plueme/wizJson huggingface dataset:
Background: Anticoagulation clinic has been implemented in Thailand with considerable success,
mostly in tertiary care hospitals. To improve accessibility of such service, a satellite network of anticoagulation
clinics in rural area was recently implemented. Objective: To compare quality of anticoagulant
control, complications and follow-up frequency among patient receiving warfarin therapy during their
attendance to a tertiary care center versus after referral to satellite clinics. Methods: Satellite network of
anticoagulation clinic was established at the Nakornratchasima province in early 2009 comprising of 4
community hospitals and a community medical unit. Patients receiving warfarin for at least 6 months at a
tertiary care hospital, who were clinically stable, were consented and enrolled in satellite clinics. Data on
anticoagulation control and other outcome variable of pre-referral period were compared with those of
post-referral period using descriptive statistics, paired T-test and McNemar’s test, where appropriate.
Results: Sixty nine patients were enrolled with a total number of 273 visits. Mean age was 56.2 ± 13.7 years
old. Most common indications were prosthetic valve replacement (40.6 %), rheumatic heart disease (20.2
%), atrial fibrillation with stroke (17.3%) and other (21.7 %). For anticoagulation control, time in target
range of patients during pre-referral and post-referral periods were similar (46.5 % vs 46.1 %; p = 0.94).
Incidence of INR value < 1.5 or > 4.0 were similar between the two groups but numerically lower in the
post-referral period (20.0 % in pre-referral vs 17.2 % in post referral periods: p=0.25). No major complication
was reported. Follow-up interval was shorter with satellite clinics (4.5 week/visit and 8.5 week/
visit). Conclusion: Satellite network of anticoagulation clinic can provide quality anticoagulation control
similar to a tertiary care setting. In addition, such service may improve safety of warfarin therapy through
a close monitoring system and improved accessibility.
The objective of the study was to determine the effect of a health education program on drug use
during the month of Ramadan among diabetic patients with chronic renal failure who attended the diabetic
clinic in Nongjik Hospital, Pattani Province, during 1 October 2009 - 31 December 2010. Of the 56
patients, 28 had the Ramadan education program and home visit (study group) and 28 had usual health
care services (control group). Data from hospital records and the drug use follow-up form during Ramadan
of both groups were reviewed. Both groups had comparable characteristics including sex, age, co-morbidity, serum creatinine, estimated
glomerular filtration rate, microalbuminuria, cardiovascular risk score, number of drugs currently
used, fasting blood sugar, and systolic blood pressure. During Ramadan, good drug practice was significantly
higher in the study group (89.3 %) than the control group (14.3 %). Patients in the study group had
significantly lower fasting blood sugar, and systolic blood pressure than the other group. Factors correlating
with good drug practice were principal antidiabetic drugs and modification of drug use during
Ramadan.
It is essential to prepare drug use among Muslim diabetic patients before Ramadan. Good drug
practice during Ramadan will provide effective treatment results in these patients.
The policy on the promotion of herbal medicine has not yet achieved the target. To achieve the goal,
knowing health care professionals’ views on herbal medicinal products and on the national policy which aims to promote the utilization of herbal medicine in health care facilities is crucial. This study used
qualitative methods. Focus group interview among the frequent user group and in-depth interviews among
occasionally user group were conducted. The results of this study can be divided into 3 parts. 1) Views on
herbal medicinal products: lack of confidence on the effectiveness and safety of herbal medicinal products
is found, the appearance and other characteristics of herbal medicinal products are not attractive, herbal
medicinal products are more expensive than western medicine. 2) Views on the national policy to promote
the utilization of herbal medicinal products in healthcare facilities: The set target in terms of expenditure
of herbal medicine products of 25% of the total drug expenditure for every healthcare facility is
difficult to accomplish. Furthermore, there are no practice guidelines and clear strategic plan to support
the policy. 3) Views on impeding and facilitating factors influencing the utilization: key impeding factors
were the criteria on reimbursement of herbal medicinal and confidence in the quality and manufacturing
standards. The key facilitating factor was the presence of key person who was able to promote the use of
herbal medicine in hospitals. Findings from this study would be used to develop the effective strategies to
accomplish the policy aims at promoting the use of the herbal medicine in the future.
Sexual assault was a critical problem with increasing incidence. It is a challenge to family physicians
as a member of multidisciplinary team responsible for provision of care to the victims. With medical
record review and interviews with sexual assaulted patients of Chaibadan Hospital, this study described
demographic profile, nature of the assaults, type of care given and made suggestions for further improvement
of health care to the victims. Seeking care at During 2007-2009, 95 female victims were identified
with an estimated cumulative incidence of 27.7-49.8 per100,000 population. Majority of them were aged
under 18(94.7%) with high school level of education (65.3%). Most of them were raped by husbands or
boyfriends (42.1%). A quarter was sexually assaulted more than once during the past year. Health care
provided to these victims consisted of birth control pills (32.6% of them), a test for HIV infection (80%) and
anti-HIV medications (25.3%).
