plueme/wizJson huggingface dataset:
The collaborative project to increase rural doctors (CPIRD) has been implemented since 1995. This
study therefore aims to assess whether the medical graduates trained by the CPIRD project were retained in rural areas longer than those trained by regular training project.
The total of 1,093 CPIRD medical graduates and 6,064 medical graduates from regular training project
during 2001 - 2007 were included. The data was traced back from 2001 to 2010 in relation to their mobility.
Survival analysis was used for data analysis.
The study found that at the 4th year of their work, 69% of CPIRD medical graduates were retained in
the Ministry of Public Health (MoPH) compared to 59% of those trained by regular training project were.
Harzard ratio was 0.66 (p<0.001) and it indicated that normal track medical graduates had a probability to
resign from the MOPH 1.5 times than that of the CPIRD, significantly. After 3 years of public compulsory
work ended, 52% of CPIRD medical graduates were retained at rural hospitals while 47% of the normal
track medical graduates were. Harzard ratio was 0.88 (p= 0.001) and it indicated that normal track medical
graduates had greater chance to move out of rural areas 1.14 times than that of the CPIRD ones, significantly.
The median survival time in rural of the CPIRD medical graduates was declined from 10 years to 4
years, comparing to that of the normal track medical graduates that was declined from 6.5 years to 3 years.
Although physicians under the CPIRD project have higher rural retention, the median survival time
in rural had declined over 10 years and it become close to that of the normal track physicians. The trends
indicated that the improvement of the CPIRD project is needed in order to attract and retain more physicians
in rural areas.
This study aimed to assess the impact of a financial measure on public and rural facility retention of
physicians in Thailand. It used a retrospective approach using secondary data from the Ministry of Public
Health (MoPH). The study population included all physicians who graduated and entered the workforce
during 2001-2007, and the data were retrieved from 2001-2011. Survival analysis was used.
Results showed that the high turnover rate of young physicians was still persistent. Large proportions
of physicians, at about 30%, resigned before the 3-year compulsory contract ended, and this trend
repeated even after the financial measure was implemented. Resignations from MoPH have increased
since 2001, and the rate remained high after the increase of special allowance. Rural retention was low,
especially after 3 years of compulsory public services. The proportion of physicians retained in the rural
area after the 3-year compulsory period was about 20-24%, and this trend repeated even after implementation
of the financial measures in 2009.
The results suggested that to retain physicians in the rural area we need both the financial and nonfinancial
measures in an appropriate combination. Non-financial measures such as, working close to hometown,
opportunities for specialist training, improvement of work environment and infrastructure would
be important for rural retention of physicians as well.
Medical council is the core component of health system governance and the regulatory body of
medical profession in many countries. In the case study of the medical councils in the United Kingdom,
New Zealand and South Africa, they have development and changes from time to time so as to protect,
promote and maintain the health and safety of the public and to keep the public trust and confidence. The
study is a qualitative and documentary research and aims to study the philosophy, conceptual framework
and the role of these medical councils as an organization regulating the medical profession, and to propose
the good governance to be applied to the Medical Council of Thailand as appropriate.
The results showed that Medical Councils of these countries have good governance mechanisms, especially,
the General Medical Council (GMC) in the UK which is the model of the Medical Council of Thailand.
The reform or changes of the these medical council have been developed with its aims of effective,
accountable with greater patient and public involvement and with faster, fairer and more transparent
procedures in making decisions on fitness to practice of alleged physicians.
Cigarette smoking is one of the most important causes of chronic diseases and immature deaths
globally which has led to numerous epidemiological studies conducted to identify the association between
smoking and various types of diseases. The objectives of this study are systematically review existing
epidemiological literature on cardiovascular risk from smoking and to synthesize a pooled relative
risks based on meta-analysis of those literature. Review protocol has been developed to identify relevant
and comprehensive keywords and to ensure appropriate inclusion/exclusion criteria are applied without
bias.
Between 1994- 2011, 881 and 272 papers have been identified from the literature search for ischaemic
heart diseases (IHD) and cerebrovascular diseases (CVD) respectively. This was later reduced to 14 for
IHD and 20 for CVD. When meta- analysis was performed, it was found that the relative risk of developing
IHD from smoking was 2.14 (1.76-2.60) for men and 2.84 (1.90-4.24) for women, while for CVD, it was
1.66 (1.43-1.93) for men and 2.18 (1.67-2.85) for women. For sub-group analysis, it was found that for Asian
population, the relative risk of developing IHD was 2.15 (1.69-2.75) for men and 1.99 (1.18-3.34) for women,
and for CVD, it was 1.31 (1.19-1.44) for men and 1.60 (1.25-2.04) for women.
