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PUBLISHED RESEARCHES IN THE YEAR 2011

VOLUME 5 No.1

Title: A study of the primary health care units readiness in the networks for network operation: 3 primary health care units in Muang district Nakhon Pathom Researcher: Krittiya Sasipuminrit Faculty of Political Science, Chulalongkorn University Abstract The organizations concerning primary care have tried to develop their effectiveness service for all people equally. This research has its main objectives to study the readiness in the networks for network operation and to study supporting factors and obstacles found in three health centers, namely Phra Pathom Chedi community medical center, Sanam Chan sanitarium and Nakhon Pathom municipality health center. The methodology utilized were semi-structured interview and, participatory observation. The results from the study revealed that all three centers had different readiness for network operation. Phra Pathom Chedi community medical center had comparatively most readiness. The second is Sanam Chan sanitarium whereas Nakhon Pathom municipality health center had not shown its readiness. The factors affecting the readiness in network operation were the community characteristics, size, and budget administration system, staff working style, executive working style, organization regulations, knowledge and capability in responsible job, executives roles in network operation, manpower allocation, quality assurance and control of network operation, cooperation with other organizations, and monitoring and evaluation system. I was also found that the obstacles of networking include the lack of policy for stakeholders participation, no information technology for coordination, no performance based direction planning, complex organization structure and line of command, inadequate morale of staff, insufficient stakeholders in the network, no knowledge management or learning organization practice, and no effective unit cost management system. Key words: primary health care units, readiness, the networks, networks of primary care units (Published in Journal of Health Systems Research Vol.5 No.1 Jan.-Mar.2011)

Title:

Cost-effectiveness analysis of community-based DOTS versus hospital care for tuberculosis patients Nagkhat Saothong*, Nusaraporn Kessomboon

Researchers:

*Pharmacy Department, Maesai Hospital, Chiangrai Province, Thailand, Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Khon Kaen University Abstract This study aimed to compare cost-effectiveness of tuberculosis treatment strategies between community-based DOTS and hospital care at Maesai Hospital, Chiangrai Province. Costs were collected in term of provider and patient perspective. Cost-effectiveness was calculated as the cost per patient successfully treated. The 9 months historical cohort study from 1 November 2009 to 31 July 2010 was designed to measure outcomes of tuberculosis treatment. By matching of new pulmonary tuberculosis patients aged 15 to 60 years, the study included 54 patients from community-based DOTS and 52 patients from hospital care. The hospital cases were divided into 3 groups i.e. 1 to 7; 8 to 14; and more than 14 admission days that were 38, 8 and 6 patients, respectively. The provider costs data was collected from medical records while the patient costs data was collected by face-to-face interview. Results show that average tuberculosis treatment costs under community-based DOTS and hospital care were 9,436.84 and 13,540.32 baht per patient, respectively. Community-based DOTS reduced cost by 30.31% comparing to hospital care. Sub-group cost analysis of hospital care of 1 to 7, 8 to 14 and more than 14 admission days were 10,051.97, 19,168.63 and 27,969.72 baht per patient, respectively. The clinical success rates of community-based DOTS and hospital care were 90.74% and 94.23% respectively. The incremental costs of a case successfully treated in hospital were 1,175.78 baht greater than that of a communitybased DOTS. The study suggested that the community-based DOTS is a more economically attractive option. This is particularly important in setting where TB clinic is implemented under limited resources of Maesai Hospital. Key words: Cost-effectiveness, Treatment of Tuberculosis Patient, Community-based DOTS, Hospital Care (Published in Journal of Health Systems Research Vol.5 No.1 Jan.Mar.2011)

Title: Expanding health care coverage for people with citizenship problems (stateless minority): a steps forward of health insurance in Thailand Researcher: Pongsadhorn Pokpermdee National Health Security Office, Thailand Abstract: Thailand achieved universal coverage of health insurance for the entire population since 2002. However, the health insurance does not cover all of people who live in country because the National Health Security Act 2002 indicates only Thai citizenship will be eligible in the scheme. This made people with citizenship problems cannot get any basic health care. It also initiated financial problems for health care providers that have to provide essential care for the people and disease control in many areas. Over 5 years (4 health ministers), there were many attempts to push forward the providing basic health care to the people with citizenship problems. This policy was complicated, and concerned with the national security. The lack of understanding from the related institutes and our society are the main obstructed. In this year, the Nation Health Security Office (NHSO) employed the MovingMountain Triangle theory which comprises 3 strategies: 1) knowledge generation 2) social movement and 3) political engagement to push forward the policy. Finally, on March 23, 2010, the cabinet had approved this policy and assigned Ministry of Public Health (MoPH) to operate the scheme instead of NHSO. Although the policy has been passed, some important issues are needed to be considered. For instance, how well MoPH can manage according to the lacking of supporting systems. The budgets may not be enough because the capitation budget was calculated by the sharing risks with 47 millions of UC population. The benefit packages also may not equal the UC scheme. Thus, these aspects are challenging issue for everyone who works in this project.

Key words: health insurance, people with citizenship problems, stateless minority, triangle moves the mountain (Published in Journal of Health Systems Research Vol.5 No.1 Jan.-Mar.2011)

Title: Reducing impoverishment from health payments: Outcome of universal health care coverage in Thailand Researchers: Prakongsai Supon Limwattananon*, , Viroj Tangcharoensathien , Phusit

*Faculty of Pharmacy, Khonkaen University, International Health Policy Program( IHPP) Ministry of Public Health Abstract The major aims of the universal health care coverage (UC) achieved in Thailand in 2002 are not only to increase access to essential health services, but also to reduce financial risk due to out-of-pocket health payments by households. This study employed the secondary data analysis of Socio-Economic Survey (SES) by the National Statistical Office to estimate number of households becoming impoverished because of the health payments before implementing the UC policy (AD 1996, 1998, 2000, and 2002) and thereafter (AD 2004, 2006, 2007, and 2008), and to compare with a counter-factual UC-absent scenario, using segmented linear regression analysis. At the national, regional, and provincial levels, the proportions of households falling below poverty lines declined gradually during the study periods. Without the 2002-UC, a total of 100,604 households nationwide would be impoverished by out-of-pocket health payments in 2008. The UC policy in the same year could reduce the number of health-impoverished households by 37,628 (37.4%) which is equivalent to 0.2% of 19 million households nationwide. Health insurance system design that takes into account both breadth (that is number of population covered) and the benefit package depth dimensions which provide better financial risk protection and prevent households from falling into poverty trap due to their health expenditures. Key words health payment, impoverishment, poverty, universal health care coverage (Published in Journal of Health Systems Research Vol.5 No.1 Jan.-Mar.2011)

Title: Dengue Fever/Dengue Hemorrhagic Fever Outbreak in Muang district, Maehongson province in Year2009 Researcher: Sumet Ongwandee Maehongson Provincial Health Office Abstract Ministry of Public Health declared a Dengue Hemorrhagic Fever the most important public health problem and provided a national guideline of medical treatment and disease control. In Fiscal year 2009, Maehongson had undergone severely a large outbreak of a dengue hemorrhagic fever as well as the second high incident rate in the country. This study was aimed to describe epidemiological data of patients at Srisangwan hospital in Maung district, Maehongson province during Jan 1 until October 30, 2009. The study also reviewed criteria of diagnosis by physicians, a lag time of patient-access to the hospital and of disease control in the community by a disease control team. Results may reveal the outcomes of diagnoses and lead to improvement of disease-control management. It was found that completeness of patient files was 502 cases. The incident rate in age group of 11-20 years of age, 21-30 years of age and 31-40 years of age equaled to 1.94%, 1.52% and 0.77% respectively. June and July had a high number of cases. The most affected sub-districts were Jong-kum, Pang-mu, and Pa-bong. According to the criteria of diagnosis, the study found that 37.65% had no record of abdominal examination and 32.47% had no record of abnormal bleeding sign or tourniquet examinations. However, a dengue rapid test-kit was used 59.36%. In the first visit of cases was diagnosed as dengue hemorrhagic or suspected cases 40.85%, acute febrile illness 36.85%, and respiratory syndrome 17.13%. The lag time of first visit at hospital was on average 1.91 days, the lag time of being diagnosed as dengue hemorrhagic fever or suspected was on average 3.51 days, and the disease control in community was performed within 1.19 days after case notification. Results showed the affected age group was majorly in adult. Criteria to diagnosis by physicians were not fulfilled to a certain extent; on the other hand, more rapid testkits were used in a large proportion instead. Therefore, indications to use should be scrutinized as well as training courses should be regularly set up. Though the disease control was delivered shortly after being notified, there were still a number of cases increasing continuously. Therefore, the efficiency and management of the disease control team should be reviewed. Key words: Dengue Hemorrhagic Fever, Epidemiology, Diagnosis, Disease control (Published in Journal of Health Systems Research Vol.5 No.1 Jan.-Mar.2011)

