location: , 'Thailand year: 2014 source: HSRI

title: Impacts of ASEAN Mutual Recognition Arrangements (MRAs) for Health Professionals on the Health System in Thailand: The Analysis of the Experience from the European Union

abstract: In 2006, ASEAN Member States signed the Mutual Recognition Arrangement (MRA) for Nursing
Services and in 2009 signed the MRAs for Medical Practitioners and Dental Services. In view of the
operationalization of the MRAs, review of the impacts in the European Union context was conducted to anticipate potential positive and negative impacts of the movement of health professionals within ASEAN
under these MRAs. We found that MRAs in the EU were complex and took 30 years (1975-2005) for the
detailed requirements in each directive to be completed. Unlike ASEAN, members of the EU have similar
levels of economic development, administrative system and culture. Movement of the health professionals
flowed from member countries with lower level of development to countries with higher level of
development. Each EU country has different responding measure to the health professional movements;
countries in need of health professionals accepted foreign professionals immediately, while those not in
need of health professionals delayed their acceptance. The movement created both positive and negative
impacts. Positive impacts are job opportunities and knowledge exchange. Negative impacts are quality of
services caused by language limitation, different levels of education and culture and insufficient number
of health professionals in countries of origin. As an ASEAN member state, Thailand may be affected by
the MRAs. Over the short term, health professionals should take a leading role in developing their country
positions with regard to the movement of health professionals. Longer-term preparation involves an
analysis of probable scenarios for further improvement of the said positions.


location: , 'Thailand year: 2018 source: HSRI

title: An Evaluation of Data and Report Systems in the Elementary School Health Services: A Case Study in Two Provinces of Thailand

abstract: The Ministry of Education (MoE) and Ministry of Public Health (MoPH) have been jointly implementing the health-promoting school (HPS) program since 1998. This program aimed to improve students’ health and education simultaneously. The Department of Health established operating standards and evaluation processes for accrediting schools in four categories (from lowest to highest): bronze, silver, gold and diamond. One of the operating standards, School Health Services (SHS), required schools to maintain student health records and reports used to evaluate the performance of the schools. However, the quality and use of the health data collected as a result of implementing the SHS had not been assessed since the inception of the program. The purpose of this study was to evaluate the situation of students’ health data management system in the SHS. The study focused on data collected from four physical exams namely, growth assessment, vision testing, hearing testing and dental examination, and vaccinations for primary school students. The study design was a descriptive in nature and applied mixed-methods. A stratified sampling approach was used with three strata: the first strata comprised two provinces; the second, nine schools; and the third, 118 informants from the education and health sectors, parents, and students. The data collection approach included in-depth interviews, a questionnaire, reviews of students’ health data and related documents. Descriptive statistics and content analysis were employed for data analysis. The results indicated that the students’ health data collected in both, diamond and bronze level HPSs, was incomplete. This may be because multiple tools were used for recording and reporting students’ health data in sample schools. Furthermore, many of these tools had overlapping content thus increasing the burden of the staff. In addition, it was found that schools did not maintain students’ health data systematically and continuously after receiving the accreditation. Finally, a difference in the priorities of the data collected by the school staff and health workers was observed. While school staff only recorded weight and height data by the MoE, health workers focused on recording health data related their key performance indicators and not those specified by the operating standards of the program. Therefore, students’ health data was not clearly communicated and exchanged between the education and health sectors. This shows that there was no system for managing the data under this program, especially the system for monitoring and collecting data.


location: , 'Thailand year: 2016 source: HSRI

title: Validity of Clinical Predictors for Patients Suspicious of Bacteremia

abstract: Bacteremia is a serious infection associated with high mortality rate. The diagnosis of bacteremia
depended on blood cultures. Published guidelines do not clearly state when blood cultures should be
obtained. The objectives of this study are to validate two clinical predictor rules: systematic inflammatory
response syndrome (SIRS) criteria and clinical prediction rule of Shapiro et al. for patients who were
suspicious of bacteremia. This study was retrospective cohort study, collected data from patients who
were suspicious of bacteremia in emergency department of Warinchamrab Hospital, Ubon Ratchathani. There were 457 patients met inclusion criteria, 65 patients (14%) whose blood cultures results were positive
for true pathogens. When applied SIRS criteria, the sensitivity and specificity were 83% and 31%
respectively. Positive likelihood ratio and negative likelihood ratio were 1.21 (95% confidence interval
1.06-1.38) and 0.54 (95% CI 0.31-0.93) respectively while applying clinical prediction rule of Shapiro et al.,
the sensitivity and specificity were 91% and 40%, respectively. Positive likelihood ratio and negative likelihood
ratio were 1.52 (95% CI 1.36-1.70) and 0.23 (95% CI 0.10-0.49), respectively. In conclusion clinical
prediction rule of Shapiro et al. is more accurate in predicting patients suspicious of bacteremia. Application
of this tool in clinical practice may reduce costs and improve quality of treatment.


location: , 'Thailand year: 2008 source: HSRI

title: Efficiency and Side Effects of GPOvir Treatment on Naive HIV-infected Patients with Different CD4+cell Levels

abstract: This retrospective descriptive study was conducted to determine the effectiveness and the
side effects of the three-drug antiretroviral tablet (GPOvir), containing nevirapine, stavudine and
lamivudine, in the treatment of naïve HIV-infected patients with varying CD4+cell levels. The
study subjects comprised HIV-naive patients 15 years old and older who received GPOvir for more
than one year at Thabo Crown Prince Hospital, Nongkhai Province, in the period from February
2004 to September 2007. CD4+cells were counted and the side effects observed after one year of
treatment. The results revealed severe drug side effects in 33.90 percent of the patients: hepatitis in
15.24 percent, and extensive rashes in 6.78 percent; the responses of CD4+ cells from the initial
counts of less than 50, 50-100 and 101-200 cells/mm3 were statistically significant after 6-24
months of treatment. The study concluded that GPOvir was effective in the treatment of
HIV-infected patients even though the level of side effects was high in one-third of the patients.


location: , 'Thailand year: 2017 source: HSRI

title: Tool Development and Evaluation Criteria for Assessment of Executive Function in Early Childhood

abstract: Executive Functions (EF) is a higher-order, self-regulatory cognitive processes that aid in the monitoring and control of our thought and action for goal-directed behaviors.  EF is related more to success in school from preschool to university, than the IQ.  In Thailand, there is no information regarding the current situation of EF skill in young children.  The main objective of the present study is to develop tools and to construct the normative criteria for assessing EF skill in Thai preschooler age between 2-6 years.  Thirty-two items of behavioral checklists that indicated development of EF related behaviors (i.e., inhibit, shift/cognitive flexibility, emotional control, working memory and plan/organize) were designed to be appropriate with the Thai social context.  The behavioral checklist is friendly for teacher to observe their student’s behavior in the class room by using the rubric scales (0-5) which indicate the frequency of behaviors that has been observed during the past 3 months.  For construction of the normative criteria, children age between 2-6 years (N=2,965) both boys (51.6%) and girls (48.4%) from all regions across the country were participated in this study. They were selected by 3 steps simple random sampling.  First, sampling the child development centers in each region of the country, then sampling the rooms and finally sampling the number of children in each room.  Teachers were asked to rate child’s behavioral in the questionnaire. Data were collected and the T scores were constructed separately by sex and age of the children using the SPSS software. Our results show that children gradually improve their behavior related with EF skill during 2-6 years old. Although boy and girls have similar development at 2-2.11 years in their behavior related to EF skill, girls are more advance in EF development than boys at the age between 3-6 years.  Nearly 30% of children demonstrate the delay development in behaviors related to EF skill (T score<45). Moreover, 30% of children have behavioral problems related to EF dysfunctions (T score>55).  Delay EF development and/or EF dysfunction in childhood is associated with worse inhibitory control. They were more likely to be failure or drop out of school at adolescents, and less likely to be successful as adults. Thus, a child’s level of EF in early childhood likely contributes to a trajectory of success or failure in the future. Our results suggest that delay development of EF in 30% of Thai preschooler should not be ignored as EF skill can predict the quality of Thai people in the next 10-15 years, which can hinder the country's development in the long term. It’s time to re-thinking about how to scaffold EF development in young children in order to create a new generation of Thai people who can self-directed towards the success, who have the ability to cope with the dynamics change of the world in the 21st century, and who can leads the country successfully toward the Thailand 4.0 national policy.


location: , 'Thailand year: 2021 source: HSRI

title: Thai National HRH core Indicators

abstract: The objectives of this study are to develop Thai Human resources for health (HRH) core indicators including the data standardization and related organizations and to propose policy recommendations to establish these indicators. Indicators engage comprehensive health labour market framework; such as education and labour market dynamics. Study’s method includes literature reviews and key informant interview. Multi-stake holders committee under Ministry of Public Health is established to be a policy platform to implement this indicators. The result shows there are 17 HRH core indicators for Thailand categoried into 4 groups, 6 indicators for HRH production, 1 indicator related HRH professional registration, 9 indicators related to health labour market including distribution, retirement and retention and 1 indicator for unit cost on the health workforce production. In term of data completion of each indicator, this study shows that only 7 indicators, namely number of faculties and production capacity, graduation rate, rate of passing licensing examination, number of foreign-trained and foreign-born, accreditation system and continuous professional development system, are completed and ready to report. Data completeness and the linkage system between data source are the main problems to report the rest indicators. Three important measures recommended for policy makers to implement Thai HRH core indicators are 1) Strengthening HRH registry 2) Establishment HRH data platform among related sources and 3) Conducting systematic researches on HRH loss rate and unit cost of production.