The Constitution of the Kingdom of Thailand B.E. 2540 and B.E. 2550, including Determining
Plans And Process Of Decentralization Act, B.E. 2542 is regarded as the starting point of the decentralization
of the state to local administrative organizations, and determined the public health decentralization
to local administrative organizations. These plans included the transfer of the health center (subdistrict
level) to local administrative organizations within 2010. Until now, 10 years gone from the above
mentioned, the progress is still unsatisfactory with a lot of problems and barriers during the operation. In
the preceding time, 28 health centers had already been transferred from 35 health centers targeted. Among
these, some of them were successful while some others faced many obstacles or restrictions in the implementation,
such as uncertainty of the policy and guidelines, coordination between the organizations, and
referring system. These made the health personnels feel insecure in their work. In order to run the process
of the public health decentralization effectively and comply with the Constitution, the related agencies
such as Ministry of Public Health, the Department of Local Government, including other organizations
must solve the problem seriously together to find the best solution.
The objectives of this mixed method study were: (1) to study situation of public health operation of
sub district administration organizations in Nakhon Si Thammarat ; (2) to study role, working process
and outputs of the sub district administration organizations related to development of public health activities; and (3) to identify conditional factors that influenced or hindered implementation of projects for
health development under the sub district administration organizations.
The population of the first phase study was 81 sub district administration organizations in Nakhon
Si Thammarat Province. The data analysis was performed using descriptive statistic. In the second phase
Thakuen sub district administration organization was selected as a case study among sub district administration
organizations and followed by the analysis using content analysis method.
The result of the first phase study showed that most sub district administration organizations were
in medium size. Most of the public health officers were untitled personnel of the manager offices (43.2%),
followed by community health development workers (35.8%). In terms of health projects, the most common
type was those for prevention and control of dengue fever (92.6%). The most successful projects were
those concerning surveillance and solving of problems of malnutrition, supporting to health centers for
their curative care services and supplying of essential drugs to community centers for primary health
care. All successful health projects (100%) were found to have promoting factors as cooperation of the
various organizations in the community such as community health volunteers and health clubs (80.25%).
The main obstacles were lack of knowledgeable, human resources and funding.
The results of the second phase of the study showed that the beginning point of public health development
by the sub district administration organizations was when they enrolled in local community health
fund. The working process was jointly carried out by sub-district administration organizations, local health
centers, community health volunteers, and health clubs. The main factors for successful health development
were team leadership, team working, strong community health volunteers and general public involvement.
Enabling factors are public-mind consciousness and open-mindedness of the public health
staff. The problems and obstacles were lack of experience in community health fund and the indifference
in health by some groups of the people.
The purpose of this study was to evaluate the service to patients with appendicitis among three
schemes: Universal coverage scheme: UCS, Social security scheme: SSS and Civil servant medical benefit
scheme: CSMBS. 401,322 records of in-patients during 2005 -2008 were utilized, and analyzed by descriptive
statistic and logistic regression analysis.
Acute appendicitis admission rate per 100,000 population between 2005 and 2008 showed that it was
highest in CSMBS, 215.4-300.4, while SSS was between 141.6-203.8 and UCS was between 165.9 and 177.6.
The trend was increasing in UCS and SSS, while it was decreasing in CSMBS. Proportion of ruptured
appendicitis to total appendicitis indicated that those of SSS, UCS and CSMBS were 12.5%, 18.2%, and
18.5% respectively. In addition, ruptured appendicitis probability were significantly different among three
schemes (P<0.00) which those of SSS and CSMBS had a lower chance compared to those of UCS, 1.48 and
1.38 times respectively. However, the trends of ruptured appendicitis to total appendicitis patients of all
schemes decreased. The trend of mortality rate of appendicitis patient in each scheme had not change
dramatically. It was highest in CSMBS and UCS (0.2%), while those of SSS were 0.02% respectively. With
regard to percentage of acute appendicitis patient receiving appendectomy, it was found that SSS patients
had a highest percentage, 89.4% while CSMBS and UCS were 83.5% and 83.0% respectively. However, the
trend of those having acute appendicitis receiving appendectomy in all schemes had been increasing.
The objective of this study was to compare the awareness, attitude and behavior on weight control of
the population before and after their attendance of the Camp for Eradicating Obesity and Belly Program
and the Weight Control Program. The study also took into consideration the efficiency of attending the
programs as one of the determining factor. The study design was the quasi-experimental research, which
studied obesity and health problem of the attendees before and after they had attended both programs.
