location: , 'Thailand year: 2016 source: HSRI

title: Development of an immunochromatographic test for double diagnosis of Leptospirosis and Dengue fever

abstract: The ultimate aim of this study is to invent a ready to use immunochromatographic test (ICT) test kit for double diagnosis of leptospirosis and Dengue fever by means of antigen detection. The research activities on invention of ICT test kit for leptospirosis diagnosis were carried out sequentially which included: 1) determination of suitability of the pre-existing mouse monoclonal antibodies to Leptospira antigens (clones LD5, LE1 and LF9 from Faculty of Medicine Siriraj Hospital, Mahidol University and clones 3, 81, and 82 from Faculty of Medicine, Chulalongkorn University); 2) development of an ICT test kit using suitable MAb1-MAb2, MAb-PAb, or Pab-MAb format; 3) acquisition of serum samples of patients with febrile illnesses from collection of Prof. Dr. Yupin Suputthamongkol, Siriraj Hospital; and 4) validation of the ICT test kit which was performed in blinded manner in comparison to the previous laboratory and clinical diagnoses. The activity 1 was carried out by Dr. Surasak Wongrattanacheewin, Department of Microbiology, Faculty of Medicine, Khon-Kaen University (third party). It turns out that suitable monoclonal antibodies were from clones LD5 and LE1 (specific to pathogenic Leptospira) from Siriraj Hospital. Therefore, the MAbLE1 was used to conjugate with the colloidal gold particles and impregnated into the gold conjugate pad while the MAbLD5 was immobilized at the Test (T) line. Control (C) line was immobilized with goat anti-mouse immunoglobulin. Alternatively, rabbit polyclonal immunoglobulin to pathogenic Leptospira was used to conjugate with the gold particles, MAbLD5 was immobilized at the Test (T) line, and goat anti-rabbit immunoglobulin was at the Control line. Both formats of the ICT test kit had the lowest detection limit at 0.375 g of Leptospira whole cell proteins/strip. They are specific only to Leptospira and did not detect antigens of 27 other bacterial species.
Sixty serum samples of patients with febrile illnesses (kept frozen) were obtained from Prof. Dr. Yupin for use for the ICT test kit validation. They were subsequently known after the ICT testing to be 14 sera diagnosed leptspirosis, 16 sera diagnosed scrub typhus, and 30 sera diagnosed Dengue viral infections. All 14 sera diagnosed leptospirosis gave positive results by the ICT test kit. Nevertheless, 11 of the 16 diagnosed scrub typhus and 3 of 30 diagnosed Dengue viral infections gave positive results by the ICT test kit. Thus, the ICT test kit shows 100% sensitivity, 70% specificity, 77% accuracy, 0% negative predictive value and 30% positive positive predictive value. It is noteworthy that, we have sent the bands at the test lines of three samples diagnosed scrub typhus which were positive by our leptospirosis ICT test kit for mass spectrometry. The results of the mass spectrometry revealed the presence of Leptospira peptides and the absence of scrub typhus antigen; implying that the original diagnosis was inaccurate. The second batch of 248 serum samples was obtained from Prof. Dr. Yupin. Among them, 201 samples were positive for leptospirosis by the ICT test kit. However, we have not obtained the diagnoses of these sera from Prof. Dr. Yupin as yet.
We have prepared ICT test kit for detection of Dengue virus antigen. The monoclonal antibodies to Dengue virus were from Dr. Chanya Putthikhan, Siriraj Hospital. One MAb preparation (SI4) is a pool of 4 MAbs (2 MAbs were mouse IgG1 and the other two were IgG2b) and another MAb (SI1) is IgM. We have used the MAbSI4 to conjugate with gold particles and used the MAbSI1 at the test (T) line. Goat anti-mouse immunoglobulin were immobilized at the control (C) line. Because the supply of Dengue virus antigens and the MAbs from Dr. Chanya was inadequate for optimization of the test kit, we cannot accomplish the test kit invention as yet.


location: , 'Thailand year: 2000 source: HSRI

title: The Implications of 1999 national essential drug list on public hospitals in Thailand

abstract: Thailand’s 1996 National Essential Drug List (NEDL) was based on the World Health Organization (WHO) minimal drug list concept. However, after Cabinet Resolution in February 1998, copayment for drugs outside the NEDL was enforced to Civil Servant Medical Benefit Scheme (CSMBS) beneficiaries. Pressures from CSMBS copayment triggered the 1996 NEDL revision resulted in a new version of “maximum drug list” 1999 NEDL. Promulgated on January 29, 1999, the current 1999 NEDL consisted of 933 items classified as sub-list A., B., C., D. and E whereby DUE must be introduced for the use of sub-list D.
The objectives of this study were 1) to compare the hospital drug list and cost of drug consumption in fiscal year 1999 broken down by sub-lists of 1996 NEDL compared to 1999 NEDL, 2) to analyze the pharmaceutical and therapeutic committee (PTC) decisions on their hospital drug list revision in 1993, 3) to assess the impact of 1999 NEDL on different types of patients, namely CSMBS, Low income patients, Voluntary Health Card Holders and Social Security Scheme (SSS) beneficiaries. The researchers used two approaches: document research and structured telephone interview.
Thirty-four hospitals (39% of proposed samples) agreed to provide electronic database of the fiscal year 1999 drug list and consumption value. Ninety five from 108 hospitals agreed to provide telephone interviews. Despite the fact of maximum list of 1999 NEDL, Department of Medical Service hospitals (DMS) and non-Ministry of Public Health (non-MOPH) public hospitals dispensed quite high proportion of  non-ED drugs. Reclassification of previously 1996 non-ED into sub-lists A., B., C., D. and E. of 1999 NEDL account for 9.9%, 24.2%, 32.4%, 42.5% and 42.2% of total drug consumption in district, provincial, regional, DMS and non-MOPH public hospitals respectively. Cost of drug consumption due to reclassification of 1996 non-ED to 1999 DEDL account for 881.67 million Baht in 34 hospitals, this implies that if there were no 1999 NEDL, there will be savings of 881.67 million Baht to insurance schemes assuming that all ED are reimbursable. Sub-list D. drug consumption in 34 hospitals was 602 million Baht in the fiscal year 1999, 24.2% of total drug consumption in these hospitals. Telephone interview reveals to the reasons for adding some more non-EDs into 1999 NEDL by PTC in 15 hospitals are patients have to take and cheap cost. All these drugs were drugs that used to be considered by 1999 NEDL developing subcommittee. There are some extent discriminating dispensing policy, biased towards CSMBS and against Low Income Scheme beneficiaries, Social Insurance and Voluntary Health Card lied in-between, during the 1999 hospital drug list revisions.


location: , 'Thailand year: 2018 source: HSRI

title: Benefit of Intravenous iron supplement on anemia and erythropoietin dose in chronic hemodialysis patients

abstract: Background: Anemia is the most common problems in chronic kidney disease especially dialysis patients. Anemia is also the important risk factors of cardiovascular morbidities and mortality in these patients. Iron deficiency is the most common cause of erythropoietin hypo responsiveness. Intravenous iron supplement had a benefit on improvement of anemia parameters and decreased erythropoietin dose in chronic hemodialysis patients. However, indication and schedule of intravenous iron supplement are different in several clinical practice guidelines. This study was conducted to explore the benefit of Intravenous iron supplement on anemia and erythropoietin dose in chronic hemodialysis patients in Thailand. Methods: The multicenter randomized controlled trial was conducted in 194 chronic hemodialysis patients in 5 dialysis centers. The participants who had serum ferritin 200-400 ng/ml and serum transferrin saturation< 30% were randomized to low ferritin ( serum ferritin 200-400 ng/ml) and high ferritin (serum ferritin 500-700 ng/ml). During run-in period (-8 weeks), intravenous iron 100 mg was given every week for 6 weeks in high ferritin group, and no iron prescription in low ferritin group. During 6 months observation period, intravenous iron prescription was given to keep serum ferritin as study protocol. Anemia parameters, iron dose and dose of erythropoietin were monitored. 61 Results. 96 participants were randomized to keep target serum ferritin 200-400 ng/ml and 98 participants were randomized to keep target serum ferritin 500-700 ng/ml. Baseline characteristics between two groups were not different. During run-in period, the mean hemoglobin was 9.1±1.4 g/dl, mean erythropoietin was 7105.1±2279.1 unit/week in low ferritin group and the mean hemoglobin was 10.0±1.7 g/dl, mean erythropoietin was 6262.5±2467.0 unit/week in high ferritin group ( P<0.05). At baseline, the mean hemoglobin was 8.9±1.3 g/dl, mean erythropoietin was 7331.2±2118.1 unit/week in low ferritin group and the mean hemoglobin was 9.8±1.8g/Dl, mean erythropoietin was 6347.1±2663.1 unit/week in high ferritin group (P<0.05). During 3 month follow up, the mean hemoglobin was 9.0±1.3 g/dl, mean iron dose was 318.8±78.8 mg/3 months, mean erythropoietin was 6946.6±1837.1 unit/week in low ferritin group and the mean hemoglobin was 9.8±1.6 g/dl (P<0.05). mean iron dose was 595.3±216.1mg/3 months (P<0.05), mean erythropoietin was 6587.4±2956.1 unit/week (P=0.55) in high ferritin group. However, the mean different change between two groups did not reach statistical significance at 3 months follow up (Hb 2.8±13.0% vs Hb 1.6±15.1%, P=0.625, erythropoietin dose -1.9±16% vs 8.1±30.4%, p=0.099 ). At the end of treatment, the mean hemoglobin was 9.4±1.4 g/dl in low ferritin and 10.1±1.4 g/dl in high ferritin (P=0.04). Conclusion: Intravenous iron prescription keeping serum ferritin 200-400 ng/ml or 500-700 ng/ml seem to maintain hemoglobin and require erythropoietin dose as the same benefit. However, the mean iron dose 100 mg/month and 200 mg/month should be prescribed to keep target serum ferritin 200-400 ng/ml and 500-700 ng/ml in Thai chronic hemodialysis patients. Therefore, at least 100 mg intravenous iron supplement every month should be used to maintain serum ferritin around 500 ng/ml.


