location: , 'Thailand year: 2005 source: HSRI

title: Draft report on einancing universal health care in Thailand

abstract: Universal health care coverage (UC) is an important policy by the Thai government, 75% of population covered by the Scheme, but capitation rate did not adequately match with the utilization rate and cost of services. While rely totally on government annual budget, its long-term fiscal sustainability is a worrying problem. This study was conducted in order to provide financial reform options for UC Scheme. Long term projection of total national health expenditure of Thailand between 2004 and 2020 was constructed using four models namely Demographic and Labour Model, Economic Model, National Health Expenditure Model and Government Model. Several information from various sources were retrieved for example; population and economic information from National Economic and Social Development Board, Labour statistic from National Statistical Office, National Health Account of Thailand 1994-2001 and Government expenditure from the Comptroller General’s Department, Ministry of Finance. Moreover, many possible assumptions were applied in these models and three scenarios of reducing UC expenditure and/or ensuring adequate budget for UC were created in order to illustrate financial implication.  	The model estimates showed that the total national health expenditure was around 3.50% of GDP in 2004, it would increase to 3.64 and 3.88 % of GDP in 2010 and 2020, respectively. The first scenario simulated the effects of the suggested revenue increases by introducing personal health tax and additional excise tax on tobacco, alcohol and beer which some proportion automatically earmarked to UC Fund. This scenario resulted in substantial reductions in the government budget subsidy to the Scheme compared to status quo. The second scenario was produced based on assumptions that Social Security Office would expand its coverage to non-working spouse and dependents of the contributors. Its effects were that the expenditure of UC reduces by around 9,210 million baht in 2005. The first and second scenarios. when combined together into the third scenario suggested, it showed that UC almost fund by itself with few budget subsidy from government.   	Three policy recommendations on the Scheme financial reform was provided. First, an earmarked sin tax with or without increase in the sin tax rate. Second, the expansion social security scheme health benefit to non working spouse and dependents of the contributors. This could be done without increasing contribution. The last was the reform of Traffic Accident Protection Act (TAP). The Department of Land Transport would be outsourced to collect premium from car owners, during the mandatory annual renewal of car license, this would enhance law enforcement.  The scheme would cover all victims by either insured and uninsured cars.


location: , 'Thailand year: 2010 source: HSRI

title: Budget Impact from Incorporating Community Pharmacy into the Universal Health Coverage Scheme

abstract: There are some practical models of community pharmacy provision in Thailand that are coordinated
with hospitals in providing care for cases of stable diabetes and hypertension. This study was aimed
at estimating the impact on budgets of incorporating community pharmacy into the Universal Health
Coverage Scheme in providing care for cases of stable diabetes and hypertension. First, secondary data
were reviewed to estimate the supply and demand of community pharmacy services. Unit cost analysis of
the community pharmacy activities were situation, using the activity-based costing technique. Finally,
the budget impact analysis was estimated under the model of refill medication at the community pharmacy.
The timeframe of this study was January to September 2009. The result showed that the budget
impact of community pharmacy in providing medication refill for stable diabetes varied between 182 and
1,044 baht per patient, or between 194,740 and 1,117,080 baht per hospital. Regarding the budget impact
for medication refill in stable hypertension, the average expenditure ranged from 182 to 1,098 baht per
patient, or 242,242 to 1,461,438 baht per hospital. It may be concluded that the community pharmacy
could be a part of an integrated package of care for people with long-term conditions, such as stable
diabetes and hypertension. However, a financial incentive is required to meet additional costs and to
connect community pharmacies to the Universal Health Coverage Scheme. Co-payments may be used in
this program to prevent inappropriate utilization.


location: , 'Thailand year: 2019 source: HSRI

title: Good clinical practice guideline in patients with arteriovenous access phase2

abstract: Background: Based on national and international guidelines (Kidney Disease Outcomes Quality Initiative-K DOQI) in patients with end staged renal disease, arteriovenous access (AVA) creation without history of central venous catheter (CVC) insertion is the recommended approach, but in Thailand, most hemodialysis patients had experiences of CVC insertion beforehand. Underestimation of consequences of such approach in our patients and medical personnel, might be a cause. Therefore, we aimed to develop the protocol that can improve the outcomes. Methods: Expressed Protocol in Northern Thailand (EPNT) was formulated. EPNT was composed of: 1) patients who did not have any experience of CVC insertion before AVA creation, 2) patients almost used vein for AVA creation, 3) AVA was under good surveillance after operation. This study plan followed up in 24 months, but this report compared and illustrated the outcome between EPNT and non-EPNT patients in the first 15 months. The outcome included the rate of maturation, AVA complications, central vein stenosis, sepsis, major adverse cardiovascular event (MACE), and the score of Quality of life by SF-36. Results: There were 100 EPNT patients and 101 non EPNT patients. EPNT group had lower cumulative rate of AVA infection (EPNT: 0% vs non EPNT 2.52%, p = 0.087), than those in non EPNT. Also 11.9% in non EPNT patients had history of CVC sepsis. EPNT group had lower rates of central vein stenosis (EPNT: 1.23% vs non EPNT 5.11%, p = 0.146), than those in non EPNT group. However, these trends did not reach a statistically significance. The rates of maturation, AVA complications, and MACE were not different between two groups. The score in the general mental health in EPNT group was significantly better than those in non EPNT group. Conclusion: EPNT patients had a trend toward lower rates of sepsis and central vein stenosis, and better general mental health scores than those non EPNT patients. However, this 15-month result does not make any solid conclusions to determine the difference between EPNT and Non-EPNT. Further results will shed more light on this field.


location: , 'Thailand year: 2010 source: HSRI

title: Health Impacts from an Open-pit Mining Project : Public Scoping

abstract: Lignite mining may result in several health impacts but at present no guideline exists to investigate
those effects. This study was aimed at setting up guidelines for the investigation of possible health impacts
from an open-pit mining project, using the participatory approach involving the public and other
stakeholders. Results from a literature review on possible health impacts and data on the living styles of
the affected community were used to identify the possible health impacts. The public and other stakeholders
were allowed to join the study and provide suggestions for public scoping.It was found that there were four aspects of possible health impacts: physical, mental, social, and
spiritual. Physical health impacts comprised accidents and injuries from mining and transportation; effects
from noise; diseases and effects from air pollution; diseases and effects from water pollution; effects
from blasting; and labor migration and communicable diseases. Mental health impacts were expected
from stress and anxiety. Social health impacts were likely from effects on community lifestyle; effects from
community migration and resettlement; and effects from depletion of forest and agricultural land. Spiritual
health impacts were likely from effects of aesthetic changes and loss of loyalty to and connection with
the locality; and the effects of people losing their spiritual haven.


location: , 'Thailand year: 2014 source: HSRI

title: Transformative Learning for Community Health Equity: the Preparation of Community Nurses by Community for community at Namphong and Ubolrat Hospitals, Khon Kaen Province

abstract: Nursing shortage leads to health problems and health equity of people in rural areas of Thailand. Namphong and Ubolrat Hospitals are community hospitals in Khon Kaen province that used to have nursing shortage. Thus, they have integrated transformative learning to produce community nurses who can stay longer in community. They have collaborated with several stakeholders, such as sub-district administrative organization, Boromarajonani College of Nursing Khon Kaen and College of Asian Scholars to start çthe Community Nurse Production for Community and by Community Projecté. To enhance capability, newly qualified nurses have to participate in several activities, including: 1) learning community with experienced nursing mentor 2) training in “near home near heart” project, and 3) training in transformative learning for self reliance under a concept of the “Sufficient Economy and Sustainable Development Philosophy” of His Majesty King Bhumibol Adulyadej. The projects’ aim is to prepare newly graduated nurses to become change agents for self sufficiency and to live their life happily in their community.


location: , 'Thailand year: 2004 source: HSRI

title: Questions on quality and quality improvement in health care Thailand project : Phase 1

abstract: For some time, quality of health care and services has been the topic of major interests of policy makers, health care administrators, health care providers, and consumers and medias in Thailand, as well as abroad.   Quality assurance and improvement has gained importance as one of major mechanisms to ensure health security for the population.   Nevertheless, to improve quality of the health services system effectively and efficiently at any of the national, provincial, community or organizational levels, we need information and knowledge to guide improvement directions, as well as to determine improvement processes and techniques.   Some may be acquired from others, but the others require research, studying and searching for knowledge within our own country.   To date, there is no extensive survey on issues in quality of health care and quality improvement that are worth being set as strategies for research in order to bring about knowledge for sustainable quality improvement of our health care system in the future. 	This research project comprises two parts.  The first part is the review of experiences in researches in quality of health care and setting a preliminary proposal for research question frameworks.   The second part is a survey of situations and questions among stakeholders, namely providers and clients, regarding quality of the health services system and quality improvement and a summary of strategies to approach quality of health care research.  	This report is the presentation of the findings from the first part of the project.  The objectives were to review published research articles on quality of health care, study research experience on quality of health care in Thailand, as well as case studies in other countries.   In addition, it aimed to explore problems and doubts concerning quality of health services from the perspectives of policy makers, system administrators, academicians, hospital quality consultants, hospital accreditation (HA) surveyors as well as health care providers and clients.   A number of research techniques were applied, including literature review, in-depth interviews, focus groups, brainstorm sessions, and study visits at organizations in the United States of America (USA) and the United Kingdom (UK) during February to December 2003. 	The literature review found that research on quality and quality improvement varied a lot in topics, understanding, principles, rationale, utilization and research designs, depending upon contexts and perspectives.  There were many definitions of quality.  It could only be defined broadly.  The scope of research was wide.  Only a general framework could be defined for the benefit of review and reference in the following areas: health care provided by health professionals, service delivery, service organization and health services systems, including linkages to health insurance mechanisms and development of aspects related to consumers and service purchasers.


