plueme/wizJson huggingface dataset:
In 2006, the reimbursement system for the Civil Servant Medical Benefit Scheme(CSMBS) in Thailand
was changed to a direct billing system. It was unknown how this new system affected drug expenditures
and the number of drugs given to beneficiaries. The aim of this study was to assess the effects of the
direct billing system on prescribing patterns in terms of the number of months of coverage per prescription
and over possession. The study was undertaken using a retrospective cohort approach on the data
recorded in the database of a university hospital in the northern part of Thailand. We gathered data on all
patients with CSMBS coverage who came to the out-patients department between Oct 1, 2005 and Mar 31,
2007. Mean cost of medication, the number of months of coverage per prescription and the medication
possession ratio (MPR) of the five highest prices of oral medication were calculated for the one-year period
before and after the system was changed.
Results: Out of 43,897 patients seeking out-patient care at the hospital, 15,632 (36%) were covered
under CSMBS. Eighty-eight percent (13,785/15,632) received medications as a result of their visit. The
total cost of medication increased from 2 million baht to 4 million baht in one year. Glucosamine,
atorvastatin, rosiglitazone, clopidogrel and diacerein were the most frequently used in terms of cost. The
average number of months of coverage based on these medications increased from 1.29 to 1.48 months per
prescription. The percentage who were prescribed medication for more than 3 months, was slightly increased
from 1.82 to 2.43. Three out of five MPRs were higher after the system was changed (relative risk
ranged from 1.19 to 2.32).
Conclusion: The direct billing system may affect prescribing patterns, as indicated by the trend of
the increased number of months of coverage per prescription and the higher medication possession ratio
found in our study. Further evidence is still needed. Policymakers need to consider all relevant and
important consequences associated with the new system prior to decision-making for policy purposes.
The project for developing a good governance index is a part of the developing research management
system of the Health Systems Research Institute (HSRI) and its research alliances. The objectives of
this project are to (a) define the framework for monitoring and evaluating project administration in accordance
with good governance practices; (b) develop good governance index; (c) study the appropriateness
of the developed index and the perceived barriers; (d) set a guideline to gather essential data for
project performance evaluation, which is based on the principle of good governance for the research management team in the health system.
The process of this project began with (a) reviewing theories, concepts, and research reports related
to good governance practices and its index both domestically and internationally; (b) interviewing experts
from related disciplines, and research managements; (c) developing and testing a questionnaire and
then analyzing the data obtained; (d) using the drafted good governance index to conduct an internal
pilot test with Health Systems Research Institute, and (e) reviewing the index and modifying it to make it
more suitable.
The results of this study indicated that two crucial conceptual frameworks of index development
emerged, with the first conforming to the six good governance practices, namely the rule of law, transparency,
worthiness, participation, quality, and accountability, and the second applying those practices to the
five steps of the research management process.
The outcome of evaluating the Health Systems Research Institute’s good governance practices has
been depicted overall at the organizational level, where HSRI has high levels of good governance practices.
When considered the perspective of the five research management processes, the process of gathering
and allocating resources gains the highest level of engaging good governance practices; it is followed
by the process of planning research management. Other research management processes were evaluated
and their utilization of good governance practices was found to be at the middle level.
The objectives of this study involved (a) the application of methods of knowledge discovery from
database using decision tree algorithms for respiratory system diagnosis to classify patients of the Pranakorn
Sri Ayudthaya Hospital into three groups: acute upper respiratory tract infection, acute sinusitis, and
pneumonia, and (b) the comparison of performance of the three decision tree algorithms, i.e., ID3, C4.5,
and CART, for the classification or screening of the patients with the three diseases. The data used in this
study came from the medical records of 7,327 out-patients with respiratory diseases who attended Pranakorn
Sri Ayudthaya Hospital in the period from 2003 to 2006. The variables considered were age, body temperature,
residential area, occupation, and certain symptoms, e.g., rhinorrhea, fever, nasal congestion,
periorbital pain, headache, wheezing and coughing. The study methods were knowledge discovery with
the employment of ID3, C4.5, and CART decision tree algorithms from the hospital’s medical records and
determination of the effectiveness of the three algorithms. The validity of the decision tree algorithms was
studied by dividing the data into two sets: training and testing data sets, which were based on the crossvalidation
and the percentage split methods.
The results of the knowledge discovery method found that, for the patients with acute URI with only
seven selected variables and a ratio 70:30 of the training data set and the testing data set, the C4.5 algorithm
was the most effective, with a classification accuracy of 92.31 per cent. For the classification of the
patients with acute sinusitis with only eight selected variables and ratio 70:30 of the training data set and
the testing data set, the C4.5 algorithm was the most effective, with a classification accuracy of 94.70 per
cent. For the classification of the patients with pneumonia with only seven selected variables and ratio
50:50 of the training data set and the testing data set, the CART algorithm was the most effective, with a
classification accuracy of 94.69 per cent. The results obtained could be used to support the diagnosis of
patients with respiratory diseases.
