plueme/wizJson huggingface dataset:
Background and rationale: Chronic kidney patients with renal replacement therapy were at risk of COVID-19. During COVID-19 pandemic with social distancing practices, hospitals postponed patient’s appointments. Methodology: The purpose of this mixed-method study was to develop and examine the effectiveness of telemedicine model in caring for peritoneal dialysis patients from lessons learned during the COVID-19 pandemic. The samples included 2 nephrologists, 6 pharmacists, 10 peritoneal dialysis nurses, and 80 peritoneal dialysis patients. Purposive sampling was used to select the participants. The study comprised 3 phases: phase 1 situation analysis; phase 2 design and development of a model of telemedicine service for peritoneal dialysis patients; and phase 3 result study of the telemedicine model by comparing the treatment time, cost and satisfaction. The research instruments covered a semi-structured interview guide, feasibility questionnaire of telemedicine model, cost record form, and satisfaction questionnaires for multidisciplinary team and peritoneal patients and caregivers. The quantitative data was analyzed using descriptive statistics, Wilcoxon signed-rank test, and paired t-test. Results: 1. During COVID-19 pandemic, patients and their caregivers have difficulty getting to the hospital as scheduled, the continuity of taking medication and the limitation of home visits. Patients and multidisciplinary teams suggested that during COVID-19, the methods of care should be adjusted, using telephone online platforms, such as Line application, to provide patients and caregivers the knowledge to promote self-care. The applications should be downloaded onto a mobile phone for immediate communication with the doctor and nurse when abnormal symptoms and problems were found. 2. According to patients and care providers, the feasibility of a telemedicine model in caring for peritoneal dialysis patients was moderate at the beginning. The model was rated highly by the multidisciplinary team, patients, and caregivers at the conclusion of the intervention. 3. Three patterns of patient journeys of peritoneal dialysis patients were identified based on clinical status of the patients: a well-controlled, a moderate control, and an uncontrolled symptom group. and 4. medication management of erythropoietin (EPO) and other medications for chronic kidney disease and co-morbidities were delivered through a nearby client hospital network. Discussion and conclusion: The cost of telemedicine model incurred higher capital costs at periphery. The higher number of services should lower the unit costs. Telemedicine was proved to be a feasible model of providing care among patients who had good disease progression control and reducing hospital visits. Therefore, the health service may develop and expand the results of this study to other chronic diseases. The provider should combine telemedicine with outpatient service.
This mixed-method study aimed to investigate the impacts of the coronavirus pandemic on occupational therapy (OT) services in Thailand and to explore the feasibility of adapting international service models into the Thai context from OT’s perspective. One hundred fifty-three occupational therapists were asked to complete the questionnaires, and 45 OTs were invited to participate in focus group discussions. The lockdown measures and the increasing number of COVID-19 patients in Thailand meant that rehabilitation services were classified as non-urgent. Many patients endured irregular service for an extended period affecting their recovery and performance. Three types of OT services were developed to deliver services in the “new normal” situation: on-site; telehealth; and hybrid. OTs redesigned the services according to patient demand and need: orofacial motor skill training; outcome measurement and follow up; home program counseling; screening and history taking; functional assessment and telephonic monitoring; Line application; material or equipment delivery to home; social skills group training as a hybrid service; and educational video production. OT telehealth remains a challenge for efficiency implementation. Policy recommendations include developing clinical practice guidelines for efficacious and cost-effective OT telehealth services. Upskilling and reskilling training courses should be available to occupation therapist. The government should provide telecommunication infrastructure for equal access to OT services to all who need.
The purpose of this mixed-method study was to synthesize policy recommendations on nursing workforce development: production, distribution, and retention during the COVID-19 pandemic. The quantitative data were collected from 396 samples through the questionnaire on actual and expected workforce retention operations due to the COVID-19 pandemic. The qualitative data were collected from 120 subjects through in-depth interviews. The findings were as follows: 1) Pre-pandemic situations of production, distribution, and maintenance of nursing workforces relied on the production plans of educational institutions. The teaching style and the distribution of nursing profession were based on big hospital setting, and the maintenance of nursing workforce as a whole was inappropriate to workload. 2) During the pandemics, the production plan did not change. However, a variety of functions and skills needed to deal with changing situations were delivered through on-line and in class to learners to solve the skill shortage problems. The movements of trained nursing workforces to cover high nursing care needs at the primary, secondary and tertiary levels of field hospitals in the community up to the intensive units in hospital. Retention measures were found in various compensation plans appropriate to the increased burdens and risks. 3) Post-pandemic policy proposals for nursing workforce were on the production, distribution, and maintenance. On the production side, long-term production plans should take account of the actual needs of the country’s health service system. In terms of distribution, there should be a review and planning the distribution of nursing staff in health care facilities at the ministry level, regional health systems and health care facilities at all levels systematically to have appropriate number of workforces according to geographical contexts, population health needs and levels of nursing services complexity. In terms of workforce retention, guidelines should be developed for building nurses morale and motivation.
