plueme/wizJson huggingface dataset:
District health system considered as a lever point to improve the quality of life of people which mechanism of driving in the district area rely on district health board in which the development process would be sustainable successfully, the process must be consistent with the context of the area and the empirical information is needed for the decision. The objectives of this study were to develop the geographic information system for health management of the district health board and to synthesize the purposed policy of using the geographic information system to improve quality of life among population in the area. Mixed method of research and development design integrated with participatory action research (PAR) were applied in the study. The study processes divided into three phases: phase 1: the development of geographic information system to improve quality of life, phase 2: the assessment of the implementation of the system, and phase 3: the synthesis of purposed policy in the development of the system. The study was set in two districts of Nakhonsawan province. The finding showed that: 1. The development of geographic information system to improve quality of life had five steps: 1) the study of essential information, 2) the distribution of data resources both in an original database and new information, 3) the connection of essential information from the database of organizations which related to the improvement of quality of life among population in the area, 4) the creation of conditions for analyzing data and presenting in the program that called Geographic information system: GIS through website (http://118.175.82.80/dhb/web/index.php) in which general population and the district health board can access to by computer and mobile phone but in a different level, and 5) the implementation combines with decision making in determine issues for improving quality of life of people, planning and evaluation 2. The assessment of the implementation of the system revealed that the for the long term care of vulnerable group, especially the elderly is thoroughly taken planning of care, can access to essential services and social welfare, and having skills for self-care that help to reduce the risk of complication from their existing diseases. 3. The synthesis of purposed policy in the development of the system had four issues:1) having district health data center for quality of life improvement, 2) having organizational structure in geographic information system management, 3) having the potential development of the committee in using information for decision making related to public health, and 4) having an exchange process for learning from practice. Therefore, in using geographic information system for the decision making to improve the quality of life of people in the area, the district health board must use the empirical information which consistent with the context of those areas. These will lead to the management of population health which is the true concept base of the district health system as saying that “The development that use community as base and people as center”.
Although, Thailand has been committed to fight against irrational use of antibiotics since 2007, an inappropriate use of antibiotic continues to occur among Thai population. Therefore, the situation poses a significant challenge to the efficient working of the national rational antibiotic program in Thailand. The objective of this research was to examine the relationship between eHealth literacy, information seeking, knowledge, attitude and self-management of upper-respiratory infection (URI) in Thai population. The quantitative approach was employed in this study. The self-administered questionnaires were distributed to 2,708 respondents who resided in 21 provinces across four regions of Thailand. The results demonstrated that respondents reported low level of eHealth literacy on the ability to evaluate the health information on the internet. Respondents were more likely to seek information regarding the treatment of upper-respiratory infection from member of the family. The overall level of knowledge on antibiotic was moderate. Respondents had a positive attitude toward antibiotic usage and reported a low level of self-management of upper-respiratory infection. Findings of this study offer useful insights into the communication program for the reduction in antibiotic usage for upper-respiratory infection among Thai population.
Thailand has achieved Universal Health Coverage since 2002. Consequentially, almost all Thai citizens
are covered with basic oral health services by publicly funded insurance schemes. However, the
proportion of Thais who receive such services is still low with inequity patterns among different groups
of people. The purpose of this study was to analyze the equity in oral health service among Thai citizens
through patterns of oral health service uses as well as unmet oral health needs by using the 2017 Health
and Welfare Survey by the National Statistical Office of Thailand. The result revealed that 9.6 percent of
Thai population received any oral health service within the past 12 months. Most (81.6 percent) of service
uses were for treatments. The main reasons of not seeking oral health service were the delays and prolonged
waiting time. On the unmet oral health needs, 1.4 percent of the population with oral health
needs was not met. The populations with no health benefits, the aged, and the lowest socio-economic
status saw twice as many unmet oral health needs compared to other population groups. These groups
received the least oral health services. The survey showed the inequity of oral health service utilization,
particularly among populations with different health benefits and different socio-economic status. This
indicates the necessity of oral health policy that responds to the needs of the people and creates an
equitable oral health service system; in particular, promotes oral health literacy, builds harmony among
three public health insurance schemes, and expands the scope of services so that people have better
accesses to necessary services.
