plueme/wizJson huggingface dataset:
A retrospective cohort study using real-world data was conducted to analyze the treatment patterns of tyrosine kinase inhibitors in patients with chronic myeloid leukemia (CML), compared with the guideline for regulating drug use of the National List of Essential Medicine (NLEM) category E(2), with the purpose of determining the effectiveness of tyrosine kinase inhibitors in CML patients covered by Thailand’s universal coverage scheme and social security scheme. This study focused on the treatment patterns and effectiveness of imatinib, nilotinib, and dasatinib. Data were obtained from the reimbursement database of the NLEM category E(2) during fiscal year 2012-2018. Patients were followed up until death or the end of fiscal year 2019. Descriptive statistics and non-parametric test using Kaplan-Meier method were performed in the analysis. CML patients were divided into 3 groups based on their medical history until the time of death or last follow-up as follows; 1) patients who received imatinib only (group A), 2) patients who received first-line imatinib and second-line nilotinib (group B), and 3) patients who received first-line imatinib, second-line nilotinib, and third-line dasatinib (group C). Of 574 CML patients, there were 400, 113 and 61 CML patients in groups A, B and C, respectively. The majority of patients in each group were between the ages of 30 and 39 years old (34.2%, 36.3% and 29.5 %, respectively), with a median follow-up of 36.6, 50.7 and 47.6 months. Prior to the last follow-up or drug switching, the average daily dose of imatinib in group A, B and C was 444.3, 474.1 and 474.8 mg, respectively. Real-world effectiveness using survival analysis revealed 2-year survival rates at 84.3% (95%CI: 80.3-87.6%) for group A, 91.0% (95%CI: 83.9-95.1%) for group B and 85.2% (95%CI: 73.4-92.0%) for group C, with 5-year survival rates in each group were 83.2% (95%CI: 78.9-86.7%), 85.7% (95%CI: 76.7-91.4%), and 66.4% (95%CI: 52.3-77.2%), respectively. Average daily dose of imatinib prior to drug switching was not complied with the guideline, which recommended high-dose imatinib (600-800 mg/day). The 2-year survival rates were comparable across groups (log-rank p-value 0.295), while the 5-year survival rates in group A and B were significantly higher than in group C (log-rank p-value: group A vs. C; 0.016, group B vs. C; 0.004). However, the causes of non-adherence to the guideline could not be identified due to the lack of important clinical data including cytogenic/hematologic response, drug resistance, and occurrence of adverse drug events during the treatment of CML.
This study aimed to investigate rehabilitation services framework by the disabled and family for people with intellectual disabilities, autism and learning disabilities, and to study the feasibility of developing other necessary services for policy recommendations. Data were collected using the process of lessons learnt and the focus group discussions with service providers, people with disabilities and their families in 8 disability service centers. Then, analyzing data based on the framework, considering the care process of people with disabilities throughout their lives from birth to death and needs of people with disabilities for each age range. The ultimate outcomes were that people with disabilities could live to their full potential. The results showed that the disability services centers for intellectual disabilities and autism had similar service characteristics including family peer counseling, independent living skills and social skills training, respite care, job skills training and job coach, life stop service and family support. Obviously, there were unclearly services providing in the center of disability services for individuals with learning disability. However, lessons learned from experts, parents of people with learning disabilities and related organizations indicated that emphasis should be placed on learning skills both in school and out of school together with school buddy for teacher and family in order to increase learning skills and potentiality based on individuals’ condition. This services framework would lead to the establishment of standards for service provision in the disability services centers in the future, together with the adjustments in accordance with the guidelines for the development of service systems for the disabled in the disability services centers. It covered the issue of amending the rules and regulations related to the establishment of service centers, setting service standards, service provider development, financial support, and information system.
The coronavirus disease (COVID-19) is a massive pandemic crisis occurring across Thailand and the world. It has entirely affected the health system responsiveness of Thailand. The purpose of this study was to examine the governance mechanism and management processes in response to the first wave of COVID-19 in Thailand in 2020. A retrospective document review was conducted by studying the government’s management during the COVID-19 situation between January and December 2020 via online resources and websites, and summarized our research team’s lessons learnt from direct participation in academic and strategic supports for the Operation Center of the Center for COVID-19 Situation Administration (OC-CCSA) as well as key informant interview in the stakeholders from government, private and civil society sectors. The results revealed that crisis management differed at each step. From the preparatory phase to the full outbreak response phase, the policies and measures were unidirectionally implemented as “one-size-fits-all”. During the continuous phase, regional and provincial decentralization has been used in order to align with local context to balance between health and economic outcomes.