Title: A Survey of Supplementary Vitamins and Minerals Prescribed for Pregnant Thai Women Researchers: Teerawattananon Utsana Tonmukayakul, Surasan Vivekmethakorn, Yot

Health Intervention Technology Assessment Program (HITAP) Abstract Iodine supplementation is, an additional intervention of the Ministry of Public Health, to alleviate iodine deficiency disorder among Thai population. This survey aims to examine opinion of obstetricians nationwide regarding vitamins and minerals supplement for pregnancies. It can be used as an input data for making national policy of iodine supplementation. Over 90 percent of obstetricians prescribed folate and iron compared to 25 percent of those prescribed iodine. The number of participants who perceived that iron deficiency, thalassemia and folate deficiency is 2-4 times greater than those who concerned that iodine deficiency was severe to most severe health problem in their responsible areas. This finding is contrast to epidemiological data where iodine deficiency could be found in most of the places. Potassium iodide plus folate and iron tablet was the most preferable as 90 percent of obstetricians selected this formulation. Thus, we suggested that the combination of 3 minerals should be provided for pregnancies. Iodine only tablet should be prescribed for thalassemic pregnant women. To effectively implement the iodine supplement tablet, guidelides for vitamins and minerals supplementation for pregnancies and good monitoring and evaluation system were strongly required. Key words: iodine supplementation, pregnant women, pregnancies, vitamins and minerals supplements, obstetricians (Published in Journal of Health Systems Research Vol.5 No.1 Jan.-Mar.2011)

VOLUME 5 No.2

Title: Expenditure of Civil Servant Medical Benefit Scheme and the use of non-essential medicines Researchers: Chulaporn Limwattananon, Noppakun Thammatacharee, Onanong Waleekhachonloet, Patchanee Thamwanna, Supon Limwattananon, Samrit Srithamrongsawat

Faculty of Pharmaceutical Sciences, Khon Kaen University, Health Insurance System Research Office, Faculty of Pharmacy, Mahasarakham University

Abstract Over two decades, the expenditure for Civil Servant Medical Benefit Scheme (CSMBS) which employed the open-ended provider payment methods has a continual double-digit annual growth. In recent years, the outpatient expenditure outpaced the inpatient one. An analysis of prescriptions and expenditures of the outpatient drugs of 26 out of 34 large public hospitals under the direct billing system in 2009 revealed that on average 41% of total prescriptions and 67% of expenditure belonged to those not covered by the current National Lists of Essential Medicines. The highest proportion of the non-essential (NE) drug prescriptions occurred in university hospitals (45%), whereas the NE proportion in the Ministry of Public Health hospitals and other ministries was relatively lower (35% and 42%, respectively). However, the NE share of drug expenditure was similar across the three hospital types (66-68%). The top six therapeutic classes of drugs, sharing 41% of total drug expenditure, were antilipids, anticancers, antiosteoarthritis (nonsteroidal antiinflammatory drugs -NSAID, COX-2 inhibitors and symptomatic slow-acting drugs for osteoarthritis -SYSADOA), antiosteoporosis, angiotensin converting enzyme inhibitors (ACEI) and antigiotensin-2 receptor blockers (ARB), and antisecretory/antiulcers (histamine-2 receptor antagonists H2RA and proton pump inhibitors PPI). The NE drugs accounted for 86.4% of the expenditure for antilipids, 87.8% for ACEI-ARB, 93.6% for antiulcers and 97.2% for antiosteoarthritis. With respect to market status, the single-source products accounted for 92.3, 86.0, 65.0, and 44.0% of the expenditure for antiulcers, antilipids, ACEI-ARB, and antiosteoarthritis, respectively. A case study of university hospital with relatively low use of NE drugs revealed that leadership of the hospital administrator and the Pharmacy and Therapeutic committee is a key to success of cost containment that can counteract threats from market strategies of drug industry and misunderstanding of prescribers toward the use of the NE drugs. It was recommended the central administration of CSMBS should give priority to cost-containment policies including reference pricing systems for drug reimbursement, monitoring and evaluation using prescriber-specific drug utilization data. In addition, appropriate financial incentive for well-performed

hospitals, capacity building for hospital personnel in data analysis and platforms for knowledge sharing should be introduced. Keywords: Civil Servant Medical Benefit Scheme, drug expenditure, National Lists of Essential Medicines (Published in Journal of Health Systems Research Vol.5 No.2 Apr.-Jun.2011)

Title: Potential saving from setting reimbursable rates of outpatient drugs for Civil Servant Medical Benefit Scheme in 2010 Researchers: Chulaporn Limwattananon, Noppakun Thammatacharee, Thananan Rattanachotphanit, Pornpit Silkavute, Supon Limwattananon, Samrit Srithamrongsawat

Faculty of Pharmaceutical Sciences, Khon Kaen University, Health Insurance System Research Office,

Faculty of Pharmacy, Mahasarakham University, Health Systems Research Institute

Abstract: The medical expenditure for outpatients under the Civil Servant Medical Benefit Schemes direct billing system continued to be very high in 2009-2010 due to the use of drugs outside the National Lists of Essential Medicines. This study estimated potential cost-savings using the aggregate drug utilization data from 28 large public hospitals under two scenarios of reimbursement: 1) the lowest price of generic in each drug group, and 2) median price of each drug. If the reimbursement rate was set most restrictively based on the minimum price of the essential drug with an equivalent Anatomical, Therapeutic, and Chemical (ATC) code 1-3 (eg. the lowest price of simvastatin for antilipids), the expenditure for antilipids, antiosteoarthritis (non-steroidal anti-inflammatory drug (NSAID), cyclo-oxygenase (COX-2) inhibitor, and symptomatic slow-acting drugs for osteoarthritis (SYSADOA)), and antisecretory/antiulcers (histamine-2 receptor antagonist (H-2RA) and proton pump inhibitor (PPI)) in 2010 would be reduced by 72.8, 85.7, and 86.5%, respectively. If each individual hospital was allowed the drug reimbursement as is but no higher than a ceiling determined as the median of price per prescription for the drug with the equivalent ATC 1-5, the expenditure for antilipids and antiosteoarthritis would be reduced by 13.4 and 13.3%, respectively. For 20 drug groups with relatively high expenditure, the reimbursement ceiling could reduce the expenditure by 14.0%. The least restrictive reimbursement condition using a fixed rate referent to the median price of drugs with equivalent ATC 1-5 from all hospitals

could reduce the expenditure for the 20 drug groups by 2.9%. Therefore, to contain expenditure using a fixed rate of reference price based on drugs with an equivalent ATC 1-5 would be the least restrictive policy option. Keywords: Cost-saving, National Lists of Essential Medicines, Civil Servant Medical Benefit Scheme, reimbursement rate, reference pricing (Published in Journal of Health Systems Research Vol.5 No.2 Apr.-Jun.2011)

Title: Preliminary financial assistance under section 41 and civil litigation Researcher: Boonsak Hanterdsith Department of Emergency and Forensic Medicine, Lamphun Hospital Abstract: Since the section 41 of the National Health Security Act B.E.2545 has been enforced, requests for the preliminary financial assistance under section 41 were increasing every year, but the civil litigation rate is undetermined. The main purposes of this descriptive research are to examine the relationship between preliminary assistance and the rate of civil litigation and to study preventable damage from medical errors. The author retrospectively reviewed all documents related to sub-committee meeting to decide the request for preliminary financial assistance between the year 2004 and 2010 and interviewed the relevant personals. Data were analyzed with frequency, percentage, and Fisher's Exact Test. The results showed that 37 cases were included in the study, 28 cases were eligible for payment of preliminary assistance. Two cases in Lamphun and 43 cases (0.93%) in Thailand filed a civil lawsuit against the Ministry of Public Health. The rate of civil litigation in cases who did not receive money compared to those received in Lamphun were not different (p-value = 1), but different (p-value = 0.031) at the national level. In conclusion, the payment of preliminary assistance in Lamphun had no effect on civil litigation, but the filing rate significantly reduced at the national level owing to this measure. Health care providers should review the service process, which the most common causes were in the communication and the referral system, to prevent any damage that may occur repeatedly in the future.