location: , 'Thailand year: 2018 source: HSRI

title: Public Health Professions Health Workforce Requirements in Thailand 2026

abstract: Thailand is encountering problems regarding the economic, social and political instability leading to inequality. Significant factors affecting the next decade health system include the complete aged Thailand, increment urban communities, more frequent and severe natural disasters, emerging infectious animal and plant diseases related to migration and increasing chronic diseases. In this regard, the National Human Resource for Health Committee has appointed a subcommittee to study public health human resources planning for the next decade. Human resources requirements can be forecasted through the demand and supply projection. The demand projection relies on a health demand approach involving only the service setting, and population ratio. The findings of the study revealed that most public health human resources are currently working for the Ministry of Public Health, i.e., sub-district health promoting hospital, followed by district public health office, and community hospital. At present, there are at least 76 educational institutes producing public health graduates by offering both 4 year bachelor’s degree program and continuing bachelor’s degree program, at a capacity ranging from 30–3,776 persons/institute/year. The public health human resources demand projection over the next decade found that if the production capacity of public health human resources remains unchanged, the human resources will exceed requirements of the health system in all scenarios as follows: scenario 1 the population ratio, 75,626-89,894 persons will exceed requirements; scenario 2 the status quo primary care system, 68,122-82,390 persons will exceed requirements; and scenario 3 the intensive primary care system (with no outpatient service at the tertiary care level and 25% transferred to the primary care system), 50,830-65,098 persons will exceed requirements. According to the present research results of a high surplus of public health human resources, the Council of Community Public Health should establish standards and core competencies of public health human resources in alignment with changing health system over the next decade, take controls and oversee quality of public health educational institutes, as well as jointly plan public health human resources requirements under the collaboration between health systems and educational institutes in order to contain number of graduates not exceeding requirements.


location: , 'Thailand year: 2014 source: HSRI

title: The use of the Diagnosis Related Group (DRG) on hospital inpatient payment in different country contexts

abstract: This article aimed to gather the knowledge about Diagnosis Related Group (DRG). The DRG is an
acute-inpatient classification system. Developed by Robert Fetter and his colleagues at Yale University, it
was initially called Yale DRG. The system has been used for over four decades. Patients in the same DRG
group are provided similar services and the hospital’s resources. The DRG-base rate multiplied by the
relative weight and country-specific adjustment factors determines the reimbursement amount. The main
purpose of utilizing the DRG system in health financing is to increase the transparency and efficiency of
hospital services. The advantages and disadvantages of the payment method should be explored so as to
improve the system and minimize any negative impacts it may have on health financing.


location: , 'Thailand year: 2022 source: HSRI

title: A Study of Factors Affecting Quality of Life of Emergency Room Doctors and Nurses in Public and Private Hospitals Affected by COVID-19 in the EEC Area

abstract: COVID-19 The epidemic continues to find more infected people, especially in the Eastern Economic Corridor (EEC) area, which is the highest controlled area. There became a public health crisis which doctors, nurses and emergency room are the front line at the risk of being exposed to germs easily. It increased workflows and processes resulting in long working hours. The fatigue and mental stress became stressful. It affects the body and mind both in the short and long term. The purpose of this research was to study the factors affecting the quality of life of emergency room physicians and nurses in public and private hospitals affected by COVID-19 in the EEC area. It is a specific population. The study was conducted from a population of 400 people. The targets were divided into 2 groups: 1) emergency room physicians 2) emergency room nurses. There perform both full-time and temporary contract work in emergency rooms during COVID-19 in public and private hospitals in the EEC area. The analyze data conducting both qualitative and quantitative research. It is a tool to perceive an opinion piece on current situation factors (WRQoL) that affect the quality of work life to measure quality of work life. A total of 472 real data were collected using both descriptive and reference statistics. The study found that the factors affecting the quality of life of doctors and emergency room nurses in public and private hospitals affected by COVID-19 in the EEC area with the highest mean were social relativity factors, including the team that support patients are part of the success. The psychological factors include that I have pride in myself every time and I take care of and keep patients out of danger. The physical factors include work performed with too much risk of harm to health and environmental factors such as receiving compensation for risks during COVID-19 delayed and overwhelmed. The results of the analysis of the importance of factors affecting the quality of life from the hypothesis. It found that there were no significant differences between public and private hospitals in the overall quality of life of physicians and emergency room nurses at the .05 level. There are improving the quality of life passed the assessment criteria were consistent with the empirical data. The probability chi-squared was .170, the relative chi-squared was 1.189, the concordance index was .979, and the mean squared root index of the error estimation was .020. The recommendations were as a result of this research, hospital administrators and agencies that utilize the research can apply factors affecting the quality of life of physicians and nurses to improve quality of life in order to create models and contextual guidelines which on each organization in accordance with the policy and culture. It can also be adapted to other agencies that need to receive critically ill patients and should be studied further developing a model to enhance the quality of life of personnel working in emergency room departments under the COVID-19 outbreak.


location: , 'Thailand year: 2001 source: HSRI

title: Community health fund and its administration : roles and alternatives for development

abstract: Development and administration of community health fund were studied to explore factors and conditions which were involved in its administration. A number of major issues were;changes and development of circumstances at micro and macro level, thoughts, definitions and administrative system of community,strengths of health fund particularly financial viability,community health activities andlinkages of health funds to health benefits and development of other community activities.	Comparison of 6 community funds was used in this study. Three regions in which the sampled community funds were located were the central, the North-eastern and the Southern region. Data were collected from existing Thai and international document and research, surveying socio-economic status of communities, interviewing key persons, discussing in group and participating community activities if opportunity available. Data were grouped into three levels, individual, family and group / community. The results showed certain differences and similarities in sampled communities, which were predisposed by community circumstances, development and goals of community funds.


location: , 'Thailand year: 2023 source: HSRI

title: Policy Recommendation for Organizing Systematic Relations in Transferring Sub-District Health Promoting Hospitals to Provincial Administrative Organizations from School Transfer Lessons Learned

abstract: Transfer of Health Mission is an additional aspect of the decentralization process of power to local government organizations in the field of public health. The research project, which proposes policies to promote the transfer of rural health promotion hospitals to provincial administrative organizations, is based on lessons learned from the transfer of schools. The objectives of the research are: 1) to study the experiences of personnel and extract lessons from schools managed locally to apply to the transfer of rural health promotion hospitals to provincial administrative organizations; 2) to study the transfer of rural health promotion hospitals to provincial administrative organizations in terms of organizational structure, personnel, finance, management, basic health service data, and primary healthcare mission; and 3) to synthesize policy proposals for promoting a systemic relationship in the transfer of rural health promotion hospitals to provincial administrative organizations. The research employs qualitative methods by collecting data from educational personnel (116 participants) and healthcare personnel (89 participants) in four provinces, namely Roi Et, Khon Kaen, Maha Sarakham, and Kalasin. The data is collected through interviews, focus group discussions, operational meetings, and participatory observations conducted from September 2022 to February 2023. Part 1 : Lessons Learned from Schools under Local Management The research found that the transfer of educational institutes to local management had a positive impact on educational management, manpower, budget, organizational media knowledge of information systems, leadership, and good governance. The lessons learned are: 1) Formulating educational policies and guidelines for educational institutions to achieve quality, emphasizing the concept of School-Based Management for Local Development (SBMLD) that provides research-based education and develops it into the context and culture of the area. 2) Developing personnel potential and providing adequate personnel. 3) Receiving a budget to support the development of learning management and special projects. 4) System development of information systems. 5) Building confidence in the leader and establishing good governance. Part 2 : Transfer of Sub-district Health Promoting Hospitals to Provincial Administrative Organizations. The research found that the transfer of sub-district health promoting hospitals in four provinces amounted to 656 transfers out of a total of 808 locations. The study shows that the transfer process needs to focus on service systems, manpower management, budget allocation, knowledge media, information systems, and leadership and good governance. The proposed guidelines are: 1) A framework for providing health services to the public that is consistent with the original affiliation so that the transferred hospitals can provide services according to the original guidelines. 2) Prepare a recruitment or recruitment plan for public health personnel to support the transfer. Provide information on the advantages and limitations of transferring to the Provincial Administrative Organization. During the initial transfer of PAOs, they should provide manpower support to areas lacking manpower until PAOs are sustainable. Part 3 : Policy Proposals.


