt, injured cases were not reduced to satisfactory level. This study was to analyze Thailand’s road accident policy by using secondary data and interviewing those who were involved in the policy-making process. Limitations of policy-making process were explored and recommendations were synthesized to improving the process of policy-making. 	Lack of networking various agencies and stakeholders to processing the policy was the prime disadvantage while resources were also restricted to effectively facilitate the networking establishment.   The road accident problems should be made realized into wider groups of people including all road users, policy makers and politicians. The most active role player should be the government to set up the institution responsible for networking a number of agencies and people to get involved in the policy-making process and for evaluating policy implementation.


location: , 'Thailand year: 2022 source: HSRI

title: Preparation of Finite Element Model of Patient-Specific Bone Geometry Dataset for Machine Learning to Predict and Prevent Bone Fracture in Elderly

abstract: Thailand is entering an aging society completely. Osteoporosis is another disease that may become more frequent as it is more common among the elderly around the world. Osteoporosis increases the risk of bone fractures and, when fractures occur, is a contributing factor in increased mortality for the elderly. If fractures can be predicted for older adults with osteoporosis and solutions to prevent fractures can be found before they occur to the elderly, these will help to reduce the danger, loss of property, wasted time, and death of the elderly. The medical images obtained either as a direct diagnosis of fractures or in the diagnosis of other diseases can be further enhanced by combining with computer modeling techniques for biomechanically analysis based on finite element method, which are used in the diagnosis, treatment, and may include prognosis of various medical conditions widely, to analyze and predict fractures for elderly people with osteoporosis. However, this analysis technique is used mainly in research laboratory. This is due to a lot of resources required. If a sufficiently large number of analytical results can be obtained and used as a sample set input for the machine learning system to learn, then the current operating procedures may be reduced. It may result in faster diagnosis or prediction with adequate accuracy compared to traditional techniques. Therefore, the objective of this study was to predict fractures in the elderly due to various activities and conducting a study on the feasibility of collecting the biomechanical analysis results to be used as a sample input for future machine learning systems to use in learning with the aim of replacing the current procedure for performing part of the finite element analysis. From the study, it could be confirmed that the condition of osteoporosis greatly affected the force transmissibility. The external load was mainly experienced by the bone tissue which has a high bone mineral density, but this type of bone tissue is less common in patients suffering from osteoporosis. Therefore, occurring of osteoporosis affect bone strength directly. Moreover, the study was likely to find a relationship between the bone mineral density values obtained from medical imaging and stress values obtained from finite element analysis under various stress conditions. This may be the possibility of using machine learning to replace engineering analysis using the finite element method leading to the ability to reduce the process of finite elements in order to get a faster but still accurate diagnosis or prediction result.


location: , 'Thailand year: 2020 source: HSRI

title: A cohort of CKD patients with high risk for cardiovascular events or renal disease progression multicenter study (CORE-CKD Thailand) ระยะที่ 2: Outcomes and Cost-Effectiveness Extension Study

abstract: Project: A cohort of CKD patients with high risk for cardiovascular events or renal disease progression multicenter study (CORE-CKD Thailand) Phase 2: Outcomes and Cost-Effectiveness Extension Study Introduction: Chronic kidney disease (CKD) has effects on quality of life, high cost of care, increases the risk of cardiovascular disease, renal disease progression and other complications. Both traditional factors including hypertension and non-traditional factors including arterial stiffness, salt and water retention, genetic factors and other biological molecules contribute to the cardiac complications and renal decline. Methods: CORE-CKD (Thailand) Phase 2 is multicenter, hospital-based, non-interventional prospective cohort which follow patients with CKD stage 1-4 enrolled in Phase 1. CORE-CKD phase 2 study comprises of 3 objectives: Evaluate risks for 1) cardiovascular disease and 2) renal decline over 3-5 years and 3) Economic impact of CKD by evaluating direct and indirect cost and cot-effectiveness of various treatment. This study will also collect data from elderly patients, patients with on hemodialysis or peritoneal dialysis for comparisons with CKD stage 1-4; Aim 3 Collect DNA, blood and urine into biobank for studies in biomarker studies. Results: 1,409 patients have been enrolled from 21 centers covering all regions of Thailand. Over 1000 samples have been stored in biobank. This report will focus on cross-sectional analysis of the baseline data 1) Control of blood pressure in Thai CKD subjects in comparison to International cohort. Among Thai CKD patients, the proportion above target BP were: <130/80 mmHg 73.1%, and <140/90 mmHg 45.5%. Just over 50% were on angiotensin receptor blockers or ACE inhibitors. 2) Relationship of arterial stiffness measured by cardio-ankle vascular index (CAVI) and abnormal cardiac contraction by echocardiography in the development heart failure in CKD. Both mean CAVI and Ventricular-arterial Coupling (VA coupling) was significantly higher in CKD patients with heart failure compared with patient without heart failure. 3) Researchers currently evaluating relationship of psychosocial impact, risks of CVD, relationship of CAVI and pelvic vascular calcification, CKD staging using creatinine or cystatin C, 24 hr. urine sodium intake, prevalence of anemia and other complications, development of metabolomics for identification of renal disease progression and economic impact in CKD patients. Conclusions: CKD patients have high prevalence of many risk factors. Arterial stiffness and abnormal cardiac contraction is associated with heart failure in CKD. The treatment of hypertension in still inadequate. This knowledge will be useful to make strategies to achieve control of various risk factors. This is the first year of a three year project. In the next 2 years data analyses on other parameters will be more complete and more information would be available on risks for CVD, kidney disease progression and economic burden of CKD in Thailand.