location: , 'Thailand year: 2016 source: HSRI

title: Effect of Hardship Allowance on Retention of Dentists and Their Performance in Community Hospitals, a Comparison between 2009 and 2013

abstract: Ministry of Public Health had put many efforts to solve shortage and manage distribution of dentists
in community hospitals by initiating special allowances based on geographical locations, hardship
conditions and working hours. This study aimed to evaluate the effect of additional hardship allowance
for dentists who were working in community hospitals. The study used secondary data from two sources and compared between 2009 and 2013. The first data source was dentists in community hospitals from the
Bureau of Dental Health database between 2009 and 2013 that were used for estimating the budget for the
hardship allowance. The second dataset was derived from performance and productivity of dental
workforce from Department of Health Service Support between 2009 and 2013.
The results revealed that the number of dentists in community hospitals was 2,638 in 2013, compared
to 1,859 in 2009, or a 41.9% increase. Additionally, the budget of hardship allowance increased
28.1%, or by 168.6 million Baht; from 599.82 million Baht in 2009 to 768.4 million Baht in 2013. However,
52.7% of dentists who started working in community hospitals in 2009 for 1-3 years, had left community
hospital in 2013. Lastly, the productivity of dental health service in 2013 appeared a little higher than 2009
on average, 1,565 cases per dentist in 2013, a 12.3% increase from 2009. Nevertheless, only 25.6% of total
hospitals were able to achieve high performance standard of 1,840 cases per dentist per year. In conclusion,
the data suggested that the hardship allowance appeared to be unable to retain dentists who had 1-
3 years of experience to continue working in the community hospitals with little effect on productivity as
a few hospitals reached the standard level of quantity performance.


location: , 'Thailand year: 2017 source: HSRI

title: Research Project in Development of Rational Drug Use Hospital

abstract: The objectives of Research Project in Development of Rational Drug Use (RDU) Hospital include: (1) to support the hospitals which join the RDU Hospital Project to achieve its goal by having a plan for concrete and effective actions based on the key advice P-L-E-A-S-E, (2) to strengthen the network of hospitals within the same geographical area, and (3) to support central tools in the implementation process of the hospital and network. The participatory action research (PAR) has been used to emphasize participation and action of local personnel and administrative team in 6 networks in the northern, northeastern-upper and lower, southern, central-eastern areas and the University Hospital Network (UHosNet). The suitable approaches are analyzed through the
self-assessment of the hospital, network, and the performance indicators at the end of the project. Good practice and advice will be shared with the collaborators, stakeholders and hospitals continuing the RDU Hospital Development along with the central supporting tools. The key findings of the projects conducted within the two-year period (10/2015 to 9/2017) can be summarized as follows: (1) In cooperation with the hospitals and networks, several good actions were recognized in each aspect of the key advice P-L-E-A-S-E, which enable us to collect, recommend and distribute the report as a KM book; (2) Results of the performance indicators revealed improvement of the RDU Hospital processes and outputs in most hospitals, even if the targets are not reached in some metrics, thus imply the project success; (3) The key success factors are identified as the support of the executive team, multidisciplinary joint collaboration and the clear national policy. These also include the importance of networking of which results
showed that more members of well-established network submitted the key performance results at the end of the project; and (4) Collaboration at multiple levels were established to develop a single and unique patient information drug leaflet in the country, that will be linked to Mobile Application ‘RDU รู้เรื่องยา’ to improve the nation's health literacy in medication for Thai people. Major impacts of the research project are (1) its utilization as the development for the 15th Ministry of Public Health Service Plan started in the budget year 2017, (2) its acceptance as one of the tools being used for the healthcare accreditation process (the subjects of pharmaceutical and therapeutic committee and medication safety), (3) its support for the RDU Core Curriculum for healthcare undergraduates, and (4) its involvement to promote the adoption of 2016 Ethical Criteria for Medicinal Drug Promotion Thailand.


location: , 'Thailand year: 2022 source: HSRI

title: AI Psychological Intervention Open Platform

abstract: Mental health has direct effects on the well-being of those who are suffering from the problems as well as indirectly affects surrounding people. Although mental health care is essential there is a limitation in accessibility to mental health care. This is because of many reasons including the inadequacy of mental health professions. The implication of mental health technology is essential because it can increase accessibility and assist mental health professionals’ work. Mental health chatbot is one of the most appropriate mental health technologies as it is convenient to use and can be used anytime, anywhere with high privacy. Although it is one of the most convenient mental health technologies, there is a huge limitation in developing mental health chatbot. It requires technology experts, AI experts, software developers, and experienced psychologists to develop one chatbot. Developing a chatbot is also time and budget consuming throughout the process. As a consequence, it is practically challenging for mental health organizations to successfully develop mental health chatbots. For this reason, this project determines to solve this limitation by developing a tool to help mental health providers to be able to develop their own chatbots without coding, AI, or software development background. This results in increasing numbers of mental health chatbots which will increase mental health care accessibility, decrease mental health problems and reduce national mental health care resources and budget. This project runs from 1 4 February 2021 to 14 February 2022. There are 21 mental health organizations take part in this project. In total, there are 53 participant consist of psychologists and technician who develop mental health chatbots using this AI Psychological Intervention Open Platform as of the following; Completely developed and published 1. Bangkok Navy Hospital has developed BNH HAPPY NAVY chatbot on Line Official to provide service to Clients for Bangkok Navy Hospital. 2. Department of Education, Suan Dusit University developed SDU Wellness Center on Facebook Page Suan Dusit University developed SDU Wellness Center to provide service to Student for Suan Dusit University 3. The Demonstration School of Muban Chombueng Rajabhat University developed งานแนะแนว รร.สาธิตฯ จอมบึง on Facebook Page งานแนะแนว รร.สาธิตฯจอมบึง to provide service to student. 4. Psychology Department, Faculty of Liberal Arts, Thammasat University developed chatbot TCAPS center on Facebook Page TCAPS center to provide service to Student for Suan Dusit University for Thamamasat University. Development in progress 1. Nan Hospital is developing Nan Sook Jai chatbot on Line Official account to provide service to Clients for Nan Hospital. 2. Chiangrai Prachanukroh Hospital is developing NongHug on Line Official account 3. Mental Health Center 7 Khonkaen is developing Mental Health Center 7 chatbot on Line Official account to provide service to people are interested in mental health care. 4. Chiangmai Neurological Hospital is developing memory clinic CMNeuro chatbot on Facebook Page to provide service to Chiangmai Neurological Hospital Clients. 5. Chiang Mai University Demonstration School is developing Hoo Kwang CMUD chatbot on Facebook Page to provide service to Chiang Mai University Demonstration School Student. 6. Student Development Division of Chiangmai University is developing Sook Jai center Chatbot on Line Official Account to provide service to Chiangmai University Student. 7. Yuwaprasart Waithayopathum Child and Adolescent is developing ‘Grow’ chatbot on Psychiatric Hospital on Line Official Account to provide service to parents or caregivers who have child behaviour management. 8. Rajamangala University of Technology Lanna is developing Mental Health Care chatbot on Facebook page ดูแลสุขภาพใจ มทร. ล้านนา to provide service to Rajamangala University student. 9. Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University is developing chatbot to provide service to Clients. ( have not connected to the platform yet) 10. Institute of Aviation Medicine, Royal Thai Air Force is developing chatbot to provide service to Institute of Aviation Medicine officer (have not connected to the platform yet) 11. Suan Prung Hospital is developing chatbot to provide service to Suan Prung hospital Client (have not connected to the platform yet) 12. Department of Education, Chiang Rai Rajabhat University is developing chatbot to provide service to (have not connected to the platform yet) 13. Kanchanaburi Juvenile and Family Court is developing chatbot to provide service to youths who get a trail. (have not connected to the platform yet) 14. Medical Services Division, Department of Corrections is developing chatbot to provide service to inmates. (have not connected to the platform yet) 15. Faculty of Associated Medical Sciences, Chiang Mai University is developing chatbot to provide service to associated medical sciences students. (have not connected to the platform yet) 16. King Mongkut's University of Technology Thonburi is developing chatbot to provide service to King Mongkut's University Student. (have not connected to the platform yet) It can be seen that this platform has successfully increase the number of mental health chatbot in a short period of time which help saving resources including budget, time and human resources. Furthermore, a randomized control trial was conducted to examine the effects of mental health chatbot applying CBT in comparison to chitchat chatbot which were developed using this platform. Participants’ stress level was measured before and after taking part. 21 participants took part in the study ( control group n= 7, experiment group n = 14). Participants were asked to use the chatbot for 14 days. Results show that after using the chatbot, the stress level of both groups were decrease. However, as this is pilot study and drop out rate was high, further study is needed. Although generalizability of the result is limited, it is still be able to point out that chatbot develop using this platform is beneficial. Mental health organizations that take part in this project can potentially conduct further research with their target groups. Based on the 21 organizations reports the result of using this platform, although there are limitations such as workload, unfamiliarity with technology, high learning curve, but most of which are satisfied with the platform and with taking part in this projects. The reasons for such satisfactions includes excellent support from the team, user friendly experience, and practicality of the platform. They also suggest that the project should be extended to support participants longer as well as support more organizations. Given the project outcomes and feedback received from the 21 organizations that take part in this projects, researchers suggest that this project has a potential for continuous development and improvement. Such suggestion can be done by inviting more organization to develop AI mental health chatbot using this platform, collecting data to develop AI models in mental health area, creating appointment system as well as sharing data for mental health big data and ecosystem in Thailand.


