plueme/wizJson huggingface dataset:
The objectives of this study were to evaluate Management of Medical Emergency
Services under Integration Management Policy, survey the member of Social Security Scheme
in term of their attitude between emergency medical service under Social Security (72 hrs.)
and Management of Medical Emergency Services under Integration Management Policy, and
work out appropriate payment method and reimbursement for eligible private hospitals that
gave provision of care to medical emergency patients. Mix method, qualitative and quantitative
were using for approach. In-depth interview were using for qualitative approach and questionnaire
were using for quantitative approach.
Policy evaluation found that for this policy follows ideology and the social justice of
Thai society, which is clearly showed in Thai Constitution and other related Acts. System
design in theory is well link systematically from input to process, output, and outcome.
However, a lot of hurdles are found at the level policy deployment. Many factors are
identified include clear assignment, appropriate resource especially reimbursement price and
asymmetrical information among staffs of social health protection schemes in different level
and beneficiaries.
The result of interview showed that when the member of Social Security Scheme
were admitted for the emergency treatment under Management of Medical Emergency
Services under Integration Management Policy. They have to reserve budget to private
hospital which provide care to them. Rate of reserve money to pay are 48.2%, the same as
the rate of not reserve money to pay (51.3%). For reserve money, it contributes to the cost
burden to patients as high as 97.6% in particular in group of income below 10,000 to 29,999
baht. The complacency of patients under Social Security Scheme between emergency
medical service under Social Security (72 hrs.) and Management of Medical Emergency
Services under Integration Management Policy were found to be similar percentage of 4.62
and 3.9, respectively.The appropriate payment method and reimbursement, payment by the Diag
Related Groups (DRGs) payment method is also appropriate in the current situation. To
propose appropriate reimbursement for private hospitals, using the reimbursement rate of
the Civil Servant Medical Benefits Scheme (CSMBS) to university hospitals, for treatment of
medical emergency patients which 17,662 baht per AdjRW, including 13,483 baht per AdjRW,
2,379 baht of labour price, and 1,800 baht of room and food prices for three days. Through
participatory approach in undertaking this project, the researchers and representatives of
private hospitals have an agreement that the appropriate imbursement rate should be
adjusted periodically in the future.
ST Elevated Myocardial Infarction (STEMI) is a life-threatening condition that requires immediate
medical care; treatments include thrombolytic therapy e.g. Streptokinase. The objective of this study was to explore the characteristics of STEMI patients associated with medication failure in the use of Streptokinase.
Method: A retrospective study was conducted in STEMI patients who were admitted to Suratthani
Hospital from 1st January 2011 to 30th June 2013. Failed Streptokinase is defined as ST resolution (STR)
<50% and ongoing chest pain >90 minutes after receiving medication. Data, including age, sex, door-toneedle
time, wall of infarction, smoking status, Killip classification, and underlying diseases such as hypertension,
were collected. Multiple logistic regression models were used to explore the association between
these covariates and failed Streptokinase, as well as each of the criteria used to define failed Streptokinase,
with a significance level of 0.05. A total number of 93 STEMI patients were identified, with a
mean age of 58. Factors significantly associated with STR <50% after 90 minutes are hypertension (OR
2.913, 95%CI: 1.014, 8.369), Killip class >1 (OR 3.057, 95%CI: 1.053, 8.878), and having anterior wall infarction
(OR 7.018, 95%CI: 2.219, 22.199). There is an association between ongoing chest pain after 90 minutes
and having anterior wall infarction (OR 5.09, 95%CI: 1.297, 19.973). Failed Streptokinase is associated with
Killip class >1 (OR 3.652, 95%CI: 1.032, 12.921) and having anterior wall infarction (OR 6.602, 95%CI 1.498,
29.089). Despite its advantages, STEMI patients with hypertension, anterior wall infarction, and Killip
class>1 may be less likely to be beneficial from using Streptokinase.
The objective of this study was to assess the hospital response to policy implementation of the Glucosamine
(GS) negative list. This study comprised both quantitative and qualitative approaches. A survey
form of quantity and expenditure of GS 6 months before and after policy implementation was sent out to
provincial hospitals, general hospitals and teaching hospitals (107 hospitals). A qualitative approach included
focus group discussion with head pharmacists of 11 teaching hospitals, in-depth interview with
pharmacists who deal with this policy, and an evaluation of patient’s written complaints sent to Comptroller
General’s Department (CGP). Completed data from 58 hospitals (54%) were analyzed. The total
drug expenditure 6 months before policy implementation was 185 million Baht, and total drug expenditure 6 months after policy implementation was 27 million Baht. Total drug expenditure saving was 158
million Baht, or 85% of total drug expenditure before policy implementation. It appeared that this policy
reduced the expenditure of original drug than generic/local drug. Results from focus group discussion
and in-depth interviews showed that hospitals which succeeded in excluding GS from their list because of
the decision of the pharmacy and therapeutic committee and hospital boards or authorized physicians.