location: , 'Thailand year: 2016 source: HSRI

title: Environmental and Health Impacts from Modern Gold Mining

abstract: Modern gold mining is of great concern on environmental and human health impacts. Based on
literature review, this article presented information on gold mining process and its related environmental
and health effects. It was found that modern gold mining mostly employs open-pit technique and uses a
huge area to explore a tiny amount of gold concentrate. Mining often generates enough dust, noise, and
vibration to affect nearby residents. Modern gold extraction process employs a large amount of cyanide, a
highly toxic compound to living organism and human. Ore exploration might also release coexisting
heavy metal, such as arsenic, lead, manganese and mercury. Moreover, a large gold mining might involve
communicable diseases and the change of social, economic and community lifestyle. Government should
support a study on a health impact on every project of modern gold mining.


location: , 'Thailand year: 2007 source: HSRI

title: Outcomes of an Easy Asthma Clinic, Banphai Hospital, Khon Kaen Province

abstract: Asthma is a chronic disease for which a good number of patients need lifelong treatment.  It is hoped that an easy asthma clinic, established according to the standard guidelines for asthma control, would provide effective treatment of asthma.  The objective of
this study was to assess the outcomes of Banphai Hospital’s easy asthma clinic from its
founding in January 2004 to December 2006. Information obtained on the 331 patients
(males 51.4%, females 48.6%) was that the in-patient admission rate decreased from 442
to 79, the numbers visiting the emergency room decreased from 560 to 241, and the total
control group increased from 5.88 per cent to 8.94 per cent. These findings provide evidence that the Easy Asthma Clinic has produced a reduction in the admission rate and
number of emergency room visits and increased the efficacy of asthma treatment. Therefore, the Banphai Hospital Easy Asthma Clinic model may be considered for implementation in all community hospitals in Thailand.


location: , 'Thailand year: 2008 source: HSRI

title: Development of Health Promotion among Diabetic Patients Using Self-efficacy and Social Support in Banphotpisai District, Nakhon Sawan Province

abstract: anphotpisai Hospital, Nakhon Sawan Province
The effects of health promotion development among diabetics, using self-efficacy
and social support, on fasting blood sugar and HbA1c in type-2 diabetes patients were
studied in four primary care units (PCUs) in Banphotpisai district, Nakhon Sawan Province, in the period from April to July 2006. The study sample comprised 126 patients who
attended the medical outpatient department and diabetic clinic of four PCUs; they had
fasting blood sugar levels higher than 180 mg/dl. The data were collected by means of
demographic questionnaires and diabetic care questionnaires, including measurement of
FBS and HbA1c. The data were analyzed using percentage, standard deviation, and paired
sample t-test. The average score for self-efficacy of pre-test was 101.28 and of post-test
113.70. The average score for social support of pre-test was 85.94 and of post-test 94.33.
The average FBS of pre-test was 142.42 mg/dl and of post-test 126.43 mg/dl. The average
HbA1c of pre-test was 5.34 mg/dl and of post-test 5 mg/dl.


location: , 'Thailand year: 2008 source: HSRI

title: Developing a Stroke-care Model for the Outpatient Department, Thoen Hospital, Lampang Province

abstract: To develop a stroke-care model for the outpatient department, Thoen Hospital in
Lampang Province, 32 patients were studied in the period February -July 2007 (six months)
by a multidisciplinary team. The method of study was a three-dimensional framework.
The first dimension was to strengthen the health-care team, focusing on control of comorbid
conditions and risk factors. It was found that, in the DM-patient group of 13
cases, the results of risk control as the compliance levels of blood pressure, plasma fasting
glucose, TG and LDL were about 23.08, 30.77, 69.23 and 23.08 percent, respectively. In
the group of 14 cases without DM but having other risk factors, we found that the levels
of blood pressure, TG and LDL were under control at 64.29, 57.14 and 14.29 percent, respectively.
By monitoring for new risk factors, we could detect such factors in 24 cases
(75%), for whom we controlled both their previous and new risk factors purposely in
order to reduce stroke recurrence. The second dimension was to encourage self-care
behavior in the patients and their caregivers; we could empower 30 cases (93.75%) to
achieve successful rehabilitation. For evaluating the quality of life, we used the Barthel
Index of Activity of Daily Living; we found that the score had statistically significantly
increased (p = 0.005). The stroke patients could pass their post-test in the topics of nutrition,
domestic vegetables and traditional Thai medicine; the increase was significant (p =
0.005). The last dimension was for providing competency for the partnership of the community
health-network. The local government and a volunteer-group participated in
home health-care activities for stroke patients in the villages. For improving the quality
of life for the stroke patients, many community plans have been implemented, such as
the screening activities among the population at risk for stroke prevention and fostering
health promotion in the Thai style. In conclusion, there is a limitation on stroke care in
the outpatient department of the community hospital, but with such a model, using the
concept of a multidisciplinary team, the effectiveness of integrated health care for stroke
patients could definitely be improved.


location: , 'Thailand year: 2020 source: HSRI

title: The development of public health laws in governance patients from drugs in adolescents

abstract: The research article aims to study to the problem of drug addicts, want to see the legal problems to develop a system for the treatment of drug addiction among adolescents in the problem of Thailand. Study, review and analyze various legal problems In Thailand and the practice of drug addiction treatment among adolescents. Compare the relevant laws of Thailand and other countries. Following the principles of the United Nations on the treatment of drug addiction among adolescents. Study and analyze support mechanisms for quality development. The effectiveness of the treatment policy for adolescents using drugs inappropriate practice and using the results of the study as suggestions for improving the laws and procedures related to the practice of drug addiction in adolescents. The research team has studied the laws and policies of Thailand. Interesting foreign law and policy And conduct interviews Small group meeting Study visit public health agencies in each of the four sectors and the central agencies. Making it known to the problems and obstacles of the operation It's not just a legal barrier But also obstacles in practice When the study was conducted, it was found that Problems with the development of that law The main problem lies in defining the offense of substance abuse as a crime. Cause no matter how child Youth or adolescence Must enter the criminal justice system inevitably With the introduction of the criminal justice system, having a lifelong criminal record, especially teenagers who use the same law as adults, are damaging to adulthood, are entering adulthood. This causes concern for them about their future stigmatization. Besides, when considering the criminal theory of drug offenses, especially the drug base, It is a criminal act that should not be punished. Also, when conducting a study visit of Surat Thani Province, there was an interest that was consistent with not bringing drug therapists into criminal proceedings and treatment guidelines with community participation of the Office of Drug Administration. Addiction and Crime of the United Nations (UNODC) through drug camps in adolescents. Other agencies operate under the law on drug abuse rehabilitation. In each area, there were insufficient operational, personnel and site problems resulting in the inability to perform the rehabilitation work for drug patients as a result of establishing the provisions of the law to enter the rehabilitation process that still exists. Need a screening process or a rehabilitation system that has a variety of sectors to work together Also, rehabilitation was forced to recover from illnesses resulting from drug abuse. Otherwise, the rehabilitation will be deemed unsuccessful, and the criminal proceedings must be continued. The researchers saw that several dimensions of adolescent drug administration law have to be developed, such as the criminal determination dimension. The dimension of integrated patient management services, which must arise from multi-sectoral cooperation, is not the only function of one agency, it may have separate functions, but integrate missions. The patient data management dimension does not lead to stigmatization, especially criminal history for adolescent patients


location: , 'Thailand year: 2019 source: HSRI

title: Healthcare Healing Environment Design (year 3)