location: , 'Thailand year: 2008 source: HSRI

title: Policy recommendation for execution of national strategic plan for development of folklore, Thai traditional, and alternative medicine specified for human resources for health development strategy

abstract: The cabinet has approved the National Strategic Plan for Development of Folklore, Thai Traditional, and Alternative Medicine B.E. 2550-2554 since June 12th, B.E. 2550. The National Strategic Plan could be utilized as a strategy execution tool to boost up the development of folklore, Thai traditional and alternative medicine in Thailand. However the systematic reviews by means of document reviews and in-dept interview of executives of agencies concerned shows failure of the national plan as there are inadequate implementations of the plan as strategic direction of program, plan, project development and resource allocation. The unclear direction and disintegration of Thai folklore, traditional and alternative medicine development policy are the explicit evidences of the situation.
Human resources for health as a crucial resource of Thai traditional health system need to have clear, relevant, integrative development direction and strategies. Lack of posts in health care system for the Thai traditional medicine workforce is the main concern among the universities and health care institutions concerned. The poor-management of the human resources could lead to the failure of human resource planning, production and health facility development. The National Strategic Plan could be utilized to develop concrete and integrated program, plan and projects to boost up strategic direction, coordination and strategic synergy among the organizations concerned.
The integrated project proposals for additional budget request for health workforce development to promote folklore, traditional and alternative medicine in Thailand could be developed according to the 4 major strategic issues as human resources database development, building up national mechanism for human resources development, determine HR standard and quality improvement, and development of HR management system.
There are 10 proposed integrated projects, implement within 3 years period (2552-2554 B.E.), and the total budget requested is 523 million baht. Furthermore the existing program plan projects for health workforce development are also need more budget support.
The main products and expected results of the proposed integrated projects are summarized as follow:
1	Establish national Thai traditional and alternative medicine health workforce development committee and national master plan.
2	Research and development of service model and hiring of Thai traditional health workforces in 150 Thai traditional medicine health centers or clinics with local authorities.
3	Research and development of service model and hiring of Thai traditional health workforces in 30 PPP type health centers with private sectors.
4	Determine standardized curricula of Thai traditional medicine, applied Thai traditional medicine and alternative medicine in collaboration with network of academia and network of health facilities.
5	Support human resource development, capacity building and trainings for folklore healers nationwide in collaboration with network of healers in 4 regions and promote the role of the networks to develop policy recommendations submit to the national health assembly.
6	Support human resource development, capacity building and trainings for alternative medicine healers nationwide in collaboration with network of alternative medicine healers and promote the role of the networks to develop long term financial sustainable HRD program and training courses.
7	Promote and support the role of Thai traditional and alternative medicine professional bodies in legislation, law enforcement, overseeing professional standard and ethics.
8	Develop essential strategic execution databases and decision support system for development of folklore, traditional, and alternative medicine workforces.
To get fully commitment and support through active participation, the proposed integrated project package need to be scrutinized by the National Strategic Plan steering committee and the agencies concerned. The National Strategic Plan could become an effective and efficient management tool for development of folklore, traditional and alternative medicine in Thailand and benefit to the health and quality of life of Thai population as an ultimate goal.


location: , 'Thailand year: 2022 source: HSRI

title: Economic Evaluation of BRCA1/BRCA2 Genetic Testing in Patient with Breast and Ovarian Cancer in Thai Context

abstract: Background: Breast and ovarian cancers are common cancers in female. In Thailand, breast cancer is the most common type of cancer and ovarian cancer is identified at 6th rank in female. BRCA1/BRCA2 are the most common types of hereditary cancer. The prognosis of woman who inherited mutations in the BRCA1/BRCA2 genes could be predicted; as the group with high risk of developing breast cancer (80%) and ovarian cancer (15-40%) in their life time. The detection of germline BRCA1/BRCA2 could lend the opportunity for offering choices of prophylactic treatments. Moreover, recent advance in development of technique for detecting BRCA1/BRCA2 with a lower price raises the question whether this intervention is affordable at the national level in Thai context. Method: The objectives of this study were to evaluate the cost-utility of testing for BRCA1/BRCA2 followed by preventive interventions compared to no genetic test in both high-risk breast cancer patients and their first-degree relatives and to estimate government budget impact using an economic model. A Markov model was used to estimate relevant costs and health outcomes using a lifetime horizon from the societal perspective for Thai healthcare system. Direct medical and non-medical costs were included. Health outcome was quality adjusted life years (QALYs). The results were presented as incremental cost effectiveness ratio (ICER) in Thai baht per QALY gained. One-way sensitivity and probabilistic sensitivity analyses were performed to investigate effects of model variable uncertainties on the results. Results: The results of this study showed that genetic testing for BRCA1/BRCA2 in high-risk breast cancer patients who should be screened for the BRCA1/BRCA2 gene mutations followed by preventive intervention was cost-effectiveness when compare with no genetic testing. The ICER of this intervention was 18,591 Baht/QALY gained which accounted as cost effective based on current willingness to pay (WTP) threshold in Thailand (160,000 Baht/QALY gained). Moreover, offering genetic testing in first-degree relatives of patients with BRCA1/BRCA2 gene mutations was found to be dominant and a cost-saving option compared to no genetic testing. The estimated five years budget impact is approximately 1,011 million Thai baht at BRCA1/BRCA2 testing cost of 21,340 baht. Policy recommendation: The results of this study suggested that providing BRCA1/BRCA2 genetic testing in high-risk breast cancer patients who should be screened for the BRCA1/BRCA2 gene mutations and first-degree relatives of patients with BRCA1/BRCA2 gene mutations detected should include in the National benefit package in Thailand.


location: , 'Thailand year: 2004 source: HSRI

title: Development of national research network of pediatric malignancies in Thailand Phase I : epidemiology

abstract: Incidence of childhood cancer in Thailand has been roughly determined by population-based cancer registration. All cancers have been registered retro-and prospectively by Thai Pediatric Oncology Group (TPOG).OBJECTIVE: To find the incidence of childhood cancers in Thailand.METHOD: All Thai children aged < 15 years newly diagnosed with childhood malignancies according to International Childhood Cancer Classification (ICCC)during January 1- December 31, 2003 were registered into a national database. The data were collected through a web-based registry from 20 treatment centers under a standardized format, using double entry method and under internal and external audit process.RESULTS: There were 999 new cancer cases in children; 94.0% was histologically confirmed, 566 (56.7%) were males. The male: female ratio was 1.3:1, 80 (8.0%) were under 1 year, 361 (36.1%) were between 1 and 4 years, 282 (28.2 %) were between 5 and 9 years, and 276 (27.6%) were between 10 and 15 years old. The median age at diagnosis was 5.64 years old. The age standardized rate (ASR) of childhood cancer was 79.7 per million. Leukemia was most common (ASR 42.6, male=282, 28% vs. female=247, 24%) followed by CNS tumors (ASR 7.6, male=53, 5.3% vs. female 49, 4.9%): medulloblastoma and astrocytoma being the most common comprising 3.2% (male = 13, 1.3%; female=19, 1.9% and 2.5% (male= 13, 1.3%; female=12, 1.2%), respectively. Leukemia and CNS tumors constituted 63.1% of pediatric cancers and Lymphoma was third (ASR=6.4, male=68, 6.8% vs. Female 22, 2.2%). The ratio of non-Hodgkin lymphoma to Hodgkin disease was 1.9:1. Neuroblastoma (ASR 4.6, male= 24, 2.4% vs. female= 27, 2.7%) and retinoblastoma (ASR 4.2, male=29, 2.9%; vs female=13, 1.3%) ranked fourth and fifth, respectively, followed by soft tissue malignacies (ASR 3.6, male=30, 3% vs. female= 15, 1.5%), bone tumors, (ASR 2.4, male 21, 2.1% vs female 15, 1.5% ), renal tumors (ASR 2.6, male=15, 1.5% vs. female= 14, 1.4%), liver (ASR 2.4, male= 14, 1.4% vs. female=13, 1.3%), germ cell (ASR 2.3, male= 19, 1.9% vs. female=13, 1.3%) and nasopharyngeal carcinoma (ASR 0.3, male 5, 0.5%) Among leukemia, ALL (ASR 31.8, male=213, 21.3%; female=176, 17.6%) outnumbered ANLL (ASR 9.2, male= 57, 5.7%, female=62, 6.2%). Conclusion: The incidence of childhood malignancy in Thailand is lower in comparison to Western and regional countries. Leukemia was the most common cancer in Thai children. Lymphoma is much lower than that of Western countries.