On the other hand, hospitals that still retained GS in their list because they did not understand the
evidence which indicated that this drug was not cost-effective. An evaluation of patients’ complaints
revealed their perceptions as follows: GS are not reimbursable even this drug was indicated for joint
disorders, the policy seems to force patients to responsible for their drug expenditure and policy seems to
be cut off the subsidy for CSMBS beneficiaries. The results of this study showed the impact of this policy
on both health care providers and patients, and unveiled the problems and burden associated with the
policy.
Subdistrict Health Promoting Hospital was promoted from health station in order to increase its
capacity of primary care services, in both proactive and passive strategies. After studying the work process
of Subdistrict Health Promoting Hospital, the significant problem of service provider’s perspective
was the issue of data collection and querying to summarize the operational report according to the Key
Performance Indicator (KPI) system. KPIs could be changed annually, depended on the public health’s
situation. Normally, it took up to 10.22 working days a year to summarize the report. This research emphasized
on developing the KPI reporting system that users were able to identify parameters of indicators.
Moreover, KPIs during the fiscal year 2007 - 2013 were collected in this reporting system to support
the case of evaluating by the previous indicators. In the system, Application Program Interface (API) was
used as a tool to connect and manage the Relational Database Management System of JHCIS application
together with PHP, HTML, and JavaScript programming. This research could reduce time spent in collecting
data, querying data, and generating summary report about 7.93 working days a year or 77.97 percent.
In Thailand, the “One Health” concept emerged with the goal of strengthening the multidisciplinary
collaborations among all sectors at all levels, subsequently leading to a holistic health by recognizing the
close relationships between human health, animal health and environment health. This study aimed to
compile and understand the evolution of “One Health” in Thailand. The methods included document
review, observation, and in-depth interviews of key informants. The study found that the public health and livestock health sectors have been cooperated for over 20 years in order to prevent and to control
zoonotic diseases. It was later expanded to be a multidisciplinary collaboration to contain the H5N1 Avian
Influenza outbreak in 2004-2006. The “One Health” concept has been adopted as a key component of
national health policy, in particular in the National Strategic Plan for Emerging Infectious Diseases (2013-
2016) in 2012. However, the current recognition of “One Health” is still mainly limited to health related
sectors, with variation in interpretations of the definitions and scope of “One Health” which is based on
organization and/or individual own interest, and lack of a variety of examples for implementation. This
study recommends that “One Health” concept should be promoted to other related non-health sectors
including the general public in order to gain mutual understanding of the concept. In addition, the One
Health concept should be implemented where different agencies work together to achieve its objectives in
a sustainable way.
The pharmaceutical manufacturing process must concern a quality requirement. There have been
chances of mixed-up of pharmaceutical products particularly when multiple drugs were produced by
using the same equipment. The mixed-up results in harmful effects on consumers and affects the image of
organizations. Therefore, the objective of this research was to improve risk management system, particularly
the problem associated with the mixed-up. The risk management system was conducted according
to the Notification of Ministry of Public Health. In this research, two unacceptable risks (risk score equal
25) caused by human errors was found from risk assessment. Those were the main causes of the mixedup.
A strict quality assurance guideline was applied in this study as a prevention measure of the mixed-up
in the process of product storage and line cleaning of filling. The result showed that the level of risk was
reduced to acceptable risks (risk score equal 5). Then, the prevention measure was established in all the
medicine production.
In Fiscal year 2013, Comptroller General’s Department (CGD) had launched the Non-essential Drug
Prescription Criteria (NPC) measure (A-F measure) to encourage the rationale drug use and control drug
cost for patients under civil servant medical benefit scheme (CSMBS) in 168 public hospitals. The measure
indicated that NPC must be notified for each non-essential drug (NED) prescribing. This study aimed to
monitor and assess implementation of the measure. Data were collected in the study hospital which NPC
were notified for all prescribing of NEDs. The selected NED in this study were celecoxib and candesartan.
For each drug, 110 prescriptions and patient medical records of the out-patient department were reviewed.