location: , 'Thailand year: 2014 source: HSRI

title: Path - Goal Leadershpi Theory and Situational Factors Affecting Performance Effectivenss among Directors of Tambon Health Promotion Hospital in The Public Health Region 3

abstract: The study aims to investigate factors related to performance effectiveness among directors of Tambon
health promotion hospital in the Public Health Region 3. One hundred and sixteen directors participated
in this study through proportional random sampling. Descriptive statistics and ANOVA were used in
analysis. The results revealed that the directors of Tambon health promotion hospital in Public Health
Region 3 had a high level of performance effectiveness. According to path-goal theory leadership, over 45
percents of the directors adopted the participative leadership style. The study also revealed statistically
significant difference between types of leadership and performance effectiveness (F=2.992,p-value≤0.05)
and a statistically significant relationship between role ambiguity and performance effectiveness (F=6.722,pvalue
=0.01). To achieve effective leadership directors of Tambon health promotion hospital should undergo
a preparation course that aims to raise their correct awareness of the role and responsibilities.


location: , 'Thailand year: 2003 source: HSRI

title: Solving anemia in pregnancy living in the catchment area of Sriratana hospital through community participation

abstract: The objective of the study on solving anemia in pregnancy living in Sriratana hospital’s catchment area is to decrease iron deficiency anemia in pregnancy through operational research using participatory group process. Data were collected by means of questionnaires, weight and height scales, antenatal care record, record of group process and laboratory investigation including packed cell volume (hematocrit) and screening for thalassemia (DCIP-KKU clear test, Osmotic Fragility test). Various medias were used for disseminating basic knowledge, control and prevention of anemia and related issues in group discussion. All pregnant women living in villages in the catchment area were participated during November 2000 to October 2001. The results showed that using participatory group process to perceive iron deficiency in pregnancy and to formulate solutions has an effect on correcting knowledge, attitude, and behavior to prevent and control iron deficiency anemia statistically significant. In addition, 11 programs had been generated to make other iron food sources available, to disseminate knowledge of iron deficiency anemia and motivate pregnant women attending antenatal care service at first trimester. The outcome of intervening programs indicated that 41.2 % of pregnant women attended first ANC at pregnancy age less than 12 weeks. And, 76.5% took iron tablets regularly according to the prescription. These findings consistent with the increasing of mean packed cell volume from 33.3% (95%CI: 32.3-34.4%) at first attending ANC to 36.8% (95%CI: 35.9-37.6%) at pregnancy age 28-32 weeks. Anemia in pregnancy also decreased from 36.8% to 16.7%. It is concluded that participatory group process in perception of anemia in pregnancy will decrease anemia in pregnancy and results in cooperating between health facility and community.


location: , 'Thailand year: 2022 source: HSRI

title: Personalized 3D-Printed Titanium Cranial Implant for Cranioplasty Patients in Multicenter Clinical Study

abstract: Cranioplasty surgery has many impacts to patients’ physical and mental health, for example, restoration of the mechanic of fluid flow inside the brain which protect from external danger with the reconstructive patient appearance that affected socialization emotional well-being. In the current years, Polymethylmethacrylate (PMMA) material has been famously used for the surgery for more than 50 years with the cost effectiveness and the inclusion in most of the government welfare in many countries. However, this material is not the best options for this surgery in term of strength and anti-infection, in other word, the PMMA may has a stellate pattern when receive a curtain point of external force that can lead to the death of the patient. The METICULY Patient-specific titanium mesh implant, model CraniMesh, was introduced in 2017 with the 3D printing technology and personalized design for the cranioplasty surgery. This product overcomes the strength and anti-infection problems of PMMA with additional properties of surgical time reduction. Despite the increased benefits and cost, the CraniMesh has not been listed in the Thai government welfare yet, also no evidence of the comparative pharmacoeconomic study between the CraniMesh and the PMMA cranioplasty plate to facilitate the listing process. This study has objectives to evaluate the safety and performance of the Cranimesh and the retrospective clinical study of usage between these 2 products in cranioplasty surgery, which comprises of 3 parts, as follow. The performance testing of the CraniMesh according to the accepted standard compliance utilize the requirement of the United States Food and Drug Administration (USFDA) for medical device control and registration. This study has shown the complied test protocols and reports of all the necessary tests required by the USFDA to confirm with one of the most restrictive standards. The results showed that the CraniMesh has equivalent safety and effectiveness in both the product and the manufacturing process in international level, and this can be used as the pathway for Thai medical device manufacturer to achieve the USFDA standard. In the retrospective clinical study for the implantation of the CraniMesh and the PMMA cranioplasty plate for 28 and 30 samples, respectively, with 6-month follow-up period in multicenter to confirm the safety and effectiveness of the device, the reoperation and infection rate of the PMMA plate is 16.7% while the CraniMesh had 0%. The CraniMesh had surgical time 169.3±71.4 minutes, while the PMMA plate had surgical time at 247.0±111.7 minutes. This data was considered with the statistical methods with p-value<0.05. The pharmacoeconomic study of the CraniMesh and the PMMA cranioplasty plate utilizing the comparative utility cost analysis with economic decision tree model for 10 years analysis showed that the Incremental cost-effectiveness ratio (ICER) has negative value in the social point of view. In other word, cranioplasty surgery with the CraniMesh will have decreased cost -11,990 baht with the increased Quality Adjust Life year (QALYs) 0.04 which is more dominant and cost-saving when compared with the PMMA cranioplasty plate. In the public point-of-view, ICER will equal to 91,330 baht for annually increased QALYs. These results showed that in the social point-of-view, the CraniMesh has 77% worthiness probability to the specified worthiness at 160,000 baht for annually increased QALYs in the context of Thailand, while the PMMA cranioplasty plate has 23% worthiness probability in the same context. For the public point-of-view, the CraniMesh has 56.3% worthiness probability and the PMMA plate has 43.7% worthiness probability. All the results from every parts of this project showed the efficiency of the CraniMesh in the phase of pre-clinical study, retrospective clinical study, and pharmacoeconomic study of medical device. This results will be lead to the decision-making support for the policy to add the CraniMesh in the medical device listing in the near future to help decrease the status quo gap in public health system of Thailand.