This study has confirmed the harm from smoking and the association between smoking and cardiovascular
morbidity. The fact that relative risk in Asian population is relatively lower compared to the rest
of the World does not imply that there is less harm from cigarette smoking in this population but may
occur as a result of significant presence of other risk factors, such as quality and access to medical treatment
for hypertension and dyslipidaemia, within the population.
Efficiency in clinical practice has become of increasing concern in the healthcare system in Thailand.
Cost-effectiveness analysis is a concept that helps in the efficient allocation of healthcare resources; however,
evidence showing the use of the cost-effectiveness (CE) information in clinical practice in Thailand is
limited. The aim of this study is to assess physicians’ attitudes towards the use of CE information in
clinical practice.
A cross-sectional survey was carried out to collect information from 140 physicians at Suratthani
Hospital, a central hospital in Southern Thailand, during 12-26 March 2012. The questionnaire consisted
of 3 main parts: physicians’ attitudes, obstacles in the use of CE in clinical practice, and sources of CE
information.
The results showed that the sample response rate was 52.1%. Concerning physicians’ attitudes, 68.5%
of physicians agreed that it is appropriate to consider CE information in the clinical decision-making
process. 76.7% of physicians agreed that cost containment in current healthcare system is necessary. The
main obstacles in the use of CE in clinical decisions are: 1) unwillingness to accept that healthcare resources
are limited by the public; and 2) social expectation for medical services exceeding the capacity of
public health system. Results pertaining to the source of CE information showed that 96% of physicians
attributed CE results to clinical practice guidelines. In addition, CE information from the same source
gains more attention from physicians when presented verbally rather than in written form.
Increasing the use of CE information in clinical decision-making is one way to improve efficiency in
resource allocation in the healthcare system. Findings from this study can be used to inform policies that
promote more efficient utilization of healthcare resources.
Background: Acute illness and accidents are the leading cause of death in Thailand. Developing a
good systematic pre-hospital care can help reducing morbidity and mortality. To achieve this goal, the
Ministry of Public health has issued a policy for all hospitals in Thailand to set up an Emergency Medical Service (EMS) system. Nevertheless, this service system is not widely acknowledged in Chiang Mai. Most
of the patients did not use the service and go to the hospital by themselves Objective: To determine reasons
of underuse of Emergency Medical Service in patients visiting the Emergency room, Maharaj Nakorn
Chiang Mai hospital. Methods: This was a prospective observational study by means of questionnaires
filled by the patients or anyone accompanied them to the emergency room, Maharaj Nakorn Chiang Mai
hospital. Only 3 level of triage was used; level 1-Resuscitation, level 2-Emergency, and level 3-Urgency.
This study was conducted during the period from March to October 2011. Analysis was made by dividing
participants into 2 groups; patients coming to the emergency room by themselves, and the ones coming
by using EMS system. Results: There were 102 participants; 64 coming by themselves and 38 using EMS.
There were 44 traumatic patients, and 58 non traumatic patients. 4 participants were of triage level 1
Resuscitation, 42 of triage level 2 Emergency and 56 of triage level 3 Urgency. Sex, degree of education and
occupation were not related to EMS activation. Many reasons accounted for this problem; 64.1% of the
patients had their own vehicles, 50% did not know of the service, and 25% thought that their symptoms
were insufficient to activate EMS system. People in Chiang Mai learned of the EMS system through many
advertising media, in sequentially billboards, television, and radio programs. Conclusion: The reasons of
underuse of EMS system in Chiang Mai were: unknown of existence, failure to recognize the importance,
and doubt in the Emergency Medical Service systems.
Empirical evidence of oral health care and dental service delivery systems for people with disabilities
in Thailand is needed. An important question for the national health policy-makers is how to improve
oral health promotion for disabled patients in healthcare priority-setting. The objective of this paper was
synthesis of common wisdom regarding financial management of the oral health promotion system for
the disabled people in Thailand. This study systematically reviewed the literature in PubMed and MEDLINE
databases and the unpublished-literature that reported data in Thailand, Japan, the United States of America,
Canada, and the Commonwealth of Australia. The relevance of 82 retrieved articles was reviewed for each
country based on its current oral-health insurance systems, cost-benefits, and healthcare financial management.
Thirty-seven stakeholders commented on these findings and made suggestions by group panel.
This evidence supports the need to develop oral-healthcare policies to support dental care service, especially
oral health promotion and prevention, and improvement of equity and quality of the disabled access
to dental primary, secondary, and tertiary healthcare delivery systems in Thailand.