In Thailand, a series of National Health Examination Surveys (NHES) have been conducted every
five years since 1991. The NHES employed two approaches for data collection including basic physical
measurements and structured interviews. The NHES exclusively provided objective information on health
status and health risks of the population which cannot be obtained from other sources. Consequently,
this information has been used for development of health promotion and disease prevention policies
as well as for monitoring health indicators and policies. Throughout 25 years of the NHES, no systematic
evaluation of the survey’s management has been conducted. The present study evaluated the NHES
management system in four areas covering the role of agencies responsible for conducting the NHES;
resources used for conducting the NHES; database management and the utilization of the NHES data;
and ethical issues related to access to the NHES database with the aim to provide policy recommendations
for future developments. The present study collected data through document reviews from September
2016 to January 2019 and in-depth interviews with 26 people including personnel in funding
agencies, survey managers, researchers who were part of survey networks and potential data users from
December 2016 to April 2017. The scope of literature review and questions for in-depth interview included
the NHES I-V. The present study found that NHES I-V involved many agencies in different capacities such as responsible
agencies for conducting and managing the survey, funding agencies, and steering committees.
There were frequent changes of agencies responsible for conducting NHES reflecting the lack of long-term
policies regarding the implementation of NHES. Every NHES reported budget constraints, yet there remained
neither budget allocation from the government in the long run nor long-term funding agencies.
Hence, the agencies implementing NHES had to propose budget request for each survey. These limitations
inhibited long-term capacity building on survey practitioners and institutionalization. Furthermore, policies
and guidelines for the utilization of NHES data and other information were vague. Although there was a
guideline drafted in the IV NHES, the guideline has not been put into practice making it difficult for researchers
outside the NHES networks in getting access to NHES database and specimens, hence NHES
data have been under-used. On the other hand, some health issues investigated by the NHES might be
duplicated with those of other health surveys conducted by the National Statistical Office or other
higher education institutes granted by the same funding agencies as the NHES. Therefore, it is highly
suggested that relevant authorities should consider the integration of health surveys at the country
level in all aspects.
The Thai Peritoneal Dialysis First Policy (PD First Policy) has improved
survival of end-stage renal disease patients since 2008. However, evidence on patients’ attitudes toward
the policy and the accessibility to kidney transplantation (KT) has been lacking. This study aims to assess
PD care satisfaction and KT attitude among continuous ambulatory peritoneal dialysis patients under the
Thai PD First Policy. Methodology: A telephone questionnaire survey asking demographic data, general
opinion on PD First Policy, PD treatment satisfaction, and KT knowledge and attitude was conducted in
April 2018 among 114 randomly selected PD patients from PD centers in Chanthaburi. Results: The mean
age of PD patients was 54.21 years, and their duration of peritoneal dialysis was 3.42 years on average.
Majority of them were satisfied (79.8%) and very satisfied (4.4%) whereas only 2.6% expressed their
dissatisfaction. One hundred and six patients (93.0%) agreed with PD First Policy, of which 65.1% stated
that this policy had saved their expenses. Of the total 114 patients, only 24.6% had KT knowledge but
73.7% would like to undergo KT. The main motivation for KT was the increased chance of returning to
work and contribute to family (88.7%). Conclusions: The Thai PD First Policy has been well received.
The perceived need for KT was high. A good strategic plan to improve knowledge on and access to KT
is required.
Background & Rationale: Ministry of Public Health introduced “antibiotic use in vaginal delivery of
normal term labor” as an indicator of rational drug use (RDU) service plan with target goal of not more
than 10% use. Mahasarakham Hospital implemented this RDU policy in October 2016 via meetings,
setting a goal and practice guideline together with regular monitoring and evaluation. The objective of
the present study was to examine effects of the RDU policy on antibiotic use, expenditure on antibiotic
and infection rate after implementing the policy among vaginal delivery of normal term labor in
Mahasarakham Hospital. Methodology: A retrospective study was conducted using hospital data of
vaginal delivery of normal term labor during October 2015 to April 2018. Antibiotic use and expenditure
were obtained from the 43-file standard dataset. Infection rate was collected from readmission record
of obstetrics and gynecology department. Patterns of antibiotic use after implementing the policy were
investigated from medical record reviews between October 2017 and April 2018. Mann-Whitney U test
was performed to compare antibiotic use rate and expenditure and infection rate between before (October
2015 – October 2016) and after (November 2016 – April 2018) policy implementation. Segmented
regression of interrupted time-series analysis was applied to examine policy effects. Results: Comparing
before and after policy implementation, the antibiotic use rate and expenditure were declined significantly
(median antibiotic use rate: 100% vs 13.2%, p<0.001 and median expenditure per month: 8,368
baht vs 1,328 baht, p<0.001). The infection rates were not significantly different (median: 0% vs 0%,
p=0.222). From time-series analysis, the policy significantly decreased antibiotic use rate (-82.1%, 95%CI:
-87.3 to -76.9, p<0.001) and decreased monthly-expenditure of antibiotic use (-6,663.2 baht, 95%CI:
-8,396.7 to -4,929.8, p<0.001) but no effects on infection rate by month (0.063%, 95%CI: -0.280 to 0.406,
p=0.709). From chart review of 721 vaginal normal deliveries, 45 women (6.2%) used antibiotics. The
major reason of antibiotic use was the 3rd - 4th degree tear (14 women, 31.11%). Amoxycillin and Cefazolin
were mostly used antibiotics. Conclusion: The findings of this study indicate that implementation of the
RDU policy significantly reduced antibiotic use and expenditure and did not increase infection rate. The
policy could improve rational use of antibiotic prophylaxis in vaginal delivery of normal term labor.