location: , 'Thailand year: 1998 source: HSRI

title: Roles of municipality in health development

abstract: Roles of municipality in health developmentThe objectives of this study were to examine the implementation of health and health related activities undertaken by municipality according to the roles and  responsibilities defined by law, to examine the readiness of health resources in the health and health related activities, and to gather municipality administrators/personnel opinions on municipality roles towards health development. A survey research design was used and mail questionnaires were sent to 149 municipalities and Pattaya City in Thailand. The response rate was 78.7 percent (118 municipalities). There were 538  municipality personnel responded to the survey questionnaires on municipality roles. The majority of the municipalities  agreed on the present organization structure of the  municipalities of provide health and health related activities to their populations, 57.9 percent and 74.2 percent by muang and tambon municipality respectively. However, 45.5 percent of  nakorn municipalities suggested that the organization structure should be changed to a higher level. Moreover, the analyses were based on 1) roles according to Municipality Law B.E.2496;  2) roles according to Ministry of Interior's regulations B.E.2535; 3) activities in which more than 50 percent of the municipalities could perform 4)municipality personnel opinions towards the roles and activities in reality and decentralization in health activities. The finding shows that most of the municipalities could perform activities in sanitation and environmental health, solid wastedisposal, prevention and communicable disease, health education, nutrition, family planning, immunization, prevention and control of non-communicable diseases, primary health care, dental health, veterinary medical car.  The results show that there were some activities that only few municipalities would do such as medical care after the office hours, inpatient care, surgery, delivery, specialized care for specific diseaes, mobile medical and dental clinic, medical laboratory and diagnosis, toxicology microbiology laboratory, occupational health, antenatal and postnatal care, mental health, and waste-water treatment and quality control. The majority of municipality personnel (75.1 percent) agreed that it was appropriate to decentralize the role and activities in health care to municipality and the resources were moderately sufficient. The opinion on building  municipality hospitals was 38.9 percent and medical centers  95.9 percent. However, the utilization rates at hospital/medical centers were very low : nakorn municipality 65 patients/day, muang municipality 14 patients/day, and tambon  municipality 7 patients/day. Moreover, if health problems  according to important health indicators (Basic Minimum Need : BMN) were considered, they were quite good. However, there are still many problems in which lack of resources especially human resources for health, lack of clear policy, roles and activities, management, and cooperation of related agencies and people were problems in implementation of majorhealth projects.The implications from this study were suggested as follow : 1)Municipality should have the major role in taking care of the health of the population in the municipality area. 2)Municipality should emphasize on health promotion and disease prevention more than curative care and should provide a proactive service by focusing on purchaser's role more than provider's role. The municipality should let other potential public and private facilities being providers.3)Expansion of hospital and medical center should be undertaken only with the case of insufficiency of health care facility, resource capacity, and the need of local people. 4)Municipality should promote and support people to be partnerships in health  and health care for individual, family, and community.      	5)Central gevernment should allocate resources and promote municipality to increase sources of income. 6)In the future, government should fully decentralize authority to municipality      and empower community organizations and people. 7)Futher studies should focus on qualitative and quantitative aspect to cover the areas and health facilities including general population on roles of municipality on health development.


location: , 'Thailand year: 2014 source: HSRI

title: Patients’ Perception and Experiences in Emergency Medical Service Under the Harmonization Policy for the Three Health Insurance Schemes

abstract: This study aims to assess patients’ perception and experiences in emergency medical service under
the harmonization policy for three health insurance schemes. A telephone interview using a semi-structured
questionnaire was employed. The study population used medical care in private non-contracted
hospitals, appeared in the Emergency Medical Claim Online database (EMCO) during August-October
2012, and was selected by simple random sampling through personal identity number. Of the 292 patients
interviewed, 105 cases were from the Universal Coverage scheme; 95 cases from the Social Security Scheme;
and 92 cases from the Civil Servant Medical Benefit Scheme. Most patients were aware of the policy, but
not the definition and boundary of the valid conditions under the policy. Most came with medical conditions
and used in-patient care service (91%). The majority chose (92%) and came (91%) the hospital by
themselves; only 2 percent called 1669 EMS. 85 percent of the patients based their selection of the health
services on the distance and quality of the hospitals. Less than 17 percent were aware of their benefits and
the referring process. Most of them were asked to pay, despite the policy stating the contrary, thus imposing a burden on them and their families. Most knew neither the hotline number nor a place to lodge their complaints.


location: , 'Thailand year: 2008 source: HSRI

title: HIV-related behaviors of female sex workers in Nakhon Ratchasima, 2007

abstract: This was the third cross-sectional survey conducted in Nakhon Ratchasima Province
in 2006 to follow up the surveillance of a cluster of female sex workers whose behaviors
potentially put them at risk of contracting HIV infection, and to verify their knowledge
about HIV. A one-stage cluster sample with equal probability was used to select the
brothels where the women worked. All the female sex workers willing to participate were included in the study. Self-administered questionnaires were used for data collection.
A total of 147 female sex workers participated in the survey; their average age was
30.4 years. Only 34.6 percent of them were capable of answering correctly all of the five
UNGASS knowledge questions. The rate of condom use with clients in the previous
week was 99.2 percent. In the previous month, 46.3 and 36.7 percent of them had sex with
their spouse and none-client partners, respectively. The rates of condom use with spouse
and none-client partners in the previous month were 30.8 and 79.6 percent, respectively.
The drug addiction rate and rate of injecting drug use in the previous year were rare, only
0.7 and 4.1 percent, respectively. In the previous six months, 78.2 percent of the female
sex workers had participated in voluntary HIV counseling and undergone anti-HIV testing.
From the results of this survey, it is obvious that female sex workers in Nakhon
Ratchasima Province still need to improve their knowledge about HIV/AIDS. Their regular
condom use needs to be extended to cover all types of sexual partners.


location: , 'Thailand year: 2020 source: HSRI

title: Clinical Outcomes and Physical Therapy Indicators for Improving Standard of   Physical Therapy Service: A Review of Systematic Review

abstract: This literature review aimed to investigate clinical outcomes and physical therapy indicators in 4 physical therapy fields, i.e. 1) musculoskeletal system, 2) neurological system, 3) pulmonary and cardiovascular system, and 4) pediatrics. Systematic reviews were searched from start to 15 July 2019 in several databases, including PubMed, ScienceDirect, Web of Science, Scopus, and PEDro. Relevant systematic reviews with full report published in English were retrieved. Data from included studies were extracted, analyzed, and synthesized. The results showed that 151 papers were included in this study. Clinical outcomes and physical therapy indicators were categorized into 22 groups. In general, assessing patient’s clinical outcome required more than one clinical tool or form to cover all aspects of patient’s problems, including signs and symptoms, functional ability, and social participation. Most common clinical outcomes and physical therapy indicators used were pain, body movement, functional ability, and quality of life. Physical therapists can apply this information to set treatment goal, planning treatment program, and evaluating treatment progression in order to improve quality of service to patients and to establish goals for service from a multi-professional team.


location: , 'Thailand year: 2007 source: HSRI

title: Thai Diabetes Risk Score

abstract: The diabetes risk score is a simple tool for predicting the probability that individuals will develop
diabetes mellitus in the future. This paper introduces the Thai diabetes risk score calculated from data
obtained from a previous study of cardiovascular disease in a cohort of employees of the Electricity
Generating Authority of Thailand. The scores were derived from coefficients in the logistic regression
model. Variables which significantly predicted the diabetes incidence included age, sex, body mass index,
waist circumference, blood pressure and family history. The predictive performance of the tool was
75 percent. This simple tool could be used to identify those who are at high risk of diabetes and encourage
them to follow healthy lifestyles.