Since the number of diabetic patients has been dramatic increasing in Thailand year by year, so the
good medical care is needed for serving all patients’ requirement. In the present, the medical care for
diabetic patients in Pua district still has many problems.Most patients could not meet the standard outcomes
on controlling the plasma glucose. This problem has been found to relate on the obstacle of transportation
to DM clinic in hospital and the confidence in the service of intermediate facilities. The aim of
this research was to develop primary care for diabetic patient by Nurse Practitioner. The period of quasiexperimental
research was started from 1st October 2010 to 30th September 2011. The study was focused
on the 418 patients that had well control of plasma glucose from 70 - 130 mg/dl and had level of HbA1C<
7%. The patients were divided into two groups. The first group was the 98 patients that received service at
the Subdistrict health promoting hospital. The second was the 320 patients that received service at Pua
Crown Prince Hospital. The result showed that the DM patients from Subdistrict health promoting hospital
could control the level of plasma glucose better than those from Pua Crown Prince Hospital. The level
of HbA1c< 7% of the DM patients from primary medical care and Pua Crown Prince Hospital were 72.55%
and 54.37% respectively. In conclusion, the developing primary care for diabetic patient by Nurse Practitioner
had found to be suitable for applying in Pua Contracting Unit Care. This concept is better to put
more effort and need simultaneous development for keeping fast track on the observation.
This study aims to analyse the situation of Cancer disease and demographic
characteristics of Cancer patients in 8 Upper Northern provinces which are Chiang Mai,
Chiang Rai, Phayao, Lamphun, Lampang, Phrae, Nan and Mae Hong Son. It also analyses
the distribution of environmental-related health problem in the area, and suggest for further
research questions in health and environment problem-solving and policy for the Upper
North. This study analyses the overview of regional and provincial levels by using secondary
data from related organization, in particular, the provincial public health offices and Cancer
Units in both Chiang Mai and Lampang.
The study result shows that the Northern region had the highest rate of Cancer
patients, and Cancer deaths have continuously be the first rank in cause of death in every
province in the Upper North. Lamphun province had the highest increase rate of Cancer
deaths, for 8.5 times between 1999-2009. Lampang had the highest prevalence rate during
the same period, with the rate of 23 per thousand. Cancer type or position mostly found in
Northern provinces is Lung Cancer which are found mostly in Male patients. Other
environmental-related health problem is Respiratory Disease which has been the major
disease found in the Upper North, and Mae Hong Son province had the highest rate of
Respiratory Disease patients (61 per cent).
Results found from this research indicate that the population of the Upper North has
been threatened by polluted environment, especially from air pollution. Not only being
enhance by its topography, climate, and settlement locations, but also by human activities s
including urban growth, economic development, lifestyle, beliefs, and culture of its population
which have accelerated and worsened the air polluted situation. Therefore, there is an urgent
needed to solve and prevent this threatened situation.
Biological products are very complex molecules, therefore the same regulatory
approach of assessing chemical drugs cannot be used. Although a variety of assays are
available, they may not be adequate to reliably predict the safety and efficacy of
biological products. Several studies indicated that the treatment responses of biological
products are not the same especially the immune responses. This study was a
descriptive study conducted by intensive literature reviews and group discussions. The
result showed that the dossiers of registered biological products were partially
incomplete comparing with international guidelines, which may cause the risk over
benefit. Thus, researchers have proposed a future system to regulate biological products
by shifting the registration and re-evaluation paradigms of biological products to be in
compliance with current international guidelines on biological products and biosimilars.
The implementation of this new proposed system requires the development of
administrative and technical aspects.
This study assessed health and economic impacts of antimicrobial resistance (AMR) in Thailand
under societal perspective by using the secondary data on hospitalizations and nosocomial infections
from 1,023 hospitals. A total of 87,751 hospitalizations developed nosocomial infections due to 5 major
bacteria (Escherichia coli, Klebsiella pneumoniae, Acinetobactor baumannii, Pseudomonas aeruginosa and methicillin-
resistant Staphylococcus aureus) that are resistant to antibiotics in Thailand in 2010. These AMR infections
resulted in additional of at least 3.24 million days of hospitalization and 38,481 deaths. Regarding an
economic loss, the cost of antibiotics to be used for therapy of AMR infections were accounted for 2,539 to
6,084 million Baht. The indirect costs of morbidity and mortality due to premature deaths related to AMR
were at least 40,000 million Baht (in 2010 values). The aforementioned health and economic impacts of
AMR are much higher than the burden of many priority health problems in Thailand. Therefore, AMR is
a major and urgent health problem in Thailand that needs comprehensive and systematic approaches at
national and local levels to resolve the problem.