Key words: preliminary financial assistance, Section 41, National Health Security Act B.E.2545, litigation, preventable damage (Published in Journal of Health Systems Research Vol.5 No.2 Apr.Jun.2011)

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Title: Abnormalities of Body Mass Index, lipid profile and the risk of coronary heart disease development in health care workers of Health Promotion Center, Region 1, Bangkok at annual health check up 2010 Researcher: Sunee Wongcharoen Health Promotion Center, Region 1, Bangkok, Department of Health, Ministry of Public Health Abstract: The purpose of this study was to examine the abnormality in Body Mass Index(BMI), lipid profile and evaluate risk for develop coronary heart disease in years by Framingham Risk Score in Health care and office workers, aged more than 35 years old, in Health Promotion Center, Region 1, Bangkok at annual health check up 2010. The results of this study indicate overall prevalence of obesity (BMI kg/m ) was . , man . % and woman . %. The most common lipid

abnormalities were LDL-Cholesterol ( mg/dl) .%, Cholesterol ( mg/dl) % and Triglyceride ( mg/dl) . %. Risk for develop of Coronary heart disease in years by Framingham Risk Score, the study group had low risk .% and no one was in high risk group. Key words: Body Mass Index, lipid profile, Framingham Risk Score, Bangkok (Published in Journal of Health Systems Research Vol.5 No.2 Apr.Jun.2011)

Title: Review on effectiveness of Glucosamine in the treatment of osteoarthritis Researcher: Noppakun Thammatacharee Health Insurance System Research Office Abstract Objective: The purpose of this study is to review the cost-effective of Glucosamine for reimbursement in the public health insurance scheme especially, the Civil Servant Medical Benefit Scheme which Glucosamine has been widely prescribed in patients for the indication of every kind of degenerative joint. Method: Reviewing meta-analysis, randomized controlled trial with at least 12month follow-up in patients and cost-effectiveness analysis of Glucosamine from 2005-2010.

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Results: Compared with placebo Glucosamine is no more effective than placebo (statistical non-difference) in people with osteoarthritis on WOMAC pain and WOMAC function, RMDQ and EQ-5D scores also no or small effect on narrowing the joint space width. Both generic and innovative Glucosamine have ICER greater than one time Thai GDP per capita. Conclusion: Glucosamine has low effect and is not recommended to reimburse the cost of treatment in health care insurance system. Key Word: Glucosamine (Published in Journal of Health Systems Research Vol.5 No.2 Apr.-Jun.2011)

Title: Alcohol Consumption in Thailand: Results from the 2007 Cigarette Smoking and Alcohol Drinking Survey Researchers: Surasak Chaiyasong* , Thaksaphon Thamarangsi *Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University Center for Alcohol Studies, International Health Policy Program, Ministry of Public Health

Abstract: Objective: The Cigarette Smoking and Alcohol Drinking Behavior survey (CSAD) has been conducted by the National Statistical Office every 3-4 years. In 2007, this survey added crucial questions for alcohol policy, including quantity of drinking, binge drinking and untaxed alcohol consumption. In addition, it has a large sample size which can represent the population at provincial level. The objective of this study is to report alcohol consumption behaviors of the Thai population. Methods: The 2007 CSAD was a stratified two-stage sampling. Data were collected from 79,560 households by structured questionnaire, face-to-face interview during July to September 2007. This study analyzed data of sample aged 15 years or older [N=168,285]. The data were estimated to represent the population using sampling weights. Results: Prevalence of 12-month drinkers, 30-day drinkers, regular (weekly) drinkers, high-risk drinkers, binge drinkers, and drink-driving is 30.0%, 21.1%, 16.4%, 2.8%, 4.9% and 10.1% respectively. 12.9% of underage people (<20 years) reported consuming alcohol in the last 12 months. Alcohol drinkers are highly prevalent in a group of people who were male, aged 20-49 years, married, low educated, middleincome level, agriculture and labor, and living in rural area and the North and Northeast. Among all provinces, prevalence of alcohol drinkers is highest in North provinces. The most consumed alcoholic beverage was beer, followed by white spirits and colored spirits. Prevalence of untaxed alcohol drinkers is 2.4% (2.3% for

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domestic products drinkers and 0.2% for imported products drinkers). Estimated untaxed consumption is 4.7% of total alcohol consumption. Discussion: The findings of this study illustrate situation of alcohol consumption of the Thai population and critical information to be used for evaluation and monitoring in populations and provinces with high prevalence of alcohol use. Keywords: Alcohol consumption, alcohol survey, pattern of drinking, untaxed alcohol consumption (Published in Journal of Health Systems Research Vol.5 No.2 Apr.-Jun.2011)

Title: Sexual abuse among children and youth under influence of alcohol consumption. Researchers: Suwara Kaewnuy, Thaksaphon Thamarangsi Center for Alcohol Studies, International Health Policy Program (IHPP, Thailand) Abstract: The purpose of this research was to study the situation and trends of sex crimes in relation to consumption of alcoholic beverages as well as to explain the types of sexual abuse carried out while under the influence of adolescents and youth in Thailand. The sources of information were cases related to sex crimes which appeared in print media over the past years (between B.E. -) and from the collection of qualitative data from in-depth interviews. Center, Nonthaburi who committed sex crimes. From the research it was found that information from print media portrayed the number, violence, and complications of sex crimes related to the increased consumption of alcohol in Thailand, at three fold over the past ten years. The age of victims and perpetrators is greatly varied, with the age of victims between - years old and of perpetrators between - years old. From information on the perpetrators it was found that the ages are decreasing and are increasingly youth or adolescents. The crimes mostly take place at night and the abuse reported in print media the most is rape. The majority of the crimes are carried out by known people, especially family members. From interviewing youth who carried out crimes, it was found that of drank alcoholic beverages - hours before committing the crime and drank with the victims. Drinking alcoholic beverages plays a role in bringing together groups The sample group consisted of adolescents and youth at the Central Observation and Protection

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which lead to planning and thinking of committing crimes. An interesting point found was that perpetrators did not drink to get drunk (- grams of pure alcohol), but to become confident and brave enough to carry out the crimes without any consideration. Recommendations from this study include the need to be more rigorous and strict with using related laws such as forbidding the sales of alcohol to people under years old according to the Royal Decree on Control of Alcoholic Beverages, B.E. . Information on sex crimes and other crimes need to be collected and there information on alcohol consumption of the perpetrators should be collected as well. This is because alcohol is related to sex crimes and other crimes. There should be measures to publicize and change attitudes in society regarding alcohol consumption and sex crimes are not a normal aspect in society. Key words: alcoholic beverages, alcohol, sexual abuse, sex crimes, adolescents and youth (Published in Journal of Health Systems Research Vol.5 No.2 Apr.-Jun.2011)

Title: Effectiveness of Intensive Behavioral Modification Program for Individual at Risk of Type 2 Diabetes Researchers: Suwat Kotsombutt, Vitool Lohsoonthorn, Wiroj Jiamjarasrangsi, Somrat Lertmaharit, Sitamanus Suwanashine, Kanokpan Kanasoot Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University Health Promotion Center of Chulalongkorn memorial hospital, The Thai Redcross society