Kanchanaburi province borders with Myanmar and a large number of migrants are cared for at
Phaholpolpayuhasena Hospital. Financial expenses in providing care to migrant patients were analyzed.
The study population was inpatients and outpatients at the hospital during fiscal year 2017. Data collection
techniques involved a questionnaire, interviews and document reviews of medical records for the
previous year. A convenience sampling method was employed. Total sample size was 519 (412 outpatients
and 107 inpatients). Of the 412 outpatients, 305 had no admissions during the previous year, while 107
had been admitted in the hospital. The results showed that 18.4% of the outpatients and 38.3% of the
inpatients were not medically insured. When classifying patients according to the most costly disease
group, cancer comprised the highest proportion in the outpatient sample at 63,459 (SD 82,872) baht per
person per year. For communicable diseases, the largest group in the inpatient sample cost 43,100 (SD
53,384) baht per person per year. Costs of medical treatment and expenses, as quoted by the hospital,
were averaged at 15,757 baht per person per year for outpatients, with inpatients at 35,280 baht per stay.
Results from focus group discussions with various stakeholders showed that expenditures of Phaholpolpayuhasena
Hospital, Samutsakhon Hospital, Krathumbaen Hospital, and this research study in terms
of relative weight greater than or equal to 2 units were 19.2%, 5.3%, 2.4% and 23.4%, respectively, while
in terms of relative weight greater than or equal to 4 units were 5.8%, 1.9%, 1.2% and 3.7%, respectively.
The top 5 outpatient diseases were cancer, trauma, non-communicable diseases, neonatal problems,
and obstetrics, while the top 5 inpatient medical departments which admitted high numbers of migrant
patients were medicine, surgery, obstetrics, orthopedics, and pediatrics, respectively.
Results can be used to formulate a support policy to mitigate the cost burdens incurred by hospitals
in border provinces. A policy of cooperation with neighboring countries should be proposed by the
Ministry of Public Health to develop adequate medical facility capacities and also review the cost of the
health insurance card scheme for migrants to reflect the cost of medical treatment. Most importantly, a
policy should be implemented to adjust budget allocations to border province hospitals to cover the
cost of treating migrant patients.
This mixed method research aimed to study perception and satisfaction of stakeholders towards national health security system in Health Region 10. The data were collected by questionnaire and semi-structured interview. Data analysis was done by using descriptive statistic and content analysis. The results of this study were based on interviews with 294 clients aged between 15 - 77 years old, and 304 service providers aged between 22 - 59 years old. Perceptions of all aspects of the national health security among providers and clients were high to highest, and satisfactions on national health security among providers and clients were highest. Their recommendations included: health promotion and
disease prevention should be emphasized; cross-boundary medical expenses should be allowed to
manage locally; fund should be transferred directly to health promoting hospital; personnel of the local
government organization should be trained on relevant regulations of fund management.