The selected samples included 40 people who attended the Camp for Eradicating Obesity and Belly Program,
operated by Viseschaichan Hospital, and other 40 people who attended the Weight Control Program
of the Department of Health, operated by Pamok Hospital. The methodologies used in this research
were descriptive analysis, statistics pair t-test and the Pearson Product moment Correlation Coefficient. The study results for both programs shown an increase in awareness, positive attitude and weight
control efficiency. Meanwhile, blood pressure, body weight and waist circumference were decrease and
were significantly different prior to their attendance of both programs at p < 0.05. The samples who attended
the Camp for Eradicating Obesity and Belly Program could reduced weight 87.5 and 77.5 % by 8
and 16 weeks, while those who attended the Weight Control Program of the Department of Health could
reduced weight 65.0 and 67.5 % by 8 and 16 weeks accordingly. By week 16th, the studies found that the
unit cost of attending the Camp for Eradicating Obesity and Belly Program was 4,489 baht, while the
Weight Control Program was 3,518 baht. However, in order for the attendance to lose weight effectively,
the cost-effectiveness for the Camp for Eradicating Obesity and Belly Program and Weight Control Program
were 5,793 and 5,212 baht per person, respectively. The result of this study suggested that the Camp
for Eradicating Obesity and Belly Program was more effective but not appropriate to used in weight
control of large group population because of its high cost. The Weight Control Program of the Department
of Health had lower unit cost and consequently, was more practical due to its cost-effectiveness.
This study was conducted to evaluate practical guideline manuals for health promoting
hospital in aspects of the level of use, appropriate use and delivery process. Data collection were
collected by self administered questionnaire with directors or staffs of health promoting hospital,
and focus-group discussion with directors or staffs of health promoting hospital and focus-group
discussion with administrative staffs of health provincial office, health district office and
contracting unit for primary care.
Results showed that most of health promoting hospitals received the set of practical
guideline manuals from Bureau of Policy and Strategy, Ministry of Health. The levels of using
each practical guideline manuals were moderate to high, and most of respondents revealed that the
contents in manuals guided them to complete work easily. However, not all contents in these
manuals could be applied in practical. The barriers of using these manuals were the lack of
communication and public relations, and the lack of staffs to work at health promoting hospital.
The finding of this study suggested that the policy of using manuals should be established
and informed to all organizations: health promoting hospital, provincial health office, district
health office and contracting unit for primary care. The monitoring and evaluation should be done
continuously and the knowledge management should be conducted in each area to gain specific
guidelines for area.
There is a notion saying “the most reliable prediction of the future is to build it”. This synthesis of
tacit and explicit knowledge in shaping referral network of health services in the upper north of Thailand reflects collective actions among doers of the region in accord with such a notion. The actions started from
a health manpower crisis of the former single node of referral chain in 2006 characterized by draining of
almost 300 nurses instantly from the node hospital to private hospitals after dramatic increased workload
without perceived competitive adjustment of financial incentives. The crisis forced the node hospital to
shift its policy of hospitalizing referred cases from unlimited to a limited quota. Joint coordinating and
collaborating mechanisms among networks of public and private hospitals were set up under the jurisdiction
of public health administrative region no. 15. The mechanisms facilitated 1) restructuring roles and
functions of the hospitals into zones of referral chains each with a node and sub-nodes; 2) capacity building
of public hospitals under the restructured zones; 3) planning of human resources, service delivery and
upgrading of facilities including buildings, medical equipment and communication technology through
public and private subsidies; 4) adjustment of payment mechanisms to mobilize previously untapped
capacity i.e., specialized cares of private hospitals; neurosurgery of a public hospital which previously
excluded emergency cases. During 2008-2010, evidence has shown a decline in the number of referred
cases being turn away; better access to standard care such as thrombolysis for acute STEMI, traumatic
brain surgery; neonatal care. Strengths and weaknesses were discussed. Finally, opportunity for future
improvement of continuity of care within the referral network was identified in terms of relational, informational
and managerial continuity.
Recently, rate of medical malpractice claim and file a law suit on the medical adverse events are
increasing. The primary etiology of claims and filing were adverse medical events which caused by either
preventable medical error or mishap. No one wants adverse event occurred. In the past ten years after the
Institute of Medicine (IOM) reported the facts of medical errors in “To Err Is Human: Building a Safer
Health System”, health care personals have been deeply concerned with and have tried to improve their
practice for patient safety worldwide. However, there are still many medical errors in recent years and
will inevitably occur in the future. So, health care providers should learn how to manage and disclose
when the medical errors occur. Several studies have proved that disclosure of medical error have taken
more benefits than risks. The main benefits are decreased in filing rate, decreased in payments for adverse
events, and maintenance of doctor and patient relationships with trust. Disclosure of medical error is the
process which closely related to the incident report system. The importance of full open disclosure to the
patient after medical error occurrence will significantly increase in the future for patient’s safety and
should be simultaneously integrated into the mediation system.