Abstract: In the past decade, Diabetes Mellitus tends to become more and more important problem in Thailand. Nowadays, research results clearly indicate that behavioral change strategies can decrease complications and death among Diabetes patients. Several studies in China, Finland and USA have reported that intensive behavioral modification program focusing on exercise and weight loss certainly decreases the risk of Diabetes in high risk group by 31-58 percent. Previous related researches in Thailand have found that giving knowledge alone have led to negative outcome of Diabetes patient care. This research aimed to test the effectiveness of intensive behavioral modification program for individual at risk of type 2 diabetes. This Quasi-experimental research is to study effectiveness of intensive behavioral modification model which focuses on diet and exercise for 24 weeks. Participants who are overweighed person (BMI > 25 kg/m2) were divided into two groups. Fortyone participants attended the intensive model while 61 participants received

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standard care. Effectiveness of the groups was compared at the end of the study. From data analysis made through changes of both physical and biochemical indicators, there was no significant difference found between two groups but subgroup analysis in overweight group (BMI > 30 kg/m2) indicate that the experimental group significantly lost more weight than control group (95%CI= -1.976 -0.019, p-value = 0.046). This finding shows that the program is more suitable for overweight person. However, long term study is still needed. Key words: Effectiveness, Behavioral Modification, Type 2 Diabetes

(Published in Journal of Health Systems Research Vol.5 No.2 Apr.-Jun.2011)

Title: An evaluation of universal health care coverage among low income groups in Thailand by using four selected characteristics of good governance Researchers: Jintana Jankhotkaew*, Peter Schrder-Bck, Helmut Brand, Yongyuth Pongsupap Sumalee Pratoonun *Maastricht University, Maastricht, the Netherlandsm National Health Security Office, Thailand Abstract Background: This study focuses on an evaluation of the universal health care coverage among low income groups by using four selected characteristics of good governance: equity, efficiency and effectiveness, participation and transparency. Methods: The interviews with policy makers and patient representatives were conducted. The purposive sampling was used to select interviewees. The data was analyzed by a template analysis style, as the templates are the four selected characteristics of good governance. Results: After the introduction of universal health care coverage in Thailand, the Thai health care system has improved. First, equity in Thai health care system is largely improved, which can be seen by improvement of the accessibility to health services among low income groups. Second, the efficiency of health care systems has enhanced. Third, people have better opportunity to participate in decision making process of the health care systems. Fourth, the transparency of health care systems is improved due to the shift of power to allocate health fund from the Ministry of Public Health to the National Health Security Office. Discussion: Despites the improvements in the health care systems, there are still several challenges that the Thai health care system is facing. For example, the geographical barriers prevent low income groups from accessing care for chronic

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conditions, this result showed insufficient allocation of resources in health care systems. Another challenge for the Thai health care system is a shortage of medical professionals. Conclusion: the universal health care coverage has improved the accessibility of health care services among low income groups, efficiency of health care systems and participation of people in decision making. However, the challenges are still occurring, for example, insufficient of human resources and geographical barriers.

Key words: universal health care coverage, equity, efficiency and effectiveness, transparency, participation (Published in Journal of Health Systems Research Vol.5 No.2 Apr.Jun.2011)

Title: Patient- Self Reporting System of Adverse Drug Reaction: International Scheme Researchers:

Nataporn Chaipichit, Narumol Jarernsiripornkul

Doctoral student, Doctor of Philosophy Program in Pharmacy and Health System, Faculty of Pharmaceutical Sciences, Khon Kaen University Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Khon Kaen University Abstract: The current system of pharmacovigilance is mainly responsible to healthcare professionals for reporting adverse drug reactions (ADRs) which major concerns are underreporting. Many countries had initiated patient participation to the direct reporting of ADRs resulting in increased the reporting rate especially possible new ADRs, non- serious ADRs which affect patients quality of life or ADRs which patients could play an important role in drug safety. Those patient reports provided sufficient and thorough details of the ADR outcome. However, they could be exaggerated, resulting from the ability to distinguish between their illness and medications that might cause the adverse effects. Therefore, to increase the report quality and the effectiveness of pharmacovigilance, the information about drugs and adverse effects, and encouraging the patients awareness of ADR reporting are required. Key words : Adverse Drug Reactions, Patient- self reporting of Adverse Drug Reactions (Published in Journal of Health Systems Research Vol.5 No.2 Apr.Jun.2011)

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Title: High-risk medication use in Thai elderly patients: Case study in Wangtaku subdistrict, Nakhon Pathom. Researchers: Wiwat Thavornwattanayong*, Jatuporn Anothayanon, Niramol Reungsakul, Phanlop Sriphiromrak, Rinapat Chomjan Department of Community Pharmacy, Faculty of Pharmacy, Silpakorn University. The fifth year student, Faculty of Pharmacy, Silpakorn University. Abstract: The high-risk medications used in the elderly is a pressing problem that is a concern in many countries around the world. However, in Thailand there is still lack of studies related to this issue. Therefore, this study was aimed at surveying the high-risk medications used in the elderly at Wang Taku Subdistrict, Nakhon Pathom based on the criteria for high-risk medications used in the elderly of Winit-Watjana W. et al. The data of this cross-sectional study were collected by surveying and interviewing the elderly. Of 118 elderly, 72.9 % were female. Average age was 72.63 5.25 years. Most medical problems found were hypertension, (76.3%). Of 421 drug items, 92 items were high risk medication use or 0.78 item per patient. The findings revealed 79 drug items with potentials to cause adverse reactions; 11 drug items with drug-disease interactions and 2 drug items with drug-drug interaction. After analyzing each subgroup, angiotensin converting enzyme inhibitors (out of 34 drug items) was mostly found in causing adverse reaction and non-steroidal antiinflammatory drugs (16 drug items) were subsequently found. In drug-disease interaction subgroup, hypertension/heart disease (9 items) were found to be the most, and the other 2 items were gout-hydrochlorothiazide (HCTZ) and asthma/ COPD-benzodiazepine. The last subgroup, drug-drug interaction, aspirin with NSAIDs and digoxin with HCTZ were found. Results of this study can be used to develop a guideline for advising and monitoring high-risk drug use. Key words : high-risk medicine, the elderly (Published in Journal of Health Systems Research Vol.5 No.2 Apr.-Jun.2011)

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Title: Forecasted expenditure due to the use of expensive drugs in Civil Servant Medical Benefit Scheme: a comparison with Universal Health Coverage Scheme

Researchers:

Supon Limwattananon*, Chulaporn Limwattananon , Areewan

Cheawchanwattana,Pornpit Silkavute, Viroj Tangcharoensatien

Faculty of Pharmaceutical Sciences, Khon Kaen University, Health Systems Research Institute,

International Health Policy Program

Abstract Therapeutic drugs, a major component of outpatient care have made the utilization pattern in the Civil Servant Medical Benefit Scheme (CSMBS) different from the Universal Health Coverage Scheme (UCS). This study analyzed a time-series of 57 months during 2003-2007 for drug prescriptions in 6 Regional Hospitals and General Hospitals and forecast the overall expenditure. Four therapeutic classes with high expenditure or frequent use, including angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-2 receptor blockers (ARB); antilipids; proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA); and non-steroidal antiinflammatory drugs (NSAID) plus coxib were analyzed with respect to two expenditure components; (1) propensity to use the target drugs, which are not covered by the National Lists of Essential Medicines or are the single-source products, and (2) the utilization quantity. Results from the expenditure forecast before and after the CSMBS direct billing policy and the UCS 30-Baht copay abolition policy using a segmented regression analysis revealed that the use of the following target drugs, including ARB, non-essential antilipids, single-source PPI and coxib was associated with the total and expenditures growth of the four classes. The close-end method of provider payment currently employed by the UCS, if applied to the CSMBS would be able to reduce 40% of the expenditures for PPI-H2RA and NSAID-coxib to 100% of the expenditure for antilipids. For the substitution measure, the degree of cost-saving would depend largely on the policy compliance levels. With the 20% compliance, 8% of the expenditures for PPI-H2RA and NSAID-coxib and 20% for antilipids could be saved. With the 80% compliance, the cost-saving would range from 30% to 80%. Keywords: Civil Servant Medical Benefit Scheme, Drug expenditure, Segmented regression, Universal Health Coverage Scheme (Published in Journal of Health Systems Research Vol.5 No.2 Apr.-Jun.2011)