location: , 'Thailand year: 2000 source: HSRI

title: The study of health risk assessment and risk management system of Map Ta Phut Industrial Estate

abstract: The Study of the health risk assessment management system in Map Ta Phut Industrial Estate	The objective of the study of health and environment management situation is to review the role and function of the health and environment management from relevant organizations in Thailand as well as in other countries. This study is sub – project of the study of the health risk assessment management system in Map Ta Phut Industrial Estate project.Result :The relevant organizations;The relevant organizations in Thailand  are Ministry of Public Health , Ministry  of Interior , Ministry of Labor and Social Welfare, Ministry of Industry, Ministry of Science Technology and Environment. Those ministries have the infrastructure at provincial or regional level to carry out the activities.The relevant organizations in other countries which involve to manage health and environment are World Health Organization, United State Environment Protection Agency, Occupational Safety Health Authority, other organizations in United Kingdom, Germany, Kazakhsatan and Japan.The health management in Map Ta Phut Industrial Estate;Increasing potential of Rayong hospital to be the center of occupational medicine and environmental medicine diagnosis.Develop and improve the nearby hospital or the clinics to be the networking  such as Ban Chang hospital, Map Ta Phut hospital , Pluak Daeng hospital and Klaeng hospital.Service the health promotion , family planning , disease control and nursing care  in the programme of public health service as well as in the active mobile service unit. For worker health examination and treatment , there are 2 services available ; on site service and at the hospital service . The result of the above management are reported routinely and accessible for the public.The environment management in Map Ta Phut Industrial Estate;There is the central wastewater treatment plant. The influent and effluent of  wastewater are monitored before released from the plant. The environment which  are canal , sea, groundwater and ambient air are monitored routinely.In the workplace , environmental parameters must be monitored according to  what have been defined in the environment impact assessment study.In the communities , the environment quality are monitored as well. The result  of the above activities are reported routinely. The frequency of reporting is based on the EIA and regulation which is different in  each type of factory.


location: , 'Thailand year: 2020 source: HSRI

title: Development of policy recommendations related to employing retired nurses in government health care service facilities

abstract: This study aims to develop a policy on employment of retiring nurses in health services under the government sector. The mixed-methods, qualitative data and quantitative data, was used to conduct in this study. The research procedures are as follows: 1) Reviewing literature on employment and employment situation for retirement proposals in various health care facilities in Thailand. 2) surveying information on employment of retiring nurses in health care centers by phone and 3) interviewing the executive representatives such as human resources director, director of nursing division, inspector of public health supervision area under the Ministry of Public Health about the opinions on the retirement nursing employment policy. The analysis of quantitative data from survey was frequency and percentage. The information from interviewing was analyzed by content analysis. The results of the content analysis from the interviews of the high level executives revealed that most of the senior executives had good attitudes towards hiring retirement nurses because it is a support to the policy to expand working opportunities for the elderly in accordance with the government policy, and also using the knowledge experience of retirement nurses. The situation regarding the necessity of hiring a nursing nurse due to 1) the shortage due to the distribution of nursing personnel is not good. Causing a lack of balance between the workload and the workforce in the health service 2) The system to maintain nursing personnel to remain in an ineffective profession Resulting in nurses in the service system lacking work motivation and resigning, and 3) shortage due to increased workload. The management has made recommendations regarding the objectives of hiring retired nurses as follows: 1) having need for employment in some positions where retirees have specialized knowledge And currently cannot find replacement personnel. 2) Hiring only department having insufficient staffs. 3) Primary care services in the community should be implemented especially to the family doctor team. 4) Social medicine work because they have the right skills. 5) Intermediate care services, with training to increase knowledge and skills in operations, 6) care manager jobs, and 7) design new jobs by studying the need of patients, and design new work services that are appropriate for the modern world by focusing on health promotion. The most work is to provide service in the community, suitable services for all age group by using the local government organization mechanism, Health promotion educational system, and health promotion operations Solving health problems in schools, etc. The policy recommendations on hiring retirement nurses were 1) the extending the retirement period according to government policy. 2) Hiring retirement nurses for services such as community service in the roles of community nurse at health services center by yearly contract and use universal coverage budget (UC). 3) Hiring retirement nurses for new services that having value and income by yearly contract and use the budget from organization in community such as education organization, local government organization or private sectors. The examples of new service are counsellor at chronic disease clinic, caregiver in community, nurse in child development center, school nurse, and etc. 4) Part time or Full time hiring depending on the need of organization to prevent insufficient human resource. The duties are almost same as before retirement. The pattern of hiring is freelance with flexible hours, and use the budget of service center services.


location: , 'Thailand year: 2020 source: HSRI

title: Risk and Safety: Commuting in Public Van in Bangkok and Vicinity

abstract: This research aims to 1) attain a better understanding in the nature of the situation related to the safety of daily commute via public passenger vans through the perception of commuters and van drivers 2) explore possible measures to prevent the danger of the daily commute via public passenger vans through the perception of the involved parties, and 3) study past policies and outcomes of the implemented policies by different working bodies related to the safety of daily commute via public passenger vans and analyze the factors affecting both the success and failure. The research procedure is divided into two phases. The first phase utilizes qualitative and quantitative research methods to achieve the first and third objective. Data collection is conducted in 3 van stations (Bangkok-Chonburi route, Chonburi – Bangkok route and Bangkok-Nakhonnayok route) with the subjects being 45 van drivers and 210 passengers, 6 business operators, 3 officers from the Land Transport Department, 6 traffic polices. The data analysis is done using content analysis and Multiple Recession method. The second phase employs the participative action research to help develop for the most effective measures to prevent the danger caused by daily commute via public passenger vans. The analyzed data from phase one is provided back to the research participants (3 officers from the Land Transport Department, police officers and representatives from Road Safety Group Thailand (RSG), 30 van drivers, and 2 operators of public passenger van business). The findings reveal the following: 1. The factors affecting the behaviors and safety of the commute via public passenger vans in Bangkok Metropolitan Region are people’s knowledge and attitudes towards safety. Such factors have significant statistical impact on the safety behaviors of the commuters at .001 with the predictable rate of 29%. 2. The driver’s perceptions towards situations related to the safety of daily commute via public passenger vans reveal that the drivers are aware of the risks of driving public vans caused by other road users. They are also aware that accidents can cost them not only, their time and income, but also their lives. Other risks include poor conditions of the roads and operating vans, drivers’ insufficient sleep and excessive passenger capacity. The risk factors are derived from families and business operators competing for clients. From the passengers’ point of view, the finding discloses the passengers’ realization in the risks of commuting via public passenger vans, which are still ongoing and somewhat normalized. 3.Compliance with implemented policies and factors affecting the success of the developing greater safety for public passenger vans encompass the understanding in the problems of the service, strict enforcement of the laws, collaborations between government agencies and understanding in the implementation of policies as well as the use of technology, social media platforms and applications to make opinions heard and complaints resolved. The problems include expired Compulsory Motor Insurance, relatively small fines, inconsistent/only occasional inspection, and problematic mindset/conflicted benefits of illegally operated vans. The solutions include the revision of Government Gazette to appropriately enable a system where safety measures can be continually and effectively monitored, as well as creating a greater acknowledgement in the passengers’ benefits and safety. 4. Conceived is a participative action approach adopted among public van drivers, which aims to develop greater knowledge in the prevention of risky behaviors, proper training that follows anger management principles, and positive communication skills. The passengers must also be properly educated about appropriate commuting behaviors and skills to ensure their own safety as well as the public’s, while the development of positive communication skills should also be encouraged.


location: , 'Thailand year: 2018 source: HSRI

title: Promoting early life nutrition intervention within maternal and child health care (1st year)

abstract: Optimal nutrition in both mothers and infants from conception to the first 2 years of
life or the first 1000 days is crucial for growth, health and cognitive development. Thailand
has made considerable progress in maternal and child nutrition, but currently facing the
double burden of malnutrition, i.e., coexistence of both under and over nutrition.
Objectives: This study aimed to improve a tool used in assessing gestational weight gain
(GWG) which is appropriate for pre-pregnancy nutritional status (Body Mass Index, BMI),
develop a new tool for assessing physical activities during pregnancy and lactation, develop
practical recommendations on dietary advice during pregnancy and lactation, develop a
food product using resistant starch for management of overnutrition and finally, to examine
the current nutrition services in maternal and child health program. Key findings: (1) GWG
data of mothers who delivered normal birth weight infants at Siriraj Hospital were obtained
from hospital records. Recommended GWG tables and charts were developed according to
pre-pregnancy BMI, i.e., underweight, normal weight, overweight or obese. (2) A physical
activity questionnaire for pregnancy and lactating women (PAQ-PL) was developed based on
the common physical activities among Thai population. The validity of the PAQ-PL against
the accelerometer was acceptable. This PAQ-PL can be used to monitor GWG and control
post-partum weight retention. (3) Optifood program, which utilized the linear programming
method, was used to create food based dietary recommendations (FBDG) for pregnant and
lactating women. The development was based on dietary consumption data (quantity,
frequency, and food items) of Thai pregnant and lactating women as well as women of
reproductive age. The developed FBDG contained recommended food groups, quantity, and
frequency which aimed to meet the recommended energy, protein, and vitamin and
minerals intake. This FBDG should be tested for acceptability and practicality prior to
implementation. (4) RS milk-based beverage, containing 30 grams of RS, was developed and
tested for acceptability and side-effects. The developed RS beverage was well accepted
among women of reproductive age and the side-effects were rare. The total daily energy intake decreased; however, further study on health impacts is needed. (5) Exclusive breast
feeding (EBF) practice during the first 6 months of age among middle income and working
outside the home mothers was evaluated using the questionnaire, then compared with the
data from the stable isotope technique. Only 31% at 3 months and 61% at 6 months of the
EBF practice data from the questionnaire were consistent with the actual practice. (6) The
current nutrition services in maternal and child health program were based on the policy
and indicators established by the Ministry of Public Health. The services were implemented
through the Regional Health Promotion Center (HPC), which acted as the advisory and
technical support group and monitored policy implementation according to the indicators.
The constraints in the real practices were the lacks of sufficient personnel compared to the
workload and inadequate nutrition knowledge. There was an urgent attention on capacity
building for the health personnel, especially those who work at the local level and
community health volunteers. Recommendation: This study suggests the importance of the
action research that integrates the developed recommendations and tools in the maternal
and child health care services and modify them to be appropriate for the implementation at
all service levels, and suggests the importance of the intensive capacity building on nutrition
aspect for public health personnel.


