plueme/wizJson huggingface dataset:
Thailand achieved universal health coverage (UHC) since 2002. There are 3 main health insurance schemes with differences in agencies in charge, benefit packages, management, and payment mechanisms operationalizing UHC in Thailand. The aim of this study was to compare the differences in management of and benefit packages between the Social Security Scheme (SSS) and the Universal Coverage Scheme (UCS) in 2020. We applied a descriptive study, and reviewed related documents on 1 January 2020. The results indicated that there were 11 different benefit packages between SSS and UCS. UCS had 7 more benefit packages than SSS, while SSS had 2 more benefit packages than UCS. However, the similar 20 benefit packages had different management. Seven benefit packages of SSS had special management or higher rate of reimbursement than UCS whereas 13 benefit packages of UCS had special management or higher rate of reimbursement than SSS. Furthermore, when compared results with the similar study in 2011, SSS changed inpatient payment mechanisms from capitation to diagnosis related groups (DRGs), implemented special drug management system and increased annual budget per person and reimbursement rate for inpatient higher than UCS. SSS added 27 new benefit packages and added new equipment and prostheses from 81 to 291 items. UCS added 30 new benefit packages and added new equipment and prostheses from 270 to 316 items. The differences in benefit packages between 2 schemes reduced from 15 services in 2011 to 11 service in 2020 and the differences in the similar benefit packages but different management reduced from 26 services in 2011 to 20 service in 2020. In conclusion, UCS had more special management and benefit packages than SSS whereas SSS had higher budget per person per year and higher rate of inpatient reimbursement than UCS. Further studies on access, cost effectiveness and quality outcome were recommended to compare between SSS and UCS. The set up of national organization to harmonize the health insurance schemes in Thailand as mandated in the latest constitution of the Kingdom of Thailand was also recommended
Background and Rationale: Thailand had the highest road traffic mortality in South-east Asia at 32.7 out of every 100,000 people. Chiang Mai was the 5th ranking in Thailand. Emergency medical service system (EMS) can help reduce mortality of the injured patients outside hospitals. Objective: To study survival of out-of-hospital cardiac arrest (OHCA) of traumatic patients who received emergency medical care from EMS. Methodology: Retrospective descriptive study was conducted by collecting survival data from electronic medical record, forensic data and the Pan-Asian Resuscitation Outcome Study database from 1 January 2017 to 31 December 2018 recruiting OHCA traumatic patients receiving emergency medical care from EMS before treating at Maharaj Nakorn Chiang Mai Hospital. Results: Among 45 cardiac arrest traumatic patients, 75.5% were men with an average age of 30.7±14.8 years. The majority of injuries (80%) were traffic accidents, 91.0% had blunt injuries, 35.6% were pulseless electrical activity (PEA) and asystole and 62.2% unknown electrocardiograph. 4.4% achieved return of spontaneous circulation (ROSC) at scene, 55.6% achieved ROSC in a hospital emergency department, 22.2% survived at 24 hours, 15.5% survived at hospital discharge, and 11.1% survived with a good cerebral performance category (CPC 1-2). The most common injuries were multiple system injuries (51.1%), 21.7% of this group survived at 24 hours, 13.0% survived at hospital discharge, and 8.7% survived with a good cerebral performance category (CPC 1-2). Head injury was the most common single organ injury (35.6%), 18.8% survived at 24 hours, 18.8% survived at hospital discharge and 12.5% survived with a good cerebral performance category (CPC 1-2). Survival rate of head injury was highest. 8 patients who received chest compressions from bystanders achieved significantly higher ROSC than those who had not received chest compressions (87.5 and 48.6; p = 0.028). Patients underwent surgery (10 patients) survived at hospital discharge significantly higher than those without surgery (50.0 and 5.7; p = 0.003). Conclusion: Chest compression conducted by bystanders increased the likelihood of ROSC in the EMS OHCA injured patients. In addition, surgery also increased the chance of survival at hospital discharge of these patients.
Dengue is a communicable disease transmitted by Aedes mosquitoes causing a significant problem in the tropical zone and humid regions of the world, including Thailand. The signs and symptoms of dengue are similar to other diseases making diagnosis more complicate. Dengue virus infection test kit (DENV NS1) is crucial for virus detection and diagnosis. This cross-sectional study aimed to study the use of DENV NS1 test kit among reported cases according to the diseases surveillance system (Report 506) in Bangkok between 2013 and 2017. The sample group of this study was 33 of hospitals in Bangkok. The data were collected in March 2019 by self-administered questionnaire and analyzed by descriptive statistics and Chi-square test. The result showed that the trend of using DENV NS1 test kit was increased following the disease situation. The highest positive results of DENV NS1 were 30.1 percent, concurrent with the number of 11,881 reported dengue cases in 2015. Furthermore, the reported cases in the diseases surveillance system (R. 506) was less than the positive result from the test kit (87.8%) and the number of using dengue rapid test kit increased every year. The use of 1 to 2-days screening test kit constantly increased from 2014 to 2017. The uses of DENV NS1 test kit results were associated with the types of dengue reported in the disease surveillance system (p < 0.001). It is recommended that the hospital should develop a surveillance system to report patients to fill out the results of using the test kit or laboratory result.