abstract: The main objective of The Healthcare Healing Environment Design research project is to explore the healthcare environment and to study the design/ landscape architecture that promotes the quality and safety of service users by designing the Healing Environment Assessment Tool and developing a model hospital based on the healing environmental concept, which is a 3 years continuous research project. The first-year research had designed and developed a healthcare environmental quality assessment tool through the collection of data in 8 hospitals that participated the program and implemented the assessment tools in the second year by allowing the participating hospitals to develop the potential area and collecting research data to be a prototype model area in the Third year through the evaluation process of research. Conducting the research by integrating 3 concepts, namely the concept of Environmental Sanitation and Safety, the concept of Evidence-based Healthcare Design and the concept of Aesthetics and Spirituality towards the Healthcare Healing Environmental Design Concept through the onsite data collecting process by implementing the healing environmental quality assessment tools combined with the evaluation form of the service users' experience in research works. From the research results, it was found that development of healthcare healing environmental quality must be considered through 5 aspects of assessment, which are: 1 Function and Safety, 2 Sense and Comfort, 3 Interaction and Support, 4 Empowerment and Informed Choice and 5 Value and spirituality When considering the outpatient department, the weight of the first aspect was found between 0.835-0.793. The second aspect was between 0.707-0.692. The third aspect was between 0.829-0.743. The forth aspect was between 0.778-0.753 and the fifth aspect was 0.541. There are researches of participating hospitals that are consistent with the results, such as the Function and Safety aspect of the Maesai Hospital’s research on the reduction of carbon dioxide in the outpatient. The research found that there was a significant difference in the amount of carbon dioxide concentration at every point measured at the level of 0.05. There were also some environmental researches on many issues of Mae Sai Hospital, Pua Crown Prince Hospital, Saiburi Crown Prince Hospital, Lom Kao Crown Prince Hospital, Nong Song Hong Hospital and Huaiplu Hospital By evaluating from the average score from the experience of service recipients, it was found that after adjusting the environment, the value was higher than before adjusting the environment for healing significantly at the level of 0.01. For the development of the inpatient ward area, the evaluation of the weight of the first aspect was found between 0.825-0.736. The second aspect was between 0.696-0.631. The third aspect was between 0.709-0.691. The fourth aspect was between 0.708-0.633 and the fifth aspect was found between 0.888-0.782, with researches that is consistent with the results of function and safety aspect, Rattanaburi Hospital has conducted a research on The effect of environmental adjustment on heat reduction and perception of service users experience: case study of rehabilitation building, by studying the effects of heat and comparing the effects of environmental improvement on the perceptions of service users' experiences in Rehabilitation Building. Comparing the differences between before and after the improvement of the rehabilitation building according to the healing environmental concept and found that there were significant differences at the level of 0.05. In addition, research on aesthetic and comfort aspect, there is a study of noise exposure level and perception of risk from noise exposure affecting in male wards of Chumphonburi Hospital, the research found that changing wheel of patient bed and wheelchair, medical service tools can reduce the volume of noise to the maximum, while the survey research is to study the volume of outpatient service units in Mae Sai Hospital, Chiang Rai, by studying the noise level of the waiting area for the outpatient department, it was found that the noise level was between 57.6-84.5 dBA. By discovering the sound source from the conversation and the amplifier Which compared the noise level within the ward and the appropriate noise level according to NIOSH standards and standards of the Department of Labor Protection and Welfare which allows the average volume of Time Weighted Average-TWA not more than 85 dBA in not more than 8 hours working period per day, found that the value does not exceed the standard. While Somdejpraboromrachineenart Natawee Hospital has studied the air temperature in the ward, it was found that before and after the ventilation management had different temperatures with significantly lower temperature in the ward. Research processing throughout the 3-year period is an affirmation of the 3-concepts of the theory of healthcare healing environmental quality development through the 5 aspects of healing environmental quality assessment. The hospital can apply the model according to the difference context of each hospital in order to answer the healthcare healing environmental problems according to the 3 concepts, 5 aspects of this research.


location: , 'Thailand year: 2022 source: HSRI

title: A Development of Primary Healthcare Model for the Elderly in New Normal Society: A Proposed Policy for Healthcare Reform

abstract: The Development of primary healthcare model for the elderly in new normal society is a challenge for the country to prepare for the hyper-aged society in the next 9 years. Innovative design of healthcare and nursing care to access health services by reducing the country's resource constraints and changing the emerging disease situation will help provide the elderly in the communities with well-being of health status and quality of life. This research aims to: 1) Study the situation of the problem, the needs of the elderly, the factors influencing the health status and quality of life among the elderly living in community; 2) Develop models of care and innovations for primary and geriatric care in the new normal society; 3) Evaluate the outcome of adopting innovative primary and gerontological care in community for the new normal society, using research and development to synthesize policy proposals for public health reform for primary care and elderly care in the new normal society. Quantitative and qualitative data were collected through random sampling from four health districts. 1-2 provinces per health districts and 16 setting to achieve differences in context and culture of elderly care. The samples were 800 elderly people, family caregivers, care managers and volunteer caregivers. Health care providers included doctors, public health officers, and health care workers, physical therapists, Thai traditional medicine practitioners, policymakers or health service advocates such as: the Provincial Public Health Office, Provincial Administrative Organizations, Tambon Administrative Organizations, the Provincial Office of Social Development and Human Security. Data were collected using six sets of questionnaires for the elderly. four sets of questionnaires for family caregivers of the elderly, three sets for care manager, three sets for volunteer caregivers, one set for public health officers and in-depth interviews. Focus group discussions were conducted to use data to design care innovations and geriatric healthcare treatments with evaluation of the outcomes of implementing the care innovations in four pilot areas in 16 health districts. The study found the majority of the elderly to be females, with a mean age of 78.54 years, primary educations, requirement for mobility aids such as walking canes for the most party, followed by wheelchairs and eyeglasses, respectively. More than half had 1-2 chronic diseases, the most frequent being cardiovascular diseases. The most common health problems were difficulty moving and urinary incontinence and the elderly were primarily assisted by family caregivers. The mean time spent in assistance and care for bedridden elderly was 22.90 hours per week. The homebound group received care for 23.31 hours per week and the social group received care for 19.18 hours per week. The activities with which the family caregivers of the elderly needed assistance as to provide the most support to the elderly by preparing food, followed by feeding, buying food or making smoothies, cleaning up after excretion from urinary and fecal incontinence. The nature of health services and the process of caring for the elderly found care managers to be the main leaders in home visits to the elderly at a mean of once a month. The elderly was visited at home by volunteer caregivers (mean=58.94%) at a mean of 1-2 times a month. According to the findings on the problems and needs of the elderly, the home visits conducted by the volunteer caregivers were no different from the public health volunteer caregivers of the elderly, usual care visiting, talking, encouraging and giving advice. The family caregivers of the elderly wanted to have knowledge and skills to properly care for the elderly. The care managers were overwhelmed with their workloads. Thus, an integrated care plan for the elderly covering all dimensions of chronic dependency and chronic disease is needed without increasing the workload of routine tasks. Furthermore, local administrative organizations need an environmental assessment tool that can quickly coordinate assistance for the elderly. The factors influencing the quality of life of the elderly include frailty, health literacy of elderly, health literacy of family caregivers, and environmental management, which can be predicted quality of life at 54.7%. (R2 = .547, p < .001). The development of innovative care models for gerontological nursing and medical care consist of the following: 1) Guidelines in caring for the elderly with chronic diseases and dependencies on 13 guidelines; 2) Implementation of the 13 guidelines; establishment of a Network Community Action Plan (N-CAP) for use in information systems for communication and care of the elderly through the use of "Awuso.net" for the elderly among healthcare professionals and elderly people, families and non-professional volunteers; 3) Elderly Care Knowledge Video Series with 18 videos; the results of the 12-month trial of care innovation in the pilot area with 521 elderly people, N-CAP's top five most frequently used issues were caring for the elderly with dependency, environmental management, hypertension, osteoarthritis, and diabetes mellitus in the community. The results of using N-CAP showed a statistically significant increase in the mean quality of life scores among the elderly (t=11.234 p<0.001). (pretest=42.25±8.89 points, posttest=46.01±8.62 points). Mean score for the performance of the activities of daily living increased with statistical significance (t=7.398 p<0.001) (pretest=8.92±5.44 points, posttest=10.54±5.75 points). Mean health literacy score increased with statistical significance (t=12.016 p<0.001) (pretest=10.19±4.99 points; posttest=12.39±4.08 points). Mean frailty score decreased with statistical significance (t=8.954 p<0.001) (pretest=7.47±3.27 points, posttest=6.17±3.16 points). The users were very satisfied. (Mean±SD=4.03±0.88) The factors influencing the quality of life that increased after implementing the Awuso.net innovation included improved environmental management (ß=0.44, p<.000), number of times N-CAP was used (ß=-0.324, p<.000), number of assignments given by a care manager nurse per week (ß=0.192, p<.000), number of home visits by volunteer caregivers per week (minutes) (ß=0.162, p<.000), changes in ADL performance scores (ß=0.162, p<.000), changes in vulnerability scores (ß=-0.162, p<.000) and changes in health literacy scores. (ß=0.162, p<.000), respectively. Together, the above factors were able to co-predict the ADL performance of the elderly in the community at 54.4% (R2=.544, p<.000). Therefore, use of the Awuso.net should be expanded to other areas to be more extensive and comprehensive to ensure that the elderly have access to standardized medical care. The innovation is safe and produces clear health outcomes, reduces the working hours of nurses, care managers and volunteer caregivers. Thus, the elderly does not have to come to the hospital unnecessarily, thereby resulting in good quality of care and cost-effectiveness with quality of elderly health services in communities.