location: , 'Thailand year: 2009 source: HSRI

title: Governance Index for Health Systems Research Management Units

abstract: As a part of developing the research management system in Health Systems Research Institute (HSRI) and its alliances, the project of developing good governance index as a tool for research administration in health system is initiated to promote various research projects to be managed transparently, efficiently, and accountability.   The operation of this project will be an empowerment tool which provides good governance practices to reform organizational management system, leading to sustainability and future breakthrough.
Objectives of this project are 1) to define the framework of monitoring and evaluating the project administration in accordance with good governance practices 2) to develop good governance index 3) to study the appropriateness of the developed index, issues, and barriers for index perceived 4) to set a guideline to gather essential data for project performance evaluation which is based on good governance principle of research management team in health system.
The process of this project begins with 1) reviewing theories, concepts, and research reports related to good governance practices and its index both domestically and internationally 2) interviewing experts from related disciplines, and research managements 3) developing and testing questionnaire and then analyzing data 4) using the drafted good governance index to conduct internal pilot test with HSRI  5) reviewing index and modifying it to be more suitably.
According to study, Good Governance means “the good and fair process which diverse organizations including private and public sector, government, and civil society apply to set their own direction. It is regarded as a process to change collective moral intentions to effective and accountable institutional actions”
The result of this study has indicated that two crucial conceptual frameworks of index development has emerged and they are comprised of 1) conforming to six good governance practices including Rule of Law, Transparency, Worthiness, Participation, Quality, Accountability and 2) applying six good governance practices to five steps of the research management process including the process of defining a policy, planning of research management, gathering and allocating resources, operating research, and utilizing research.   Shown in this study are total thirty indices which are collapsed into six composite indices to evaluate holistic picture of good governance practices in research management process.
The outcome of evaluating Health Systems Research Institute (HSRI)’s good governance practices has been depicted that overall in the organizational level HSRI has high good governance practices. When considered in the perspective of five research management process, the process of gathering and allocating resources gains the highest level of engaging good governance practices and is followed by the process of planning the research management as a second.  Other research management processes are evaluated that their involvement in good governance practices are in the middle level.


location: , 'Thailand year: 2022 source: HSRI

title: Policy Recommendation: Promoting Health Literacy for Delayed Progressive Chronic Kidney Disease of Diabetes Mellitus and Hypertensive Patients in the 4th Public Health Region