Adverse events that occur in health service settings are resulting in more lawsuits than ever before.
The new patient compensation bill is expected to resolve patient-provider conflicts. It will be designed to
cover all groups of Thai people with acceptable claim process and amounts for compensations. This
communication reports the results of a study on the decision-making processes involved in compensating
injured patients under Article 41 of the National Health Security Act 2002.This was a descriptive study. The reasons used by committees in making decisions on whether to
“pay“ or “not pay“ the agrieved parties under the provisions of Article 41 were analyzed and compared
with the compensation criteria set out by the National Health Security Office. Altogether 1,276 claims
made during the period 2003 - 2008 were included in the study.
It was found that, of 1,276 claims, compensation was “paid out“ for 1,049 cases (82.2%) and 227 cases
(17.8%) were “not paid”. The main reason for paying compensation was that “it was an unavoidable
situation“ (76.5%). However, the reason above was not in accordance with the criteria for compensation.
Only 27.1 percent of the claims were made in accordance with the criteria, stating that the injuries were
related to medical errors or mistakes or substandard care. The main reason for not paying compensation
was that “the adverse events were the results of disease processes“ (61.6%). This was in accordance with
the criteria.
The conclusion was that inconsistency and unclear decision-making on patient compensations existed.
Of two cases with the same kind of injury, one might be paid and the other not. This type of
situation might motivate patients to bring cases to court.
Decentralization is one of the tools for the development of a health system which can produce many
benefits, such as improvements in technical and allocative efficiency, and improvements in the responsiveness
of the health system in meeting the needs of the people. According to Rondinelli(1), decentralization has been categorized into deconcentration, devolution, delegation and privatization. In Thailand, an
increasing emphasis has been put on community participation and decentralization following the Constitution
of B.E. 2540 and the Decentralisation Act of B.E. 2542 which has led to the development of the
Decentralization Plan of B.E. 2544 and the Devolution Plan to Local Administrative Organizations in B.E.
2545. These plans dictated that the provision of public services was to be devolved to LAO, and this
includes the transfer of infrastructure and the authority to provide health and health promotion services.
This study examines these issues by reviewing the international experience of Portugal, Spain, Italy, Mexico,
and the United Kingdom in health system decentralization.
From the review, after the reform, decentralization has led to many benefits in the provision of
health services and in the health system as a whole. In Portugal, it was found that the health status of the
population improved significantly after improvements were effected in access to care. Furthermore, the
local authority has become more autonomous and more flexible in being more responsive and efficient.
Also, in Italy and the United Kingdom, the internal market and the purchaser-provider split have been
introduced in order to improve efficiency, quality and service satisfaction. However, problems related to
decentralization were also found. For example, the occurrence of political conflicts from the reform, inequity
which emerged in many forms, problems relating to responsiveness in the deconcentration system,
and problems with unfavorable conditions and contracts in the internal market system.
Although community pharmacies normally provide health services to communities, they have never
been officially recognized as a primary care unit under any health security scheme. After the National
Health Security Scheme had been implemented in Thailand, efforts were made to test accredited pharmacies as part of a network within the scheme. In order to put a community pharmacy into the network, it is
essential to clarify the role and function of a community pharmacy as a primary care provider within the
network. Therefore, this study was aimed at projecting the role, function and activity of community pharmacies
from the viewpoint of community pharmacy experts, both from the private and government sectors.
The Delphi method was used by sending questionnaires to experts twice. Seventeen experts completed
the questionnaires twice. Levels of agreement were calculated as in the median, mode and
interquartile ranges. The results showed that the experts agreed that it was possible to have community
pharmacies play a role in treatment, health promotion and disease prevention in a community. The medians
of agreement levels were between 4 and 5 out of 5 on the Likert scale and the interquartile ranges were
narrow. With regard to the treatment role, a community pharmacy would have functions and activities in
dispensing drugs for common illnesses, refilling prescriptions for chronic diseases, and providing patients
with counseling. Regarding the health promotion and disease prevention role, a community pharmacy
would have functions and activities in screening for risk of chronic diseases, referring a high-risk
patient to physicians, promoting appropriate drug use, providing advice regarding nutrition and exercise,
campaigning for smoking cessation and reducing alcohol consumption, and coordinating with local
authorities to promote community health.