location: , 'Thailand year: 2007 source: HSRI

title: Participation of Public Health Volunteers in a Community Public Health Center Activity in Ban Muang District, Sakhon Nakhon Province

abstract: This was a descriptive research study, the purposes of which were to study the nature of participation of village health volunteers (VHVs) in all the community primary
health care center (CPHCC) activities and to investigate the relationships between the
supporting factors and the participation of VHVs in Ban Maung district of Sakhon Nakhon
Province.
The samples comprised 104 VHVs who were selected by the multistage random
sampling method.  The subjects were interviewed, using the following instruments for
gathering data:  1) the general characteristics of VHVs,  2) supporting factors,  and 3) the
participation of VHVs. Reliability of the supporting factors and the participation of VHVs
were tested by Cronbach’s alpha coefficient; reliability was 0.92 for supporting factors,
and 0.78 for the participation of VHVs. The statistical procedures employed were frequency distribution and percentage; the data were analyzed using descriptive statistics,
while the relationship between the independent and dependent variables was carried out
using Pearson’s Product Moment Correlation Coefficient. Then t-test was done to test for
statistical significance. The open-ended and independent questionnaires were analyzed
by content analysis.
The findings were as follows:
On average, the VHVs participated moderately in CPHCC activities.  In terms of
assessment of needs and planning,  the VHVs participated in the meeting and were more
likely to comply with the  policy and planning.  Participation in implementation, organization and resource mobilization. The VHVs were most likely to participate in the following
activities: nutritional surveillance, disease preventation, immunization, maternal and child
health promotion, and family planning.  However, they were less likely to participate in
health promotion activities.  The VHVs and their  families tended to claim the right to free
treatment and medication. Participation in evaluation.  Most of the VHVs shared their experiences in problem-solving to improve their work. This study was supported by public
health officials, and villagers; support facilitating the activities was highly  correlated
with the participation of VHVs (r = 0.597,0.309 and 0.338  p < 0.01)
The findings of this study led to the recommendation that public heath officials
should set forth a plan to educate the villagers and VHVs to understand fully the concepts that underline the establishment of CPHCC, revolving funds and mobilizing resources, including the management of the organization.  In-service training should also
be promoted and incentives should be provided.  In addition, the area of evaluation should
be considered to enable the VHVs to properly implement their activities.


location: , 'Thailand year: 2007 source: HSRI

title: Diabetes in Thailand : Lessons Learned from Policies of Developed Nations

abstract: The prevalence and burden of chronic diseases, particularly diabetes, are
rapidly increasing in Thailand and worldwide. Yet in a national survey, it was
reported that 41 percent of those diagnosed with the diabetes were unaware of
the condition and only 26 percent had their blood glucose controlled effectively.
The national health care cost for the  3 million cases is estimated to amount to
350-840 billion baht in 2007. Several studies have been reported that microvascular complications existed prior to the diagnosis of diabetes and later resulted in
retinopathy (10-29%), proteinuria (10-36%) and neuropathy (9%). Furthermore,
risk of macrovascular complications and their death rates of those with prediabetes were equal to those with diabetes and twice of those without. Studies
showed that among those with high risk, the chance of developing to diabetes
can be reduced by changing to  of healthy life style - nutrition, physical activity,
and weight reduction - which cut down the incidence of diabetes by 58 percent.
It was reported that risk factors among Thais that might be related to diabetes were   high blood pressure, over weight, high blood cholesterol, inadequate
fruit and vegetables intakes, limited physical activity and malnutrition.
In Thailand, among those with diabetes, the prevalence of diabetic complications were nephropathy 43.9%, cataract 42.8%, retinopathy 30.7%, ischemic
heart disease 8.1% and stroke 4.4%. In Finland, the major causes of death among
over half of cases with diabetes type 1 and 2, were myocardial infarction and
ischemic heart disease.
Review of national diabetes prevention and control programs of the United
State of America, Canada, England, Finland and Australia shows that programs
on prevention of diabetes type 2 by changing of life style were commonly endorsed. Advocacy on early diagnoses by screening service for high risk group
and underserved population were clearly spelled out. However, the program in
Finland used a screening questionnaire focusing on risk factors to identify those
with high risk rather than depending alone on laboratory test. Similarities were
reported on the efforts of the 5 developed nations to provide high quality service, continuing care and forming networks at all levels reaching communities
in particular. Many of them underlined the essential of adequate information for
general population in order to increase awareness and commitment in changing
life style. Likewise diabetic patients need this continuing health information pertinent to their participation in treatment and self-care. The national health plans
always underline strategies to strengthen infrastructure and capability of the
health services and health manpower development.


location: , 'Thailand year: 2020 source: HSRI

title: Synthesis of the government policies and measures to mitigate COVID-19 spreading based on the compliance of Thai peoples to those policies and measures

abstract: Background The Coronavirus disease (COVID-19) pandemic invoked the government’s declaration of state of emergency nationwide taking effect from March 26 to April 30, 2020 in Thailand. The country promoted the public health campaign “Stay Home, Stop the Virus, For the Country” hoping to bend down the epidemic curve. This research aims to assess people’s adherence to such lockdown measures in order to provide recommendations for policy adjustments based on the changing situations from population’s side as well as inform the results and recommend desirable behaviours to the general public. Methodology We used online survey platform run by Google Forms service. Questionnaires were adjusted every week throughout the survey period from April 2-30, 2020 making four sets of questionnaires in total. Population were recruited by convenient sampling advertised through communication channels of various public or ganisations and social media influencers. Results These surveys achieved 99,865 respondents in total. Key demographic data were: 28.4% male and 71.6% female; average age of 42 years; and 84.8% holding bachelor’s degree or higher. We found that 99.8% understood how to follow “Stay Home, Stop the Virus, For the Country” campaign and 93.7% believed that such measure could slow down the outbreak. As much as 53.0% of respondents reported they stayed home all day whereas the main reasons among those who went out were going to work (62.3%) and doing necessary activities such as buying consumables or seeking healthcare (62.1%). The support needed most to make staying home possible was discounted utility bills (35.4%). The surveys showed that Personal Prevention Indices, a geometric mean of five desirable behaviours namely 2-metre physical distancing, wearing face mask, hand washing, avoid touching face, nose, eyes and mouth, practicing good food hygiene, were 0.70, 0.76, 0.75, and 0.78 respectively for Weeks 1-4. Most respondents (80.2%) agreed to have state/local quarantine located in their residing communities. Household’s economic impact was observed as 43.3% of respondents found experiencing income loss in Weeks 1-2 and 52.1% in Weeks 3-4. In addition, 49.1% of respondents believed their provinces were not ready for easing lockdown restrictions and 60.1% stated that they could bear living with these measures for additional four weeks or longer after April. However, 22.3% of the respondents planned to travel out of their residing provinces within a week should the government allowed. Conclusion The public health campaign “Stay Home, Stop the Virus, For the Country” achieved good adherence by the public in terms of trying to stay home and practicing personal preventive behaviours although a significant number of people facing detrimental impact on incomes. Overall, people did not believe the country was ready for easing lockdown and could accept this strict policy for at least another month after April. We propose the following policy recommendations: continue promoting the stay home policy and personal prevention behaviours; considering easing lockdown based on risk of transmission and essential activities for daily lives as well as preparing adequate state/local quarantine; and continue monitoring people’s behaviours until the situation becomes desirable.


location: , 'Thailand year: 2004 source: HSRI

title: Oral health promotion and prevention process in the contracting unit of primary care under the under the universal health coverage policy : Situation analysis

abstract: This situation analysis of health promotion and oral disease prevention in the contracting unit of primary health care under the health care coveraage insurance  policy is a qualitative study. The sample consisted of 48 contracting unit of primary health care located in 8 purposively selected studied areas which are Chiangmai, Nhan, Khonkhane, Bureerum, Songkla, Phattalung, Prathumthanee, and Bangkok. The depth interview using semi-structured questionnaire and the observation techniques were used in the stage of data collection. The respondents were the executive officers, those who involved in the health care service under the health insurance for all policy at the province level, dentists, dental hygienists, and resident population. The study period is between July, 2002- March 2003. The summary is reported as followed. The result of this study was the dental benefits specified in the insurance are conformed with the existing dental service provided prior to the insurance program. These include the general dental treatment such as filling, extraction, scaling, root canal treatment, and prosthodontic treatment, and also the heath promotion and prevention activities such as screening for the high risk group, oral health education, dental sealant and fluoride therapy. The main target groups for health promotion and prevention program are the pregnant women attending ANC, preschool children in WBC and child care centers, primary school children and the elderly. But the activities were decreased  because of the increasing of the treatment for dental care in the CUP, approximately 15-20%.  Most dentists were lack of understanding in the concept of health promotion and skill in empowerment for the people to take care themselves. The other workload in the hospital, such as , hospital accreditation activities, were the condition for dentists to step down their oral health care promotion and prevention activities.  However, most of them still had a good attitude for the principle of the health care insurance project, but they were not agree with the propaganda on the “ 30 bath for all treatment “.


location: , 'Thailand year: 2017 source: HSRI

title: The Healthy Public Policy Process for Trang Provincial Driven Tobacco Control

abstract: This study is a mixed methods research between quantitative and qualitative research focusing on action that aimed to develop a Trang province tobacco control model by using healthy public pol¬icy concept. Purposive sampling was employed to recruit the target groups including: 1) 50 leaders of the central and local government and people sectors, and 2) 120 cigarette sellers and 120 restaurant owners; 240 persons, altogether. The operation comprised two phases: preparation phase and the 5 steps of healthy public policy process phase (as agenda setting, policy formulation, decision-making, policy implementation and policy evaluation). Data were collected by the survey, group discussions, and in-depth interviews, and analyzed by descriptive statistics for quantitative data, and by content and thematic analysis for qualitative data. The results showed that the model of driving public policy to tobacco control of Trang province consisted of 1) provincial network coordination, 2) team estab¬lishment, 3) exploration on the tobacco control awareness of the people, 4) the establishment of tobacco control measures in the province, 5) driving tobacco control measures into practice, as 5.1) measures to understand the law: focusing on the outreach campaign at the provincial and district levels to inform the effects of smoking in all media accessible to the public (such as location-based, radio campaigns, posters and leaflets, and 5.2) non-smoking enforcement measures: starting from government offices and expanding to public areas (such as markets, bus stations, and parks), and 6) performance evaluation. The research found the increases in the perception of non-smoking law enforcement in the restaurant without air condition, hospitals and health care services, other gov¬ernment offices and fresh markets (21.16%, 19.71%, 15.39%, and 15.16%, respectively). The cigarette sellers were more aware of the cigarette/tobacco vending law that selling cigarette to those under 18 years of age is illegal, and displaying cigarettes in the window even without seeing brands also consid-ered advertising (4.11% and 3.7%). The key success factors were identified: 1) having a non-smoking leader (the governor of Trang province himself) 2) having a dedicated and capable team to coordinate the network and 3) having a variety of communication channels. Therefore, the provincial tobacco control model requires strong public communication management to empower network partners to participate in the public policy process and to develop people to be an active citizen and care for the health and well-being of the society.