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.
There are an increasing number of dental specialists in Thailand especially within the Ministry of Public Health (MOPH), but information about their tasks’ characteristics is not well understood. This cross-sectional descriptive study aimed to explore the task proportion of specialists in MOPH’s hospitals and the determinants of their performance in three dimensions; work factors, health facility environment, and administrative environment. The results show that, aside from specialized dental services, 95.5% of dental specialists still provided basic services, and 68.2 % of them had documentary and administrative activities as part of their routine. On average, dental specialists allocated their working time to basic, specialized service, documentary and administrative works at a proportion of 41%, 48% and 11%, respectively. Work factors that might influence the performance of dental specialists were: 65.9% of respondents reported an intra-organizational agreement, 40.9% pinpointed the overwhelming burden of basic treatments over advance procedures. 18.2% reported low number of patients wanting specialized care, and 15.9% reported a shortage of general practitioners compared to work burden. Regarding health facility environments; 4.6% of dental specialists indicated lack of equipment for their advanced skills, while 31.8% mentioned absence of clear guidelines and systems for consultation or referral within a provincial dental service network. Regarding administrative environments; 38.6% and 43.2% of dental specialists pointed to a lack of policy and monitoring systems that support specialized dental services at provincial and regional levels, respectively. In conclusion, dental specialists in MOPH were responsible for basic and specialized services at similarly high proportions (41% vs. 48%), with additional documentary and administrative works. There are still rooms for development in terms of equipment adequacy, consultation and referral guidelines, policy direction and monitoring system.
3-Moh policy launched in 2020 aims that each family has three doctors at the community, health center (or Health Promoting Hospital) and hospitals (a district hospital and a provincial hospital/regional hospital). The three-doctor policy recognize three doctors at three levels. The first doctor or Moh#1 is a village health volunteer who provide health services at community level. The second doctor or Moh#2 is health workers of a health center or a sub-district health promoting hospital providing health services at Tumbon or sub-district level. The third doctor or Moh#3 is a family medicine at district or provincial hospital. working at district level. Furthermore, 3-Moh policy aims to strengthen primary care development in Thailand. This study aims to explore lesson-learned and implementation process of 3-Moh policy in 4 target provinces namely Kamphaeng Phet, Roi Et, Saraburi and Trung. These provinces have had outstanding primary care development and they target a full-area implementation of 3-Moh policy. Mixed method was employed to capture all information. To assess an understanding and satisfaction on this policy, a total of 644 self-administered questionnaires were completed by 597 respondents who are Moh#1 and47 respondents who are Moh#2 & 3. In-depth interview was conducted among 30 administrators at provincial, district and sub-district level, and 24 healthcare providers. The study demonstrated that 3-Moh policy notably fostered an achievement of Primary Care Act B.E. 2562. In term of quantity, these 4 provinces achieve the target on registration of health and care providers to population. However, the implementation of this policy is still far from achieving its goal in term of quality which consist of “recognition, familiarity, accessibility and trustworthy”. There are rooms for improvement to achieve the goals of this policy. Key enabling factors for success are an integration of primary care-related policies among departments at ministerial level, an establishment of primary care division at provincial health office for integrated implementation and systematical monitoring and evaluation and an increase number of family doctors which is considered as a bottleneck of this policy. In addition, key challenge in the future is decentralization of health centers to local governments which is considered to affect a relationship and implementing of this policy
The universal hepatitis B vaccination for Thai newborns was integrated into the EPI in 1992. After that HB vaccine schedule had to be changed for facility to provide the vaccination. In the future, WHO will be not provide a weakened poliovirus given by mouth to infants and changed to be an inactivated poliovirus given by injection as combine vaccine likes pentavalent (wP) or hexavalent (aP) vaccine which result in the infant will be received five doses of HB vaccination in age at birth, 2, 4, 6 and 18 months. Therefore, this study is the long term to determine anti-HBs titers in the new born whom were received combine wP or aP vaccine.This study is determine anti-HBs titer in the new borns in age at birth, 7, 18, 19, 24, 36, 48, 60 and 72 months. And the results show that aP vaccine group had the anti-HBs titer and GMT level higher than wP vaccine group. However, the vaccination in age 18 months (5th dose) was influent to stimulate anti-HBs titers more than 4th dose for the both of combine vaccine. Then the long-term study show that the ant-HBs titer was initiate decreasing at age 2 year old and rapidly dropping at age 3 year old but the GMT level was remain in the same log scale in age between 3 - 6 year old. Children aged 6 year old had the level of anti-HBs (anti-HBs ≥ 10 mIU/ml) 94.2 and 62 of aP and wP vaccine group, respectively. Thus, the 5th dose for the both of combine vaccine was influent to stimulate the long term protective HB infection likes the long term study of the antibodies persistence more than 20 years after infant received monovalenct hepatitis B vaccination. Moreover, the study of antibody response to hepatitis B after immunization with monovalent hepatitis B vaccine at birth, and DTPw-HiB-HB+OPV at 2, 4, 6 months as part of national program immunization was imitating in June, 2019. After 1 and 6 moth of the 4th dose stimulation found that anti-HBs and GMT level was highly increasing levels and similar with the results of aP vaccine group at age 7 and 18 month. Therefore, the combine vaccine in EPI program might be highly effective long term against HBV infection.