In the situation of the COVID-19 pandemic, people were stressful due to the impact on social, economic and health situation from the pandemic. As a result, the number of people with mental health problems and the burden of mental health problems has been increasing. Recognizing the importance of mental health issues during the COVID-19 pandemic, Thailand proposed a mental health preparedness and response for the COVID-19 pandemic as the agenda of the 148th session of the World Health Organization Executive Board and played a leading role in developing a decision on this issue with supports by many countries. Thailand’s movement on mental health was the result of close collaboration between different organizations, continuous investment on capacity building of potential global health personnel and a strong network with countries and the WHO. Therefore, what Thailand has gained from driving mental health issue on the global platform is building a positive role and image of Thailand, incorporating Thailand’s interest into a decision and adapting lessons from other countries on mental health into Thai context.
The National Health Security Office (NHSO) has encouraged the free treatment of patients with acute ischemic stroke with thrombolytic treatment starting in 2008 only at university hospitals in Greater Bangkok. Subsequently, the aforementioned treatment services have been expanded to all areas in Thailand. The challenge of such treatment is that the time from the patient’s neurological symptoms until receiving thrombolytic treatment must be within 270 minutes as soon as possible. A shortage of neurologists in the provinces challenged the development of stroke service network. Using the principles of NETWORK (N: national standard, E: engagement, T: teamwork, W: wisdom, O: organization, R: reach target, K: knowledge management) and STANDARD (S: seamless, T: timeliness, A: awareness, N: network, D: drug available, A: ability, R: referral system, D: district health system) enabled nationwide service expansion in 2011. The current rate for acute ischemic stroke patients with thrombolytic treatment was approximately 8%.
Health maintenance organization (HMO) is one of interesting models for responding to Social Security Office’s (SSO) medical service developments. Therefore, feasibility and acceptability of stakeholders were needed to be studied for further planning decisions. Methodology: This policy research study was to assess the feasibility and acceptability of three proposed HMO models with the SSO transforming into supervisory and monitoring roles. Model one was the HMO through a large private hospital network; model two, HMO through the public health insurance or regional health system; and model three; HMO through a private insurance company. Four key informants groups were selected by using purposive sampling including 1) policy executives serving as HMOs, 2) service providers, 3) service users, and 4) executives or experts with relevant roles. Qualitative data were collected, and content analysis was performed. Results: HMO model two was the most feasible model regarding service area coverage, economies of scale, experiences of management and credibility, etc. However, there were other challenges such as regional health system capacity. Stakeholders concerned that insurer’s overhead cost would take away the desirable benefits of service users, especially in private HMOs that might have a for-profit culture. Some opinions suggested on more precise improvements of the current system instead of establishing HMOs. In addition, they disagreed on the sub-district health promoting hospital acting as gatekeeper at primary care level, as this would deprive user’s rights and create barrier of access to health services. Conclusion and discussion: Although the proposed HMO model two was considered the most possible, skeptics were on limited competitions within the HMOs. HMOs might not reduce the health expenditures because of overhead cost and long-term investment in primary care system. Further study should consider possible competitive HMO models or other HMOs in Thailand such as medical schools network.