location: , 'Thailand year: 2020 source: HSRI

title: Behavioral Economics on Life journey and Collective Action of Thai Household under COVID-19 Situation

abstract: This research aims to evaluate the compliance level of Health Measure and its constraints to prevent and control COVID-19 pandemic of several population groups in Thailand; general urban people, urban poor, rural people and people in Southern border. This research uses questionnaire survey via google form and telephone with 7,569 samples and then repeats two more times with different but continuous surveys. The Behavioral Insights concept is applied. Results find that each population group can comply with Health Measure in public area indifferently, but each one has different capacity to comply in house due to physical constraint such as limited space, which is from limited wealth and income before. Moreover, repeated survey finds that low-income people have to face with higher risk because of insufficient income to survive for their family. So fiscal measure for the poor such as subsidy is necessary and important to capacity to comply Health Measure and then to prevent and control COVID-19 pandemic.


location: , 'Thailand year: 2022 source: HSRI

title: Artificial Intelligence and Health and Social Equity

abstract: This research aims to develop a concept and basic framework for research regarding a topic of artificial intelligence technology, and health and social equity; and to propose research agendas in response to long-term research on the topic. Data were collected from documents and multi-disciplinary workshops. The documentary data provided a basis for development of a basic conceptual framework regarding artificial intelligence technology, and health and social equity. Subjected to further development based on data from the workshops, the framework was applicable to research agenda analysis. Three workshops were organized comprising a total of 27 experts from the fields of philosophy and ethics in technology, laws, sociology, environment and development, computer science, bio-medical engineering, bio-science, and bio-medical information technology. From the study, a framework was obtained for analyzing issues and research agendas regarding a topic of artificial intelligence technology, and health and social equity. The framework consists of general and management principles. The general principles include respect for human dignity, justice, non-maleficence, and beneficence. The management principles are connected to and serve implementation of the general principles. In addition, the data from the workshops were analyzed through the framework and synthesized to form agendas for long-term research. These agendas are (a) research on factors from human nature and culture influencing equity in digital technology and artificial intelligence; (b) development of citizens' competencies related to digital technology and artificial intelligence; and (c) development of frameworks for policy development and implementation to develop and apply artificial intelligence to promote health equity.


location: , 'Thailand year: 2020 source: HSRI

title: Alternatives for managing the participation of private "Ob-Oon" community clinics in the National Health Security Scheme in the Bangkok area

abstract: The incident that the National Health Security Office (NHSO) terminated primary care contracts with the private clinics, so called “Ob-Oon” community clinics, around the end of the fiscal year B.E.2563 as a result of suspected frauds raises a key question if there is any system solutions to correct and prevent a similar incident in the future. This report, therefore, aims to analyze how Ob-Oon community clinics are managed under the NHSO system and propose options for future management. Mixed qualitative research methods over the period of two months were applied, including literature and document reviews and a modified focus-group discussion organization by the Health Systems Research Institute. It is found that participation of the private sector in providing healthcare under the universal coverage scheme (UCS) has been there and developing almost since the beginning of the scheme. Having Ob-Oon community clinics contributed to increasing healthcare access in the Bangkok area. However, other areas of performance, including quality of care and satisfaction, were not as impressive. In addition, there lacked continuous systematic monitoring and evaluation of the private-sector participation, resulting in shorting of information needed for thorough investigation of advantages and disadvantages of the roles of the clinics as key primary care providers in the Bangkok area. There are three possible system management solutions proposed by the study: Solution # 1: Cancel all private sector participation in the UCS as Ob-Oon community clinics; Solution #2: Allow private Ob-Oon community clinics to become full-scale main primary-care providers; Solution #3: Only permit private Ob-Oon community clinics to be network primary-care providers, given the “free-provider choice” policy In considering preferred solutions, the following set of criteria were used: (1) Support for achievement of the balancing and competing goals of universal health coverage, including accessibility of primary care, cost containment and resource efficiency, quality improvement of healthcare and services, and choice; (2) Execution possibility, based on availability of primary care providers, financial and service network management, Information technology, governance and civic participation, and support for future learning and service innovation. Based on the criteria, the most preferred solution is the combination of Solution #2 and Solution #3 as shown in detail in Table 6.4. Nevertheless, there are certain actions that need to be done regardless of which of the solutions for primary care in the Bangkok area is selected. These include the use of the information technology system to enhance capabilities in service arrangement and management, Utilization review by NHSO, Regional 13 Bangkok office, development of the indicator system for key primary care performance along with health management for information system that allow feedbacks to providers and area managers for performance review and improvement, area-based knowledge management to support the development of primary-care service network, review and design for area-based collaborative management platform for planning and improvement of health services and patient referral to ensure quality primary care for all regardless of their registered providers, review and improvement of provider costing and payments based on service requirements and service targets including value-base healthcare programs, urgent review and planning to enhance capabilities of referral centers in Bangkok, and effective implementation of monitoring and evaluation of progress and accomplishment of all operational plan.


location: , 'Thailand year: 2008 source: HSRI

title: Demo-socioeconomic and Health Differential of Mortality among the Thai Elderly

abstract: This study was aimed at assessing the mortality differential according to demographic, socio-economic
and health status among the Thai elderly (aged 60 years and older) during the period 2004 and
2006. The data used were from the National Health Examination Survey III, 2004 (NHES III) and death
registry between 2004 and 2006. Area of residence, geographical area, marital status, education, house-hold income, dependence on daily activities of living and cardiovascular risk factors
were selected as demo-socioeconomic and health status indicators. The standardized
mortality ratio (SMR) was used to measure old-age mortality according to these indicators,
disaggrageted by sex.
It was found that mortality differences existed in almost all demo-socioeconomic
and health status indicators of the Thai elderly, except area of residence. Male and female
elderly people who lived in northeastern and northern Thailand had higher mortality,
while those who lived in the southern part of the country and Bangkok had lower
mortality than those who lived in the central region. Furthermore, the elderly who had
always been married, widowed, divorced or separated had higher mortality than those
who had always been single. The dependent elderly or those with cardiovascular (CV)
risk factors had higher mortality than those who were not dependent or who did not
have CV risk factors. These mortality differences could reflect health inequality among
different groups of the Thai population.


location: , 'Thailand year: 2008 source: HSRI

title: Situational Review of Ethics in Research Involving Human : A Study of Human Subject Protections in the Ministry of Public Health (Central Part)

abstract: The objective of the study is to study the mechanism of human subject protections focusing on ethics committee in central part of the Ministry of Public Health. The methodologies include literature review, questionaire, and indepth interview. The study revealed that most of Departments in the Ministry had established ethics committee, i.e., Ministry of Public Health, Department for the Development of Thai Traditional and Alternative Medicine, Department of Medical Service, Department of Disease Control, Department of Medical Science, Department of Mental Health and the Health System Research Institute. There are institutional ethics committee in Department of Medical Service, e.g., the National Neurological Institute and the Queen Sirikit National Institute of Child Health. Most of members of the committees acquainted with the international ethical principles and guidelines for research involving human. The composition of the committees are in line with international guidelines. Each committee have their own guidelines and standard operating procedures. Only one committee has been surveyed, evaluated, and recognized by SIDCER/ FERCAP Recognition Program, i.e., the Ethics Committee for Thai Traditional and Alternative Medicine. Since the research is not the first priority of the Ministry of Public Health, there are some shortcomings that need consideration for correction and improvement. Most of medical and health journals have no policy for requirement of ethical clearance of the studies submitted for publication. Most of the ethics committee focussed only on preview of the protocol, no proactive activities on continuous review and site visit. Most of the committees review both scientific and ethical aspects meanwhile most members of the ethics committee have limited knowledge and experience in research on advance and complicated sciences. The supports of most committees are insufficient. The information  technology are not fully used in most committees. Some committees have problems in timely review and may have doubt of independence in some cases.