In Thailand, incidence of chromosomal abnormalities such as Down syndrome is 1:800 - 1:1,000, with the risk increasing with maternal age. However, 75-80 percent of newborns with Down syndrome are found in pregnant women who less than 35 years old. In 2016, the subcommittee on health promotion and disease prevention Under the National Health Security Board (NHSO) approved the screening of Down syndrome in pregnant women as a new benefit for pregnant women aged 35 and over, and the NHSO has had agreed to expand the quadruple test in pregnant women of all age groups (quadruple for all). In 2019, there was A report evaluating the Down Syndrome Prevention and Control Pilot Program in five provinces which found that the acceptance rate for quadruple screening was relatively high, but the results of quadruple screening were false positive around 95 percent. This situation resulted in a larger number of unnecessary amniocentesis which lead to the service system cannot support. Currently, there is a non-invasive prenatal screening test (NIPT), which is a screening test for chromosomal abnormalities of the fetus by examining the genetic material of the fetus in the mother's blood, such as Trisomy 13, Trisomy 18, Trisomy 21. This test is very high sensitivity and specificity. This study used a model decision-tree to analyze the cost and benefit of various prenatal chromosomal abnormalities screenings compared to no screening, and budget impact analysis From the cost-benefit analysis, it was found that, from a government perspective, NIPT was the most cost-effective among the three groups. It was found that pregnant women younger than 35 years had a 2.37:1 cost-benefit ratio. Pregnancy over 35 years, the proportion is 12.41 : 1 and all pregnant women the proportion is 5.44 : 1. Since the cost of NIPT testing is a factor that increases the cost-effectiveness of universal NIPT testing, at the NIPT test price of 1,805 baht (80 percent reduction) found that the increased budget from serum screening at the acceptance rate that varies from 50 to 100 percent is 19-39 million baht. In summary, there are policy recommendations as follows: Governments should introduce NIPT screening policy to screen all pregnant women nationally which may be required to limit the price of NIPT examination by various agencies to be in the range of approximately 1,800 – 2,000 baht.
Objective: The objective of this study was to identify gene or genetic variants that would be responsible cannabis dependence in Thai people. Methods: We studied 144 cannabis dependent Thai people and 20 cannabis non-dependent people using whole exome sequencing and bioinformatic analysis. We used an integrated bioinformatic pipeline that combines two techniques: gene collapsing and disease module detection to identify potential genes involved in cannabis dependence. Results: Disease module detection analysis identified a single module of 53 genes with significantly higher rate of potentially damaging variant careers in cannabis dependent group compared to non-dependent group (Percentile Bootstrap’s p-value = 0.0000337, FDR=0.024). Of this module, we found that MYEF2 (Myelin Expression Factor 2; MIM 619395) was associated with cannabis dependence in our Thai cohort (Fisher’s Exact p-value = 0.0013, Odds ratio = 2.43(1.38-4.23), FDR = 0.04). MYEF2 is a single-stranded DNA-binding protein. Its role is to inhibit transcription of MBP (Myelin Basic Protein; MIM 15940) gene. MBP regulates maintenance of myeline structure. Conclusion: We propose for the first time based on our bioinformatic analyses that MYEF2 was associated with cannabis dependence.