abstract: The development of policy recommendation: promoting health literacy for delayed progressive chronic kidney disease (CKD) of diabetes mellitus and hypertensive patients in the 4th public health region research was the research & development by using mixed method design. Health literacy concept of Nutbeam (2000; 2008; 2009), an integrated conceptual model of health literacy of Sorensen & et al. (2012), and health literate organization of Brach et al. (2017) were used as the conceptual framework in this study. Also, literatures review and evidence-base were integrated into the conceptual framework. Data were collected from diabetes and/or hypertensive patients with 3rd CKD, healthcare providers, and community networks or related group to delay progressive CKD in eight provinces of the 4th public health region that were Nakornnayok, Nonthaburi, Pathum Thani, Phra Nakhon Si Ayutthaya Lopburi, Saraburi, Singburi, and Aungthong. The study was divided into three phases within five purposes as follows: Phase 1 was situation analysis (R1) and included 2 purposes that were to: 1) examine the levels of health literacy to delay progressive CKD among diabetes and/or hypertensive patients, and 2) study the situation of health literacy promotion, CKD, and healthcare systems to delay progressive CKD in the 4th public health region.
Phase 2 was the period of the development and testing the model of promoting health literacy to delayed progressive CKD, and developing the prototype model of healthcare service to delayed progressive CKD in the 4th public health region (D1, R2, D2, R3). In phase 2, it covered two study purposes that were to: 3) develop and test the model of promoting health literacy to delayed progressive CKD among diabetes and/or hypertension, and 4) develop the model of health literacy to delayed progressive CKD system among diabetes and/or hypertensive patients in the 4th public health region. Phase 3 was the period of the development of the policy (D3). The study in phase 3 included one purpose that was to: 5) develop policy recommendation to promote health literacy to delayed progressive CKD among diabetes and/or hypertension in the 4th public health region.
The study instruments included both quantitative and qualitative tools. The quantitative instruments were 1) the health literacy to delayed progressive CKD in diabetes and/or hypertensive patient questionnaire, 2) the health literate organization promotion to delayed progressive CKD in diabetes and/or hypertensive patient questionnaire, and 3) the assessment form of self-management to delay progressive CKD in diabetes and/or hypertensive patents. All instruments were tested for validity by five experts and CVI were .97, 1.0, and .97 respectively. Cronbach’s alpha reliability were .94, .96, and .96 respectively. Qualitative instrument included 1) the semi-structure open-end question about health literate organization to delay progressive CKD for healthcare providers, and diabetes and/or hypertensive with stage 3rd CKD patients, and 2) the semi-structure question for related person and stakeholders who related to develop policy recommendation. The experimental instrument was the model of the promoting health literacy to delayed progressive CKD in the 4th public health region. Quantitative data were analyzed by using frequency, percentage, mean, standard deviation, multiple regression procedure, and pair t-test. Qualitative data were analyzed by content analysis which was interpretation, synthetization, and analyzation as reasonable criteria for developing inductive conclusion. Study results revealed as follows: 1. Average score of the health literacy to delayed progressive CKD of diabetes mellitus and/or hypertensive patients with stage 3rd CKD in the 4th public health region was at more levels (mean = 3.59, SD = .81). The most average score was the health decision aspect (mean = 3.85, SD = .81). The lowest average score of health literacy score was media literacy (mean = 3.45, SD = 1.02). Sex, ability of listening, sufficiency of income, receiving information from various sources, participating in health activities, receiving information by group, receiving various information channel, and having social role as a healthcare volunteer were statistically significantly on levels of health literacy to delayed progressive CKD at .00 - .05 (p ≤ .01 - .05). 2. Average score of health literate organization to delayed progressive CKD in diabetes and/or hypertensive patients with stage 3rd CKD was at the more levels (mean = 2.77, SD = 1.02). The most average score was the aspect of the participation in health literate organization to delayed progressive CKD in diabetes and/or hypertensive patients (mean = 2.83, SD = .93). The lowest average score was the organization and leader of organization aspect (mean = 2.73, SD = 1.09). The total scores of health literate organization to delayed progressive CKD in diabetes and/or hypertensive patients with stage 3rd CKD were at neutral level 46.96% (n = 54). The situation of the promotion of health literacy to delayed progressive CKD of healthcare settings in the 4th public health region were found among primary, secondary, and tertiary healthcare settings, however, they did not follow the concept of health literate organization. The major activities were health education. Healthcare providers did not know the meaning of health literate organization and the method to promote health literacy. Nevertheless, they can provide healthcare services to diabetes and/or hypertensive patients to delayed progressive CKD by health education both individual and group for the patient to modify their behaviors. Additionally, healthcare providers screened for CKD and managing the problems of the patients. Few healthcare providers received training of health literate organization. Healthcare providers would like the clear methods and guidelines to develop them to be health literate organization to delayed progressive CKD in the 4th public health region. Healthcare organization leaders and leading style included 4 methods as 1) doing health literacy before they ordered, 2) did not know policy of health literacy and did not doing anything, 3) they order us to do health literacy and I do as my understanding, and 4) they ordered us to do health literacy, and I can do it because they provided us the training of health literacy. Diabetes and/or hypertension with the 3rd stage CKD patients have less knowledge about CKD, and relationship between diabetes/hypertension and CKD because these patients did not experience abnormal symptoms and they cannot access, understand, and analyze reliable data/sources of health data. Patients would like the support to have health literacy to delayed progressive CKD through the specific care, easy to understand, reliability and sufficiency media to develop knowledge, understanding, and deciding for self-management to delayed progressive CKD. 3) The model of promoting health literacy to delayed progressive CKD among diabetes and/or hypertension in the 4th public health region. The program focused on the promotion of health literacy and self-management through the training for cognitive skills, behavior skills, and social skills. The model, also, included comprehensive health education, individual counseling, training for reading skill, communication skill, knowing important number, and media literacy skill. Also, training for self-management that included goal setting, problem solving, monitoring, motivation, and evaluation were conducted to modify health behaviors for controlling diabetes mellitus, hypertension, and delaying CKD. Patients can decide to choose suitable methods that were appropriate to their contexts (tailored made intervention). The use of health information and short message that fit to delay progressive CKD was added into the model. The patients were required to interact in all activities. The program used various media, communication technique, and good relationship between patients and healthcare team both in person, by telephone, and line application. The number of activities were nine times that included five times in healthcare settings, 2 times home visit, and 2 times telephone visit through seven months. After participating in the program, diabetes and/or hypertensive patients had average score of health literacy to delayed progressive CKD (t = 11.407), and average score of self-management to delayed progressive CKD (t = 8.041) to be statistically significantly higher than the score before participating in the program at 0.01 level (p< .01). Clinical outcomes that included body weight (t = 6.951), waist circumstance (t = 6.777), systolic blood pressure (t = 6.100), diastolic blood pressure (t = 8.617), fasting plasma glucose (t = 3.745), HbA1c (t = 3.838), blood urea nitrogen (t = 3.117), and creatinine (t = 5.089) were statistically significantly lower than those clinical outcomes before participating in the program at .01 level (p< .01). Additionally, glomerular infiltration rate (t = -8.216) was statistically significantly increased more than those before participating in the program at 0.01 level. Study sample, 138 patients can delay CKD (88.46%). Patients had average decreased renal function 5% as 1.70 (SD = 0.74), the same and increased renal function 5% as 2.84 (SD = 1.41), and increased renal function over 5% as 13.49 (SD = 10.69) respectively. 4) The prototype model of healthcare system to delayed progressive CKD in primary healthcare settings included ten characteristics as follows: 1) administrators took the concept of health literacy to healthcare system for delayed progressive CKD, 2) development of health literacy skill of delaying CKD for healthcare staff, 3) the use of healthcare service for delaying CKD should be integrated by the health literacy concept, 4) preparation of environment and channel that promote the access of information and service, and sign, 5) providing media and publications related to information to delaying CKD that were simple and easy understanding, 6) opening opportunity for patients and families to participate in healthcare system for delaying CKD, 7) development of health literacy skill of delaying CKD to population in community through home, temple and school, 8) communicate the clear healthcare coverage and out of pocket, 9) preparation the channel of transfer system for continuum of care, and 10) administrators participate in planning for modifying the system to delay CKD with network server continuously. For secondary and tertiary healthcare settings, there are four characteristics out of eleven differently form primary healthcare settings as follows; 1) the use of healthcare system to delayed progressive CKD by integrating health literacy concept in all settings, 2) setting the main team and channel to providing consult to primary client team network, 3) developing the database that support patients who would like to delayed progressive CKD, and 4) providing the chance to the administrator of primary client healthcare settings to participate in planning for improving the system of care to delaying CKD. The research results suggested that the healthcare settings both primary and secondary/tertiary levels that are network should modify the plan of system together for continuous and sustainable of care. 5) The promotion of health literacy to delayed progressive CKD was complex and being necessary to have strategic plan. Also, the progressive action and the cooperation of all related person among healthcare providers, patients, health administrators, communities, society, public health region, and Ministry of Public Health are needed. The various, clear, and continuous actions and specific model for the patient problems that fit the context of the patients are needed at the first diagnosis and suitable for the context, community, and society. Additionally, the adjustment of healthcare system and working culture of healthcare providers that focus on health literacy to delayed progressive CKD, patient center, effective communication, informatics system, and network are needed to be care for the patients systemically and continuously. Furthermore, all parts should cooperate to manage social determinant of health because it is significant basic to promote health literacy, particularly the support of people to have ability of reading, education base, life-long learning, and economic that lead people to have good living and caring for themselves. Also, the preparation of environment that supports health literacy to delayed progressive CKD should be action both in healthcare settings and outside as shown in policy recommendation documents.