This study focuses on establishing health workforce data sharing platform between health professional councils and the Ministry of Public Health. Minimal dataset adopted from WHO’s recommendation was created. This standard dataset was agreed by all health profession councils according to Thai’s context. This essential data for each health profession is basically required for planning and management for national and organization level. International definition was kept in mind for future global comparison. Essential personal data includes personal identification number, name and surname, birth history information, current address, contact information, and a professional license. Certification of education and training, employment status, and address of the place of employment. Moreover, the centralized platform has been created to facilitate the collection of data for supervision, monitoring, evaluation, and research between related sectors particularly health professional councils and the Ministry of Public Health. Establishing of a data link and personnel registration system Establishment of a system for registering professional personnel It complies with several operational standards regarding hardware equipment, software, and adequate vocational training. And data storage is mandated by law. The main result aims to strengthen the national health workforce core indicators to facilitate policy makers to establish proper plan, effective management, and good monitoring system on health workforce both national and sub-national level
This study aimed to study attitude of health workforce toward primary health care management to examine, synthesize, and develop appropriate model of people public private partnership (PPPP) for managing primary health care. Quantitative and qualitative methods were used in this study. Data collection was conducted in two study areas namely Kuchinarai district, Kalasin province and Dansai district, Loei province. Samples in this study included 61 participants for quantitative and 44 participants for qualitative data collection. They were from community, private and government sectors. Nonetheless, they were identified as executives, implementing staff and common people. The result revealed that samples had relatively high positive attitude toward partnership among people, public, and private sectors. The samples thought that contributing factors of partnership model for primary health care management included 1) national policy, 2) strong health leadership, 3) homogeneous and closerelationship community, and 4) natural and man-made environment capitals and social capital. While hindering factors that the samples figured out were 1) the red-tape system, and 2) lack of resources (human, money, material and knowledge). Processes of developing PPPP for primary health care management included 1) developing relationship among partners, 2) building trust and safety zone of working together, 3) having continuing knowledge communication, 4) empowering each other, 5) strengthening and expanding network, and 6) working together under the rules, regulations and committees. The samples believed that this partnership model could contribute to four dominant outcomes including 1) health outcome (not only access to services in the community), 2) economic outcome, 3) environmental outcome, and 4) learning and knowledge outcome. To materialize the model in other areas, the following two broad recommendations are proposed: 1) integration of the partnership model in the district health system (DHS) that could benefit primary health care in terms of human resource, budget and other resources efficiently; 2) all related stakeholders and their staff should acquire knowledge, skills and positive attitude toward partnership model among three sectors for primary health care management.
This study aimed at analyzing the level of system governance of the participatory health region and the committee roles on system governance; and categorizing system governance of the participatory health regions at national level. Mixed methods of both quantitative and qualitative studies were used. The study covered 13 health regions. The study population consisted of 638 committee members and secretariat teams. Quantitative data were collected by self-administered questionnaires designed according to United Nations’ good governance criteria, and analyzed by descriptive statistics and exploratory factor analysis. Qualitative data were collected by in-depth interview, focus group discussion, report review and observation, and analyzed by content analysis. The study took 15 months from October 2018 to December 2019. Quantitative analysis showed that the participatory health regions had high system governance level since all components got scores greater than 2.5. The top three highest scores consisted of following the rules of law (score 4.01), equity and inclusive coverage (score 3.91) and transparency (score 3.81). The three least scores included efficiency and effectiveness (score 3.65), accountability to people (score 3.66) and responsiveness to target population (score 3.72). Qualitative data analysis revealed 20 important committee roles on the system governance. Holistic care provision and regular meeting reporting got the same highest levels (score 4.04) while the least achievement role was on fulfilling the setup plans (score 3.48). By factor analysis, two categories of system governance were found: the planning and the implementation process. The present study suggests that the network governance can be used to strengthen both the National Health Security Office’s area health and the regional health of the Ministry of Public Health. Public relations, experience sharing in working with soft power, and building collective leadership are recommended for improving system governance. The weakness of the present study was the lack of impact evaluation.