Over the past 5 decades the government initiated compulsory three years rural service and scaled up the production. Although the number of physicians is constantly increasing, there is a lack of policy to control their mobility. The distribution of physicians varies over area and time, increases, or decreases in their number are important issues for the healthcare system. This study aimed to examine associated factors and synthesized policy options to increase the supply of rural physicians. Mixed method descriptive research design was conducted. Data collection process comprised of STEEPV analysis from document review, expertises indepth interview, rural physician stock and flow analysis, survey of factors associated with rural retention among 121 last 5 years graduated physicians, applied DCE method to determine job preference among 400 last year medical students and introduced Modified Delphi method comprising panelist with 32 expertises to develop policy options. Findings showed that 1. ageing society, chronic diseases, urbanization, technology disruption are major driving forces to transform health care system in Thailand. 2. COVID-19 impacts are still to be determined. 3. primary care is a foundation of population health improvement, any where any time service is needed. 4. Tele-health, Digital health and rapid change of advance medical & information technologies can reduce the geographical imbalance in the health workforce and increase health care accessibility. 5. urban facilities, specialist residency training and low intensity of workload are preferable job characteristics among young generation of physicians. 6. rural background physicians retain in rural areas longer than others 7. Ten policy options with high impact to retain rural physician and high possibility to implement include 1) targeted admission 2) promote task shifting & sharing among health professionals with appropriate training and regulation 3) senior/expertise supervision system 4) Telemedicine/Tele-consultation strengthening 5) prosecution support 6) fair performance based payment 7) career advancement 8) good work-life balance and manageable workloads 9) cooperation among all sectors to share resource in local area 10) Decentralized HR management in the regional level to improve performance. This study suggested to improve important interventions of compulsory service, taking multiple factors of rural retention into distribution strategy. Increasing reasonably penalty rate, non-civil servant employment and demand side financing for medical students are policy measures that should be improved based on the evidence from further studies.
When high–price drugs or new drugs with immature information about their efficacy come to market, will cause uncertainty in the health systems, especially for health–service buyers as the payers in the health systems. Managed Entry Agreement (MEA) is the tools for manage uncertainty that are widely used in many countries such as United Kingdom, two third of OECD member countries, European Union countries. MEA can be divided into two types: financial–based agreement and performance–based agreement. The financial–based agreement aims to limit budget impact through controlling drug costs. It is a simple method, effective in reduce drug prices and limit budget impact, but the details contained in the agreement are confidential, resulting in a lack of transparency. It may give some payers the benefit of such details. It can be implemented at 2 levels: population level and patient level. At the population level, consists of MEA in the model of discount / rebate, price–volume agreement, and expenditure cap. At the patient level, consists of MEA in the model of free initiation treatment and utilization cap that provides individual patient coverage. The performance–based agreement is an agreement based on the actual treatment efficacy. Sometimes referred to as health outcome–based agreement. This agreement is divided in two groups. The first group aims to optimize drug use, known as performance linked reimbursement, which consists of MEA in the model of conditional treatment continuation and pay by result. The second group aims to address uncertainty about drug efficacy with more research studies. This model of MEA is known as coverage with evidence development, or CED. It is a good solution to the problems, but it is complicated to operate, and affect stakeholders in the health systems widely, and high cost in operation. However, the decision–makers in the health system should carefully consider in the selection and implementation of MEA, as each model of MEA has different strengths and limitations, for efficient budgeting and equal access to medicines.
The study of a situation analysis and system development to increase the accessibility of assistive devices with telehealth, Phase 1 was survey research. by surveying the situation of access to assistive devices in the type of wheelchairs in Thailand regarding the supply of wheelchairs, service and access systems, system gaps, obstacles, and development opportunities as well as the possibility of implementing telehealth systems. Then develop a model of a system to increase the accessibility of wheelchairs with telehealth. The study found a wheelchair for Persons with a physical disabilities to be able to be independent living, it needs to be a customizable type of device with the physical condition and lifestyle of each person with disabilities. However, it was found that the wheelchairs that can be disbursed from the three health security funds are non-adjustable metal folding wheelchairs. which is not suitable for people with physical disabilities. At the same time, a customizable wheelchair for people with disabilities can be disbursed from the list of high-value assistive devices from the Sirindhorn National Institute for Medical Rehabilitation only. causing limitations because Persons with disabilities must pick up the equipment at Sirindhorn Institute. Or even there will be a development of hospital networks in 5 provinces to be able to disburse this type of equipment. It still doesn't add much to the device's accessibility. Combined with the disbursement of such wheelchairs, body measurements, angular measurements, adjustments, and trials are required to ensure that people with mobility disabilities get the right equipment for their disability. which requires experience and knowledge of service. Therefore, training courses for providers and intensive consultations between Sirindhorn Institute and the hospitals that provide services by telehealth will help people with mobility disabilities get a truly suitable wheelchair that is for each person with disabilities under the system model which must be further implemented piloted in the second phase study.