location: , 'Thailand year: 2011 source: HSRI

title: Gaps and Opportunities in Addressing Non Communicable Diseases in Thailand with WHO’s Best Buys and Good Buys interventions

abstract: Non Communicable Diseases (NCDs) is the most important health problem in Thailand, in terms of
both mortality and morbidity. In the Global Status Report on Noncommunicable Diseases 2010, World Health Organization recommends 26 effective and cost-effective interventions to tackle NCDs crisis. Further
divided into 12 Best buys intervention and 14 Good buys, these population-wide policy interventions
aim to address NCDs at their five major risk behaviours. These include tobacco use, alcohol consumption,
food and beverage dietary, physical activity and Hepatitis B vaccination. This study describes theoretical
concepts of the intervention, and analyses situations, gaps and opportunities of Thailand to adopt these
26 interventions. These interventions differ in terms of strength of policy content, implementation and
feasibility to be strengthened. In conclusion, Thailand faces many major limitations in embarking these
Best buys and Good buys health interventions, including priority, resources, capacity, sustainability, monitoring
and evaluation, and coordination. While some are not exists at macro scale in Thailand, some interventions
were not primarily designed for health purposes.


location: , 'Thailand year: 2008 source: HSRI

title: Mini-laparotomy Exploration in Peptic Ulcer Perforation

abstract: This retrospective descriptive study was designed to determine the clinical outcomes
of mini-laparotomy exploration (MLE), with simple closure of a perforated ulcer in patients
treated at Chaibadan Hospital. Of the 70 ulcer patients, 62 (M:F 8:1; aged 51.2 ± 15.6
years and 12.8% over 60) underwent the MLE procedure in the period between October 1,
2001 and September 30, 2007. The ulcer types were type I (prepyloric part of stomach and
first part of duodenum) 78.4 percent, and type I (antrum) 14.5 percent. The average operative
time was 32.8 ± 12.7 minutes. Operative complications were encountered in 30
percent of the patients, i.e., 12 patients with an infected wound, and four patients had
postoperative fever; however, there was no death. Postoperative medication included
anti-H. pylori and proton pump in all patients. The benefits of the surgical procedure
studied were small abdominal wound and scar with less pain, decreased severe complications
with early ambulation and no mortality.


location: , 'Thailand year: 1998 source: HSRI

title: The development of public health budget system for efficiency and equity of budget allocation and administration at the policy level

abstract: The Development of Public Health Budget System for Efficiencyand Equity of Budget Allocation and Administration at the Policy Level	The current public health budgeting system is largely determined by the Budget Bureau, the Ministry of Finance. Its obvious weak points are the existence of budget ceiling which responds neither people’s demand nor needs, lack of outcome-based activity evaluation, and the use of historical base budgeting system in which new activities are less likely to initiate. Two main objectives of the public health budgeting system should be on improvement of resource use equity and efficiency. It is suggested that health services be grouped into their hierarchies to lessen the existing current problems in addition to using health service information for categorizing such services.


location: , 'Thailand year: 1998 source: HSRI

title: Social and health problems of the construction workers in Thailand, 1995

abstract: Social and health problems of the construction workers in Thailand, 1995The multicenter survey of "Social and health problems of the construction workers in Thailand, 1995" aimed to describe working and health status of the labors. Multistage and       purposive sampling was applied to get 20 construction sites each from Bangkok, Chang Mai and Phitsanulok in the North, Khon Kean and Nong Khai from the Northeast Hatyai and Phuket in the South and Chon Buri province from eastern sea board area. 714 construction site were compatible with the selection criteria,  and 184 sites were selected for this study. 243 foremen and 3,623 workers were interviewed. Main collected data were general appearance of the working sites, working status, life       style, safety procedures and practices, deaths and hospitalization, health seeking behavior of the workers and sanitation of the shelters. Major findings are in the followings: Most construction workers were in low socio-economic class as well as working in the risk area. More male workers died from working related accidents, it might be from a lack of enough measures to protect and prevent accident among the workers. There were also not enough safety devices and, moreover, few workers used the safety devices habitually.  The government sectors seldomly visited the sites and usually ignored the well being of the workers. Most workers were temporary and daily employed, without written contract. These were very few insurance for the workers, especially medical insurance. So the workers usually paid for their hospitalization and other medical reatment.Only 1/3 of the workers knew and concerned about their right, especially female workers. Most employers provides the shelters for the workers in the construction sites. The sanitation were poor. There were lots of littering and wastes water around the shelters. The shelters usually had not enough light, no windows and few latrines. Pipe water was the main source of drinking and other purposes.      Most workers in Bangkok and Chon Buri province were migrated from the northeast and the north, while other provinces were local residences. There was twice of females, most in aged 20-35 years and got only primary school education.Not only the environment and working conditions had threatened the workers, but also the risk behaviors, such as, regular smoking which was high among males. In addition, they usually consumed alcohol, took analgesic drug, and some consumed amphetamine. Moreover, there were lots of social problems inshelter area, such as alcohol addiction, violence among workers or in the family, and gambling. Main activities of the workers after working hours were talking with their friends of family and watching television. Few workers admitted to the physical and mental exercises. Even though, the living condition  was quite poor, most workers still satisfied on their work.  However, they would not encourage their children and sibling to get this job.  Main recommendations from the study are: increasing the governmental role to control the safety, sanitation of the construction sites, increasing safety prodesures for the workers, regular and intensive training for the workers and foremen focusing on knowledge, safety awareness and practices,      law enforcement and regular visit by the government sectors, especially the local governors, and providing special health care for the workers and their family, and schooling services for their kids.


location: , 'Thailand year: 2017 source: HSRI

title: Improving the quality of life of people with disabilities by using the rehabilitative devices and assistive devices from local wisdom

abstract: This research aims to identify and disseminate the local wisdom knowledge on equipment for people with disabilities and develop care systems for people with disabilities by using the rehabilitative devices and assistive devices from local wisdom. There were 2 phases in this research; phase 1: find, collect, analyze and disseminate information on the disabled equipment. The data was collected by quality of life questionnaire, the Barthel Activities of Daily Living, data recorder, and interview guideline with 70 disabled people and families with disabilities in Phitsanulok Province. Phase 2: development of care systems for people with disabilities by using the rehabilitative devices and assistive devices from local wisdom
within stages of action research. The data was collected by quality of life questionnaire, Barthel ADL index, group discussion, interview, and brainstorming guideline from 48 of 1) District Health Officers 2) District Sub District Health Officers 3) Community Leaders 4) Sub District Administration Officers 5) Volunteers 6) Village Health Volunteers 7) Disabled People And 8) families of PWDs. Content analysis was used analysis in qualitative data. Frequency, mean, percentage, median, deviations, and Paired t-test were used analysis quantitative data. The results found that 1) there were 53 the rehabilitative devices and assistive devices from local wisdom. The security and be careful in how to use the device
were advised. 2) The development of care systems for people with disabilities by using the rehabilitative devices and assistive devices from local wisdom was found that the system consisted of two levels, namely, the support of the district level, 1) vision and goals, 2) the management center, and 3) the development of human resources for the care of the disabled. 4) supporting budget 5) The Disability Resource Center 6) providing 24-hour for counseling 7) supporting by health organization administrator and the prefect. The process of caring for people with disabilities at the sub-district and community level consisted of: 1) assessment of disability condition and ability for finding the need 2) coordinate with the community health center of the hospital for plan 3) think and design the production of
equipment to care for people with disabilities; 4) physiotherapists to verify academic
accuracy and safety; 5) take care of people with disabilities at home; 6) develop knowledge between carry out of caregiver. 7) publish the work on the line group and
8) evaluate the use of the equipment. The results of the development of the system
found that the quality of life of the disabled and the movement of people with
disabilities improved.


location: , 'Thailand year: 2001 source: HSRI

title: Health management service for informal sector : hawkers and residual collectors