The study was divided into two parts. For the first part, consistency between information in medical
records and reasons specified in prescriptions and rationale of prescribing based on the Ministry of Public
Health criteria were assessed during November 2012 to January 2013. For the second part, trend of prescribing
was monitored before and after the measure was implemented (August 2012 to October 2012 and
November 2012 to April 2013). Descriptive statistics were used in data analysis. Reasons for drug prescribing
were not completely specified in medical records. Therefore, the consistency between information
in medical records and reasons specified in prescriptions could be assessed in only 52 patients (47.3%)
who received celecoxib and 57 patients (51.8 %) who received candesartan. Data in medical records and
the notified NPC in prescriptions were consistent in only 7 patients (6.4%) who received celecoxib and 54
patients (49.1%) who received candesartan. Rational of prescribing could not be assessed for more than
40% of prescriptions. Prescribing was rational in 54 patients (49.1%) who received celecoxib and 7 patients
(6.4%) who received candesartan. Most common indicated reason for celecoxib prescribing was an intolerance
to side effect or allergy to drugs in essential drug (ED) list (N=74, 67.3%). For candesartan prescribing,
most common indicated reason was failure to achieve therapeutic goals (N= 100, 90.9%). After an
implementation of the NPC measure, prescribing of 35 patients (31.8%) who received celecoxib and 36
patients (32.7%) who received candesartan were changed to other ED drugs. In conclusion, the efficiency
of the measure was quite low as the completeness of NPC documentation and the change of prescribing to
ED were about 49 and 32 percent, respectively. Measure should be supported and promoted to enhance its
efficiency and precipitate into rationale drug use.
Worthiness of investment in the health promotion programs remains a question. The objective of
this study was to evaluate the achievement of the projects supported by the health promotion and disease
prevention fund in the fiscal year 2011. The project based evaluation following CIPP model was used.
Project documents and opinions of the program head and program participants were assessed. Two questionnaires were developed. The study was done between December 2012 and December 2013. Twentyseven
projects met study criteria. Of these, 11 projects had outcome measurements which mostly were
humanistic outcomes (68.57%). Of 577 self-administered questionnaires sent, the response rates were 59.26-
54.55%. Most scores of CIPP dimensions were at high to very high levels. The evaluation revealed the
lowest scores in the context; use of the information of the community need; the input; support from other
sources; the process; public relations; the product; continuous budget support. There was high satisfaction
of participants for an opportunity to get involved. Three out of four projects were found net benefits.
In conclusion, most projects had a high level of the achievement from 3 perspectives. Nevertheless, the
projects need to further develop for a project framework and clear defined outcomes which directly occurred
to the patients.
This study was a cross-sectional descriptive research. The purposes were to study motivation and
organizational support affecting an evaluation of the public health officers at subdistrict health promoting
hospitals in Buri Ram Province. Population size was 324 persons and a sample size of 207 persons was
selected by systematic random sampling. The research instruments were the questionnaires. The Cronbach
coefficient of instrument was 0.97 and validity was checked by 3 experts. The 207 questionnaires and The
12 in-depth interviews were collected by a research assistant during 1 February 2014 to 28 February 2014.
The data was analyzed by SPSS for windows program to acquire a percentage, mean, standard deviation,
percentile, Pearson Product Moment Correlation Coefficient and Stepwise Multiple Regression.
The findings revealed that most males (53.6 %) with the average age of 40.80 years. The marital
status was 67.1%. The educational degree was a Bachelor’s degree or equivalent for 87.9 %, Duration of
working as public health officers, at subdistrict health promoting hospitals was averaged at 10.35 years.
They were used in 60.4% of practice in evaluation programs. It was revealed from the study that The
overall motivation was in a high level at an average 3.68 (S.D. = 0.42). The organizational support at high
level averaged 3.64 (S.D. = 0.52). And an evaluation of the public health officers at subdistrict health
promoting hospitals in Buri Ram Province at high level, average 3.79 (S.D. = 0.54).The motivation factors
and hygiene factors, also an organizational support, were positive influence on an evaluation of the public
health officers (r = 0.649, p-value < 0.001; r = 0.575, p-value < 0.001; and r = 0.779, p-value < 0.001, respectively).