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Title: Antibiotics prescribing for acute diarrhea at Pua Crown Prince Hospital , Nan province. Researcher: Adisak Wongnai Pua Crown Prince Hospital , Pua district, Nan province. Abstract Antibiotic prescribing for acute diarrhea was common among prescribers although most for acute diarrhea conditions were not caused by bacterial infection. The purpose of this study was to investigate antibiotics prescribing for acute diarrhea in the outpatient department in Pua Crown Prince Hospital, Nan province. Medical record of the targeted patients during 1 January to 31 December 2009 were evaluated regarding antibiotic prescribing. Criteria for antibiotic prescribing for acute diarrhea included having fever (38 c or above) and mucous or bloody stool or stool exam with red blood cell and/or white blood cell. Result showed that of a total of 613 patients with acute diarrhea, 406 patients (66.23%) were prescribed antibiotics. For patient who received antibiotics, 90.40% were identified as irrational antibiotics prescribing. This data showed that clinical practice guideline was important data to make good decision to start antibiotics in patient with acute diarrhea. Key words : acute diarrhea, antibiotic, prescribing behavior (Published in Journal of Health Systems Research Vol.5 No.2 Apr.-Jun.2011)

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VOLUME 5 No.3

Title: Development of Friendship Networks and Potential of Self-Help Groups to promote Healthy Aging among Community-Dwelling Older Adults Researchers: Kattika Thanakwang*, Jitana Rattanawitoon, Jamjuree Tanurat *Faculty of Nursing, Naresuan University, Phitsanulok Pua Crown Prince Hospital, Pua district, Nan province Abstract: Older persons are the important resource of nation; however, they are previously viewed as persons only received support from family and society. This research project aimed to develop friendship networks and potential of self-help groups to promote healthy aging among community-dwelling older adults. Participatory Action Research was applied to older adults in Woranakhorn subdistrict, Pua district, Nan province. Data were collected using focus group discussion and questionnaires. Content analysis was performed for qualitative data. For quantitative data analysis, mean, standard deviation, and paired t-test were used. The development of friendship networks and potential of self-help groups resulted several self-care activities including performing basic physical examination and health evaluation, reciprocal caring and taking care for each other within community, and creating health-promoting activities applying folk art and local wisdom. Compared to changes of older adults after developing of friendship networks and self-help groups, there were found that, after project intervention, the older adults who regularly participated in the friendship group activities had friendship networks, friendship support, self-efficacy, health-promoting behaviors, and healthy aging greater than before intervention with statistical significance at 0.05 level. Therefore, promoting potentials of the elderly individuals, empowering and using social capital within community can promote friendship group activities and self-help group among community-dwelling elders, facilitating to achieve healthy aging. Key words: friendship networks, self-help group, health-promoting behavior, healthy aging (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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Title: Hardship area: criteria and classification Researchers: Kwanpracha Chiangchaisakulthai*, Nichakorn Sirikanokvilai, Pongpisut Jongudomsuk, Somsak Chunharas, Pinij Fahamnuaypol * International Health Policy Program, Ministry of Public Health Bureau of Health Policy and Strategy, Ministry of Public Health Health Systems Research Institute

National Health Foundation Health Information System Development Office

Abstract This study was aimed to develop criteria and guideline for identification and classification of hardship areas. This was part of a study on Reform of Financial Incentive of Public Health Personnel submitted to the Ministry of Public Health, Thailand. Criteria to identify hardship areas included transportation, city-life effect and economic development. It was found that classification of hardship areas using developed criteria was 69.8% correspond with opinions of the Provincial Chief Medical Officers. A guideline to classify hardship areas using hardship score and confirmation by using opinions of the Provincial Chief Medical Officers and Health Inspectors was found some difficulties and limitations during implementation. This is a need to improve this methodological approach. Keywords: hardship areas, financial incentive, criteria and classification (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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Title: Impact of overweight and obesity on health care cost in Thailand Researchers: Paiboon Pitayatienanan,* Rukmanee Butchon,, Jomkwan Yothasamut, Wichai Aekplakorn, Yot Teerawattananon, Naeti Suksomboon, *Montarat Thavorncharoensap *Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University Abstract: Overweight and obesity are associated with several chronic diseases. Economic cost attributable to overweight and obesity is substantial. In Thailand, prevalence of overweight and obesity increases rapidly. It was also found that overweight and obesity was the 6th leading risk factor attributable to DisabilityAdjusted Life Year; (DALY) loss in Thailand in 2004. However, there has never been a study, which examining health care cost due to overweight and obesity in Thailand before. This study aims to estimate the healthcare cost attributable to overweight and obesity in Thailand in the year 2009 employing the overweight and obesity attributable fractions (OAFs), which are generally defined as proportion of a disease in population which is attributable to overweight and obesity, to calculate for each disease associated with overweight and obesity. OAFs can be calculated using the prevalence of overweight and obesity and relative risk of each disease. The number of patients in each disease category attributable to overweight and obesity was then calculated as the product of OAFs and the total number of patients with that disease in 2009. The health care costs of overweight and obesity was further estimated by multiplying the number of patients in each disease category attributable to overweight and obesity by the unit cost of treatment. Health care costs attributable to overweight and obesity in this study was estimated at 5,580.8 million baht (i.e. out-patient department = 847.4 million baht and in-patient department = 4,733.4 million baht). The top three leading causes of health care costs were diabetes mellitus (3,386.6 million baht), ischaemic heart disease (1,070.5 million baht) and colon and rectal cancer (377.2 million baht), respectively. The findings clearly confirmed that economic impact of overweight and obesity on health care cost in Thailand is substantial. More effective policies/ interventions aimed at reducing prevalence of obesity should be implemented. Key words: health care costs, overweight, obesity, economic, impact (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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Title: Factors Affecting the Obesity of Undergraduate Students in Chiang Mai Province Researchers: Wannapa Lekuthai*, Lily Ingsrisawang*, Naeti Suksomboon*, Yot Teerawattananon*, *Health Intervention and Technology Assessment Program(HITAP), Ministry of Public Health Department of Statistics, Faculty of Science, Kasetsart University Department of Pharmacy, Faculty of Pharmacy, Mahidol University Abstract The aims of this study were to explore the situation of obesity among undergraduate students and to determine the socioeconomic and economic factors associated with obesity. A cross-sectional survey using questionnaires was conducted from students in universities of Chiang Mai province, Thailand. The data were then analyzed by using Logit regression model. We found the situation of obesity in undergraduate students as follows: % of the study sample was either overweight or obesity. Of those, % were male, % stayed in dormitory, % failed to exercise, % were not willing to pay for obesity treatment, % did not acknowledge themselves as obesity and % had health insurance. The socioeconomic factors significantly associated with obesity among university students were family incomes, fast food consumption, place of living, willingness-topay for obesity treatment and gender at the . significant level. However, economic factors such as myopic view underlying eating habits, asymmetric information and incomplete information on nutrition and causes of obesity did not show a significant impact on obesity among the undergraduate students. It possibly concluded that undergraduate students had no myopic view behavior or they knew very well concerning the information on nutrition and causes of obesity. Keywords: obesity, socioeconomic factors, economic factors (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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Title: Diabetic Disease Management Comparison among Community Hospitals, in Ubon Ratchathani Researchers: Aporn Jaturapattarawong*, Parichart Butdeemee, Sirirat Boonjarat, Nuchjarin Apinun, Watcharodom Supaluk*, Teeraporn Chanakit, *Warinchamrap Hospital,

Mongsamsib Hospital, Khuangnai Hospital, Trakarnphuetphon Hospital, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University