abstract: Health  Management  Service  for  Informal  Sector :  Hawkers  and  Garbage  Collectors This  research  is  aimed  to 1)  know  their  working  conditions , major  health  risks,  health  problems  and  care,  2)  know  their  awareness,  understanding  and  access,  of  health  service  system  for  them,  their  selection  of  health  service,  rights  and  benefits,  their  satisfaction  and  problems  of  health  service  system  use,  their  expectation  of  health  service  system  and  their  ability  to  make  additional  payment  into  the  health  fund,  and 3)  propose  guidelines  on  provision of health service system for informal sector : hawkers and  garbage  collectors.	This  is  qualitative  research  and  data  were  collected  in 3 ways  including  1) in-depth  interview  with 165 hawkers and  garbage  collectors  in  Bangkok  and  peripheral  zones,  2) interview  with 5 officials  directing  health  service,  and  3) 2 focus  groups  of  the  health  service  receivers  and  providers. 	The  research  can  be  concluded  that   most  of  165 samples  are women  being  31-40 years  of  age  and  having  primary  education,  single  families  and  about 4 family  members.  Most  samples  migrated  seasonally  or  permanently  form  the  northeastern  region,  reside  in  rented  houses  with  about ฿ 800/month.  Most  samples  have  worked  for  over  10 years  with  daily  income  of  ฿300-400 being  equal  to  their  expenditure.  Some  have  short-term  debts  with  monthly  interest  rate  of  7-20%  being  incurred  to  be  their  revolving  fund  for  trade  or  to  be  their  expenses  for  medical  treatment.	They  work  at  kerbs  or  in  public  and  crowded  places  for 8-10 hours  a  day  without  taking  any  holiday  for  relieving  their  stress  or  exhaustion  from  hard  or  repetitious  work.  They  also  encounter  polluted  air,  dust,  strong  sunlight  and  noise  of  heavy  traffic.  So,  this  is  rather  risky  work  without  certain  income. 	As  for  their  belief  in  health  care,  they  believe  that  their  families  and  themselves  are  strong  at  this  middle  age,  so  they  are  not  aware  of  health  protection  or  improvement.   In  case  of  illness,  Most  of  them  buy  drugs  instead  of  seeing  a  doctor  for  saving  on  time  and  money  and  for  quicker  recovery.	Most  of  the samples and their  families  were  not  seriously  ill  during  the  past  year  but  they  suffered  only  from  headaches,  armaches,  legaches,  backaches, shoulderaches,  colds,  exhaustion  and  stress.   Yearly  expenses  for  health  care  are  ฿ 200-300 per  family.  More  than  half  of  them  have  health  insurance  but  the  48% remainder  have  not  because  they  know  nothing  about  health  insurance  schemes  or  think  that  such  schemes  are  not  worthwhile  because  they  have  never  been  ill  or  that  better  service  results  from  cash  payment,  not  from  the  use  of  health  insurance  cards.	As  for  their  problems  of  health  service  system  use,  those  having  no  health  insurance  must  bear  medical  expenses  or  borrow  money  if  they  are  seriously  ill.  Public  hospitals  are  open  only  during  official  hours  and  the  health  insurance  schemes  are  usually  publicized  in  announcements  or  leaflets  which  are  hardly  or  cannot  be  read  by  them.  Those  having  health  insurance  usually  face  problems  with  hospitals  being  provided  for  them  according  to  administrative  zones,  so  most  of  them  suggest  that  suitable  hospitals  should  be  chosen  in  not  only  the  social  insurance  schemes  but  also  these  health  insurance  schemes.  Moreover  they  can  willingly  make  additional  payment  into  the  health  fund  for  about ฿ 500 –600 a year.	The  guidelines  on  provision  of  health  service  system  for  hawkers,  garbage  collector  are  as  follows :	1.  Public  awareness  of  health  improvement  and  protection  must  be  more  stimulated  than  medical  treatment  which  finally  requires  high  expenses.	2.  Suitable  health  insurance  should  be  basic  health  service  system  being  provided  for  informal  sector  having  no  health  insurance.  It  should  be  the  same  rights  and  benefits  as  those  offered  by  the  schemes  of  the  poor  and  needy  relief.   The  expenses  of  this  basic  health  insurance  must  be  borne  by  the  government.  If  anybody  wants   more  rights  and  benefits,  e.g.  selection  of  hospitals,  treatment  for  chronic  diseases,  use  of  extra  drugs,  etc.,  should  be  offered  and  additionally  paid  for.  The  insurer  taking  good  care  of  himself/herself  without  using  health  service  of  medical  treatment  should  be  given  a  discount  for  continuous  insurance.  Besides,  the  health  insurance  schemes  must  be  fully  publicized  by  local health  volunteers  or  radio  and  television  programmes  for  creating  correct  understanding  of  health  insurance.


location: , 'Thailand year: 2018 source: HSRI

title: Health System Development for Screening, Early Diagnosis and Management of Cholangiocarcinoma in Northeast, Thailand

abstract: Bile duct cancer (cholangiocarcinoma) is a cancer caused by abnormalities of the lining of the bile duct inside and outside the liver. Thai people die of cholangiocarcinoma and liver cancer in the number of 10,000 - 20,000 cases per year, with more than half of the population being northeastern. The World Health Organization has made liver fluke a major cause of this type of cancer. The knowledge gained from the research from Khon Kaen University has been applied to prevent and search for the first stage of cancer patients in order to accomplish curative treatment. Importantly, about 55 percent of the working-age population is a head of household between the ages of 40-60 years, which is a serious disease and causes loss of economic, social, quality of life of people in the society. Therefore, the Health System Development for Screening, Early Diagnosis and Management of Cholangiocarcinoma in Northeast, Thailand) by the support of the Health Systems Research Institute (HSRI) with the co-funding with Khon Kaen University through the Cholangiocarcinoma Screening and Care Program (CASCAP) and The National Research Council of Thailand via the Grand Challenges Thailand: Fluke Free Thailand is running the project with the aim of establishing a comprehensive program for the long-term control and elimination liver fluke infection and CCA in Thailand in all aspects. There are 11 interrelated projects running under this program in Thailand, which provide a holistic approach covering primary-, secondary-, and tertiary prevention of liver fluke and cholangiocarcinoma. The program has successfully negotiated with the Thai government to launch a 10 years strategic plan for the elimination of the liver fluke and CCA running from 2016-2026. In addition to the Ministry of Public Health, this policy involves several other ministries including the Ministry of Education, the Ministry of Agriculture, the Ministry of the Interior, the Ministry of Communication and the Ministry of Foreign Affairs. The data obtained and fed into the Isan Cohort database are being used for monitoring and evaluating the policy’s progress. In addition, there are 4 innovations have been established in order to solve liver fluke and cholangiocarcinoma problem as followings. 1. The Isan Cohort software (https://cloud.cascap.in.th/) which is an online and real-time database system used for nation-wide at risk population registration, data recording, monitoring, evaluation and reporting to the Thailand Ministry of Health as well as the general public was established. The registration and inclusion of the high-risk population takes place at primary health care hospitals. The at-risk people are then transferred for ultrasound screening to district hospitals and suspected CCA cases are referred for further investigation and treatment to super-tertiary care hospitals. Screening is performed simultaneously with at the risk members of the local population at the primary health care units. Some initial data have been published in the BMC Cancer (Khuntikeo et al. 2015) 2. An ultrasound screening system has been developed (Chamadol et al. EMSO open 2017), composed of ultrasound machines with mini-PACS, which allow the transfer of ultrasound images through the internet into the Isan Cohort database. This system also includes online-based consultation where the images can be reviewed by an expert radiologist for confirmatory diagnosis (Figure 3). In addition to increasing the screening capability, hepatobiliary ultrasonography training courses are offered for radiologists and general practitioners. 3. A new technology to detect the liver fluke antigen in urine has been developed (Worasith et al. 2015). The new method id more sensitive and specific than the
detection of parasitic eggs in feces. Interestingly, the Ov antigen detection kit is now under mass production 4. Network Hospitals for Screening, Surveillance, Diagnosis and Treatment of Liver Fluke Disease and Cholangiocarcinoma Patients. The Ministry of Public Health's service units are involved in about 3,626 health units, including the District Health Promotion Hospital, Community Hospital, General and Center hospital. Network hospitals are designated for the diagnosis and treatment of cholangiocarcinoma and for further management of the suspected CCA cases identified by ultrasound screening. This network comprises all 7 super-tertiary care hospitals in the northeast of Thailand. Moreover, hepatobiliary and pancreatic surgery training courses are provided to increase the number of the specialist surgeons available to perform potentially curative surgery Therefore, the successfully this project is an example of the results of research and development to solve the problem of the country. Importantly, the people could access services related to liver fluke and cholangiocarcinoma in all level including primary, secondary and tertiary level in timely manner with high quality.


location: , 'Thailand year: 2012 source: HSRI

title: Result-Based Strategic Health Planning Processes: A Case Study of Bureerum Provincial Public Health Office

abstract: This case study was aimed to explore the processes of developing result-based strategic plan for
health promotion, prevention and disease control. Participants were 13 staff members who highly involved
with the processes of strategic development and plan of Bureerum Provincial Public Health Office.
They were purposive selected. Data were collected using focused group interview. Findings from the
study revealed three major processes of strategic planning including preparation, reviewing strategic agenda and binding up the master plan. The process of preparation involved seeking a better understanding,
early planning and data preparation. The steps in reviewing strategic agenda consisted of linking policy
from central level to the provincial needs, brain storming and revising the strategic agenda. Binding up
the strategic plan consisted of developing master plan, integrating projects and outcome indicators and
making plan more flexible. Suggestions to the findings of this study are to promote the strong intention of
the provincial admistrators in using result-based strategic planning for their administration and to promote
development of essencial competencies and skills related to the planning for their human resources.
The survey of core and functional competencies in relation to result-based management may guide the
plan for human resource development in diferrent levels of their team as well as promoting continuing
development of working processes covering overall areas in relation to the plan.


location: , 'Thailand year: 2019 source: HSRI

title: Situation, Personal and Household Characteristics Associated with Disability in Children

abstract: People with disabilities face several challenges, especially children who are often discriminated against and have limited access to social services. Despite the significant impact on a child’s development, family life, and its economic implications, research on childhood disability is inadequate. This study aimed to study the situation of children with disabilities up to the age of 14 years by type of disability and explored factors associated with disability. The study involved analyzing the National Statistical Office’s 2015 Household Socio-Economic Survey. There were 22,499 children aged 0 – 14 years in the sample of 15,538 households. Applying sampling weights, the country-wide estimates were derived. The study found that 93,129 children aged 0 to 14 years (0.87%) suffered from some kind of physical and intellectual disabilities, and most of them were congenital disabilities (0.80%). High prevalence of child disability was found in the following groups: males (0.93%), the 11-14 year old age group (1.12%), household heads with vocational diploma (1.20%) and unemployed household heads (1.16%). Among children with disabilities, more than one-third did not attend school. In addition, almost all children with both physical and intellectual disabilities could not take care of themselves or go out independently (81.6% and 94.5%). After multivariate adjustment, it was found that the children aged 7 – 14 years had a 1.39-time higher prevalence of disability compared to children aged 0 – 6 years (Adj.OR=1.39; 95%CI= 1.05-1.84). On the other hand, the prevalence of children with disabilities was lower in households where the heads were employed by the government and by private companies (51% and 41%, respectively) than those with unemployed household heads. The prevalence of child disability was concluded to be high among school age children (5 – 14 years) and in households with unemployed household heads. School aged children lacked educational opportunities especially those with congenital disabilities. The present study suggests that the government should pay more attention on special education of people with disabilities, and children with disabilities should have education or vocational training appropriate to their condition. Special education policies for children with disabilities have to be evaluated for improving the effectiveness. Moreover, authorities should promote private or public organizations to employ the head of family having children with disabilities.