The objectives of this research study were to (1) examine the type 2 diabetes patient journeys and (2) synthesize recommendations on communication campaign contents to reduce the number of new type 2 diabetes patients. Two qualitative methodologies were applied in this study. First, 26 purposive samples from 8 provinces in different regions of Thailand were recruited for in-depth interviews. Second, focus group discussion was employed to collect data on the contents of the communication campaign. The results revealed that the type 2 diabetes patient journeys were divided into three stages. In the initial stage, the risk group exhibited habits that contributed to diabetes in terms of consumption and physical activity. The under 35-year-olds also lacked access to diabetes screening and had misconceptions about type 2 diabetes causing them less aware of the risk of developing the disease. The second stage was the beginning of treatment. Patients chose to come for screening after seeking advice from their family member, village health volunteer, the mass media, and after they themselves faced physical conditions interfering with their daily lives. The beliefs in high blood sugar findings and doctor’s advice were the driving force for seeking treatment. Additionally, patients started seeking more information on diabetes through various means. The third stage was to live with diabetes. Patients acknowledged having disease, yet often reported feeling stressed when they were unable to control their blood sugar levels or encountered diabetes-related problems. There were two main categories of content suggestions for developing communication strategies for lowering the number of new cases. The first was the hygiene content for regularly delivery, such as, food and drink risk behaviors, and physical exercise. The second was the hero content to increase awareness on dangerous complications of the disease.
Although the Pharmacy Council has launched the Guidelines for Telepharmacy, it required additional details for implementation. The present study aimed to develop the standard practice for telepharmacy and guidelines for pharmaceutical care and to design data architecture that supported and facilitated the operation of telepharmacy. This developmental research was designed into 2 phases. The first phase combined literature review, focus group discussion, and stakeholder hearing with the aim of developing the basic guidelines for telepharmacy and guidelines for pharmaceutical care. Minimum dataset consisting of patient data, prescription, dispensing, logistics, and guidelines for pharmaceutical care was an output and recommendation of phase I study. The results from the first phase were inputs for stakeholder consultation of the second phase. The output of phase II study was the telepharmacy data architecture compliance to HL7 FHIR (health level 7 fast healthcare interoperability resource) for telepharmacy data sharing consisting of patient personal information, health data, treatment history, and logistic statistics. The recommended data architecture of the phase 2 study was named “Thailand Telepharmacy Profile”. Finally, this present study proposes the Pharmacy Council of Thailand to implement the guidelines and standard data set.
Diabetic retinopathy (DR) is one of the most common microvascular complications in diabetes patients as well as one of the most important causes of blindness worldwide. Therefore, DR screening is vital for health care system to prevent blindness. Although, in Thailand, we utilize the percentages of diabetes patients who undergone DR screening program as an indicator of effectiveness in eyes health services, this indicator is not directly reflect the number of diabetes patients who truly go to see retinal specialists for proper management. As a result of the problem mentioned above, this prospective study aimed to compare referral adherence of diabetes patients screened by artificial intelligence (AI) with integrated system group with diabetes patients screened by health care personnel (manual or conventional group). In this study, we screened DR using fundus camera which connected with digital health platform and divided diabetes patients into artificial intelligence (AI) group and manual (conventional) group week by week for 8 month period. However, fundus photo in AI group were reviewed by retinal specialist (overreader) from tertiary hospital and mismatch cases were contacted. Furthermore, referral information was recorded by nurse at tertiary hospital to evaluate referral adherence. Total 1,454 patients included for our analysis (708 patients were screened by AI and 746 patients were screened by manual). Referral adherence of patients diagnosed as referral diabetic retinopathy in AI group was more than manual group and even more than manual group who referred from uncertain fundus images (89.15%, 72.7% and 70.73%, respectively.) Moreover, screening health care personnel’s satisfaction increased after deployment of AI. In conclusion, implementation of an integrated system of artificial intelligence in real clinical setting may improve efficiency in DR screening and also increase referral adherence of diabetic retinopathy patients.
The coronavirus disease 2019 (COVID-19) pandemic has spread across the globe and impacted everyone, everywhere. Despite COVID-19’s negative impact in several aspects, this pandemic has created an opportunity for researchers to explore new research questions and approaches to the challenging situation which the world is facing with the overall aim to support our communities. The purpose of this study was to address policy-relevant questions arising from the COVID-19 pandemic by investigating the impact of COVID-19 on outpatient (OPD) and inpatient (IPD) service utilization, ambulatory care sensitive conditions (ACSCs), mental health, low-value care (LVC), and mortality. Literature reviews and analyses of real world data from existing administrative databases were used to achieve the overall goal of creating evidence to support the healthcare system in Thailand. In conclusion, this study can consider to be the first study that use real-world data from existing administrative databases to address policy questions. The study delivers outputs on two main areas: 1) answering policy-related questions; and 2) raising new topics for future research based on the study results. This study seeks to turn a crisis into an opportunity and our research team hope that it will help spark and create a foundation for many further studies.