location: , 'Thailand year: 2023 source: HSRI

title: Roles of Primary Care Network in Screening and Monitoring the COVID-19 Risk Groups in Three Southern Border Provinces of Thailand

abstract: This study was a convergent parallel design mixed methods study collecting quantitative and qualitative data in Yala, Pattani, and Narathiwat provinces. The study aimed to determine the roles of primary care network in screening and monitoring the COVID-19 risk groups. Purposive sampling and quota sampling were used to recruit samples from two districts with the highest infection rate in each province, 2 subdistricts per district, and a total of 6 subdistricts. The samples were consisted of 80 people per subdistrict, including 10 village health volunteers, 10 local government officials, 10 community leaders, 10 religious leaders, and 10 other people, totaling four hundred eighty-one people for quantitative data collection. A questionnaire on knowledge and practice in screening and prevention in risk groups of COVID-19 was the instrument used. The data collection was from January to December 2021. In parallel 270 people provided qualitative data through either focus group discussions or in-depth interviews. Quantitative data were analyzed using frequency and percentage, while qualitative data by thematic analysis. The quantitative results showed that the average scores of primary care network roles for screening and monitoring COVID-19 risk groups were rated as high (mean = 3.19, SD = 0.51). The highest score (mean = 3.33, SD = 0.56) was found for the screening and monitoring of people exposed to COVID-19, followed by the community control of the COVID-19 pandemic and communicating the risk of infection (mean = 3.25, SD = 0.59, mean = 3.22, SD = 0.60 respectively). Findings from qualitative methods were as follows. 1) Village health volunteers played an important proactive role in screening and monitoring risk groups by zoning households under responsibility, and providing communication on risk of infection. 2) Health professionals had the role of health system management based on cultural beliefs, fostering unity among all professionals, and working proactively to control the spread of COVID-19. 3) Local governments supported people’s daily livelihoods and worked with all sectors in the community. 4) Community leaders supervised people to comply with public health measures, took care of safety and shared household responsibility zoning with village health volunteers. 5) Religious leaders directed people based on Islamic principles and practices to implement public health measures to control the spread of COVID-19 at community acceptance level. The outbreak of COVID-19 in the 3 southern border provinces was under control through synergy of cooperation of primary care networks. These collaborations and participations could be important in other areas of community health management.


location: , 'Thailand year: 2011 source: HSRI

title: Comparison of Adherence of Antiretroviral Therapy between Community Hospitals and Regional Hospitals under the Universal Coverage

abstract: The adherence of antiretroviral therapy (ART) higher than 95 % is needed for the effectiveness
of HIV suppression. prevention of opportunistic infections, reduction chance of HIV transmission
and overall health improvement. Aim of the study was to find facility factors related to adherence of
ART under the universal coverage. Methods: A cross-sectional study was conducted among 823 HIVinfected
individuals who were receiving antiretroviral under National AIDS Program (NAP) in 9 public
hospitals in 3 provinces (3 regional and 6 community hospitals). Adherence had been assessed by pill
count and self-report using Visual analog scale (VAS). This study was approved by ethical committee of
the Ministry of Public Health. Results and discussion: Average adherence from pill-counts and selfreport
was 87.4% and 49.7 % respectively. Adherence from regional and community hospitals evaluated
using pill-count respectively was 82.7 % and 95.2 % while using self-report respectively was 46.3 % and
56.5 %. Logistic regression model shows community hospitals were correlated with higher adherence
than regional hospital from self-report by VAS (OR=1.51; 95 % CI:1.13 -2.02, p=0.006) and from pill-counts
(OR=4.17; 95 % CI:2.10-8.31, p<0.001). Although ART service in all hospitals was under the same Universal
Coverage scheme, the difference of adherence is existed. Related factors might be from patient-staff
relationship, ease of travel, ART-one-stop service and exclusively isolate clinic in small hospitals while in
large hospitals there are many patients visited under limited service area and not separated from other
clinics for receiving ART. Conclusion(s): Regional/general hospital might need substantial supports on
budget and personnel as well as the allocation of service space and increasing interest of the clients on
adherence on ART.


location: , 'Thailand year: 2022 source: HSRI

title: Human-Centered Design Research Project to Redesign Employment Model and Benefits for Future Health Personnel Workforce

abstract: This research focuses on redesigning employment models and employment benefits in order to retain civil servant healthcare workforce. The research leverages the process of design thinking or human-centered design as a methodology. The target users of the redesign exercise in this research are 1. physicians, 2. dentists, 3. pharmacists, and 4. nurses. Taking into consideration the systems perspective of this research, the research team has also involved employers and relevant policy makers throughout the process. Starting with in-depth interviews of the stakeholders, the research team has come up with five potential employment models for further adjustment and consideration in employing future civil servant healthcare workforce. The five models are: 1. Flexible employment scheme: providing a more flexible part-time positions for healthcare workforce in city hospitals 2. Part-time employment with private sector benefits: providing private sector employment and benefits for healthcare workforce outside the civil service working hours 3. Employment through healthcare districts: providing more flexibility in handling healthcare workforce and resources by shifting the employer role from the hospitals or healthcare centers to the healthcare districts 4. Employment through non-government health units: extending civil servant health employment to cover employment in selected non-government health units, and 5. Redesigning employment restriction: allowing employers to manager their own lumpsum funds rather than strictly allocating the fund per head The research team recommends that a healthcare regulatory sandbox should be set up to design and test some of the proposed redesigning of the employment schemes so policymakers can gather feedback and leverage on the learning to revise and replicate effective schemes and models in a larger context.


location: , 'Thailand year: 2012 source: HSRI

title: Knowledge and Awareness on Rational Use of Antibiotics among First Year Students of Mahidol University in the Academic Year 2011

abstract: Background: One of the important factors associated with overuse of antibiotics is a lack of knowledge
and awareness on rational use of antibiotics. The objectives of the study were to determine knowledge
and awareness of rational use of antibiotics for upper respiratory tract infections, acute diarrhea, and
simple fresh wounds among first year students of Mahidol University in the academic year 2011 at Salaya
Campus, Mahidol University. Methods: 2,700 first year students were given the questionnaire set I to
determine knowledge and awareness of rational use of antibiotics before the campaigns. The campaigns
were executed by distributing the media of the Antibiotics Smart Use program. The students were given
the questionnaire set II after one week of campaigning to determine knowledge and awareness of rational
use of antibiotics after the campaigns. Results: Sixty six percent and 74% of the students responded to the
questionnaire set I and II, respectively. The range of the correct responses of the questionnaire set I was
18.7% to 75.9% and that of the questionnaire set II was 51.7% to 82.2%. The average correct response of the
questionnaire set II was significantly higher than that of the questionnaire set II. The number of the
students who intended to use antibiotics for upper respiratory tract infections, acute diarrhea, and simple
fresh wounds for the next episode of such ailments was significantly less than the rate of antibiotic use for
such ailments experienced by the students. Conclusion: Knowledge and awareness of rational use of
antibiotics for upper respiratory tract infections, acute diarrhea, and simple fresh wounds among first
year students of Mahidol University in the academic year 2011 at Salaya Campus, Mahidol University
were insufficient. The knowledge, awareness and attitude towards rational use of antibiotics of the students
after the campaigns were much improved.


location: , 'Thailand year: 2005 source: HSRI

title: Thailand's policies on genetic modified organisms

abstract: Genetically Modified Organisms have a great potential in national economic development. However, the global market acceptance is presently yet quite limited. Intellectual property, ecological risk, organization, rule and regulation as well as economic analyses indicated that Thailand should impose the so-call “Safe Use of Forefront Technology” policy on GMOs issue. Prior to the acceptance of the technology for the enhancement of the country competativeness, the enacting process to have a complete legal system on biosafety must be accelerated in order to have the system fully implemented within 3 years. Capacity building for government officials who will responsible in controlling GMOs must also be urgently executed. The knowledge on the risk from using and consuming GMOs as well as the responsibility of GMOs developers and producers should be disseminate nationwide. Policy organization and regulatory organization must be permanently established to oversee the GMOs issue. The component and the role of these organizations must be stated in an Act. The above action has to be fully in place before the policy organization starts working. The policy organization will consider and determine the national direction on research, study and utilization of GMOs, especially in an open system. For the time being, capacity building in science and technology must be emphasize on biosafety management. Other research works must aim to obtain a patent able result as well as to serve the demand of Thai society and her markets. A unit in the Ministry of Natural Resource and Environment should be assigned to implement the biosafety regulation. The expense arising from GMOs utilization shall be born to the producer, on polluter – pay principle. The above suggestion is based on the present evidence that cannot yet confirm that GMOs do not pose higher risk than ordinary organisms.