location: , 'Thailand year: 2023 source: HSRI

title: Cost-Utility Analysis of Automated Compared with Continuous Ambulatory Peritoneal Dialysis in Children with End Stage Kidney Disease using Markov Model

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


location: , 'Thailand year: 2019 source: HSRI

title: Study of health situations, aging society and travel problems for health services; A case of the urban community surround Sirinthorn Hospital, Bangkok

abstract: Study of health situations, aging society and travel problems for health services; A case of the urban community surround Sirinthorn Hospital, Bangkok has relationships with the environment in determining education, social health activities of the elderly with travel patterns in urban communities, Bangkok. From problems due to deficiencies of the body according to age and from diseases with age making the elderly need to get health services to maintain, promote, prevent and rehabilitation for the elderly to have a good quality of life. By attending health services for the elderly There are many factors involved both the hospital's service system Access to hospitals or health services, public transport travel system and personal vehicles for the elderly. Objective of the research was to study the health activities of the elderly. With travel patterns in urban communities. To study the factors related to traveling to receive health services for the elderly in the urban community lead to the reporting of health situations, social aging and travel problems for health services. In the urban community in order to make recommendations for development to relevant agencies. The methods of the study were quantitative and qualitative research, which is divided into 3 steps; Step 1: Survey data from a sample of aged 60 and over with a questionnaire traveling from the accommodation to receive health services at Sirindhorn Hospital Bangkok. The amount of 407 samples, divided by data groups 1) Good walking group, 2) Group sitting in a wheelchair and 3) Group lying on the bed. Step 2. Select the elderly volunteers from the questionnaire responses in Step 1 to interview, traveling from home to Sirindhorn Hospital by using the accompanying map to explain 154 examples. Step 3. Selection of elderly volunteers from interviews Map of the journey in step 2 in order to travel to the hospital with a sample of the elderly and use the survey to observe the travel patterns of the elderly. To study factors related to traveling to receive health services at Sirindhorn Hospital. Situation research results Elderly social health and travel problems to get health services. In conclusion; 1. Elderly social health activities Scheduled to travel to the hospital as scheduled More than other types of travel. By the majority of the elderly, there are participants traveling to receive health services. In which the traveling group already knows the route to the hospital. Therefore most travel times are between 30-59 minutes. From the survey of elderly social health activities and traveling patterns in urban communities contribute to the analysis of factors related to traveling to receive health services for the elderly. According to the research objectives, item 1. The study of health activities of the elderly with travel patterns in urban communities Bangkok. 2. Factors related to traveling to receive health services for most of the elderly รs receiving information for health care, in which the elderly listen to their own notifications. And followed by listening through the caretaker, in which the bedding group takes the time to prepare for the longest journey. Next is the wheelchair group and the group was able to walk conveniently, taking the least time to prepare before traveling. It is a decision to travel in a variety of ways. Analyze according to research objectives, item 2. The study of factors related to traveling to receive health services for the elderly in the surrounding urban community Sirindhorn Hospital Bangkok. By showing travel patterns for health services, for the elderly in the urban community, the sample consisted of 1) Travel information to receive health services from a sample of elderly people in the category of walking easily 2) Travel information to receive health services from a group of elderly people in a wheelchair 3) Travel information to receive health services from a group of elderly people in bed. Assessing the situation of traveling to receive health services for the elderly analyze according to research objectives article 3. Reporting of health situations, elderly society and problems of traveling to receive health services in the surrounding town community. Sirindhorn Hospital Bangkok lead to make suggestions for development to the relevant departments for the development of a technology model to promote health care for the elderly 1) Design of Activities for the elderly group according to the schedule of health services and public relations creates a community participation 2) Establishing supporting factors for traveling to receive health services. With basic information that is standard, will make the design of travel factors convenient and high efficiency. Especially map analysis, in a convenient travel information system save time for traveling and able to communicate basic health information of the elderly to the destination hospitals to prepare the management of appropriate areas and health services, meets the needs of the elderly most.


location: , 'Thailand year: 2022 source: HSRI

title: Development of Systems and Mechanisms for Management of Coronavirus Disease 2019 Crisis, Ubon Ratchathani Province

abstract: This action research aims to develop systems and mechanisms for managing the coronavirus disease 2019 crisis in Ubon Ratchathani Province of district and sub-district departments. A tool used as a guideline for questions in group discussions. Data were analyzed using frequency, a percentage for quantitative data, and content analysis for qualitative data. The results revealed that district and sub-district departments established the cooperation system with guidelines. There are clear guidelines in the disease control manual. Infectious waste was properly management. There is a budget plan for the municipality and the sub-district administrative organization to prepare for disease control in the next year. It planned to use the budget from the Community Health Security Fund to be sufficient for disease control in the sub-district. Kham Krang sub-district created a local health Charter to strengthen the operation, as well as be ready to prepare for the crisis from another infectious disease. The results of this study can be used as a model for budget support from local government organizations, causing the preparation of budgets for disease control by including packaged in the strategic plan and supported by Community Health Security Fund. It can measure the success of the budget administration. They use information and information for learning, assessing, and improving the process of disbursing the fund budget to support the control and prevention of coronavirus disease 2019 continuously and sustainably.