location: , 'Thailand year: 2018 source: HSRI

title: The Systematic Review of Economic Evaluation of Oral Valganciclovir and Intravenous Ganciclovir for Cytomegalovirus (CMV) Prevention and Treatment in Transplant Recipients

abstract: Oral valganciclovir is the alternative option for prophylaxis and treatment of cytomegalovirus (CMV) disease that is widely used in transplantation due to the equivalent safety and efficacy compared with intravenous ganciclovir. So valganciclovir was proposed for the inclusion into the national list of essential drug. The systematic review criteria were the original article of the full economic evaluation for valganciclovir or intravenous ganciclovir in various durations of therapy. Prophylaxis, pre-emptive prevention regimen and wait-and-treat regimen of only one or both of these drugs for all organ transplantation recipients were included to the study. The eligible studies showed 4 studies in the US, 2 studies compared between different duration of therapy of using prophylaxis valganciclovir, 1 study compared prophylaxis with pre-emptive therapy using valganciclovir, and the other compared pre-emptive valganciclovir with no prevention therapy. In European countries, there were 3 studies: compared prophylaxis ganciclovir among durations of therapy, compared prophylaxis with pre-emptive ganciclovir, and compared prophylaxis ganciclovir with prophylaxis valganciclovir. The studies targeted in kidney, lung, liver, pancreas, and hematopoietic stem cell transplantation in hospital, societal, or health system perspective. There were 5 of 7 studies modeled the Markov and decision tree and discounted 3-5% with 5 month to 10 year horizon to estimate costs and outcome, while 2 of 7 studies considered costs and outcome in 1 year after transplantation. The results showed prophylaxis 200 days was more cost-effective than pre-emptive and wait-and-treat regimen because of the superior outcome of longer duration prophylaxis in preventing early DNAemia, CMV disease, opportunistic infection, and graft rejection, but the costs were equally high of drug for prophylaxis, and laboratory monitoring for pre-emptive therapy. To compare the cost effectiveness between ganciclovir and valganciclovir, it could be concluded only the costs of using ganciclovir were high particularly in 1 year after transplantation due to catheter culture test, drug administration, room expenses, and intravenous caused adverse event. However, there was no the long-term costs and outcome presented. The studies from other countries were differently designed of comparator approach upon their routine practice and resource concerns. This systematic review could explore the elementary information for further economic analysis and making decision included valganciclovir into the Thai national list of essential drug.


location: , 'Thailand year: 2012 source: HSRI

title: การพัฒนาระบบการกำกับดูแลยาชีววัตถุในประเทศไทย กรณีศึกษา epoetin

abstract: Biological products are very complex molecules, therefore the same regulatory
approach of assessing chemical drugs cannot be used. Although a variety of assays are
available, they may not be adequate to reliably predict the safety and efficacy of
biological products. Several studies indicated that the treatment responses of biological
products are not the same especially the immune responses. This study was a
descriptive study conducted by intensive literature reviews and group discussions. The
result showed that the dossiers of registered biological products were partially
incomplete comparing with international guidelines, which may cause the risk over
benefit. Thus, researchers have proposed a future system to regulate biological products
by shifting the registration and re-evaluation paradigms of biological products to be in
compliance with current international guidelines on biological products and biosimilars.
The implementation of this new proposed system requires the development of
administrative and technical aspects.


location: , 'Thailand year: 2008 source: HSRI

title: Implementation of standard pratices in mental health and psychiatric services for a primary care unit, Phichit province

abstract: Mental and psychiatric illnesses are major health problems and the trend is increasing.
Most seekers of health care still lack adequate treatment, and preventive and rehabilitative
coverage. Thus, health personnel working in primary care units (PCUs) are persons
who are able to provide complete services in better caring for their clients.
The purpose of this descriptive study was to assess the standard practice of mental
health and psychiatric services in various PCUs in Phichit Province. The survey samples were colleagues who authorized mental health and psychiatric services at 51 PCUs in
Phichit Province. Data were collected from September to November 2007. The instruments
consisted of questionnaires for the standard practice of mental health and psychiatric
services from the Department of Mental Health, Ministry of Public Health (2005).
The data were analyzed by descriptive statistics and content analysis. The findings of the
study revealed that 66.27 percent of the overall PCU analysis was fairly satisfactory.
Independent PCU analysis found that 17 PCUs (33.3%) were dissatisfied, 14 PCUs (27.5%)
were fairly satisfied, 13 PCUs (25.5%) were satisfied and 7 PCUs (13.7%) were very satisfied.
However, this study found that important limitations to mental health and psychiatric
services that followed standard practices were the patients’ lack of knowledge and
understanding about mental health and psychiatric services, a lack of specialists in mental
health and psychiatric services and continued development of specialists; these shortcomings
must be resolved. Other limitations were an inadequate support system and
insufficiency of mental health reports. This article suggests that the strategy and policy
planning for the mental health and psychiatric services for the primary care unit (PCU) in
Phichit Province need improvement.


location: , 'Thailand year: 2001 source: HSRI

title: Cooperation between public organizations and local administrative organizations in Haadyai and Banpru metropolitan before decentralization

abstract: Cooperation between public organisations and local administrative organisations in Haadyai and Banpru metropolitan before decentralisation	Health care administration by local administrative oragnisations or cooperation with public health organisations were feasible particularly large areas like Muang district. The local administrative organisations received health budgets not correspondent with local health problems while the public facilities under the Ministry of Public Health did. Therefore, the local organisations could then be networked with the hospitals. 	It is recommended that:Initially, public health budget be administered by the Provincial Committee for Health which should have representatives from local administrative organisations, Health budget be given to local administrative body for developing health funds providing opportunity for community involvement,Local administrative organisations be able to provide health care which is not complicated and easily monitored but effective for building health for example vaccination, school health program, condom use promotion, exercise and nutritional campaign.


location: , 'Thailand year: 2023 source: HSRI

title: Clinical Characteristics of Diabetes Diagnosed Age before 30 Years in Thailand

abstract: Currently, there is no epidemiological study of diabetes diagnosed before the age of 30 in Thailand. The aim of this study was to determine type of diabetes and clinical characteristics of Thai diabetic patients diagnosed before age 30 years. Six hundred and forty-six patients were enrolled from 31 network hospitals in Thailand between August 2018 to December 2021. Type 1 diabetes was identified in 63.6% of patients, type 2 diabetes in 19.8%, and other specific types of diabetes in 16.6%. For type 1 diabetes patients, the median age at diagnosis was 11 years and presentation with diabetic ketoacidosis (DKA) was common (45%). The average glycated hemoglobin (HbA1c) at diagnosis was 9.9%. For type 2 diabetes patients, the median age at diagnosis was 18 years and the presentation of DKA was 4.7%. The average HbA1c at diagnosis was 10.9%. In conclusion, type 1 diabetes was more common in diabetes diagnosed before age 30 years and DKA was frequent. The prevalence of type 2 diabetes increased with age and HbA1c increased during adolescence. This study can be used as reference and may lead to applicable public health policies related to diagnosis, treatment, and prevention of diabetes in young people in Thailand as well.


location: , 'Thailand year: 0 source: HSRI

title: The 9th National Oral Health Survey 2022-2023 (phase 1)

abstract: Bureau of Dental Health, Department of Health conducted of the National Oral Health Survey consequently, every 5 years. The 9th National Oral Health Survey (2022-2023) was held to assess oral health status, oral health behaviors, key factors related to oral health among Thai population. This survey is divided into two phases, phase 1 is the survey preparation and phase 2 is the data collection and report. The implementation of this phase 1 received research funding from the Health Systems Research Institute (HSRI) to develop tools, calibration and prepare the survey team to achieve its aimed. This cross-sectional survey conduct in 7 index age; 3 years, 5 years, 12 years, 15 years, 35-44 years, 60-74 years and 80-85 years and the impact of oral health related quality of life among 12 year-old-children. Survey areas are in 25 provinces, namely Bangkok (Phaya Thai, Wang Thonglang, Khlong Sam Wa, Phra Khanong, Thon Buri, Bangkok Yai) and 2 provinces per Health Region, cover 24 provinces, namely; Chiang Rai, Phrae, Tak, Phitsanulok, Kamphaeng Phet, Chainat, Ang Thong, Pathum Thani, Suphan Buri, Ratchaburi, Chachoengsao, Rayong, Kalasin. Nong Khai, Nakhon Phanom, Chaiyaphum, Buriram, Yasothon, Sisaket, Chumphon, Krabi, Phatthalung and Satun. And collect the impact of oral health related quality of life data from 7 provinces; Phrae, Kamphaeng Phet, Pathum Thani, Chaiyaphum, Sisaket, Krabi, and Bangkok. The National Oral Health Survey tools were developed. Workshop with experts was held as a part of quality of tools development. This allowed experts to suggest on content and suitability of the tools. The results of the experts meeting was used to improve the survey forms and questionnaires, Moreover, the content validity was performed by 3 experts and the Index of item objective congruence (IOC) was between 0.81–0.94 and the total IOC was 0.88. The pilot of the interview questionnaires in 4 age groups; 12 years, 15 years, 35-44 years, and 60-74 years, were done, in order to test the suitability of language and the understanding of the interviewees. Results were used to develop the interview questionnaires forms and interview guideline. Organized a workshop aimed to clarify the guidelines for the 9th National Oral Health Survey among coordinators and 25 survey areas. Including coordinating with the survey team in order to obtain a plan in the survey area of each province, prepare samples for data collection and management plan, to ensure accuracy and completion of data. Likewise in Bangkok area, held the workshop to staffs from 13 Public Health Service Centers. The manual/ guideline of the survey was done to be used as a guideline for conducting survey. Moreover, the calibration of examiners and interviewers workshop was done in order to ensure for the reliability of the data collection covered all examiners, recorders, oral health behavior interviewers and Child-Oral Impacts on Daily Performances (Child-OIDP) interviewers. The calibration of dentition status in primary teeth was done in 5 years old children and likewise in permanent teeth among aged 12, 35-44 and 60-74. Results showed that the Kappa and Percent agreement of all examiners met the target criteria within the acceptable range. (See in table 9) In addition, the calibration of Child-Oral Impacts on Daily Performances (Child-OIDP) interview was done in the 12-year-old child. Process consisted of interview practice and result showed the Intraclass Correlation Coefficient statistic (ICC) within the range of 0.73-0.92. (see in table 8)