Abstract: Background: Evaluation of diabetic management program among community hospitals is incomparable. Therefore, it is recommended to data analysis from EMRs in evaluating diabetic care in order to drive diabetic care quality at community hospital level. Objective: To compare and evaluate the process and clinical outcomes of diabetic care. Method: EMRs from 2006-2009 were retrieved from 18 community hospital database system to evaluate the process and clinical outcomes of diabetic care. The process of care was measured as receiving at least one clinical lab test each year. Data were encoded for patient confidentiality. Results: Process of Care Quality of diabetic care process increases from 2006 to 2009. The proportion of patients who received at least one HbA1c lab test, CHO, TG, HDL, LDL, UA and Scr were determined in 3.95%,37.85%, 39.80%, 29.40%, 34.14%, 17.61%, and 65.98% of patients in 2006 respectively. These numbers increase to 26.55%,56.09%, 59.30%, 52.07%, 57.52%, 32.15%, and 66.52% in 2009 correspondingly. Outcomes of Care: Compared to 2006, the proportion of patients who had LDL<100 mg%, TG <150 mg%, HDL>40 mg% were 39.53%, 32.88%, and 19.30% in 2009 respectively. In 2009, however, the proportion of patients whose HbA1c<7%, FBS<90-130 mg %, BP<130/80 mmHg decrease to 25.63 %, 11.55% and 12.01% , compared to 31.40%, 11.86% and 20.47% in 2006 correspondingly. Conclusion: Although the process and some clinical outcomes of diabetic care improve from 2006 to 2009, other clinical outcomes decrease. Proactive diabetic management program should be implemented to enhance diabetic control. Keywords: Diabetic Disease Management , Evaluation of Diabetic Outcome, Community Hospitals (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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Title: Construction workers drinking and smoking behaviour: research for health communication planning Researchers: Jomkwan Yothasamut, Choenkwan Putchong*, Songyot Pilasant, Kanlaya Teerawattananon, Sirinya Teeraananchai, Roongnapa Khamphang, Rukmanee Butchon, Sripen Tantivess, Yot Teerawattananon Health Intervention and Technology Assessment Program (HITAP) Abstract: This study aimed to explore current situation concerning risk factors and behaviours that construction workers were facing at both individual and community levels as well as to examine existing health promotion interventions. These information were expected to be used for constructing useful recommendations for the development of existing and new interventions employing social marketing principles. Methods: The study began by employing qualitative methods. Research team was assigned to embed in a purposively selected construction camp for two months to collect data concerning lifestyles, social value, as well as risk behaviours and risk factors. Afterward a cross-sectional survey on interested issues was implemented. Finally the data were analysed and presented to the communities representatives in focus group discussions. This was to verify and investigate explanations underpinning the findings, moreover it was expected that such a payback method including findings would be beneficial to people in the communities. Results: It was found that one of major risk behaviours observed in the study community was alcohol and tobacco consumption. Although the target group had a number of constraints in terms of purchasing power and time. They received relatively low payments with excessive workloads; however, they were offered with convenience and motivations to access to alcohol and tobacco products. It was observed that legal interventions i.e. restriction on alcohol-selling time did not perform effectively as population usually purchased these unhealthy products from small community groceries where there was a lack of inspections from police officers, besides these workers rarely knew about this regulation. For those who have seen or known about the law, they still did not understand the reasons behind such a restriction on selling time. Strengthening law enforcement was therefore recommended by academics as a strategic solution. On the contrary, this study pointed out that the use of social marketing principles to communicate with the target group regarding the true purposes and relevant facts of the interventions tended to help increase effectiveness of legal interventions. Conclusions: In order to develop suitable health promotion interventions for the target groups, health promoters needed to understand the context and develop ways to burden their access to unhealthy products. It was recommended that social marketing should initially be applied for promoting behaviours that are easy and require low costs to change e.g. stop drinking in certain period of time. This is to offer reachable targets to the target group and once they achieve such a goal, they would be empowered believing in their abilities, and this will help them to step up to overcome more difficult goals e.g. stop drinking or smoking. The application of social marketing

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principles into existing legal interventions can help facilitate prompt behaviour change as well as maintain desired behaviours in the target populations. Keywords: risk behaviours, social marketing, health promotion, construction workers (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

Title: Is there anything new in health policies of political parties in 2011 general election? Researchers: Danwattana Pongpisut Jongudomsuk*, Thitima Nawachinkul*, Saisiri

*Health Systems Research Institute, Independent Health Communicator Abstract: This study is aimed at analyzing health policies proposed by political parties during a campaign for the general election on 3 rd July 2011. Review of official documents as well as information disseminated through websites and mass media was used for analysis of these policy contents. It was found that there were many health policies proposed by political parties although they were not the main policies used for the campaign. Policies on universal healthcare coverage and development of healthcare system were almost equally important while there were fewer policies on health promotion. Civic movements and mass media could introduce new policy agendas into the concern of politicians. There is a need to follow up these political parties whether they will do as promised or not if they have been elected as leading parties to form the government. Key words: health policies, political parties, general election in 2011 (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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Title: Why Tobacco should be excluded from Free Trade Agreement? Researchers: Pitayarangsarit*,
*

Risatarn Jarungsuccess*, Nithat Sirichotiratana, Siriwan

Tobacco Control Research and Knowledge Management Center, Mahidol University,

Faculty of Public Health, Mahidol University, International Health Policy Program

Abstract: The free trade agreement is intended to spread the high quality goods to all countries without any barriers so that the standard of living and the wealth would be heightened. Tobacco, however, is not the typical goods. In contrast, it is detrimental to humans life. The more the cigarette is consumed, the more harmful incurred to both the consumer and the people in the same environment. Hence, the dissemination of tobacco products should be controlled. This paper considers the statistic data and the relevant articles, and then presents the negative impact of the free trade agreement. After the tariff reduction to 0-5 percentages resulting from The ASEAN Free Trade Area (AFTA), the production of domestic and foreign cigarettes rose. Likewise, the tobacco consumption rate in adolescences grew up. Despite the wide-range campaign in smoking recession, the decline of tobacco consumption rate in other age ranges was not as remarkable as it should be. Moreover, the free trade agreement hindered the development of tobacco control regulations. The government was likely to chill the new regulations to avoid the infringement of the free trade agreement, whereas the tobacco industry prevented such regulations by threatening the government with the free trade agreement. This paper, therefore, suggests that in order to strengthen tobacco control schemes, tobacco products should be put in the exclusion list in the free trade agreement. Keywords: Free Trade Agreement, Tobacco, Cigarette (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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Title: Effectiveness of health screening and health program for prediabetes and prehypertension individuals at the Municipality branch of University Pharmacy Researchers: Phiraya Wongpattanatanadeach*, Peeraya Somsaard, Pornchanok Srimongkon *Pharm.D. student, Faculty of Pharmacy, Mahasarakham University Faculty of Pharmacy, Mahasarakham University Abstract: The objectives of this study were to evaluate the effectiveness of the health screening and education for the prediabetes and prehypertension individuals by randomized controlled trial. The samples were randomized to experimental group was received health education and not received in control group follow up for 2 months. Outcomes were modifying of health behaviors, blood pressure, fasting blood sugar (FBS) and knowledges. There were 367 participants attended health screening process. There were 6.56% of prediabetes, 33.75% of prehypertension and 13.75% of prediabetes and prehypertension. Thirty-one of prediabetes (15 in experimental group and 16 in control group ) and 49 of prehypertension (24 in experimental group and 25 in control group) were followed up. The result showed that eating, alcohol drinking and exercise behavior of those who were prehypertensive individuals in experimental group were significantly changed (Pvalue <0.05) and that salt eating and alcohol drinking behavior of those who were prediabetic individuals were significantly decreased (P-value <0.05). Blood pressure levels and FBS were significantly decreased from baseline (P-value <0.05) in both of experimental groups but no differences from control group. The knowledge scores were significantly higher in experimental group than the control group (p-value <0.05). The result indicated that effectiveness of the health screening and education for the prediabetes and prehypertension individuals could help subjects realized to modify health behaviors and reduced blood pressure and blood sugar level. Keywords: screening, health promotion, prediabetes individuals, prehypertension individuals (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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Title: Cost Saving, Cost Addition, and Cost Avoidance from Medication Error Interventions in Sawangdandin Crown Prince Hospital, Sakon Nakhon Province Researchers: Virojanawat* Sukanya Numchaitosapol *, Nusaraporn Kessomboon, Viroj