Community pharmacy is a health service that provides drug distribution and primary health services in the community. Proper distribution of community pharmacies in each area will allow people to access pharmacy services resulting in safe drug use. This study aimed to examine the distribution of community pharmacies in relation to health needs by health region of Thailand. Secondary data obtained from relevant government agencies:  the number of population, the number of patients with ambulatory care sensitive conditions (ACSC), gross provincial product (GPP) per capita, modern pharmacy (type I), accredited pharmacy and type II pharmacy along with other public and private health establishments, were analyzed using descriptive statistics. The results showed that in 2016, there were 16,053 community pharmacies in Thailand. Health region 13 (Bangkok) had the most community pharmacies (4,774 stores), representing 29.74 percent of the country total. In provincial area, Health region 4 had the highest number of community pharmacies (1,780), representing 11.09 percent and Health region 3 with the least community pharmacies (333) representing 2.07 percent. When considering the distribution of community pharmacies in relation to health needs, Thailand had 2.47 stores per 10,000 population and 2.72 stores per 10,000 cases of patients with ACSC. The number of community pharmacies was positively correlated with gross provincial product (GPP) per capita. In provincial area, majority of community pharmacies located in municipal area. The study showed unequal distribution of community pharmacies in Thailand. These may affect unequal access to medicines and pharmacy services.
Background & Rationale: The peritrochanteric hip fracture or hip fracture in an elder is one of the most fatal orthopedic trauma which needs surgical correction and appropriate rehabilitation after surgery until the patient can live an independent living. This condition causes a prolonged postoperative hospital stay increases postoperative cost crowds out other patients to limited hospital bed and overloads hospital workforces. The intermediate postoperative care project has been developed between the regional and district hospitals in Chiang Rai province to increase the capability of postoperative hip fracture care in district hospitals. The hip fractures patients after surgical treatment in Chiangrai Prachanukroh Hospital will be referred back to district hospitals for inpatient rehabilitation. This was the way to decrease the postoperative hospital stay and increase clinical outcomes in elderly with hip fractures in Chiang Rai province. Objective: The objective of this study was to compare the clinical outcomes of peritrochanteric hip fracture in the intermediate postoperative care project between the regional hospital and district hospitals in Chiang Rai province. Methodology: This study was a prospective cohort study recruiting hip fractures elderly patients who were assigned to intermediate postoperative care in Chiangrai Prachanukroh Hospital and district hospitals from February to June 2019. The population in this study covered 91 patients of two medical benefit schemes. There were 27 patients taken care in Chiangrai Prachanukroh Hospital and 64 patients taken care in district hospitals. Results: The average ages of the elderly patients with hip fractures taken care in Chiangrai Prachanukroh Hospital and district hospitals were 76.2 and 76.6 years respectively. Most of them (70.4 and 62.5 percent respectively) were suffered from the intertrochanteric area fractures. The percentages of the patients who were operated by the proximal femoral nail antirotation (PFNA) fixation were 59.3 and 64.1. The average length of postoperative hospital stay in Chiangrai Prachanukroh Hospital was statistically significant lowered from 5.4 to 3.5 days (p=0.001). There were no significant differences in postoperative complications (p=0.305). The activity of daily living scores (Barthel’s index) of the elderly patients on discharge date were 13.6 and 13.3, and at 6 weeks after discharge were at 17.0 and 17.2 respectively (p=0.874). Conclusion: The clinical outcomes of peritrochanteric hip fracture in the intermediate postoperative care project treated at the regional and district hospitals in Chiang Rai province were not different. The project lowered the average length of postoperative hospital stay in Chiangrai Prachanukroh Hospital.