location: , 'Thailand year: 2016 source: HSRI

title: Management Model of Referral Coordination Center in Health Region 6

abstract: The objective of this study was to develop the management model of referral coordination center in provincial and region level. The conceptual framework is 4M; Management, Man, Material and Money. The sampleswere divided into 3 groups. The first groups are 8 executive of referral coordination center, 9 directors in general hospital and 15 directors community hospital. The second group is 24 operational personnel inreferral coordination center. The third groups are 40 patients. The instruments are observational formsand semi-structured form, data collection from in-depth interviews and focus group. Analysis data by descriptive statistic and content analysis. The study found that; 1. All Provincial Referral Coordination Centers (PRCC) has a similar management pattern. 1) Management mostly has chain of command clearly and be unity. There has a target work, referral practice guideline, but the structure of referral coordination center that still unclear. There are no strategy, no plan and no project that specific problems or role of PRCC. The PRCC operation was not beneficial to the community hospital. The database of PRCC has quality problem and can’t to analyze.2) The operational budget of PRCC from hospital subsidy but no project support. There is a full-time nurse who operated PRCC only 08.30-16.30.The executive of PRCC has not build
employee morale process. Allmaterial of PRCC join with emergency accident department but it wasn’t enough to work.
2.The Region of Referral Coordination Centers (RRCC) has a similar PRCC management pattern. There have a regional referral practice guideline and a full-time nurse who operated work only 08.30-16.30but still implementation problem, i.e., no strategies or plan to develop work and personnel skill, lack of development to make the strengthening in network hospital, technology computer was used but can’t link the data, no pattern for regional referral data analysis. 3.The Management model of reasonable, have 3 figure; 1) high level of Provincial Referral Coordination Center Model : H model 2) moderate level of Provincial Referral Coordination Center Model : M Model 3) level of Region Referral Coordination Center Model : R Model.


location: , 'Thailand year: 2022 source: HSRI

title: Cochlear Implants Registry in Thailand – Phase 3

abstract: The cochlear implant surgery is currently an only option to treat the patients with bilateral severe or profound hearing loss. The cost of cochlear implant surgery in Thailand is around 1 million baht per case and it needs the experience surgeon to perform this operation. The success of the operation depends on many factors such as hearing level before surgery, the cause of hearing loss, duration of hearing loss, experience of using hearing aids, and readiness to rehabilitation. The Royal College of Otolaryngology – Head and Neck Surgery of Thailand had issued the guideline for cochlear implantation and suggested the need of cochlear implants registry to collect the operation results prospectively including hearing and speech levels, costs, and quality of life of the patients after surgery. This report collected the cochlear implantation data from 16 May 2016 to 29 June 2022. 1. The status of Cochlear Implants Registry in Thailand. The phase 1 to phase 3 of this study start from 16 May 2016 to 29 June 2022. There were 580 patients who underwent cochlear implant surgery. There were 289 males (52 percent), 268 females (48 percent), and 23 no gender data (4 percent). The mean age was 27. 43 ± 24. 65 years. Most patients were adults (50 percent). In children, the most common age group was 2-4 years old (15 percent). The most common cause of hearing loss was congenital (45.36 percent) and mostly idiopathic (38 percent). While the most common cause of acquire hearing loss is meningitis (18.56 percent). The mean hearing level before surgery was 95.53 dB (profound hearing loss). The mean CAP score before surgery was 0 (no awareness of environmental sound). 2. The results of cochlear implantation in Thailand After surgery, the mean hearing level at 500-4,000 Hz was significantly improved at first month post operation. The mean pure-tone hearing level was improved from profound to mild hearing loss at third month after surgery (p < 0.001). The speech hearing level was also improved from profound to mild hearing loss at third month after surgery (p < 0. 001). The speech discrimination score was improved to the level that can communicate that sixth month after surgery. The complication after surgery were found in 7.51 percent of patients. The most common events were facial palsy, vertigo, and extrusion of electrode. 3. Pre-authorization System The National Health Security Office of Thailand announced the cochlear implantation benefit for the newborn and young children since 1 January 2021 who had severe to profound hearing loss to improve the speech and language development of this group of patients. Pre-authorization (PA) for cochlear implantation surgery was developed by this project to ensure the benefit of patients including review pre-surgical condition to ensure the fitness to undergo cochlear implant surgery, review that the surgeon is adequately trained and review that the hospital has adequate staffs and instruments for surgery and rehabilitation after the surgery. The National Health Security Office of Thailand agreed to use this project’s preauthorization system as announcement NHSO 2.57/vor.2685 on 3 May 2021 before performing the cochlear implantation under the National Health Security Office of Thailand benefit.


location: , 'Thailand year: 2015 source: HSRI

title: Levels of Quality of Life and Method to Develop Quality of Life  in Thai Chronically ill patients

abstract: Background:   Diabetes mellitus and hypertension are major health problem in Thailand. Patients who suffer from these diseases experience undesirable symptoms and complications at target organs that affect levels of quality of life of patients.
Purpose:   This study purposed: 1) to examine quality of life levels of diabetes patients and hypertensive patients with/without complications 2) to explore the method to increase levels of quality of life in diabetes patients and hypertensive patients with/without complications.
Method:   Mixed method design was used in this study for examining quality of life of the patient. Sample of quantitative study include 543 patients with diabetes and/or hypertension and these patient were with/without complications. Study sample was recruited from 17 health care settings in Saraburi province. For qualitative study, sample was 36 patients with diabetes and/or hypertension, including with/without complications. Quantitative data was collected using WHOQOL-BREF-THAI. This questionnaire was tested for validity and reliability. The reliability was 0.82. With respect to qualitative study, data was collected by in-depth interview procedure using the list of 12 questions. Field note and voice-recording were performed during interview with the patient.
Data analysis:  Demographic data was analyzed using frequency, percentage and S.D. Predictive factors of quality of life was analyzed by performing multiple regression procedure. Qualitative data was analyzed and categorized for major theme of perception of quality of life, levels of quality of life, and method to increase quality of life in diabetes mellitus and hypertensive patients.
Results:   Average age of patient was 60.08 years (S.D.= 13.37)  The majority of study sample was female (65.54%, n= 350). The major group of patient was married (66.88%, n= 374 ), and education levels was primary school  (71.64%,  n= 389). The majority of patient was low income, 0-1,000 Baht a month (36.1%, n= 196). Many patients can control diabetes mellitus and hypertension (60.22%, n= 327). The period of diabetes was 3.64 years (S.D.= 7.06), hypertension was  5.47 years (S.D.= 6.89), and both diabetes and hypertension was 2.25 years (S.D.= 8.12) Average score of quality of life of the patient was moderate levels ( = 3.42, S.D.= 1.79). With respect to perspective of the psychological aspect was the lowest score ( = 2.97, S.D.= 1.32) when comparing to all perspectives. The highest score was physical quality of life  ( = 3.61, S.D.= 1.01) With regard to the predictive factor of quality of life, marital status, relationship in family, performing exercise, period of diabetes, period of hypertension, controlled diabetes mellitus and hypertension, and complication of diabetes and hypertension were statistically significant with levels of quality of life    (p≤ .001-.05, r2 = .70). The effect of these predictors on quality of life was .70 (r2 = .70).
For qualitative results: The qualitative data was categorized to be three themes that were         1) the perception of diabetes mellitus and hypertension included diabetes mellitus and hypertension being chronically illness, diabetes mellitus and hypertension being caused by unhealthy behavior, and diabetes mellitus including dry and wet symptoms, 2)  quality of life of diabetes mellitus and hypertension patients included levels of quality of life in diabetes mellitus and hypertension patients being moderate levels, diabetes mellitus and hypertension affecting physical aspect of the patients, diabetes mellitus and hypertension leading the patients to have morbidity, suffering from diabetes mellitus and hypertension having to dependent family member, and caring from health care providers can help the patient to be better 3) methods to improve quality of life included patients with diabetes mellitus and hypertension could have good quality of life by diet control, doing exercise, medication compliant, emotional management, self - management, good caring from health care provider and alternative medicine could help the patient to increase quality of life.