* Sawangdandin Crown Prince Hospital, Sakon Nakhon Province, Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Khon Kaen University Abstract: This study aimed to analyze cost saving, cost addition, and cost avoidance from medication error interventions at Sawangdandin Crown Prince Hospital, Sakonnakhon province. A prospective descriptive study was conducted from a provider perspective during February July 2010. Cost analysis data were direct medical care costs, probability of harm if the patient did not receive pharmacists interventions, Relative Weight of the related DRG, and average cost of the DRG. Results showed that the incidence of medication error of out-patient was 7.56 per 1,000 prescriptions and inpatient was 5.01 per 1,000 patient-days. The cost saving was 6,309.21 baht. The cost addition of interventions to dispense the right medicines was 5,676.52 baht. The cost avoidance of outpatients treatment was 50.60 baht. The cost avoidance of inpatients treatment was 199,280.66 baht. Cost addition for treatment of medication error category E-I was 7,361.90 baht. The net cost saving was 192,602.05 baht in 6 months. In conclusion, medication error interventions can save the hospital budget and promote patient safety. Key words: Cost saving, Cost addition, Cost avoidance, Medication error (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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Title: Policy Analysis for Response and Preparedness of Avian Influenza Pandemic and/or Influenza in Thailand Researchers: Petcharat Pongcharoensuk*, Chantana Padungtod, Pornpit Silkavute *Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand Department of Disease Control, the Ministry of Public Health, Nonthaburi 11000, Thailand Health Systems Research Institute, Nonthaburi 11000, Thailand Abstract Since 2005, a national strategic plan aimed to control and prevent future Avian Influenza (AI) pandemic and/or influenza in Thailand, was established as a policy measure to tackle the public health threat. The objective of this paper is to study the formulation process of two policy measures for AI; poultry vaccination and stockpile of antiviral drug for human. We used qualitative approach with in-depth interview of 38 key stakeholders from many organizations. In addition, literature review was carried out along with the interview. After collecting data from literature and in-depth interview, we analyzed the emerging themes relevant to the policy formulation process in Thailand. We found that policy formulation concerning poultry vaccination is a very complex and politically driven process since many stakeholders are involved with different special interest and power influence. Small scale poultry producers, representing rural people are the ones who would rather use vaccine, because nonvaccine measures (such as culling or bio-security) are against their rural culture. However, the majority of key stakeholders are against the use of poultry vaccine. There are four major reasons: 1) evidence of vaccine effectiveness is not convincing, and thus, a public health threat remains possible; 2) the government has confidence in their infrastructure to fight the AI outbreaks with non-vaccine measures; 3) the management system of vaccination (acquisition of quality vaccine, finance, logistics, monitoring and exit program) is not quite effective; and 4) the government implicitly, wants to protect the chicken export industry. Thus, the government decided not to use poultry vaccine. Contrary to the poultry vaccine policy, anti-viral drug stockpile for human is determined primarily by experts at the MoPH, following the WHO guidelines, but under budget constraint. Others factors relevant to policy analysis are: government leadership, budget constraint, animal and human health co-ordination, scientific evidence and risk communication for the public. Keywords: policy analysis, pandemic influenza, avian influenza, Thailand (Published in Journal of Health Systems Research Vol.5 No.3 Jul.-Sep.2011)

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VOLUME 5 No.4

Title: Implementation and outcome evaluation of satellite network of Anticoagulation clinics in Nakornratchasima province, Thailand Researchers: Buncha Sukanantachai*, Ubonwan Sapoo*, Arunee Supsinwiwat* , Wijin Pongrithsakda*, Nuntiya Tangsriseree, Sittipong Kanokhong
*

Maharat Nakornratchasima Hospital Watboon Community Medical Unit Dankhunthod Hospital, Thailand

Abstract: 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 prereferral period were compared with those of post-referral period using descriptive statistics, paired T-test and McNemars 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 prereferral 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. Keywords:, Satellite network, Anticoagulation clinic, Warfarin network (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

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Title: Alcohol consumption control: From cost-of-illness study to policy recommendation Researchers: Montarat Thavorncharoensap,*, Tivarat Woothisai *, Pattara Leelahavarong *, Naiyana Praditsitthikorn*, Yot Teerawattananon* *Department of Pharmacy, Faculty of Pharmacy, Mahidol University Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health Abstract: According to the cost-of-illness studies, economic impact of alcohol consumption is substantial. Impact of alcohol and smoking on productivity loss due to premature mortality and morbidity is enormous and clearly affect economic system of the country. According to the cost-of-illness studies, the followings are policy recommendation; 1) Alcohol control policy should be set as the national priority; 2) collaboration from all related organizations especially economic organizations both government and private as well as enterprises at all levels are needed; 3) Policy/ intervention aims at preventing new drinker as well as encouraging drinker to quit at the early age are essential. However, policy/intervention targeting at prevention of adolescent from start drinking are more cost-saving than policy encouraging drinker to quit. In addition, encourage drinker to quit at early age are more cost-saving than at the older age; 4) Policy/ intervention targeted at preventing new responsible drinker or encouraging responsible drinker to quit is still important, as responsible drinkers accounted for the highest proportion in the country; and 5) All related organizations should collect data in term of the number of new drinkers or quitters prevented from the policy/intervention in order to use them to conduct cost-effectiveness of such policy/intervention in the future. Keywords: Alcohol, Economic, Policy, Cost-of-illness (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

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Title: Role of Family Physicians in Sexual Assaulted Patients in Chaibadan District Hospital Researcher: Pradit Tanadechakul Chaibadan District Hospital, Lopburi province, Thailand Abstract 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%). Key words: Family Physicians, Sexual Assaulted Patients, District Hospital (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

Title: Screening, Treatment and Rehabilitation for Alcohol Problems: Gaps under the Universal Health Coverage Suwara Kaewnuy, Thaksaphon Thamarangsi, Sopit Nasueb, Prapag Neramitpitagkul Center for Alcohol Studies, International Health Policy Program Abstract Services to provide screening, treatment and rehabilitation of alcohol-related problems are covered under the Universal Health Coverage Scheme in Thailand. However, massive number of population with risks and patients are practically ignored, do not get what they should be serviced, from the current health care system and practices. Unintentionally but significantly, the shortage to provide proper care, escalates the magnitude and severity of alcohol problems. Technical evidence shows the need, appropriateness, benefit and practicability of the comprehensive services for alcohol related problems with in Thai health care system. The comprehensive service should cover four interconnected components; 1) alcohol screening and brief intervention, 2) Detoxification and treatment of physical comorbidity, 3) Alcohol treatment and rehabilitation, and 4) Long term after care. Major

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limitations at macro scale is the lack of policy to strengthen health care system in addressing alcohol problems, including in raising significance, building up preparedness and capacity of the systems, providing incentive, and resource management. Critical constraints at institutional level include awareness and capacity of health workforces, the lack of risk assessment and management, the unavailability of clear and comprehensive policy. The framework to strengthen Thai health care system response to alcohol problems should tackle major system gaps in current systems, and strike balance of and cover all four components in parallel. Key words: Alcohol, Universal Health Coverage, Thailand (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

Title: Systematic review on food and beverage tax and price interventions Researchers: Sirinya Phulkerd*, Thaksaphon Thamarangsi*,** *International Health Policy Program, Thailand **Center for Alcohol Studies, Thailand Abstract: While a fiscal policy has been shown to influence food and beverage prices in ways which help encourage healthier eating behaviour, evidence about the use of tax and price interventions is still unclear and questions about their effect still remain. A systematic review on food and beverage tax and price interventions was conducted in order to explore evidence about tax and price interventions to promote healthy dietary behaviours and investigate their effect on consumers. The English and Thai-language published and grey literature for studies on tax and price interventions including monetary subsidies or taxes levied on food and beverage and their effects were searched. Twenty-seven studies met the inclusion criteria. 4 were from the peer-reviewed literature, 21 were published online and 2 were from grey literature. The studies mostly focused on taxing snack, confectionary, soft drink and soda, and on subsidizing staple food such as rice, wheat and maize. These interventions particularly taxation were found in influencing diet and body weight. In conclusion, taxes and subsidies in food and beverage may be a useful tool contributing to healthier consumption patterns at the population level. However, more information is needed on actual response on food and beverage and consumers in food and beverage taxation and subsidy in developing country particularly Thailand along with information on how effective food and beverage taxation and subsidy would be and particularly their effect on people in developing countries. Key words: fiscal policy, taxation, subsidy

(Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

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Title:Working process and supporting factors and barriers for the development of public health programs under the Sub-district Administration Organization in Nakhon Si Thammarat Province Researcher: Piyaporn Khanom Sichon Hospital, Nakhon Si Thammarat Province Abstract 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 (92.61%). 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.