The study explored the patterns of antibiotic utilization, the antibiotic control and surveillance systems,
and measures in promoting rational use of antibiotics among public and private hospitals, health
promoting hospitals, clinics, and drug stores. A cross-sectional survey using self-administered questionnaires
was conducted in 9 purposive sampling provinces in Thailand during April-May 2012. The preliminary
results were analyzed from 484 returned questionnaires (30% response rate) from 10 large public
hospitals, 11 private hospitals, 53 district hospitals, 184 sub-district health promoting hospitals, 69 private
clinics and 157 drug stores. The findings revealed that all of 47 items of antibiotics listed in the questionnaire
were available in large public hospitals whereas private clinics and drug stores had 35 and 36 items
of antibiotics, respectively. Ceftriaxone, a third generation cephalosporin, and fluoroquinolones were available
in all levels of healthcare facilities as well as drug stores. A measure regulating prescription only sales
of all antibiotics created a wide range of disagreements among respondents from different health facilities
i.e. a vast majority of private hospitals (82%) but only 8% of drug stores agreed with such a measure.
However, the regulatory measure emphasizing prescription only sales of some antibiotics appeared to be
acceptable for all levels of health facilities and drug stores. The rate of antibiotic prescription for upper
respiratory infection and acute diarrhea in district health promoting hospitals (35% - 40%) was lower than
those in the private clinics and drug stores (43% - 56%). Most large public hospitals (90%) applied drug
utilization evaluation whereas almost all district hospitals (98%) implemented the antibiotics smart use
concept in promoting rational use of antibiotics. The study results demonstrated that operating systems to
strengthen antibiotic regulation and to promote rational use of antibiotics are strongly needed in all levels
of health facilities and drug stores.
Background: One of the important factors associated with overuse of antibiotics is a lack of knowledge
and awareness on rational use of antibiotics. The objectives of the study were to determine knowledge
and awareness of rational use of antibiotics for upper respiratory tract infections, acute diarrhea, and
simple fresh wounds among first year students of Mahidol University in the academic year 2011 at Salaya
Campus, Mahidol University. Methods: 2,700 first year students were given the questionnaire set I to
determine knowledge and awareness of rational use of antibiotics before the campaigns. The campaigns
were executed by distributing the media of the Antibiotics Smart Use program. The students were given
the questionnaire set II after one week of campaigning to determine knowledge and awareness of rational
use of antibiotics after the campaigns. Results: Sixty six percent and 74% of the students responded to the
questionnaire set I and II, respectively. The range of the correct responses of the questionnaire set I was
18.7% to 75.9% and that of the questionnaire set II was 51.7% to 82.2%. The average correct response of the
questionnaire set II was significantly higher than that of the questionnaire set II. The number of the
students who intended to use antibiotics for upper respiratory tract infections, acute diarrhea, and simple
fresh wounds for the next episode of such ailments was significantly less than the rate of antibiotic use for
such ailments experienced by the students. Conclusion: Knowledge and awareness of rational use of
antibiotics for upper respiratory tract infections, acute diarrhea, and simple fresh wounds among first
year students of Mahidol University in the academic year 2011 at Salaya Campus, Mahidol University
were insufficient. The knowledge, awareness and attitude towards rational use of antibiotics of the students
after the campaigns were much improved.
Objectives: to study the process of implementation of the increasing access to high-cost medicine
listed in the Category E2 of the 2008 NLEM policy to practice under public health insurance systems: the
Universal Health Coverage scheme (UC), Civil Servant Medical Benefit Scheme (CSMBS), and Social Security
Scheme (SSS) and in hospitals as well as to explore factors that promote policy achievement and
problems occurred during policy implementation. Methods: A qualitative approach was employed including
review and analysis of relevant documents. In-depth interviews and focus group discussions
with stakeholders, who involved in the Category E2, were conducted. Results: 1) The policy implementation
under public health insurance schemes: The NLEM subcommittee created the Category E2 guidelines
including other rules and regulations for the three public health insurance schemes to follow. However,
the UC was the only scheme which developed its internal regulations related to the Category E2.
Moreover, it was also found that the three public health insurance schemes had implemented some projects
to increase access to some medicine listed in the Category E2 before the policy initiation. Also, these
projects were, in some respects, managed differently from the rules and regulations of the Category E2
policy. 2) The implementation of the Category E2 policy in hospitals: Most administrators, clinicians and
pharmacists who involved in this study agreed with the policy of increasing access to expensive medicines.
The implementation of this policy would reduce hospital expenditure on medicines particularly
medicines for patients who were covered under the UC and promote a rational use of the medicine under
the clear guidelines. However, the rules and regulations regarding the Category E2 that developed by the
NLEM subcommittee and the three public health insurance schemes could cause problems in practice
because it may introduce confusion and various management systems in hospitals. There were also some
problems of compliance with the rules and regulations of the UC and prescription for people under the
CSMBS coverage. These problems were obstacles for patients’access to medicines listed in the Category
E2. Conclusions and suggestions: Policy implementation of increasing access to the Category E2 to practice
faced many barriers. Coordination among the NLEM subcommittee, public health insurance schemes,
and hospitals as well as policy monitoring and evaluation were necessary and facilitated the success of
policy implementation.