The objective of this research was to test the physical fitness, evaluate physical well-being, analyze relationships and cluster analysis of physical fitness, and investigate indicators for physical fitness in Thai elderly throughout Thailand. The samples were self-help elderly consisting of males and females, aged 60-69 years old. They were recruited from 5 regional parts of Thailand, 400 participants in each region, including a total of 2,000 participants. The research instruments were two set. Set one was the physical fitness testing for Thai elderly in 6 categories including with body composition, cardiorespiratory endurance, muscular strength and endurance, agility and balance, flexibility, and reaction time and coordination. In addition, there were recordings of electromyograms (EMG). Set two was the physical well-being in elderly including with physical activity, nutrition, rest and sleep, and health problem and non-communicable disease (NCD). The analysis of general data were used with distribution of frequencies, percentages, means and standard deviations, classifying by genders and regions. The classifications of physical fitness groups in Thai elderly were used with cluster analysis and physical fitness indicators. The results demonstrated that the physical fitness groups of the elderly were classified into four groups composed of the 522 participants in very good group (26.14%), the 770 participants in good group (38.56%), the 478 participants in fair group (23.93%) and the 227 participants in risk group (11.37%). The cluster results revealed that the waist circumference could be best used to classify (F = 669.732), followed by the VO2 max from the six-minute walk test, body weight and body mass index (BMI) respectively. The results of indicators were 12 assessment criteria including 30-s block transfer test, reaction time, sit and reach test, TUG time, distances in six-minute walk test, body fat percentage, hip circumference, and waist circumference. In conclusion, the physical fitness test of Thai elderly and assessing the physical well-being of most Thai elderly. This information can be used for health promotion planning for Thai elderly.
Background: Situations in the drug system in Thailand have been changing constantly over time, a study to analyze situations in the national level to assess up-to-date research questions in the area of drug system is necessary. Objectives: The primary objective of this study was to summary the situation of national drug system. The secondary objectives were 1) to summarise direct and indirect factors affecting the drug system and 2) to assess research questions for further developing the national drug system. Method: This study employed qualitative research methods including document analysis, semi-structured interview and focus group discussion. Results: The research questions were classified into four areas according to the national strategic plan on drug system: 1) developing the national drug control system, 2) supporting research and development to promote local pharmaceutical manufacturing, 3) promoting access to essential medicines among Thai people, 4) promoting rational drug use. Conclusion: Research questions from this study will be used for guiding potential research topics in the areas of national drug system and consumer protection in drugs.
Background: Adult-onset immunodeficiency syndrome (AOIS) due to anti-interferon-gamma (IFN-ϒ) autoantibodies has emerged in otherwise immunocompetent adults. Currently there is no specific treatment for the diseases. Immunosuppressive agents to inhbit antibody production are the mainstay treatment of several autoimmune diseases. This study aims to evaluate the effectiveness of bortezomib in decreasing level of autoantibodies (Abs) in patients with anti-IFN-ϒ auto-Abs. Methods: A pilot pre-and postintervention study of patients with anti-IFN-ϒ auto-Abs was conducted between February 2017 and June 2019 at Faculty of Medicine Siriraj Hospital. Five patients with high titer of anti-IFN-ϒ auto-Abs were selected to receive bortezomib at the dose of 1.3 mg/m2 body surface area (BSA) once weekly for a total of 8 weeks and cyclophosphamide at the dose of 1 mg/kg/day for the following 4 months. The primary outcome was the difference of autoanibody level at 8 and 48 weeks compared to baseline and any adverse event occurred during the study period. The clinical characteristics, the number of opportunistic infections (OIs) within 72 weeks of study enrollment and the inflammatory biomarker such as C-reactive protein or erythrocyte sedimentation rate were also evaluated. Results: A total 5 patients were enrolled, of which the median age was 46 years (34-53 years) and 2 patients were male. All patients had 3-5 OIs before enrollment. There was no significant difference in the mean (+SD) optical density (OD) values of autoantibody at 8 weeks (3.73 + 0.72) and 48 weeks (3.74 + 0.53) compared to baseline (3.84 + 0.49) (p=0.336 and p=0.555, respectively). No recurrence of infection was observed in the first 6 months. However, during the 72 weeks of follow-up, 4 of 5 cases had a total of 10 recurrent OIs of which Mycobacterium abscessus was the most common. Infection with Talaromyces marneffei was observed in 3 patients at approximately 1 year after bortezomib administration. Conclusions: Bortezomib appears unable to reduce autoantibody in patients with anti-IFN-ϒ auto-Abs. Although no recurrent infection was observed within the first 6 months during the study medication, recurrent OIs were observed thereafter. Bortezomib seems to increase risk of infection with T. marneffei. Long term follow-up should be considered in patients with anti-IFN-ϒ auto-Abs who received immunosuppressive agents.