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Keywords: Sub-district Administration Organization, Working Process, Health Project Development (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

Title: Public Health Decentralization: Background, Situation and Future Trends Researcher: Jukkrit Wungrath Faculty of Public Health, Chiangrai College Abstract: 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 (sub-district 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. Keywords: Public Health decentralization, Health center (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

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Title: Views of Health Professionals on Herbal Medicine and Policy for Promotion of Herbal Medicine Use in Healthcare Settings Researchers: Kakanang Tosanguan*, Nattiya Kapol, Montarat Thavorncharoensap, Neti Suksomboon, Wantanee Kulpeng*, Sripen Tantivess*, Yot Teerawattananon* *Health Intervention and Technology Assessment Program (HITAP), Nonthaburi

Faculty of Pharmacy, Silpakorn University, Nakhon Pathom Faculty of Pharmacy, Mahidol University, Bangkok

Abstract 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. Key Words: herbal medicine, policy, opinion (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

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Title: Appendicitis of three Schemes during 2005-2008 Researcher: Pornrawin Sripengpech National Health Security Office Abstract 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, 0.68 and 0.72 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. Key words: Ruptured Appendicitis, Appendicitis, Appendectomy (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

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Title: Comparison of Adherence of Antiretroviral Therapy between Community Hospitals and Regional Hospitals under the Universal Coverage Researchers: Sukhontha Kongsin1, Sukhum Jiamton2 , Kanoksak Wongpeng1,

Kitiya Prom-On1,Sittikorn Rongsumlee1, Nootchawan Boonruang1,Saranya Boonyai1, Kulyisa Tachapetpaiboon1, Benjaporn Youngviset1,Siriporn Monyarit1 Research Centre for Health Economics and Evaluation , Faculty of Public Health, Mahidol University
1 2

Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University

Abstract Background: The adherence of antiretroviral therapy (ART) higher than 95 % is needed for the effectiveness of HIV suppression. prevention of opportunistic infections, reduction chance of HIV transmission and overall health improvement. Aim of the study was to find facility factors related to adherence of ART under the universal coverage. Methods: A cross-sectional study was conducted among 823 HIV-infected individuals who were receiving antiretroviral under National AIDS Program (NAP) in 9 public hospitals in 3 provinces (3 regional and 6 community hospitals). Adherence had been assessed by pill count and selfreport using Visual analog scale (VAS). This study was approved by ethical committee of the Ministry of Public Health. Results and discussion: Average adherence from pill-counts and self-report was 87.4% and 49.7 % respectively. Adherence from regional and community hospitals evaluated using pill-count respectively was 82.7 % and 95.2 % while using self-report respectively was 46.3 % and 56.5 %. Logistic regression model shows community hospitals were correlated with higher adherence than regional hospital from self-report by VAS (OR=1.51; 95 % CI:1.13 -2.02, p=0.006) and from pill-counts (OR=4.17 ; 95 % CI:2.10-8.31, p<0.001). Although ART service in all hospitals was under the same Universal Coverage scheme, the difference of adherence is existed. Related factors might be from patient-staff relationship, ease of travel, ART-one-stop service and exclusively isolate clinic in small hospitals while in large hospitals there are many patients visited under limited service area and not separated from other clinics for receiving ART. Conclusion(s): Regional/general hospital might need substantial supports on budget and personnel as well as the allocation of service space and increasing interest of the clients on adherence on ART. Key words: Antiretroviral therapy, Adherence, universal coverage (UC), size of hospitals (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

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Title: Cost - effectiveness analysis of cases weight control program for King Rama IX in Angthong Province Researcher: Thaval Poblap

Angthong Provincial Health Office Abstract: Objective of this study was to compare of knowledge attitude weight control behavior of population who attended between two weight control programs. The first program was Camp for eradicate obesity and belly program, the second was Weight control program of the Department Of Health. Study design was quasi-experimental research which studied obesity and health problem before and after attended cost ,cost effectiveness of both programs. The samples were the 40 people who attended Camp for eradicate obesity and belly program which operated by Viseschaichan Hospital and 40 people who attended Weight control program of the Department of Health which operated by Pamok Hospital. This study analyzed by descriptive and used statistics pair t-test, Pearson Product moment Correlation Coefficient. Study results, both programs were found that knowledge, attitude and weight control behavior of people were increase, blood pressure, body weight and waste circumference were decrease and were different between before and after attended both programs significantly at p < 0.05 . People who attended Camp for eradicate obesity and belly program could reduced weight 87.5 and 77.5 % by 8 and 16 weeks ,who attended Weight control program of the Department of Health could reduced weight 65.0 and 67.5 % by 8 and 16 weeks accordingly. By week 16 th , the studies found that unit cost of Camp for eradicate obesity and belly program was 4,487 baht and Weight control program of the Department of Health was 3,518 baht. Cost effectiveness of Camp for eradicate obesity and belly program and Weight program of the Department of Health were 5,793 and 5,212 baht per person who could lose weight accordingly. Suggestion, Camp for eradicate obesity and belly program was more effective but not appropriate to used in weight control of large group population because of higher cost. Weight control program of the Department of Health had lower unit cost and cost effectiveness . Key words: Cost - effectiveness , Weight control program for King Rama IX (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

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Title: Gaps and Opportunities in Addressing Non Communicable Diseases in Thailand with WHOs Best Buys and Good Buys interventions Researchers:Thaksaphon Thamarangsi*,, Siriwan Pitayarangsarit*,, Prapapun Iamanan, Sirinya Phulkerd*, Suladda Ponguttha*, Orratai Waleewong*,, Attaya Limwattanayingyong
*

International Health Policy Program (IHPP) Center for Alcohol Studies (CAS) Tobacco Control Research and Knowledge Management Center (TRC) Department of Disease Control

Abstract Non Communicable Diseases (NCDs) is the most important health problem in Thailand, in terms of both mortality and morbidity. In the Global Status Report on Noncommunicable Diseases 2010, World Health Organization recommends 26 effective and cost-effective interventions to tackle NCDs crisis. Further divided into 12 Best buys intervention and 14 Good buys, these population-wide policy interventions aim to address NCDs at their five major risk behaviours. These include tobacco use, alcohol consumption, food and beverage dietary, physical activity and Hepatitis B vaccination. This study describes theoretical concepts of the intervention, and analyses situations, gaps and opportunities of Thailand to adopt these 26 interventions. These interventions differ in terms of strength of policy content, implementation and feasibility to be strengthened. In conclusion, Thailand faces many major limitations in embarking these Best buys and Good buys health interventions, including priority, resources, capacity, sustainability, monitoring and evaluation, and coordination. While some are not exists at macro scale in Thailand, some interventions were not primarily designed for health purposes. Key words: Non communicable diseases, NCDs, health intervention, Thailand (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)

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Title:

Drug using among diabetic patients with chronic renal failure during the month of Ramadan :Case study of Nongjik Hospital , Pattani Province Researcher: Ninnard Cheyoe Nongjik Hospital , Pattani Province Abstract 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. Keywords: Muslim, month of Ramadan, diabetes, renal failure (Published in Journal of Health Systems Research Vol.5 No.4 Oct.-Dec.2011)