location: , 'Thailand year: 2013 source: HSRI

title: Improving the inventory management system using modified vendor managed inventory: a case study of primary care units in Klonglan District, Kampaengpetch

abstract: Logistics management is a useful tool with applicability to many businesses. However, drug distribution
from Klonglan District Hospital to its primary care networks was still in its infancy, resulting in an
excessive drug inventory. This is a quasi-experiment study that monitored 3 Key Performance Indicators
(KPIs) for comparison before and after using the modified vendor-managed inventory (VMI). The KPIs
were 1) inventory efficiency evaluated by ratio analysis, 2) cost-benefit analysis, and 3) stakeholder satisfaction
evaluated through content analysis from focus group discussions. The KPIs were monitored for
eight months at ten primary care units in Klonglan district. The period before using the modified VMI was
from December 2011 - March 2012; the period after using the modified VMI was from April 2012-July 2012
The results showed that KPIs were improved. The average inventory turnover ratio was reduced
from 6.67 months to 1.31 months. The inventory cost saving was 1,006,416.55 baht and the benefit-to-cost
ratio was 80.03. Stakeholders expressed satsifaction with the modified VMI because of the lower workload.
Regular meetings among stakeholders, however, are needed for improvement and maintenances of the
new inventory management system.


location: , 'Thailand year: 2008 source: HSRI

title: Psychosocial Adjustment among Perimenopausal Women Attending Proprathabchang Hospital, Phichit Province

abstract: This descriptive research was carried out to study psychosocial adjustment during
the perimenopausal period of women. The subjects were 89 married women in the
perimenopausal period who visited the outpatient department of Phoprathapchang Hospital,
Phichit Province, in 2007. The study used a questionnaire consisting of two parts:
personal data record and psychosocial adjustment in the perimenopausal period.
The results showed that 53.93 percent of perimenopausal women reported overall
psychosocial adjustment at a good level and 46.07 percent at a poor level. In considering
each aspect, the aspects of the vocational environment, domestic environment, social environment
and psychological distress were at good levels, i.e., 59.55, 51.69, 62.92 and 55.06
percent, respectively, while the aspects of health-care orientation, sexual relationship and
extended family relationship were at a poor level of 51.69 percent.
The results of this study could be utilized as basic information in planning care,
counseling and for enhancing psychosocial adjustment for the well-being of the perimenopausal
women.


location: , 'Thailand year: 1999 source: HSRI

title: Evolution of Thailand's HIV/AIDS prevention and alleviative National Programme

abstract: Evolution of Thailand's HIV/AIDS  Preventive and Alleviative National ProgrammedObjectives : To study evolution of Thailand's HIV/AIDS  Preventive and Alleviative National Programmed from the advent of HIV/AIDS epidemic until the end of 1997. Subjects and methods : Researchers revised and analyzed the HIV/AIDS related  studies to illustrate Thailand 's missions and activities to prevent and control HIV/AIDS epidemic. To conceptualize AIDS paradigm shift the studies were subcategorized into 6 parts : AIDS  paradigm  development,  evolving  HIV/AIDS  information  system  for  good governance, HIV/AIDS catalytic role for civil society,  AIDS public policy development, as well as evolution of the HIV/AIDS social and health services.  Then the conceptual frame work for Health Promotion from the Ottawa Charter was employed to analyze the emerging Thailand's societal AIDS response.Results : HIV/AIDS public policy have been developed to create up the strategic infrastructure for HIV/AIDS prevention and alleviation. The crucial strategic areas which was the main finding are social environment, personal and community empowerment as well as social and health measure reorientation.   To achieve these societal evolution, the well developed information system to intercommunicate all the strategic alliances have been undertaken and an effective advocacy had been continually worked out so that the government can play their central role to collaborate the participatory function all the sectors. The individual and community empowerment have been turned to be the major tooldeveloped  to  change  the  people's  life  style  so  that   the epidemic of HIV/AIDS is under control and the HIV incidence have declined to a lower rate than last 5 years ago.Conclusions : AIDS crisis is so serious and complex that it can alert Thai society to learn and understand the intertwined health causal determinants which have its roots from social, economic, cultural and political infrastructure. The way its government develop a sounded health promotion strategy is the valuable lesson learnt then apply to other kind of health  problems.


location: , 'Thailand year: 2011 source: HSRI

title: Implementation of Health decentralization : Progress Evaluation and Impact Analysis

abstract: Decentralisation is a fundamental of the state policy; it is a one of main scheme that dedicated in the Constitution of the Kingdom of Thailand B.E. 2540. The plan and the process of Decentralisation to local government Act B.E. 2542, was enacted as a sub-constitution law under the Constitution Act. The important principles is a determining the procedures and timing period to transfer power from the central government to the local government organisation (LGOs). The Decentalisation plan is an important and systematic mechanism of successfully the Decentralisation policy. Although later it was announced the new Constitution in the year of 2550 the principle of decentralization is to remain unchanged additionally it is a major reason has been given the decentralised in health care reform occurs.

The concept of decentralisation in health, as shown in the decentralisation plan B.E 2543, it is the first issue states that a public health is a priority, one of which appears in the promotion of quality of life function. The mission identified several public health activities need to be transferred to the LGOs. This is part of the decentralisation of health is an important and concrete result in a major transformation of the Thai health care reform. Data from the study and follow-up operations shows that after promulgation of the decentralisation plan (first edition) in the year 2543 was the decentralisation of health, there is yet no clear and concrete progress as much. Despite there were some public health activities to be transferred to local governments. However, the evaluation was not operating in accordance with the procedures and methods set forth in the Plan. The National Board of Decentralisation-NBD as a national policy organization who’s acted as supervising and monitoring body of the policy are often and call for an operations on the issue of decentralisation in health. As a result, the Ministry of Health-MoPH has a fine way for the decentralisation of health in the year 2549, which important issues arise. The proposed models of transferring the mission to the local government on a variety of forms to suit the availability and circumstances of each area of four types: 1) transfer Split 2) transfer to Network 3. ) establish a public organisation, and 4) establishment of the Service Delivery Unit. In case of split transfer model as a separate unit has offered to transfer facilities in areas under the LGOs at different levels. This is an important turning point was an idea that is proposed to transfer the health centre to the LGOs at the different levels. The decentralization plan in Volume 2, published in the Year 2551 issue of the health centre has to transfer to the LGOs has been clearly defined in the Plan. The Health centre-HC determining the complete the final phase of the plan is that if the end of year 2553 can not proceed to completion, and then transferred to the Provincial Administration Organisation- PAO. The direction of health decentralisation is to focus on health centre transferred to local governments is critical to that time have undergone significant changes. The NBD has approved the transfer of the health center to local governments then in the late of year 2550 has been seriously driven and living an intensely driven political leadership of the senior administrators of the MoPH were successfully completed on issue of the Health Centre transfer to the LGOs. Perfectly targeted transfers by the total number of 35 and has transferred 22 of the Health Centre has completed at the first time and followed for 6 of the later included as a transfer 28 of the Health Center to the LGOs. It is an interesting and has been watching a lot of people involved. Regarding on evaluation found that in the first phase of the transfer of the obstacles in the nature of the connection that many unsettled, however, it was solved by approach manage well on a certain level. Yet the problem is a lack of planning and problem solving in a systematic way is to develop the strength and capabilities of the LGOs staff both the executive and operative level. Including uncertainty and policy advocacy that is not good enough that result of the Health Center from 7 to target the transfer of the first stage had to cancel the transfer with caused both by reason of the transferor and the transferee of the same. In later stage of the Health Centre transfers to local governments scheme has not been driven very strongly and clearly enough, especially in the central policy of the MoPH. Additionally in the local governments administrators that they are no clear in the uncertainty and ensure the sustainability of policies, there are many areas has changed the attitude of willing to transfer to the staff recruit plan by themselves. As well as find a way to produce and develop their own staff which wide affect the overall efficiency and fairness of the health resources allocation and distribution in the countries.
Overall progress on the issue of health decentralisation was beginning to change slowly and has accelerated in the late plan. Although the health decentralisation that occurred in the Thai health system will have been trying to format a variety of models, such as the Local Area Health Broad-LAHB, public organisation hospitals-POH, the Local Health Fund-LHF, etc. With regard to the Health Center under the local governments, this is a form of decentralisation by transferring a separate facility that have received attention and watch over both may have the option of decentralised system for health care appropriate to the context and reality. Due to health services that are specific, and public goods that much affect society. In this study, It is therefore proposed to review and select a form of decentralisation and careful analysis is very comprehensive. It should not be the single blueprint as a model nationwide. This is important topic that should be studied and analysed in terms of actual practice in each model carefully. Alternatively of the area health administration is one of health decentralisation it would be the alternative of interest can be integrated guidelines and form of decentralization in a variety of areas with problems and resource constraints similar. Each form of decentralization has been a body of knowledge and developed a certain level in Thai society. In the beginning, in the process of decentralisation of health, this is an issue that might be a solution that should be analysed and were taken to a form appropriate to the context of each area. The health decentralisation is based on knowledge, evidences and a participation of stakeholders at all levels.


location: , 'Thailand year: 2022 source: HSRI

title: Why Insured Persons under Social Security Act Article 40 Missed Paying Contribution: A Qualitative Study

abstract: The present qualitative study aimed to explore and understand reasons why insured persons under Social Security Act Article 40 missed paying contribution. Two data collection methods were used. First, telephone interviews, data were collected from nine village labour volunteers and community-based social security network members for Article 40 and one insured person who had experiences with Article 33, 39, and 40. The informants were from Lamphun, Burriram, Khon Kaen, Bangkok, and Phuket. Second, online public comments related to Social Security Act Article 40 published during 2011-2021 were reviewed. The findings showed that reasons the insured persons under Article 40 missed contribution payment included: too complex procedures of benefit claim, less elderly lump sum than expected, unequal benefits compared to other insurance schemes, not knowing the consequences of missed contribution payment, not knowing what and how to do when having missed contribution payments, being unaware of contribution payment deadline, inconvenience with available contribution payment channels, and poverty. These findings suggest eliminating barriers and improving ease of claiming benefits, raising awareness of health risks and consequences of missing contribution payments on benefit claims, and developing out-reach communication for contribution payment alert system, and easy to access contribution payment methods in remote communities.