The problem of shortage of human resource for health (HRH) in remote areas has been concerned for decades. Providing financial and non-financial incentives is one of the effective solutions. The objectives of this study include (1) to indicate incentives and quality of life of HRH working on remote areas and (2) to develop policies for motivating HRH to be willing to working in remote areas. The quantitative and qualitative research has been used. We used qualitative method for development of attributes and response level for an analysis of Discrete Choice Experiment (DCE). The DCE was conducted into two groups: group 1 - physicians, dentists and pharmacists; and group 2 - nurses and multidisciplinary team. The thematic analysis and conditional logit regression model were used for qualitative research and DCE, respectively. Regarding results from qualitative analysis, the attributes influencing decision making of HRH working in remote areas include income, workload, self development, working in hometown, horizontal relationship, good facilities (e.g. electricity, water supply, especially the internet that is important for work and recreational activities), having a safe and convenient house, being instilled as government official, clean environment and family issues. The results from conditional logit regression model determine that workload, convenient stores, and private accommodation are important incentives, however, the most important attribute was income. It was found that if they got income a 40% higher than friends working in urban areas, they had 4.2 times more chance to work in remote areas; If a 60% higher, 8.3 times more chance to work in remote areas. For Nurses and multidisciplinary team, workload, self development, working in hometown, living in private accommodation, being instilled as government official, especially income are important incentives. It was confirmed that income is the most important incentive to motivate HRH working in remote areas. The current incentive policy of providing subsidy for HRH working remote areas should be remained. Another policy to be considered is providing scholarship to local students to work in their hometown as well as providing private accommodation to meet requirement of workers. This policy can be managed at the level of provinces and regions.
Information tools are the tools for transforming collected data into meaningful and useful information which is important for district health system management and health service quality improvement. Objective of this study is development or adoption of appropriate information tools for analyzing or displaying information for district health system management and health service quality improvement. Three types of information tools were developed or adopted including Business Intelligence, Geographical Information System (GIS) and Data mining by applying in 3 districts. The results revealed that Business Intelligence tool for visualizing mortality data, disease surveillance data, health status and health service data was appropriate because of easiness and adequacy for use. It can compare data across sub-districts and across health facilities within each particular district. Trend over time is also provided together with map across sub-districts. Business Intelligence tool should be, therefore, the main tool for further expansion and improvement for covering all districts as it uses mainly national databases. For GIS tool, which is open source software, it can be the additional tool for interested districts as well as Data mining tool which can produce various models from service data such as Decision Tree, Neural Network, Logistic Regression and Clustering. Data mining can be used for knowledge generation by interested organizations and requires specific training for applying software and learning related fundamental knowledge.
An Implementation research program on development of Integrated People-centered Primary Care System (IPCPCS) in Thailand aims to redesign health services at primary care level to be an integrated-people centered health care and develop tools to support the implement in addition to evaluation on implementation outcomes. The program has been implementing in 20 piloted primary care clusters (PCC) and started to implement the new model since August 2019. The program employed mixed research methods including literature review, in-depth interview, focus group discussion, and a survey of 200 patients with diabetes and hypertension from each PCC on chronic care experiences. Initial assessment found that PCC under the research program performed better than other health facilities in the same areas in all components of integrated people-centered care (patient and family health team relationship, shared individual care plan, personal health record, health literacy and self-management support, and continuity and coordination). However, there is room needed for further improvement especially on patient and family care team relationship and health literacy and self-management support. Further implementation research is needed for further development and evaluation of service outcomes.
The Thai Health Literacy Survey (THL-S) of Thais aged 15 years and above has four objectives as follows: 1. to study the current situation of health literacy among Thais aged 15 years and above at the health regional and national level across health literacy competences and health domains. 2. to explore relationships between relevant factors and health literacy for identifying populations at risk. 3. to raise awareness among health professionals and relevant professionals on the impact of limited health literacy on national public health. 4. to produce evidence – based knowledge for better policy making, planning and implementation. The survey took place between March – August 2019. The Office of DoH 4.0 and Health Literacy led the project in collaborations with the 12 health promoting centers and Metropolitan Health and Wellness Institute. The project was financially supported by the Health System Research Institute. The valid sample size was 17,530 people. 38.67 percent were male and 61.33 percent were female. Key Recommendations Relevant organizations in health, educational, and social sectors should raise awareness and improve understanding among their personnel about the impact of limited health literacy on access to and utilization of their services. Effective health literacy related interventions should emphasize two approaches; one is to motivate and build individual capacity needed for finding, understanding, communicating and making health related decisions. The other one is to reduce the system demand and complexity and empower the people to become self-reliant so that the systems and services are health literacy friendly for all. Relevant educational organizations should build a strong literacy among students for finding, understanding, communicating about health information and making health related decisions. They might emphasize e-health literacy skills. The people in communities should be encouraged to take part in community based activities and assigned a role. All organizations should develop reliable and accessible channels for disseminating and searching for information. They also should announce and explain how to make use of the channels in appropriate manners. Curricula for health professionals, educators and social workers should address knowledge, skills, and technologies that can be used to facilitate and assist those who have limited health literacy.