location: , 'Thailand year: 1998 source: HSRI

title: Current problems of controlling TB (Tuberculosis) in Thailand

abstract: Current Problems of Controlling TB (Tuberculosis) in Thailand	Two major problems of controlling TB in Thailand were lack of new vaccines and drugs development and increasing phenomena of TB drug resistance due to inconsistent drug taking by most patients. Controlling TB by DOTS (Directly Observed Therapy, short course) was a new strategy determined by most international health organizations. One of the DOTS was simply to have the patient’s helper who monitors his or her drug consumption so as to keep continuity of drug taking. The helpers may be the TB official, the health official at a health center, the health volunteer, the community leader, and the family member. Current situations and problems of controlling TB in Thailand by the DOTS were reviewed in this study. The DOTS coverage was found 34.1% of all districts by December 1999 while its operation was lower than the WHO target and likely to decrease. Its effectiveness was found better than the conventional based on the RCT study whereas no significant difference was found under the non-RCT study. Most operations at district level did not have quality monitoring and evaluation process while a number of the patients’ helpers were not trained. 	The problems of DOTS operation in Thailand were regarded into firstly, policy level at which policy makers gave relatively low priority of TB controlling than many communicable diseases, secondly, a number of personnel dealing with TB control neither trained nor interested in getting trained, thirdly, less motivation in health officials to put forward the DOTS operation in their own areas, fourthly, poor reliability in performing the DOTS by family members, and fifthly, lack of based-cohort study to illustrate levels of success or failure in addition to less qualitative study on this topic so far. Establishment of research networking on the DOTS and its policy-based research were recommended. The research topics should be on the DOTS efficiency, the DOTS model development, factors related to its success and failures, and criteria for the DOTS performed by family members.


location: , 'Thailand year: 2022 source: HSRI

title: The Development of the Essential Competencies of Registered Nurses during and after the COVID-19 Pandemic: A Case Study of SongKhla Province in Thailand

abstract: This research aimed to develop essential competencies of registered nurses in terms of nursing for emerging infectious disease COVID-19 and develop a competency development model of emerging infectious disease COVID-19 nursing of primary, secondary, and tertiary health service units in collaboration with stakeholders. Research implementation was conducted using Emancipatory Action Research. Research participants were 6 physicians and 53 registered nurses, of which 10 were from primary, 31 from secondary, and 12 from a tertiary health service unit. Research instruments consisted of 1) instruments for quantitative data collection including the questionnaire of essential competencies of registered nurses in terms of nursing for emerging infectious disease COVID-19, the questionnaire of the competency development model of registered nurses in terms of nursing for emerging infectious disease COVID-19, and questionnaire of satisfaction of competency development model of emerging infectious disease COVID-19 nursing, 2) instruments for qualitative data collection including 1) behavioral-based interview form, 2) in-depth interview form, and 3 focus group discussion form. Quantitative data were analyzed using descriptive statistics and content analysis was used for qualitative data. Research results revealed that 1) registered nurses of primary, secondary, and tertiary health service units had an overall higher mean score of essential competencies of registered nurses in terms of nursing for emerging infectious disease COVID-19 in each loop of research. A higher mean score was found on both professional and technical competencies. 2. Competency development model of registered nurses in terms of nursing for emerging infectious disease COVID-19 consisted of 3 components including practice guidelines, competency development method, and factors promoting competency development. Practice guidelines consisted of 5 main steps including 1) specification of essential performance competencies, 2) development of monitoring system, support, and empowerment, 3) specification of self-competence development guideline, 4) implementation of the competency development plan and, 5) summarization and report of development result. The Competency development method consisted of 6 activities including 1) workshop, 2) on-the-job training, 3) learning from experts, 4) coaching, 5) self-study, and 6 knowledge sharing. Factors promoting competency development included the role of nursing leaders, policy and explicit practice guidelines, and a good attitude towards the profession


location: , 'Thailand year: 1999 source: HSRI

title: Drug price comparison between Thailand and the United States

abstract: Drug price comparison between Thailand and the United StatesThe price differential of drugs, calculated by item, group and purchasing power parity (PPP), was conducted to compare drug price between Thailand and the U.S. The 209    samples accounted for 34.9 percent of the total import, or 12.9 percent of the total import and manufactured. The comparison by item showed that 17 drugs in Thailand were more  expensive than in the U.S. The total import of the 17 items was 17,491,517 US dollars. Of these drugs, four of them were AIDS/virus drugs and five were antibiotics. The comparison analysis by therapeutic group showed that AIDS/virus group were priced 6percent higher in Thailand than in the U.S. where ones of antihypertensive drugs, phychotropic drugs, anticancer agents, miscellaneous group, cardiac drugs, antibiotics, vasodilating agents and antiinflammatory agents were(percent) 18.7,  24.3, 28.1,  45.0,  49.2,  47.5,  73.1 and  73.6  differences respectively.   Comparison by registration type demonstrated higher price of the new drugs over the old drugs category with percentage of differences at(percent) 20.0 and 44.4 lower in Thailand than in the U.S.  Comparison by dosage for did not show significant differences among groups of injection, tablet and capsule; and other form which were 38.0,  37.4 and  34.4  lower in Thailand than in the U.S. respectively. Comparison by using the 1995 PPP (Thai PPP=28 and U.S. PPP=100) indicated that most imported drug were charged more in Thailand than in the U.S. expect antiinflammatory drugs and vasodilating agents.


location: , 'Thailand year: 2023 source: HSRI

title: Pharmacogenomics and Pharmacokinetic Study of Mycophenolic Acid and Its Metabolite (Phase 2)

abstract: Mycophenolic acid (MPA) is an immunosuppressant medication used to prevent rejection following organ transplantation and is under investigation for its efficacy against osteosarcoma. We investigated the genetic variability of whole-exome sequencing (WES) data from 15 osteosarcoma patients who receive mycophenolate mofetil (MMF), a prodrug of MPA. Using whole-exome sequencing (WES), we found 48 variants from the 15 genes which are related to MPA and its metabolite (MPAG) metabolism. Three variants were found to significantly correlate with the pharmacokinetic parameters of MPA after single-dose MMF administration including SLCO1B3 (rs4149117, T>G), SLCO1B1 (rs2306283, A>G) and ABCG2 (rs2231142, G>T). Moreover, five variants were found to significantly correlate with the pharmacokinetic parameters of MPA after multiple doses of MMF administration (at steady state) including SLCO2B1 (rs2306168, C>T), ABCG2 (rs2231137, C>T), UGT1A8 (rs3755323, T>C), UGT1A8 (rs3755321, T>C) and UGT1A8 (rs4148323, G>A). All of these variants are missense mutations. In addition, in this study, we could build the population pharmacokinetic models for MPA in Thai osteosarcoma patients and healthy volunteers, which include genetic covariates. It was found that the pharmacokinetics of MPA in both populations can be described by a two-compartment pharmacokinetic model with 1st order drug elimination. Furthermore, the addition of the absorption lag time in the model for drug absorption following multiple doses of MMF (steady state) could significantly reduce the objective function value. Based on the population pharmacokinetic study, genetic factors affecting the pharmacokinetic parameters of MPA have not been identified. Based on the results of this population pharmacokinetic study, the pharmacokinetic parameters of MPA are different between healthy volunteers and osteosarcoma patients. Osteosarcoma patients had lower CL/F and Vc/F of MPA compared to healthy volunteers. Moreover, in osteosarcoma patients, it was also found that MPA pharmacokinetic parameters differed between post-administration of MMF in a single dose and multiple doses (steady state). After a single dose of MMF administration, the CL/F and Vc/F of MPA were approximately 2-fold and 1.4-fold higher than after multiple doses of MMF administration (steady state), respectively.