location: , 'Thailand year: 2022 source: HSRI

title: Development of Early Warning Tool for Identification of Clinical Deterioration in Intensive Care Patients Using Machine Learning from the Songklanagarind’s Critical Care Database

abstract: Patients in critical care are at risk of clinical deteriorations such as congestive heart failure, when the heart muscle could not pump the blood as good as it should be, and sudden cardiac arrest, which is caused by the disruption of the heart’s pumping function These clinical deteriorations often appear without any warning. They can cause patients losing consciousness, having clinical complications, or death. A timely treatment is necessary after such complications. The early detection of clinical deteriorations can both improve patient outcomes and reduce the utilization of healthcare resources. Many early warning scores (EWSs) are designed to identify patients at risk of deterioration. The Modified Early Warning Scores (MEWS), for example, utilizes patient data including blood pressure, heart rate, respiration rate, body temperature and patient’s responses in order to identify patients according to their severity. Clinical staff can use the MEWS score as a guide to monitor the patients and give help immediately if needed. This research focuses on the development of machine learning algorithms for the identification of deteriorating patients in intensive care wards with physiological parameters acquired from the hospital information system and the central patient monitoring system. In contrast to other studies in which the algorithms were developed only on public datasets, our study utilizes both public datasets and local clinical dataset from Songklanagarind’s Hospital with an aim to make our algorithms work in local narratives. In the first part, we proposed a data-driven framework for predicting the risk of mortality that combines high-accuracy recurrent neural networks with interpretable explanations. Our model processes time-series of vital signs and laboratory observations to predict the probability of a patient’s mortality in the intensive care unit (ICU). We investigated our approach on three public critical care databases: Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III), MIMIC-IV, and eICU. Our models achieved an area under the receiver operating characteristic curve (AUC) of 0.87–0.91. Our approach was not only able to provide the predicted mortality risk but also to recognize and explain the historical contributions of the associated factors to the prediction. The explanations provided by our model were consistent with the literature. Patients may benefit from early intervention if their clinical observations in the ICU are continuously monitored in real time. In the second part, we used the recurrent neural network (RNN) model to predict the risk of occurrence of clinical conditions. Our results varied with an area under the receiver operating characteristic curve (AUROC) of 0.55-0.73 depending on the clinical condition. Our model can provide interpretive data to explain the influence of model prediction parameters and increase confidence in the model. The clinical staff was informed before the clinical conditions and could determine the treatment plan to achieve a better outcome for the patient.


location: , 'Thailand year: 2004 source: HSRI

title: People involvement and participation mechanism and health system reform process in the northeast of Thailand

abstract: This qualitative study aimed to identify people's concepts, values, perceptions, practices, expectations on health, health system reform process and its effects on people. It also focused on the formation of people involvement and participatory mechanism in health system reform process in the Northeast of Thailand. There were 2 phases of data collection, First, was during the Northeast People Health Assembly on Breaking the Impasse!, from Chemical Agriculture towards Alternative Agriculture of the Northeast, organized in Sakolnakorn.  Second phase focused on people health assembly networks and general population in Sakolnakorn, Mahasarakham and Nongboulumpu. Key informants were, people organizations, people, people assembly regional coordinators, governments officers and NGOs.  Document reviews, in-depth interviews, focus group discussion and observation were applied for data collection. The Information from various sources was undergone content analysis.The results revealed that, people had different concepts on health. People who did not or seldom participated in any people health assembly viewed health as an absent of disease, physically fit and could continue their work. Those who involved in people health assembly defined health in a wider aspect as, the state of well being not only physical but also psychological, conscious, spiritual as well as environment and life style which is similar with those identified by coordinators and NGos. People who did not involve in the process thought health is individual responsibility, whereas those who involved suggested that it should be a share responsibility of individual, community as well as government and other sectors.  It was found that people health assembly had effects on people perception on health, however it was limited within those who continuously involved in the process.  People attentions were on alternative (organic) agriculture, organic fertilizer, people rights protection, environmental development, traditional life style, and herbs.  They linked the issues with the Health Bill, which hoped to be the main mechanism in creating a system, which would facilitate good health of the people.  People were not familiar and understand some terms used in the health assembly and health system reform process, since they were new and rather academic. The common terms used were health, spiritual, holistic health, health system reform, health assembly, Health Bill, vision, health strategy, focusing on health promotion not curative and quality care at hand. People involved in health assembly in various meetings of groups, organizations, and networks. Agendas in the meetings were based on community problems. They shared information, brain stormed for appropriate strategies in problem solving in the assembly especially on alternative agriculture, environment, local wisdom, traditional medicines and supports for the Health Bill.   Most of the groups and networks were formed before the initiation of the health system reform process such as the forest protection groups, herbal groups.  After joining the health assembly they could relate their activities with health and develop activities on health. They strengthen their groups by leading and participation of members, identifying problems and strategies in solving them, as well as requested for outside financial supports. Groups and networks, which formed after the health system reform process, were mostly exercise and consumer groups.  There were loosely integrated, they just joined activities but not involved in identifying problems or strategies.  Some of them join the process from being directly told or invitation letters by coordinators or organizers.  People who continuously joined or followed the process had similar concepts with the health system reform and had insight on holistic health.  Those who never or seldom joined the process had different perceptions.  They could not relate health determinants, some perceived that exercise was the only method of health promotion.  People main concern was how to make health, health assembly and health system reform widely known to the public.


location: , 'Thailand year: 2022 source: HSRI

title: Genetic Variation Study of Obesity in Thai Patients: To Develop a Polygenic Risk Score for Clinical Risk Assessment and Personalized Medicinal Treatment

abstract: Obesity has become one of the world's most serious public health issues. Because the causes of obesity are complex and multifactorial, new eras of research are opening for the effective control of obesity through gene and nutrition intake interactions. Individuals' obesity tendencies are thought to be determined by GWASs (genome-wide association studies), which leads to powerful discoveries relevant to population health. Over 300 Thai obesity participants in the Siriraj Genomic Thailand cohort to conduct a GWAS on obesity-related variables such as BMI, body composition, blood clinical profile, and dietary intake. We examined 446,370 single-nucleotide polymorphisms (SNPs) and obesity trait associations, yielding 50 SNPs with significant obesity-associated traits. We discovered five SNPs (rs114330431, rs4964357, rs12190237, rs140552528, rs12103676, and rs4713103) that were associated with increased weight, BMI, waist circumference, and hip circumference (P 0.05). Seven SNPs have been linked to rising lipid profile levels, including rs4964357, rs12190237, rs117828572, rs142722966, rs9577364, and rs11779272. We discovered the effect of genetic variants on the risk of obesity-related comorbidities, including rs142722966, rs116845541, and rs2059238 have been associated with Diabetes and metabolic syndrome difficulties, while 6 SNPs have been linked to high blood pressure issues (rs79392564, rs12033263, rs79949466, rs77592423, rs6111497, and rs1597468). Linear regression analyses of dietary energy and macronutrient intakes with the SNP. The risk allele at rs4739762 and rs75047180 was associated with increased total fat (per allele effect: 18.06 g/d (95%IC 3.83-32.29, p= 0.013)), animal protein intake (per allele effect: 23.45 g (95%IC 10.69-36.22, p<0.001)), Vitamin A intake (per allele effect: 993.86 RAE (95%IC 454.68-1533.03, p<0.001) and Niacin intake (per allele effect: 5.24 mg (95%IC 1.39-9.09, p=0.008)). In conclusion, the obesity-related genetic loci identified here provide new insights into the genetic underpinnings of adiposity in the Thai population. This study adds to our understanding of the factors that contribute to obesity, which can help influence precision nutrition for obesity prevention and treatment.