location: , 'Thailand year: 2007 source: HSRI

title: Implications of the Universal Coverage Scheme on Health Service Delivery System in Thailand

abstract: The Universal Coverage policy has incorporated two major reform elements,
financial management reform and strengthening primary care which inevitably
affects health service delivery system in Thailand. This paper was aimed
to review implications of the Universal Coverage policy on service delivery system
in terms of financial implications and service provision. Review of secondary
data was the method adopted to explore the implications and the study was
conducted during 2004 - 2006.
The result revealed that the Universal Coverage scheme had a great impact
on the service delivery system. Inadequate funding in addition to change
of allocation criteria from supply-based allocation to demand-based allocation,
per capita, had great financial implications on hospitals. Big hospitals, for example,
regional and general hospital, and hospitals with relatively high concentration
of health personnel incurred financial deficit in the first year when salaries
were included in the capitation. However, the problem had been shifted
from regional and general hospitals to community hospitals and those hospitals
in the Northeast when salaries were removed from the capitation in the following
years. Change of criteria of allocation out of inadequate funding was inevitably
shifted the problem from one to another. Providing universal coverage of
health insurance apparently increased demand for care and burden of work.
Strengthening primary care policy drove more service utilization toward community
hospitals and health centers. Mobilizing doctors or professional nurses
to provide care in primary care units and health centers improved overall quality
of care. However, inadequate funding and stagnation of investment budgets
may have negative consequences on quality of care in the long run.


location: , 'Thailand year: 2021 source: HSRI

title: Automated Surveillance Systems for Assessment, Monitoring, Prevention, and Management Guidelines for Extravasation of Norepinephrine’s Administration from Skin Images using Artificial Deep Neural Network on Smartphone Application

abstract: Extravasation is a condition of extravasated drug was leaked and potentially damaged the site of infusion. In serious injury cases can cause permanent loss of tissue organ. As a clinical workflow in Thailand, nurses have to define the grading and management of extravasation after intravenous (IV) infiltration. But this procedure also has a limitation by the traditional nurses’ shift schedule, which is make the grading and management of extravasation not continuously by the same person. So, this research project proposes an automated screening of extravasation for surveillance, assessment and monitoring during IV therapy. These included 4 steps: data collection, image labeling, convolution neural network modeling, and application development. Total of 1,084 extravasation images were collected from 5 hospitals: Rajavithi Hospital, Nopparatrajathanee Hospital, Rayong Hospital, Songkhla Hospital, and Thammasat Hospital using our own data collecting application. All images were labeled by three dermatologists by locating the skin lesion and rating the severity of extravasation. If no majority vote of any images, the fourth dermatologist will decide the severity of extravasation. After image labeling, all of image data was used to train a densely connected convolutional neural network (DenseNet-121) model, using five-fold cross validation and transfer learning with data augmentation technique. The results from hold-out testing set have a sensitivity and specificity of 96.30% and 93.90% in normal control images, 80.00% and 88.41 in mild extravasation images, 83.33% and 74.12% in moderate extravasation images, 90.91% and 86.74% in severe extravasation images, and 71.43% and 78.43% in others images, respectively. The results from the model were combined to the final application for surveillance, assessment and monitoring extravasation during IV therapy for providing an ease of extravasation management and increasing the efficiency of clinical workflow to reduce the economic cost spent on patient with extravasation in Thailand.


location: , 'Thailand year: 2005 source: HSRI

title: Using hospital quality development and accreditation process as a tool in developing health promotion in hospitals

abstract: The aim of this research project is to look into the possibility of using the hospital
quality improvement and accreditation process (HA process), which has been well accepted
by a large number of hospitals in the country, to help develop health promotion (HP) in
hospital setting. A study was conducted with two-fold objectives: (1) To study health
promotion in HA accredited hospitals, looking for the relationship between HA process and HP
and other factors including concept of HP, and (2) To form a learning network of hospitals to
clarify the above relationship in order to utilize it in facilitating the HP movement in hospitals.
Soft Systems Methodology fits the purpose of this study. It is an action research
methodology that involves developing “a learning system” (Model) to be used as a tool of
inquiry, with declared world-views (the HA process, the Thai HPH standards, and the
empowering core strategies from the WHO Working Group). The model was used to study 8
selected HA accredited hospitals.
The findings included: (1) Traditional health promotion services and activity-based HP
were evident in all hospitals. None of the hospitals used the concept of empowerment in HP.
However, they realized that some parts of HA overlap with HP such as the issues of “Health
of personnel” and “Environment”. Those hospitals which determined to become HPH obviously
put much greater effort into program-based HP activities. (2) None of the hospitals was aware
of care-based HP. However, quality development of patient cares was evident in all hospitals.
Health or quality of life of patients was used as target. The process used was empowering,
including self-care and self-help groups; patients, family and even community participation.
These were obviously health promotion but never referred to as such. This finding should be
crucial for establishing a link between HA process and HP. 3) Hospitals were confused as to
their roles in health promotion. Clarification regarding care-based HP could lessen some of the
problems particularly among tertiary-care hospitals. Other issues, such as the definition of
“community” that includes “group of people having same characteristics or same purposes”
would help hospitals realize that they are already providing HP in many areas, and could see
them as their meaningful and satisfying roles. (4) PDCA, a tool provided by HA was used only
in isolated CQI projects. Promotion of its use for “learning by doing” could be expected to
connect HA process to HP. (5) HP activities were carried out sporadically and unrelated to one another. System thinking was another concept from HA that could be expected to help
HP.
A learning network was formed during the last phase of the study to include a
volunteered group of 11 hospitals (main target group) and 29 associate members which were
willing to join the learning process. The majority of the hospitals appreciated learning by doing
within the network. The most important lessons learned were the concept of health promotion
and empowerment. They became comfortable with the use of care-based HP. This subjective
assessment was confirmed objectively by a large number of presentation of programs that
emphasized “empowerment’, and later “empowerment and PDCA” to epitomize the
connectedness between HA process and HP. It is recommended that care-based HP should
be the starting point to use HA as a tool to develop HP in hospitals.


location: , 'Thailand year: 2008 source: HSRI

title: Effectiveness in the Application of the Ministry of Public Health's Operative Plan for Type 2 Diabetes Screening in the Catchment Area of Phonpisai Hospital, Nongkhai Province

abstract: Objective : To assess the coverage of the type 2 diabetes screening program among
the high-risk population in the catchment area of Phonphisai Hospital, Nongkhai Province
before and after the implementation of the application of the Ministry of Public
Health’s operative plan for diabetes screening.
Methodology : The target population comprised residents of the catchment area
aged 40 years and older who were covered by health insurance during the period 2003-
2005. Verbal screening of the Ministry’s Bureau of Non-communicable Disease was used
in the diabetes mellitus screening program. Annual data about the number of the target
population, persons screened, and detected diabetes cases relevant to the catchment area
of Phonphisai Hospital were collected for the years 2003 to 2007. The coverage and prevalence
rates of diabetes mellitus were then analyzed and presented.
Results : The coverage rates of diabetes mellitus (DM) screening in 2003-2004 and
in 2005-2007 and the application of the Ministry’s operative plan for DM screening were
49.76 and 78 percent, respectively. The population with the highest coverage rates were
females and those in the 50-59 year age group. The overall DM prevalence rate during
the period 2005-2007 was 2.46 percent. Detailed analyses showed that males had lower
prevalence rates than females, and the 50-59 age group had the highest DM prevalence
rate compared with the other age groups. Compared with the whole Nongkhai Province,
DM was more/less prevalent in the catchment area of Phonphisai Hospital. The DM
prevalence rates for these two areas for 2005 were 419.02 and 286 per 100,000 population,
respectively.
Conclusions : The application of the Ministry’s operative plan for DM screening
resulted in clarification of its policy and importantly that of the Chief Provincial Health
Officer as well as the vision of the administrator as the Director of the District Hospital
applies to his operating staff with regard to the participation and integration of the community
and to increases in the effectiveness of efforts to detect DM cases in the catchment
area of Phonphisai Hospital. Thus, the Ministry’s operative plan for DM screening should
be continued and applied to other areas.


location: , 'Thailand year: 2017 source: HSRI

title: Healthy Happy Kids Mobile Application (Year 2)

abstract: Childhood is an important age for growth and continuing development. A child is more
likely to reach their full potential if they recieved adequate care. The care giver has a crucial role in raising, delveloping and making sure the child receives adequate care and health supervision to enable the child to be healthy so that they become our country's future asset . Mobile applications are becoming more popular with increase usage at affordable prices. We developed a mobile application (KhunLook Mobile Application) as a platform for parents, caregivers and health care providers. It can keep health and immunization records, eases basic child health supervision assessment, developmental screening and enables notifications. It contains health supervision and anticipatory guidance information from creditable sources made readily accessible to its users in Thai language. The information can be accessed from smartphones, tablets or computers and supports numerous and a wide range of users. It also has a back up feature and can be easily updated when health care information and child health supervision guidelines are revised KhunLook Mobile Application is easy to use and enables parents to initially assess their child’s health parameters. It is distinctive for it’s mobile and back-up features; it supports up to date health care knowledge and is scalable. There was no statistically significant difference between the agreement of parent-physician assessment of their child’s health status by using KhunLook Mobile Application or the Maternal and Child Book. KhunLook Mobile Application received higher overall scores than the Maternal and Child Book; the difference was statistically significant in all subject groups. KhunLook Mobile Application benefits parents, caregivers and health care professionals. For maximal potential it should be ongoing studies, it should be endorsed and supported for more user coverage and sustainable future development.