location: , 'Thailand year: 2012 source: HSRI

title: Study of Opinion of General Practitioners on Incentive Money and Professional Opportunity Strategies to Physician Retention in Community Hospital

abstract: Shortage of physicians in rural areas was one of main problem in Thailand. Previous studies found
that there were several factors which related to the existence of a doctor in the community hospitals. The
major factor was financial issue. Thai government has launched special incentive money and professional
opportunity strategies to rural doctors since 2008. After these motivated strategies, the recruitment of physician had been rising in community hospitals. The purpose of study was to evaluate the opinion of
general practitioners on incentive money and professional opportunity strategies to the retention of
physicains in community hospitals. This was cross sectional descriptive study of the physicians in the
community hospitals nationwide covering 720 hospitals. Mail questionnaires were distributed and collected
data between 1st to 31st January 2011. Data were analyzed by SPSS-PC version 11.5 by reporting as
descriptive statistics such as frequency, percentage, average, and standard deviation including analytic
statistics with Chi-square and binary logistic regression. The results revealed that response rate was 38.52%.
Most of physicians were male 66.59%; average age was 35.92 years old. A 30 bed-sized community hospital
was the most current work place 52.64. The opinion of responders to incentive money and professional
opportunity strategies revealed that this financial strategy with incentive money related to the retention
of physicians and influenced longer duration of working up to 88.00%. There were 71.15% of physicians
that strongly disagreed to the exception of this incentive money. Moreover, professional opportunity
strategy directly affected physicians with high satisfaction rate 70.95%. This study demonstrated the
financial strategy such incentive money and professional opportunity strategy were the major factors that
related to the retention of physicians in community hospitals. These motivation strategies should be considered
and applied to human resource policy.


location: , 'Thailand year: 2008 source: HSRI

title: Epidermiology of Diabetes Mellitus in Phanomphrai District, Roi Et Province

abstract: Objective: To study diabetes mellitus epidemiology in Phanomphrai district and
to assess diabetes risk factors in the Phanomphrai sub-district (tambon).
Methodology: Descriptively reviewed the Phanomphrai population and diabetes
registration and services for epidemiologic data in fiscal year 2006, and carried out a
community survey to assess diabetes risk factors through interviews using questionnaires
and specimen collection among those aged 20 years and older in Phanomphrai tambon in
the period July - September 2005.
Results: The Phanomphrai population was 100,870, with 38,069 (37.7%) aged 40 or
older; 2,648 diabetic patients were registered, with a prevalence rate of 2.6 percent. There
were 10 (0.4%) with type 1 diabetes, 2,630 (99.3%) with type 2 diabetes, and 8 (0.3%) with
gestational diabetes. New cases of type 2 diabetes totaled 299, 300 and 192 cases during
2004, 2005 and 2006, respectively, making the incidence rate 0.29 percent, 0.30 percent and
0.20 percent, respectively. After complication screening, there were 8.4 percent renal, 2.0
percent neurological, 1.7 percent arterial and 1.2 percent ophthalmologic complications
with 0.5 percent experiencing amputation and 0.9 percent multiple complications. After
the community survey of a total of 1,540 subjects, 474 (30.8%) were classified as cases of
disease, 605 (39.3%) as being at risk and 461 (29.9%) as normal. Risks by body mass index
(BMI ≥25) were 46.9 percent, 31.8 percent and 22.1 percent in the disease, risk and normal
groups, respectively. Risks by abdominal circumference were 41.3 percent, 28.3 percent
and 17.8 percent in the disease, risk and normal groups, respectively. High blood pressure was found in 84.6 percent and 97.4 percent in the disease and risk groups, respectively. Abnormal fasting blood glucose levels were 44.7 percent and 9.0 percent in the
disease and risk groups respectively. Abnormal triglyceride levels (≥250 mg%) were found
in 27.6 percent, 14.2 percent and 12.0 percent of the disease, risk and normal groups,
respectively. High density lipoprotein levels (≤40 mg/dl) were 47.2 percent, 49.2 percent
and 45.5 percent in the disease, risk and normal groups, respectively.
Conclusions: Epidemiologic study helps increase understanding of the diabetes
situation and disease burden, and indicates that diabetes has imposed huge public health
and economic burdens. Measures of high priority must be emphasized in relation to the
quality of care, information systems and the interventions made to prevent or delay diabetes in high-risk groups, and to study the risk factors for diabetes and metabolic syndromes for the development of efficacious preventive measures.