Doctor shortage has long hindered the development of Thai health service system. It is thus crucial
to understand attitudes towards working and living in rural areas and factors driving job of choices of
doctors. The cross-sectional study conducted with 1,219 newly gradated doctors in 2011 was conducted.
Self-administered questionnaire comprising individual characteristic information, questions on attitude
towards working and living in rural areas, factors affecting their jobs of choice was used. Statistics used
were percentage, and Logistic regression.
The results showed that of the population 1,219 (527 from normal track and 313 from rural doctor
track), the majority of doctors were female. Half of the rural track doctors were from regional areas, and
the majority graduated from regional universities. Whereas, the majority of normal track doctors were from Bangkok and vicinity, and graduated from universities located in Bangkok and vicinity. Factors were
likely to affect their job of choices were workplace that : close to their hometown, enhance their learning
experience, provide case consultancy. With regards to their intention to work, few of them intended to
work at rural areas after 3 year and factors associated with their intention to work in rural areas were:
rural background and regional training.
As a crucial component of a health system, the shortage of health workforce could deteriorate health
outcomes. Though newly graduated physicians entering the rural areas every year, the turnover rate of
rural physicians was as high as 11% of rural physicians. It is thus crucial to explore strategies to attract and
retain physicians in rural areas. This study was a cross sectional study with 255 physicians serving in
years 1-3 from 9 provinces included in the sample. Job preference was assessed using the Discrete Choice
Experiment (DCE) method, which involved asking subjects to indicate their preference between 2 hypothetical
jobs, one rural and one urban. Each job was characterized by 7 job attributes. A total of 211 physicians
responded, with females (57.8%) responded slightly more than males. The majority of subjects was
from an urban background (83%), and graduated from a regional university (63%). There were 24% of physicians under the rural recruitment project. In relation to their job preference, all attributes were found
to be statistically significant in determining the decision to choose a job in a rural area. The results showed
that high salaries, workplace close to hometown, small hospital size, less overtime work, opportunities
for specialty training and faster career promotion were important for young physicians to choose rural
posts.
The results suggested that the combinations of salary increase, specialty training opportunities, reduce
overtime work, and accelerated promotions seem to be good policy candidates to attract and retain
physicians to rural areas.
The study is aimed at evaluating the recent effects of increasing hardship allowance paid for dentists
who are particularly working in community hospitals. The focused effects were 1) distribution and retention
of dentists; 2) hospital financial status; and 3) performance and productivity of dental workforce. Overview data was collected from many secondary sources such as dentist personnel database and payment
during 2005-2009; dentist mobilization from personnel management database (2008-2010); and dental
service outcome database in 2008 compared to 2010. Primary data included surveying hospital finance
during 2008-2010 using self-reported questionnaire to 725 hospitals and then interviewing a group of 7
senior inspectors in the Ministry of Public Health. The result was revealed that financial measure was
likely to have no impact on distribution pattern or retention of dentist workforce as the mobility found
was mainly from remote areas to rural areas with better social amenity. Regarding community hospital
financial status, paying hardship allowance showed no effect because a budget of 2,750 million baths was
subsidized by the government in 2010. Lastly, comparing performance outcome between 2008 and 2010, it
was found that oral health promotion activities by dental hygienists in 2010 was pushed up to 707 cases/
personnel per annual, while basic dental service performed by the dentist showed no difference in their
productivity.
As the health needs increased, health workforce requirements have been increased too. However,
the policy to downsize the civil servant positions implemented has made the Ministry of Public Health
failed to attract and retain health workforce into public health facilities. This study therefore aimed to assess the factors affecting the health workforce’s decision making in choosing public health facilities as
their job of choices. A Discrete Choice Experiment (DCE) tool was used and that each health workforce
was asked 16 questions to choose between 2 jobs which have different attributes. The data were analyzed
by conditional logistic regression.
The findings showed that both financial and non-financial incentives played important roles in health
workforce decision making to choose their job of choices. Benefit packages that were significantly associated
to their choices of non-civil servant positions were: salary increase at 20%-40%, career advancement,
opportunity for continuing education, bonus provision, pension fund and a longer employment contract.
The results indicated that the government needs to develop the appropriate employment packages that
could attract health workforce in public sectors. The attractive benefit packages comprise: higher salary,
career advancement, opportunity for continuing education, bonus provision, pension fund and longer
employment contract. These packages could be attractive for health workforce to choose to be hired as
non-civil servants.