Six factors that could predict an evaluation of the public health officers at subdistrict health promoting
hospital in Buri Ram Province including Organizational Support in management, Company policy
and Administration, Responsibility, Organizational Support in Time, Organizational Support in Technology
and Job Security with a level of statistical significance (68.9%). The main problem from the study was
the Organizational Support in human resources for 37.21%
The objective of this study was to develop drug reimbursement prices for National Health Security Office (NHSO) Region #13, Bangkok. Specifically, it was intended to be used for outpatient referrals, disability, accident, and emergency. Proposed models were tested with claim data of nine hospitals. This study adopted three criteria, including quality, cost containment, and sustainability, to conceptualize the framework for the eimbursement prices.Results proposed 3 different models of regressive mark-up roportion for reimbursed price setting.These 3 models were tailored for 3 different groups of drug: pharmaceutical product in general, pharmaceutical product by GMP-PICs assured manufacturers and pharmaceutical product with Narrow therapeutic index; in order to promote uses of quality assured product and maintaining quality of health care
service. The mechanism to ensure system sustainability was assigned by employing the reference prices enacted by Ministry of Public Health as the based price to calculate reimbursed price. This consistent and updated input of based price data will be promised. A number of cost containment mechanisms were also built in this model: setting single reimbursed price for one generic name of drug, assigning lower rate
of markup proportion than what Comptroller General’s Department established, regressive markup proportion for the later baht of drug price which aimed to encourage cheaper pharmaceutical products prescribing. Finally, financial impact to stakeholders was thoroughly investigated and ensured. In conclusion, this study proposed a model of pharmaceutical reimbursed price setting for cases of out outpatient referrals, disability, accident and emergency. A number of crucial mechanisms has been deliberately incorporated in the model ensuring sustainability, promoting quality of care and optimal
expenditure. This reimbursed price setting model is an applicable policy option for Thai health insurance system.
The National Institute for Emergency Medicine specifies a criteria for triaging patients into five
levels according to the urgency of treatment needed. Canadian Triage and Acuity Scale (CTAS) is a five-level triage tool used worldwide that can rapidly assess patients, and is proved to be accurate and reliable.
However, no study in Thailand has confirmed CTAS as an initial predictor of the severity of patients. This
research aim study the correlation between CTAS level and early outcome of patients, including; 24-hour
mortality rate, intensive care unit (ICU) admission rate and rate of immediate life-saving interventions in
emergency department. Researchers conducted a retrospective observational study and reviewed medical
records from all patients presented to the ED and were triaged by using CTAS in August 2013. There
were 2,508 patients who were triaged by using CTAS and met the inclusion criteria. Five patients died in
24 hours after ED visit and CTAS levels were I and III in 4 (8.16 %) and 1 (0.12 %) patients, respectively. 84
patients were admitted to the ICU and theirs CTAS levels were ranged from I to IV in 18 (36.73 %), 47
(17.41 %), 17 (1.97 %) and 2 (0.17 %) patients, respectively. 115 of the patients received immediate lifesaving
interventions following their arrival and CTAS levels for these patients were from I to III in 29
(59.18 %), 59 (21.85 %) and 27 (3.12 %) patients, respectively. The differences were statistically significant
between each CTAS levels and each early outcomes of patients (p-value < 0.001), so the higher the patient’
s triage level, the higher the severity. Conclusion: Canadian Triage and Acuity Scale (CTAS) has a significant
correlation with early outcomes of patients, including 24-hour mortality rate, ICU admission rate and
rate of immediate life-saving intervention. Therefore, CTAS can be used as an effective five-level ED
triage tool.
One of the strategic plans for a current policy in an integrated management of the problem involving
violence against children and women is to develop the data register and management system. This research
aims to study the basic data and characteristics of children treated at the Maharat Nakhon Ratchasima
Hospital. The study found that during the year 2010-2012, 437 children were treated at OSCC, 412 cases
were female, and 25 cases were male, aged between 4 days and 17 years and 10 months. The main reason
for arrival at the hospital was sexual and physical violence. Nearly all cases were suffered from first time
violence. Main problem in teenagers were having sex with their boyfriends. In case of physical abuse,
most of those children were abused by their parents or close relatives. Event of violence usually occur
from January to March and October to December each year. Sexual violence tends to happens on weekdays
over weekends. Time of sexual violence was highest during 06:01 and 09:00 pm. Most of patients
came to the hospital within one day after the incident. Nearly all perpetrators were non-family member
persons, but the stranger was only 11 percent. The main external factor that encouraged acts of sexual
violence was an intimate environment and the opportunity allows. The scene of violence mostly occurred
at home. The main result of treatment was cure or palliative, however, some died of violence. The average
cost of medical-related care was 3,306.06 THB. In conclusion, sexual problem among teenagers are the
primary problem for OSCC. The major risk comes from the patient’s own and external factors. Parents
should take care to protect their children closely.