location: , 'Thailand year: 2018 source: HSRI

title: Patients’ Experiences on Using Non-Contracted Private Hospitals and Applying Eligibility for the Universal Coverage for Emergency Patients (UCEP)

abstract: This study aimed to assess patients’ experiences on using non-contracted private hospitals and applying for eligibility under the Universal Coverage for Emergency Patients (UCEP). A telephone survey was conducted by using a semi-structured questionnaire. Populations were beneficiaries of three public health insurance schemes, Universal Coverage Scheme (UCS), Civil Servant Medical Benefit Scheme (CSMBS) and Social Security Scheme (SSS) who used non-contracted private hospitals and applying for eligibility through the Emergency Pre-Authorization program (PA) during July–October 2017. A simple random sampling was employed with an equal quota of samples for each scheme in each month for calling. Samples of the study included 212 and 210 cases who were receiving the call and willing to provide information out of 393 and 405 or 54 and 52 percent of calls made for those who met and did not meet the criteria of critical emergency respectively. Data analysis was done by using SPSSpc version 18 and weighted according to actual proportion of each scheme users was applied. Results show that the Universal Coverage for Emergency Patients (UCEP) was quite successful in the implementation. Patients with critical emergency conditions increased in access to financial protection under the program. Convenience in transportation to the hospital and being trust in regular hospital were two main reasons of getting emergency care from the private hospitals. Those with non-critical emergency conditions were more likely to choose their regular hospital than those with critical emergency conditions. The program could protect eligible patients quite well from financial risk during the critical period or the first 72 hours of admission; however, more than half of those with non-critical emergency conditions spent out of their own pocket to cover the cost of care. Furthermore, strengthening of enforcement process of the Sanatorium Act is needed to prevent patients with emergency conditions from being asking for payments prior to provision of services or during the critical period in addition to strengthening of public relations on channel for making complaints.


location: , 'Thailand year: 2013 source: HSRI

title: Direct non-medical cost for health care seekers at the out-patient department: a cross-sectional survey

abstract: While direct non-medical costs (DNMc) are inevitable for healthcare seekers, little is known about the magnitude of the economic burden on the household. The study aims to estimate the DNMc of outpatients
at Suratthani hospital and four primary care units (PCUs) in Suratthani’s municipal area. In addition,
the DNMc of patients were compared across different health centers as well as the patients’ household
areas.
We interviewed 200 patients/caretakers at the out-patient department at Suratthani hospital and
147 patients/caretakers at 4 PCUs in the municipal area from 24 October to 21 December 2012. All cost
data were collected and calculated using 2012 as the base year. Statistical analysis, including t-test and
ANOVA, was performed to compare the DNMc between subgroups, with a statistical significance level of
0.05.
The average DNMc of patients at PCUs, 76.7 baht, were significantly lower than those incurred by
patients at the hospital, 585.6 baht. Within this latter group, the DNMc of those who lived in the municipal
area, outside the municipal area, in Suratthani, and outside Suratthani were 248.3, 774.8 and 1,719.4 baht,
respectively, with statistically significant differences.
The study quantifies the household cost for out-patients, demonstrating potential economic barriers
faced by health care seekers. Information from this study can be used when designing a treatment and
referral system that seeks to minimize the financial burden on the patient.


location: , 'Thailand year: 2020 source: HSRI

title: The Review of Country’s Global Health Strategy Development Process and the Monitoring and Evaluation Mechanism of Global Health Strategy in Eight Countries

abstract: This study aimed to explore process for the selection of global health issues, frameworks for
monitoring and evaluation (M&E) activities, and the management of global health strategies internationally,
and to provide recommendations on future development process of Thailand’s global health
strategy. This study collected data through descriptive literature search and document reviews. Literature
search was conducted from July to August 2017 and was updated in August 2019. Global health
strategies of eight countries were selected as case studies, namely Canada, Japan, Norway, the USA,
Switzerland, England, Australia, and Thailand.
This study found that in most countries, the ministries of foreign affairs were responsible for the
development and the monitoring and evaluation (M&E) of global health strategy. The widely used
principles for the selection of global health issues comprised: (1) the globally threathening health
problems which also threatened own country, and (2) the country’s public health and foreign policies.
Deliberative discussion and consultation with stakeholders were the methods that all eight countries
employed to select global health issues for the development of their global health strategic framework.
There was no evidence of using quantitative methods or weighting methods for selection of global health
issues. The main principles underpinning the M&E activities focused on: (1) incorporating the M&E
activities as an integral part of the global health strategic framework at the beginning of the process;
(2) evaluating both outcomes and impacts (if possible) and (3) appropriately designing the M&E process
that fits with the implementation of the strategic framework.


location: , 'Thailand year: 2012 source: HSRI

title: Factors related to disease and injury preventative behaviors of garbage collectors during flood crisis: A case study in a district of Bangkok Metropolitan

abstract: The purposes of this cross-sectional study were to study the disease and injury preventative behaviors
and to exam factors related to disease and injury preventative behaviors of garbage collectors during flood crisis. Data collection took place during February to March 2012 by using self-reported questionnaires
from non-randomization of 186 garbage collectors who worked in one district office of Bangkok
Metropolitan. Employing descriptive statistics, chi-square and multiple logistic regression, the overall
results found that the garbage collectors had the disease and injury preventative behaviors at a low level
(60.5 %). The relation between factors and the disease and injury preventative behaviors after adjusted for
the other variables in the model showed: 1) using self-preventative equipment behaviors statistically correlated
with the provision of these procured by the office for individual prevention tools at a high level
[ORadj (95% CI)=15.37 (4.24, 55.69)] and at a middle level [ORadj (95% CI)=4.63 (1.64, 13.09)] and appropriated
income with responsibility during flood crisis at a high level [ORadj (95% CI)=10.21 (2.56, 40.74)] and
at a middle level [ORadj (95% CI)=3.94 (1.46, 10.66)] respectively. 2) injury preventative behaviors statistically
correlated with the appropriated income at a high level [ORadj (95% CI)=6.76 (2.31, 19.79)] and thoughtfulness
and admonition of colleagues for during work accidents at a high level [ORadj (95% CI)=5.25 (1.50,
18.31)] respectively. And 3) risking injury occupational behavior statistically correlated with worked training
at a low level [ORadj (95% CI)=9.28 (2.71, 31.81)] and at a middle level [ORadj (95% CI)=4.05 (1.11, 14.73)]
respectively. In conclusion: Collecting garbage during flood crisis, the responsible office should plan and
modify predisposing factors, enabling factors and reinforcing factors for management in order to prevent
the diseases and occupational injuries.