The Ottawa Charter has been adopted in many countries as a model for their health promotion policies which emphasize community participation. Mexico has developed a method for evaluating its
progress in implementing health promotion policies, and has developed a national policy on health promotion,
called Health Promotion Operation Model (MOPS,) which is based on the Charter and consists of
several components: management of personal determinants, health capacity-building, community participation,
development of a healthy environment, social marketing in health, and evidence in health
promotion. Sweden, a welfare state, developed its National Public Health Policy in 2003 with the main
aim of providing societal conditions for good health on equal terms for the entire population. It has 11
objectives which consider only the determinants of health. Interestingly, Pettersson summarized the evolution
of Swedish local authority in dealing with health promotion into “The Health Promotion Staircase
for Building Local Capacity”, which could be beneficial in the development of LAOs in Thailand. In New
Zealand, the Local Government Act of 2002 was passed which clearly defined the roles and responsibilities
of the central and local governments according to the risk-specialization model. Furthermore, to enhance
the role of the community, a long-term council community plan must be developed in line with the
expected ‘community outcome’ in order to improve community living conditions and address their health
concerns.
This research was intended to discern the adverse mental state of prison inmates based on their
expression of art images. Thirty inmates, 20 males and 10 females aged 24-57 years, were subjected to
psychoanalysis by two psychologists, and interpretation of their drawings by the art investigator.
Results obtained by the psychology group and the art educator were then compared, discussed and
a conclusion reached. It became evident that in the present project the drawings did not demonstrate
revelations as expected in the objective nor were they in accord with the psychologist’s findings; the
outcomes of both groups denoted only the prisoners’ present mental state, reflecting their factual situation
as prisoners. In realizing that the present study included subjects who were prisoners because of
having committed crimes that were not so serious, mental state was similar to that of normal persons.
Therefore, the researchers decided to carry out further research on persons convicted of committing more
serious crimes, which theoretically might be reflected in a more severe innate mental status.
This is a translated and edited article from chapter III (pp. 55-83) of the book published by Charles C.
Thomas Publisher, Springfield, Illinois, in 1994 entitled Art-centered Education and Therapy for Children with
Disabilities by Frances E. Anderson. Art adaptations for children with disabilities are focused on providing
children with an easy and comfortable way to obtain art experiences and produce creative artworks of
their own. The most important and challenging work for the working team (which comprised teacher,
physical therapist, occupational therapist, medical staff, art therapist, and the disabled child) involves the
method for solving various types of adaptation problems. In general, art adaptations are grouped into
four categories: in the physical space, in the art media and tools, in instructional sequence, and in technological
adaptations. Details on how these art adaptation categories are implemented in children with
mental retardation, learning disabilities, behavioral/emotional disturbances, physical disabilities, hearing
and visual impairments are elaborated in the text.
Lignite mining may result in several health impacts but at present no guideline exists to investigate
those effects. This study was aimed at setting up guidelines for the investigation of possible health impacts
from an open-pit mining project, using the participatory approach involving the public and other
stakeholders. Results from a literature review on possible health impacts and data on the living styles of
the affected community were used to identify the possible health impacts. The public and other stakeholders
were allowed to join the study and provide suggestions for public scoping.It was found that there were four aspects of possible health impacts: physical, mental, social, and
spiritual. Physical health impacts comprised accidents and injuries from mining and transportation; effects
from noise; diseases and effects from air pollution; diseases and effects from water pollution; effects
from blasting; and labor migration and communicable diseases. Mental health impacts were expected
from stress and anxiety. Social health impacts were likely from effects on community lifestyle; effects from
community migration and resettlement; and effects from depletion of forest and agricultural land. Spiritual
health impacts were likely from effects of aesthetic changes and loss of loyalty to and connection with
the locality; and the effects of people losing their spiritual haven.
There are some practical models of community pharmacy provision in Thailand that are coordinated
with hospitals in providing care for cases of stable diabetes and hypertension. This study was aimed
at estimating the impact on budgets of incorporating community pharmacy into the Universal Health
Coverage Scheme in providing care for cases of stable diabetes and hypertension. First, secondary data
were reviewed to estimate the supply and demand of community pharmacy services. Unit cost analysis of
the community pharmacy activities were situation, using the activity-based costing technique. Finally,
the budget impact analysis was estimated under the model of refill medication at the community pharmacy.