location: , 'Thailand year: 2018 source: HSRI

title: An Effectiveness Analysis of the Long-Term Care Plans in Udon Thani Province

abstract: As Thailand enters ageing society, it is increasingly necessary to be economically and socially prepared. The health care system deserves particular attention for the reason that elderly’s health tends to deteriorate overtime. In this regard, in fiscal year 2016, the National Health Security Office (NHSO) allocated 600 million baht for the “Long-term Care System for Dependent Elderly (LTC)” program. The objective of this study was to analyse the effectiveness of long-term care services under the LTC program in Udon Thani province. The study examined a total of 405 elderly who received long-term care services. The participants were divided into two groups: a control group of 261 elderly who received regular services; and an intervention group of 144 elderly who were under the LTC program. The elderly participated in the LTC program received long-term care services according to care plan provided by care manager. The services included vital sign measurement, Barthel activities of daily living (Barthel ADL) care, and physical therapy. After four months of receiving long-term care services, the effectiveness of the LTC was analyzed based on the average Barthel ADL index of both groups of participants. The study found that both regular services and LTC program encouraged the elderly to be more independent in performing activities of daily living. Specifically, the intervention group has significantly higher Barthel ADL index than that of the control group (p<0.05) by approximately 1 point. This difference suggests that the LTC program was likely to be more effective than the regular program. In addition, the LTC program was more cost-saving than regular services. The LTC program costed only 0.72 million baht, saving the intervention group’s costs of care by approximately 5.7 million baht. The results suggested that the government should support the LTC service and encouraged participation from various societal sectors, ranging from family, communal, local, to governmental levels.


location: , 'Thailand year: 2014 source: HSRI

title: Oral care utilization among Thai children aged 5-14 years : The analysis of the nationwide crosssectional survey.

abstract: This descriptive study aimed to explore oral care utilization among children aged 5-14 years under
the Civil Servant Medical Benefit Scheme (CSMBS) and the Universal Health Coverage System (UCS)
which have been implemented since 2001, using the data of 2003, 2007 and 2011 Health and Welfare Survey
conducted by the National Statistic Office. Members form households selected by stratified two-stage
sampling were interviewed. Total samples were 68,433; 69,679; and 71,847 persons, respectively, in which
there were 12,048; 11,395; and 10,489 persons respectively, in the 5-14 age group. The data were weighted
to represent total population.
Among three surveys, this age group had decreasing utilization rates and frequencies. The UC children
had lower utilization rate than those of CSMBS (14.89 vs. 22.35 persons/ 100 population, 11.99 vs.
20.26 persons/100 population, and 10.60 vs. 15.74 persons/100 population, respectively) as well as lower
frequency (0.23 vs. 0.40 visits/ per capita, 0.16 vs. 0.33 visits/ per capita and 0.15 vs. 0.27 visits per capita,
respectively). The greater differences were found in regional areas than in departmental areas.
The differences of utilization rates increased from 33.38 % to be 40.82 % in 2007 and decreased to be
32.66 % in 2011 while the frequency percent differences increased to be 51.52 and 44.44 % in 2007 and 2011,
respectively. These evidences indicated inequity of oral care accessibility between the two schemes.


location: , 'Thailand year: 2021 source: HSRI

title: Study of Contamination and Control of Antibiotic Resistance Bacteria from Hospital and Pig Farm

abstract: This study had investigated contaminants and control of antimicrobial-resistant microorganisms (AMR) from hospitals and pig farms. In the study of pig farms, the questionnaire survey was conducted at four farms nearby the surface water body in Prachinburi province. It shows that 50% of the farms use antibiotics for disease prevention and treatment, while that 50% mix antibiotics with feed. The commonly used antibiotics are Amoxycillin (100%), Enrofloxacin (50%), and colistin (25%). The residual antibiotics found during the rainy season were Amoxycillin (54%), Florfenicol (14%), and Tiamulin (13%), of which the concentrations were significantly higher than those found during the summer season (P<0.05). The detection of antibiotic resistance among 143 isolates of E. coli, 29% was in pig manure, 36% in wastewater, and 33% in treated water. Nevertheless, the antibiotics that those isolates were found more than 50% resistant against were Ampicillin (90%), Florfenicol (67%), and Tetracycline (66%), 13% of ESBL. None was of Imipenem resistance. The resistant genes of E. coli were found higher for beta-lactamase followed by Tetracycline (tetA, tetB) and Aminoglycoside (aadA1, aadA2, aadB), while no mcr1 gene showed in all samples. The probability that microorganisms having identical genes of 1 pair (100%) and 80% similarity was about 20%. The study of treatment efficacy of activated sludge (AS) wastewater treatment plant of Chao Phraya Abhaibhubejhr hospital revealed 68-69% removals of basic pollutants, and 20-100% removals of 13 types of antibiotics. A similar AMR population (60-100%) to 20 antibiotics of E. coli, K. pneumoniae, and A. baumannii appeared in wastewater and the AS effluent. The study of pilot-scale membrane bioreactor (MBR) operated without excess sludge wastage in hospital wastewater treatment revealed 79-100% removals of basic pollutants and 32-100% removals of antibiotics. The MBR could effectively remove microorganisms (100%). Antimicrobial resistant test in the MBR sludge revealed higher percentages of sensitive colonies, especially those of K. pneumoniae and A. baumannii >80% were sensitive to 75-85% of tested antibiotics. The 1-2 log reduction of antibiotic resistance genes (ARGs) in the influent with 106-1010 copies/ml by the MBR had been achieved. The use of post-chlorination and ozonation slightly improved in removals of ARGs.


location: , 'Thailand year: 2003 source: HSRI

title: A study of a model and evaluation of an autonomous district hospital on administration and management with in the hospital : a case study of Banpaew hospital

abstract: Banpaew Hospital, located in Samut Sakorn province, was the First Autonomous Public Hospital on October 1, 2543.  The hospital charged 40 baht each for outpatient visit and 100 baht for inpatient services.  A study should then be conducted to identify population in health impact in Ampur Banpaew.  The purpose of this study was to figure out the changes in health status, attitudes, awareness, healthcare behavior, social and environmental factors, and any other changes regarding to the use of Autonomous Public Hospital services.  The study will be  compared the changes before and after became an autonomous public hospital using Quasi experimental Stratified Multistage Sampling method was used to sampling the area,  Banpaew consists of 12 tambons divided into two stratus: municipal area and non-municipal area.  Within each area, a random of village (moo-baan) was selected and, within each village, 40 households were randomly picked for the total of 1,000 households, with an average number of 4-6 members per each household.  The total of 4,485 head of household both male and female participated in the study.  The data was collected through interviews and observation of  household status, environments, and its members.  The research in conducted twice.  The initial survey was performed after one year of Autonomous hospital during March to April 2001.  The second survey in the same area was done form August to September 2002.  But in October 2001, the government has launched policy of 30 baht for every disease was in effect in Samut Sakorn province. 	The results from both survey periods are at satisfactory level in all aspects.  Due to the changes in public health system that occurred during the second study period, which charges 30 baht for both outpatient and inpatient services, the medical supplies and medicines (that cannot be claimed) expenses averaged significantly lower than the first study period.  Those who attended the hospital services as inpatients and outpatients were more satisfied with the quality, effectiveness, and its staffs than the first study period (p<.05).	As for the aspect of health insurance cards for household members, during the second study period, 95 percent went to either public hospitals of health centers when they become sick,  due to the 30 baht for all disease policy, in comparison to only 49 percent during the first study period.  The overall  population health status was in a good to excellent level.  The findings from both study periods found that those patients were mostly seniors of 60 years and older with diabetes, high blood pressure, and joint diseases.  The study also found that there were more of them in the second study period than the first one (P<0.5) because there are more public health personnel to go visiting with households and giving advice and suggestions to the community, in addition to the public increased interests of better health awareness.  However, this is only the beginning phase of the study covering the period of two years.  After the status change of Banpaew Hospital along with the 30 baht for every disease policy, which was first introduced in October 2001, a longer-term study of 4-5 years should be conducted in order to yield more accurate estimates and results.


location: , 'Thailand year: 2008 source: HSRI

title: The Current Nursing Workforce Situation in Thailand

abstract: This study is aimed at providing a detailed analysis of the nursing workforce in Thailand and monitoring
the supply and demand of the nurse workforce. The study was conducted in order to identify the
size, age structure, and the increasing trend of the current registered nurse workforce and to assess the balance between the supply and demand for nurses in order to understand whether there is any current
shortfall or surplus. The research population consisted of 100,671 nurses registered in the Thai Nursing
Council database. The findings led to the following conclusions:
1. There were approximately 97,942 nurses in the active age group (under 60 years) registered in
Thailand by December 2005. Of these, around 88,440 or 90.3 percent participated in the nursing workforce.
At the same time, owing to the impact of the increasing demand for health services and the decreasing
supply of nursing professionals, their numbers remain woefully insufficient for meeting the country’s
health needs, with the total shortage being on the order of 31,260 full-time equivalents.
2. Although total nurse numbers have been relatively constant during the period 2000-2001, between
2000 and 2004 there was also a substantial overall decrease in the net additions to the nurse population of
35.29 percent (from 6,086 to 3,938) because of the decreases in the production of nurses and the increases
in the loss rate, from 2.35 percent in 2000 to 4.15 percent in 2005.
3. The workforce is aging; the average age of Thai nurses has increased to 37.8 years and the average
working life declined to 22 years, which is typical of most Western countries.
The nursing shortage occurring in health systems is bringing in its wake a serious crisis in terms of
their duration of adverse impacts on the health and well-being of the population. This situation poses
unprecedented challenges for policy makers and planners to take effective action in developing and sustaining
an appropriately prepared, equitably deployed, well-motivated and well-supported nurse
workforce.