location: , 'Thailand year: 2007 source: HSRI

title: Adherence to Treatment and Clinical Outcomes in Hypertensive Patients Attending Nangrong Hospital

abstract: Background & rationale Poor adherence to medication is a common problem in
handling patients with chronic disease.  Induction of patient adherence to a long-term
regimen requires impressive information about the regimen being given and the importance for the patient of following strictly the treatment, together with the full support of
their families.
Objectives To evaluate the adherence to medication and clinical outcomes in hypertensive patients with or without diabetes mellitus.
Methodology A retrospective study of hypertensive patients was conducted by reviewing outpatient medical records from June 2006 to June 2007 at Nangrong Hospital.
Two groups of subjects included men and women aged over 18 years old: the group of
primary hypertensive patients had blood pressure above 140/90mmHg and the group of
hypertensive patients with diabetes mellitus had blood pressure above 130/80 mmHg.
Patients with other causes of hypertension, or blood pressure over 200/120 mmHg, or
who had serious complicating illnesses, such as terminal stage of cancer, chronic renal
failure, chronic liver disease, congestive heart failure, stroke, and uncontrolled angina,
were not included.
Results Among the total of 54 patients, the hypertensive patient group (n=30)
had higher blood pressure than the group with hypertension and diabetes (n=24).  The
average ages of patients in the hypertensive group and the group with hypertension and
diabetes group were 60.56±8.97 years and 57.75±7.87 years, respectively.  The risk factors,
i.e., cigarette smoking and alcohol consumption, showed no difference in the two groups.
The study disclosed that the major factors for poor adherence were the complexity of
treatment (66.66%, 83.33%) and a poor provider-patient relationship (66.66%, 75%); the
major factors for improving adherence were emphasized value of the regimen (93.33%,
95.83%) and family support (93.33%, 96.66%).  Impediments to successful adherence to
medication in individual cases, namely taking drugs at the wrong time (36.66%, 37.50%)
and taking extra doses to make up for missed doses (20.00%, 20.83%), showed no difference in the two groups.
Conclusions Poor adherence to a medication regimen is common, contributing to
substantial worsening of disease, death, and increased health-care costs.  Improving adherence requires emphasizing to the patients the value of the regimen, making the regimen simple, medication-taking behavior and family support.


location: , 'Thailand year: 2008 source: HSRI

title: Knowledge, Attitude, and Practice in Using Insulin Pens among Diabetes Mellitus Patients of Leongnoktha Crown Prince Hospital, Yasothon Province

abstract: Insulin treatment is one of the standard regimens for controlling blood glucose in
patients with diabetes mellitus (DM). The use of the “Insulin Pen” device for injecting
insulin, instead of the traditional vial/syringe for injection, provides additional convenience and accuracy and it reduces pain during injection. This descriptive observational
study was aimed at studying the behavior of 124 DM patients using insulin pens. Questionnaires were used to assess the following items: knowledge, history of using the insulin pen, attitude and practice in using the pen.
Data were analyzed by independent sample t-test and one-way ANOVA (F-test).
The majority (70.17%) of the samples were women, the average age of the samples was
57.0 ± 5.0 years; 87.90 percent of the patients were primary school graduates; 74.19 percent were experienced in using the pen for 6-8 months; 78.20 percent had used the traditional syringe insulin injection twice daily before switching to the insulin pen; 41.19 percent self-administed the insulin injection; 92.74 percent were instructed about the insulin
pen, using the method described by health-care staff. The average knowledge score was
8.25 ± 2.17 out of a possible 10; the average attitude score was 3.14 ± 1.55 out of a possible
4 and the average practice score was 2.62 ± 0.54 out of a possible 3. When comparing the
differences in sex, age, knowledge, history of using the insulin pen, attitude and practice
in using the pen, we found that differences in educational background affected the knowledge of patients about using the insulin pen. The ones who were experienced in using
the insulin pen were more likely to use it correctly than those who were inexperienced (p
< 0.05).


location: , 'Thailand year: 2022 source: HSRI

title: miRNA Expression in Cholangiocarcinoma Patients

abstract: Cholangiocarcinoma is a major public health in Thailand, especially in the northeastern region. Due to lack of early detection and poorly responsed of chemotherapeutic treatment, thus new biomarkers are urgently needed. MicroRNA/miRNA is an important genetic molecule that may function as either oncogenes or tumor suppressors. The current study aimed to identify the differential miRNA expression among serum of 50 CCA patients and 50 healthy subjects. The miRNA expression was measured by Nanostring technology. Four miRNA were found siginificantly increased expression in CCA patients; miR-320e, miR-223-3p, miR-122-5p and miR-302d-3p. These miRNA might be played a key role in oncogenesis. And three miRNA that decreased expression in CCA patients were miR-451a, miR-16-5p and miR-23a-3p. The role of these 3 miRNA might be involved with suppressed tumor growth. All these candidate miRNA might be further used as diagnosis markers or prognosis markers.


location: , 'Thailand year: 2009 source: HSRI

title: Occupational Health: Significance of Physical_x000D_
Examinations

abstract: This article emphasizes primary prevention and its application through physical examinations.
Physical examinations can be categorized into various types: pre-employment, pre-placement,
periodic, return-to-work, exit, post-exposure, and upon illness. This article also gives some hints on
selecting physical examination services.


location: , 'Thailand year: 2007 source: HSRI

title: Pufferfish Poisoning

abstract: Pufferfish belong to two families of marine and estuarine fish: Tetraodontidae and Diodontidae. The term
Tetraodontidae refers to the four large teeth fused into the upper and lower plates of the fish’s mouth, which are
used for crushing the shells of crustaceans and mollusks; the Diodontidae, as denoted by the name, possess only
two cutting teeth.
Poisoning by consumption of the members of puffer fish families is one of the most violent intoxications
caused by marine species. The ovary, liver, intestine and skin of pufferfish can contain levels of tetrodotoxin
sufficient to produce rapid and violent death. Treatment of the victims consists of supportive care and intestinal
decontamination with gastric lavage and activated charcoal concurrently with diuretic drugs. On the other
hand, the flesh of many pufferfish is not usually dangerously toxic and may be beneficial, producing a feeling of
well-being for the consumer. A pharmaceutical product derived from tetrodotoxin called Tectin is a potent pain
reliever and helper in opiate addicts going through withdrawal, when administered in very small quantities.
Both events conform to the mechanism exercised by hormesis, i.e., the effect of small doses of a toxic substance
that at higher doses has an adverse effect. A less powerful biotoxin of the puffers, named saxitoxin, the cause of
paralytic shellfish poisoning (PSP), can also be found in these fish. It should be noted that puffer toxins seem
not to be synthesized by the fish itself, but can be traced to the food chain through the ingestion of toxin-bearing
organisms, such as starfish, gastropods, crustaceans, flatworms, and ribbonworms.
Nevertheless, the meat of some pufferfish species is considered a delicacy in both Japan (as fugu) and
South Korea (as boh-guh). The good news for staunch pufferfish eaters is that non-toxic pufferfish have been
produced in netcages or land culture; even the formerly toxic liver is now available as a Japanese traditional
dish “fugu-kimo” (puffer liver).


location: , 'Thailand year: 2021 source: HSRI

title: Does Exclusive Breastfeeding Increase Risk of Anemia During the First 6 Months of Life?

abstract: Background: The World Health Organization recommends exclusively breastfeeding (EBF) for the
first 6 months of life. However, infants undergo WHO EBF for 6 months may have an increased risk of
anemia. Evidences regarding anemia associated with EBF are limited in the Northern part of Thailand.
Objective: To investigate the incidence of anemia at 6 months of age among EBF infants and non-EBF
infants, and risk factors of anemia at 6 months of age. Materials and Methods: The retrospective cohort
study was conducted in term-healthy infants at a well-baby clinic, Nakornping Hospital in 2019. Mothers
answered a questionnaire regarding history of breastfeeding. Hematocrit (Hct) level of infants was retrospectively
recorded at birth and 6 months of age. Infants with Hct less than 40% at birth were excluded.
Anemia was defined as Hct less than 33%. Data were analyzed comparing Hct between 2 groups of infants:
the EBF in the first 6 months of age and the non-EBF. Multivariable linear regression and exponential risk
regression were performed to investigate an effect of EBF. Results: Of 259 infants, 137 cases (52.9%) were
male, the overall incidence of anemia was 61 cases (23.6%). Prevalence of 6-month EBF infants was
45.9%. Incidence of anemia in the EBF and non-EBF infants was 24.4 and 22.9%, respectively. When
compared to the non-EBF group, no statistically significant differences were revealed, adjusted RR
0.98(0.61-1.58), p = 0.934. The mean of Hct in EBF and non-EBF infants were 34.18±3.23 and 34.57±3.38,
respectively. There was no statistically significant between mean of Hct of the two groups with adjusted
beta coefficient equals to -0.21(-1.09, 0.66), p = 0.631. Factors predicted anemia in infants at 6 months
of age included maternal age <20 years (adj. OR 3.88, 95%CI 2.68-5.60), >35 years (adj. OR 2.26, 95%CI
1.44-3.53), mothers with HbE positive (adj. OR 3.01, 95%CI 1.62-5.60). Conclusion: Overall incidence of
anemia in infants at 6 months of age was 23.6% classified as a moderate public health problem that
urgent investigation is needed. There was no statistical significance between incidence of anemia in the
EBF and non-EBF infants. EBF for the first 6 months of life does not increase the risk of anemia in healthy
infants compared with non-EBF.