Objective: To determine the frequency of symptomatic hypoglycemia and its associated factors and fear of hypoglycemia in a population of elderly patient with type 2 diabetes at primary care unit of Songklanagarind Hospital. Methodology: This cross-sectional study was conducted from July to October 2018 at primary care unit of Songklanagarind Hospital. The participants aged 60 and older with type 2 diabetes were included. The socio-demographic characteristic questionnaire was interviewed by a researcher or research assistants. Baseline clinical data, included body weight, height, underlying disease, duration of diabetes, complications of diabetes (diabetic retinopathy, diabetic nephropathy, cerebrovascular, peripheral vascular, neurovascular and diabetic foot complication), HbA1c, fasting plasma glucose, type and dose of glucose lowering drugs, were reviewed from the hospital information system (HIS). The participants were asked on their experiences of hypoglycemic symptoms in the previous month. Fear of hypoglycemia was measured by the Thai version of Hypoglycemia Fear Survey (HFS) covering behavior subscale (HFS-B) and worry subscale (HFS-W). The higher scores indicate higher fear of hypoglycemia. Chi-square, Wilcoxon, and Fisher tests were applied to study significant variables. Logistic regression analyses were performed to evaluate the associations between associated factors and hypoglycemic symptoms. Results: Overall, 160 participants were involved (mean age 68.6 ± 6.1 years, 53.8% females, diabetes duration of 10.5 ± 6.4 years, 57.5% diabetic complications, 7.5 ± 1.8% HbA1c), of whom 30% reported hypoglycemic symptoms. The associated factors of hypoglycemic symptoms were diabetic
complications (aOR = 2.75; 95% CI 1.23 - 6.14; p = 0.012), glipizide use (aOR = 5.03; 95% CI 1.99 - 12.71; p < 0.001) and fasting plasma glucose (aOR = 0.97; 95% CI 0.96 - 0.99; p < 0.001). The mean of hypoglycemia fear survey score was 16.9 ± 16. The score on the fear of hypoglycemia (HFS) and
worry subscale (HFS-W) for the patients with more frequent hypoglycemia episodes in the previous month (>2 episodes) was significantly greater than another group (1-2 episodes) (p = 0.006 and 0.002), indicating a greater degree of fear of hypoglycemia in the first group. Conclusion: The occurrence of symptoms of hypoglycemia is one of complications in the elderly with type 2 diabetes and their presence is associated
with complications of diabetes and glipizide use. Frequent symptoms can have a negative impact
on fear of hypoglycemia. Minimizing the risk of hypoglycemia represents a high priority in the diabetes
treatment of the elderly people.
This research had two major objectives: 1) to determine incidence, access to treatment and clinical outcomes of patients with cerebral aneurysm who received clipping or coiling procedures; and 2) to examine whether coiling instrument should be included in the reimbursable list of beneficial package for patients under the Universal Coverage Scheme. Although coiling procedure has been performed worldwide, a slightly increasing rate of patients receiving coiling procedure in Thailand was observed during 2012-2018. In addition, increasing rate of patients under the Universal Coverage Scheme receiving clipping was significantly higher than that of those receiving coiling. Since the year 2012, survival rate among patients undertaking clipping was higher than the rate in 2006-2011. This finding did not support the hypothesis that patients receiving clipping had poorer prognosis than those receiving coiling or clipping was performed only in those who were not candidate to coiling. Survival rate of patients receiving clipping in the university hospitals was higher than those in the Ministry of Public Health (MOPH) hospitals and non-MOPH hospitals. Survival rate in hospitals with high volume of intervention (clipping or coiling >30 cases/year) was higher than the hospitals with low volume of intervention. Access to treatment and clinical outcomes varied across the health regions. Collaboration among the health regions to improve referral system for enhancing the service efficiency and patient outcomes should be addressed. Planning for neurosurgery or radiology manpower who have a specialized training for endovascular coiling should be considered, especially in the university hospitals. Based on the societal perspective, incremental cost effectiveness ratio (ICER) of coiling as compared to clipping was cost saving. Therefore, coiling instrument should be included in the reimbursable list of beneficial package for patients under the Universal Coverage Scheme.
The objective of this study was to report drinking patterns and alcohol-related health risks using Provincial Alcohol Problem Index (PAPI) of Thai population by region and province. Data from the 2017 Cigarette Smoking and Alcohol Drinking Behavior Survey, a stratified two-stage random sampling to select 120,003 Thai participants aged 15 years and over, were analyzed using descriptive statistics. The prevalence was estimated by weighted proportion and presented at national, regional and provincial levels. A composite PAPI score, ranging from 0-1, was also calculated to represent a relative level of alcohol risk problem in each province. At regional level, the Northern and Northeastern regions had the highest prevalence of adult (35.4% and 32.8%, respectively) and adolescent drinkers (19.0% and 16.8%, respectively), while the Central and Southern regions had the highest proportions of regular to heavy drinkers and drink driving. Provinces with the highest PAPI score were scattered in the Northern and Central regions, including Lampang (0.72 point), Chiang Rai (0.69 point), Phitsanulok (0.65 point), Chantaburi (0.64 point) and Sukhothai (0.63 point). This study showed that alcohol use and related problems remained significant health issues in Thailand with a diversity of specific problems that needed to be prioritized in each local area. Lampang, Chiang Rai, Northern, and Northeastern regions should urgently consider these issues. These hence warrant comprehensive measures targeting both establishment of local community actions and national alcohol policies.