location: , 'Thailand year: 2016 source: HSRI

title: การประเมินสถานการณ์ของการบริการปฐมภูมิในเขตกรุงเทพมหานครด้วยการศึกษา Ambulatory care sensitive conditions

abstract: Ambulatory Care Sensitive Conditions (ACSC) are disease groups or medical conditions
that, if patients are effectively taken care of in the ambulatory setting, hospital admissions can
be avoided or preventable. This study aimed to assess performances of primary-care provision
in the Bangkok area using 13 ACSCs set by Agency for Health Research and Quality (AHRQ),
USA. The analyses were conducted by using inpatient-service reimbursement databases from
2007 to 2014 of the Universal Coverage Scheme (UC), the Civil Servants Medical Benefit
Scheme (CSMBS) and the Social Security Scheme (SSS).
The study findings indicated that it was very likely to use ACSC statistics to assess
primary-care performances in the Bangkok area. Based on the year 2011 data which was the
most complete for all population groups, the Top 3 ACSCs were urinary tract infection,
congestive heart failure and adult asthma, respectively. The other close-call groups included
hypertension and angina without procedure. Surprisingly, the hospital admissions caused by
short-term and long-term complications of diabetes mellitus were not as high as expected.
ACSCs’ Inpatient services in the Bangkok area, particularly for the UC population, were
mainly for patients from Bangkok itself rather than those from vicinity provinces or other
provinces. It was worth noted that the amount and proportion of the hospital admissions in most
of the ACSCs were highest among patients registered with private providers (e.g. private
hospitals), followed by those registered under Bangkok Metropolitan’s provider network. It was
also found that the CSMBS patients tended to be in older than UC and SSS patients in almost all
ACSCs. They were also more likely to get admitted with Hypertension and COPD, compared to
the latter two groups.
Nevertheless, ACSC might not be applicable without restriction. There were problems
with the databases as they were from different responsible agencies with differing working
processes and data-processing capabilities. Quality of the databases varied somewhat.
Moreover, data analyses were affected by the fact that the three health schemes were designed
differently in terms of beneficiary registration.
In sum, primary-care services in the Bangkok area needed improvement. The most
significant ACSC target would be around heart and vascular diseases, along with the development of ACSC measures and quality of the databases such that they could be applied
in monitoring access to and quality of primary care.


location: , 'Thailand year: 2015 source: HSRI

title: Factors Relating to Access of Medical Rehabilitation Services Amongst the People with Mobility Impairment

abstract: The methodology of this research was a Mixed method ,combination of survey research and In-depth interview. The Objective to study medical rehabilitation services situation ,  to study factors relating to access of medical rehabilitation service amongst  people with mobility impairment and to utilize information for policy planning in the aspect of development of the service system. A sample of people with mobility impairment were drawn using multi-stage sampling from 10 provinces in 4 regions of Thailand. The samples used in the research were 400. The questionnaire was used to collect the data from June to September 2013.The response rate was 97.25%. The data were analyzed using percentage, mean, standard deviation, t – test, F test, chi-square test, and Forward stepwise logistic regression analysis. The study results situation of 26 items of rehabilitation services, service sectors can provide only some items. The most accessibility of service consist of evaluation, medication and advice & councelling. While the less accessibility consist of vocational rehabilitation, skill & knowledge training for care giver and social skill training for  people with mobility impairment. Correlation factors according to rehabilitation accessibility consist of gender, medical right, type of impairment, onset of disability, travelling to the health service and public facilities. These factors can be used as a predictor of rehabilitation accessibility at 14.5 percentage.


location: , 'Thailand year: 2008 source: HSRI

title: Factors Influencing Teenage Pregnancy in Wangpong District , Phetchabun Province

abstract: This cross-sectional research consisted of a quantitative and a qualitative study. The study
was aimed at determining the factors influencing teenage pregnancy/giving birth. In the quantitative
part, 31 samples, who had given birth in Wangpong Hospital between October 1, 2006 and September 30, 2007, were selected and interviewed by using a questionnaire. In the qualitative part,
the participants were purposively selected and interviewed by using an interview guide until data
saturation had been achieved; there were eight subjects in this study. Quantitative data were
analyzed by using descriptive statistics, namely percentage, mean and standard deviation, and
qualitative data were analyzed by the process of summative analysis.
The study results showed that the majority of pregnancies were females 18 years old,
whose husbands were 22 years old. Most of them studied to the junior high school level. They were
farmers with low income. The age of first pregnancy was between 12 and 17 years and included
both wanted and unwanted pregnancies. The complications of pregnancy included preterm labor,
eclampsia, low birth weight and dystocia. The causes of the child being unwanted by the parents
were lack of knowledge of sexuality, birth control and family planning. The pregnancies that were
wanted reflected different problems, such as economic problems, and those related to family support
and the environment. Suggestions given by the pregnant teenagers were (1) be strong minded and
donût take it easy, (2) obtain a higher education before becoming pregnant, and (3) practice birth
control if one is at risk of pregnancy. These findings suggested that hospital or health services
should be offering antepartum care for pregnant teenagers in order to provide knowledge about
family planning and effective care of a pregnancy. Moreover, hospitals should also coordinate with
high schools in giving classes on sex education and family planning.


location: , 'Thailand year: 2018 source: HSRI

title: Resources for the Elementary School Health Services in Thailand

abstract: In Thailand, health promotion and disease prevention in children have been operated through school health programs with the collaboration between primary health care units and schools. This study aimed to explore the availability and quality of essential resources at school level of the Elementary School Health Services (ESHS) in Thailand. The methods used in this study were semi-structure interviews and in-depth interviews. Two provinces were purposively selected with specific sampling method, while schools were selected using simple random method. The informants included school directors and school-health teachers from 9 schools and health care workers from 3 health promoting hospitals at the subdistrict level. Although school-health teachers played an important role in this program, this study showed that most of the teachers were newly recruited with little or no experience in providing school health services and that the turn-over rate was high. This was because the unclear career path for such a position also due to inadequate training provided. Moreover, school directors mentioned about shortages of ESHS budget. Devices and equipment for health checks in most study settings were not properly maintained or regularly calibrated. As a result, health information of students was likely not accurate. Also, it was found that a lack of management and linkage between the agencies were the problems in school health services. To sum up, the school health services lacked the necessary resources in all aspects. Therefore, there was a need for knowledge development of human resources, supported budget and materials for health checks, and better management of school health services.


location: , 'Thailand year: 2021 source: HSRI

title: Outcomes of Home Health Care in Patients with Schizophrenia by Multidisciplinary Team of Donmoddaeng District Health Service Network in Ubonratchathani

abstract: Background and Rationale: Treatment discontinuation and medication non-adherence are critical problems in caring patients with schizophrenia; this could cause recurrence and serious consequences of schizophrenia. A multidisciplinary team in Donmoddaeng district, Ubonratchathani province developed a home health care, proactive approach, to promote patient care and treatment continuity. This study aimed to determine outcomes of home health care in patients with schizophrenia provided by a multidisciplinary team in Donmoddaeng district, Ubonratchathani province. Methodology: A randomized controlled trial was conducted in 60 schizophrenia patients (30 in study group and 30 in control group). All patients received usual care at the hospital. The patients in the study group received three visits of home health care by a multidisciplinary team and brief motivation counseling by a pharmacist. This study was a 6-month trial, run during July – December 2019. Clinical outcomes and quality of life were measured together with problem-solving results and patients’ satisfaction pertaining to home health care. Results: Most patients were male (study group 60% vs. control group 63%), aged above 30 years (93% vs. 67%), single (47% vs. 63%), with primary school education (67% vs. 53%), employed (57% vs. 57%), living with family (77% vs. 90%) and had disease longer than 5 years (73% vs. 53%). After brief motivation counseling, the follow up rate with doctor increased from 87% to 100% in month 1 and 2 (p = 0.043), the medication compliance rate also increased from 87% to 100% in month 1 and 2 (p = 0.043). Patients were very satisfied with home health care (4.37±0.49). At month 6, the recurrence rate of schizophrenia in the home health care group was 0% vs. 17% in control group (p = 0.020), and hospitalization due to the recurrence was 0% in the home health care group vs. 13% in the control group (p = 0.038), with average length of stay of 0 day vs. 0.60 ± 1.85 day (p = 0.040). No significant difference in quality of life scores was found (11.00 ± 10.86 vs. 9.50 ± 9.13, p = 0.7). Conclusion: Home health care by multidisciplinary team in patients with schizophrenia was effective. Healthcare facilities should support this proactive approach in order to improve efficiency and effectiveness of schizophrenia patient care.