location: , 'Thailand year: 2022 source: HSRI

title: An Investigation of the Efficacy and Safety of Favipiravir in COVID-19 Patients without Pneumonia−An open-label randomized controlled study

abstract: Background: Favipiravir is an antiviral agent, mechanism of action is selective inhibition of RNA-dependent RNA polymerase and maybe effective against the SARS-CoV-2 virus. While no established treatment for COVID-19 is available, epidemiological studies conducted to date suggest a risk of further increase in patient exposure in the future. Therefore, to verify that the efficacy of Favipiravir exceeds that of the supportive care (symptomatic therapy) in mild SARS-CoV-2 infected patients (COVID-19 patients) without pneumonia, using the time required to improve clinical symptoms as the primary endpoint and it will contribute immensely to the improvement of public health in the future. Methods: To verify that the efficacy of Favipiravir exceeds that of the supportive care (symptomatic therapy) in mild SARS-CoV-2 infected patients (COVID-19 patients) without pneumonia, using the time required to improve clinical symptoms as the primary endpoint. In the case of chest imaging, no new findings and turning negative in the RT-PCR test with nasopharyngeal swab were set as the primary endpoints. Since this study is an open-label study, 96 patients to be enrolled all of the following inclusion criteria. (2:1, 64 in Favipiravir group with 1,800/800 mg twice daily) for 5-14 days and 32 in control group) The treatment period is 5 -14 days in principle and 10 patients in a clinical pharmacology study of Favipiravir. Results: This study examine the superiority of treatment of Favipiravir adding to the supportive care for mild COVID-19 patients without pneumonia, compared to those treatments without Favipiravir, to efficacy improve clinical symptoms with using NEWS Score, the treatment period is 14 days , in Favipiravir group have improved clinical symptoms rate 79% and in control group rate 32.3%. (p=0.027) Half of those treatments with Favipiravir have improved clinical symptoms on Day 2. As for in control group have improved clinical symptoms on Day 14 (p<0.001) Therefore, efficacy of Favipiravir to improve clinical symptoms than the control group. Conclusions: Coronavirus disease 2019, treatment with Favipiravir 1,800 mg is orally administered twice on Day 1, and then 800 mg is orally administered twice daily on Day 2 when you have mild symptoms.


location: , 'Thailand year: 2013 source: HSRI

title: Impact of Free Trade Agreement (FTA) on nursing workforce in Thailand

abstract: Objective: To explore policies and effects of Free Trade Agreement on nursing workforce.
Research design: Qualitative research design Methods: 1. Relevant documents were collected; content was attracted and classified into research questions. 2.Ten key informants were interviewed under semistructured
questions to summarize policies, state plan, problems and effects of FTA, AFTA, AFAS and
AEC related to health care services and nursing workforce. Results: This study revealed that Thailand had
a good potential to be a World Class Health Care Hub. Notable cost, quality of medical care and Thai
hospitality led to a rapid increasing number of foreigners who came to Thailand seeking for medical
treatment. Number of registered nurse working in private hospitals in 2010 had increased for 66.08 %
comparing to the year 1999; the highest increasing rate was 83.59% in 2007. On the other hand, it deteriorated
nurse shortage in Thailand and un-equivalent accessibility to health care among Thai people. The
Priority Integration Sectors (PIS) of AEC targeted in 2015 facilitates travelling across boarder among ASEAN
people but two anticipated problems were identified; 1) aggravating the increasing number of patient
seeking medical treatment and worsen the situation of nurse shortage, and 2) nurse migration from ASEAN
countries. As nursing education systems are much different among ASEAN countries, problems of unequivalent
education of nursing personnel are encountered and may harm patients. Preparation for FTA
in health care services in Thailand has not been very well arranged. Strategic plan, action plan and hosting
organization were not clearly identified resulting in fragmentation of work of related parties and imbalance
services provided to Thais. Policy implications: Leading organization is essential for driving nation
strategies of the government. Ministry of Public Health, Ministry of labor, Ministry of Education and
Ministry of Commerce must be liable. Roles and responsibility of private hospitals must be heightened
and be integrated with the government to balance benefit and loss from being World Class Health Care
Hub for better health service system and good quality of life of Thai people, ultimate goal of the nation.


location: , 'Thailand year: 2002 source: HSRI

title: Training workplace health promotion

abstract: Training workplace health promotion	Training workplace health promotion (WHP) was a part of the national "Workplace Health Promotion" project implemented in 2001-2002 by various partners .The aimed of this study was to evaluate the input, process, output, and outcome of the training project. Progressive and summative evaluation was used as a design of this project evaluation. The sample was recruited from four provinces with major industrial parks by the Social Security Office. Subjects were composed of 60 WHP facilitators from 20 hospitals, 44 managers and worker's representatives, as well as, 4,400 employees form 44 workplaces. Quantitative data was collected by using questionnaire, interview and reviewing record. Qualitative data was gathered by using focus group, In-depth interviewed, and observation  	The results indicated that, for input evaluation, a comprehensive and integrative five day-long training contents was relevant to the project objectives, but it lacked the content of building attitudes toward working with workplace. Process evaluation showed that the participants satisfied all of learning contents, instructors, activities, and duration of training. However, the group process was viewed as time-consuming activities and could not sufficiently link to learning outcome concepts. For output evaluation, the knowledge and perceived WHP skill of the participants were significantly improved (p<0.05); but the activities according to WHP facilitator’s roles were not clearly performed. Most of them had more routinely workload and reported shortage of implementation time. For outcome evaluation at 6 months follow up, workplace policy, environment, and health promotion activities were not significantly improved. Changes in health behaviors as well as health status of employee were not significantly observed. However, increases in understanding and awareness in workplace health promotion were found.Findings suggest that the training project was useful for workplace health promotion and should be implemented further with cooperation between workplace and hospital's facilitators. The Social Security Office at provincial level should also act as coordinator and motivator to assure sustainability of the project. Meeting for sharing the learning experience should also be set up. Financial support and regulation for workplace health promotion should also be provided.


location: , 'Thailand year: 2005 source: HSRI

title: Computerized information system in hospital and quality of care

abstract: Information system of most hospitals in Thailand have increasingly been computerized mainly to improve administrative works without adequate concerns about quality of care. This study aims to explore major issues related with the use of computerized information system in hospital and quality of care. There were 4 phases: literature review, hospital survey, stakeholder analysis, as well as in-depth analysis of some famous systems. It was found that information system in at least 80% of the hospitals, especially private and large public hospitals were already computerized. Report production for various health insurance systems was the major reason. At least 44 different systems were available in Thailand without appropriate and effective information exchange mechanism both nationally and locally. IT-related investments by hospitals were found to be quite large despite the lack of evidence to prove their return. In addition, many problems including IT-related clinical risks were not efficiently taken care of. Nationally, the most important problem was hospital readiness, especially the inadequacy and poor competency of IT-related healthcare personnel. Moreover, the inefficiency of cooperation among central organizations forced most hospitals to solve major problems with their limited resource and comprehension.


location: , 'Thailand year: 2022 source: HSRI

title: Standard of Primary Care and Accreditation of Health Promotion Hospital under Provincial Administrative Organization

abstract: The act determining plans and procedures for the decentralization of power to local government organizations in B.E. 2542, requires the transfer of public health missions to local government organizations. Health promotion hospitals under the local government organization should provide health services for people based on the Primary Health System Act B.E.2562. The purpose of this mixed methods research was to 1) explore the standard of primary care, availability of primary care services, and the accreditation process of health promotion hospitals under the local government organization and 2) to analyze, synthesize and then provide recommendations for the standard delivery in primary health care and standard service delivery of health promotion hospitals under the local government organization. The participants were recruited using purposive sampling. The study was composed of 3 phases: phase 1 was documentary research to identify situation analysis of policy and law related to the decentralization and primary care act, health promotion hospital quality assessment guideline and standard health care service of health promotion hospitals; phase 2 was quantitative research to identify standard service delivery of health promotion hospitals and to determine availability and gap of primary care services after the transfer to a local government organization, and phase 3 was qualitative research using in-depth interview and focus group discussion with the stakeholder who is involved with standard health care service of health promotion hospitals. The research instruments were a semi-structured interview. The characteristic information from health promotion hospitals and local government organizations was collected by a questionnaire. All the questionnaires were developed and validated by five experts. The qualitative data were analyzed using content analysis and the quantitative data were analyzed using descriptive statistics. The results of this study revealed that: 1. The component of standard primary health care service includes: 1) determinants of health such as infrastructure, health workforce, health information, medicine, other medical supply, and digital health technology; 2) service delivery including prevention, promotion, treatment (acute and chronic) rehabilitation and palliative care in all age groups; and 3) health system objective such as outcomes and impact of service delivery 2. The improvement criteria of Tambon Health promoting hospital (star hospital) is the highest quality standard for primary health care service delivery accreditation. However, there were some limitations. For example, some assessment criteria were inconsistent with the local context, and the audit team from the district and provincial level assessed and helped to pass. There for no actual quality improvement in some areas. Another standard evaluation criteria for primary health service in Bangkok was developed by The Healthcare Accreditation Institute (Public Organization) that can be extended to use with primary care units throughout Thailand. 3. Primary care units should be accredited by an external organization composed of healthcare teams that include physicians, nurses, and pharmacists, who know quality assessment, apprehend the working system and are not a stakeholder. The audit includes both internal and external audits. The process of audit may use the same method as the previous year which is using the network partners and mentor teams to provide support and advice for quality improvement and participation of people in the community. 4. Health promotion hospitals that are going to transfer to local government organization state that the structural readiness to provide services were at the right level or higher. However, the number of health professionals and supportive personal readiness was at a low level. 5. Most of the health promotion hospital rate their availability to provide standard service delivery after transfer to the local government organization were the same and more quality in all health services except dental care and physiotherapy which is reduced.