The timeframe of this study was January to September 2009. The result showed that the budget
impact of community pharmacy in providing medication refill for stable diabetes varied between 182 and
1,044 baht per patient, or between 194,740 and 1,117,080 baht per hospital. Regarding the budget impact
for medication refill in stable hypertension, the average expenditure ranged from 182 to 1,098 baht per
patient, or 242,242 to 1,461,438 baht per hospital. It may be concluded that the community pharmacy
could be a part of an integrated package of care for people with long-term conditions, such as stable
diabetes and hypertension. However, a financial incentive is required to meet additional costs and to
connect community pharmacies to the Universal Health Coverage Scheme. Co-payments may be used in
this program to prevent inappropriate utilization.
An abdominal operation affects gastrointestinal (GI) motor activity. Post-operative care for early
recovery of GI motility is recommended. The purpose of this quasi-experimental research was to study
the effects on bowel function of using a rocking-chair in patients who had undergone gynecological ab-dominal surgery. The framework of this study is based on the effect of mechanical pressure and relaxation
technique on the GI tract. The sample of 60 abdominal hysterectomy patients was drawn by carefully
selected criteria from a patient population admitted for abdominal hysterectomy during the period from
June to October 2008. The patients were randomly assigned into two groups: the experimental group who
ambulated by rocking-chair exercise and the control group who did not. The data collected consisted of
four parts: demographic, treatment, bowel function and patient satisfaction. The experimental instruments
were rocking-chair and stethoscope. The bowel function was measured 16 hours after surgery. The
experimental group who were assigned to ambulate by rocking-chair exercised for 45 minutes and the
control group who did not. Data were collected and analyzed by using mean, standard deviation and
independent t-test. We compared the difference by χ2 test and independent t-test.
The results revealed that the frequency of bowel sound and belching was statistically significant
with the difference being p = 0.001 and 0.01, respectively. There was no difference in the number of days
marked by flatus and the passing of feces. The majority (53.3%) of patients had high satisfaction and
almost all (90%) of the patients experienced no dizziness.
We suggest that the post-operative abdominal surgery patients should be ambulated with a rockingchair.
The outcome of our study theoretically applies also to the other patients undergoing abdominal
surgery.
The National Health Security Office (NHSO) region 8 in Udonthani Province surveyed health personnel
in six provinces: Loei, Nongbualampoo, Nongkhai, Udonthani, Sakon Nakhon and Nakhon Phanom
for the purpose of evaluating understanding of the benefits, information and people’s satisfaction with the health security system. The results revealed that the majority (76.9%) of pharmacists and dentists
knew about the benefits of the health security system, which was less than that of other health professions.
Most personnel received information about health security via television (68.1%). For radio, the
popularity of songs, news and general events was almost the same proportion (31.5, 30.2 and 26.5%,
respectively). The most popular period was between 6 and 8 a.m. (37.1%); 62.6 percent of health personnel
did not read newspapers. The satisfaction of personnel with health security was 8.15 out of a possible
score of 10 and general personnel had highest satisfaction at 8.5. The least satisfaction was among pharmacists
at 7.37. The study found that the satisfaction of the personnel who were positive related to their
knowledge of health benefits in the health security system and satisfaction with the media provided by
the national health security office. The Internet is also an interesting route as it is easy to use and efficient
in communicating to target populations.
It is suggested that NHSO should perform specific public relations campaigns and work more specifically
with each group of health personnel. Attention should be paid to the low level of information that
personnel had received. Formal letters are still the main route for providing information to health personnel.
Alternative routes of information dissemination should be used, especially newsletters, to create
good attitudes toward the national health security system, taking into consideration aspects such as quantity,
style and content conforming to the taste of the personnel concerned.
This study was aimed at identifying and developing nutritious ingredients in local Thai recipes for
healthy elderly people, based on their nutrient requirements. Community leaders were identified and asked
to point to community cooks within their communities. A list of 201 local dishes was identified through indepth
interviews performed among 74 local food experts. From the list, 40 dishes were selected that had
the potential to improve the overall nutritious quality of food, for instance adjusting meat and vegetable
quantity and substituting coconut cream with cereal cream and/or soy milk. The recipes were adjusted
and tested for sensory acceptability by the elderly in their communities. Mixed-dish recipes provided the
highest average energy content (319 Kcal per serving), while namprik (fish sauce with chillies) and noncoconut
cream curry provided the lowest energy content (89 Kcal per serving). Noodle soup with chicken
had the highest content (6 mg). Thai rice noodles in sweet chilli sauce (kanom jeen nam prik), Thai rice
noodles in spicy sauce (kanom jeen nam ya), steamed snake-head fish with Morinda Citrifolia Linn (Noni)
leaves (hor mok pla chon bai yor), and namprik had the highest fiber, iron and vitamin A content. Since cereal
cream and/or soy milk, which contain appropriate fat content, were used instead of coconut cream in this
study, these recipes may help to decrease the risk of chronic non-communicable diseases in the elderly.