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PUBLISHED RESEARCHES IN THE YEAR 2010

VOLUME 4 No.1

Title: An application of Decision Tree Algorithms with Diagnosis of the Diseases of theRespiratory System

Researchers: Ditapol, Mantuam Lily Ingsrisawang

Corresponding author, e-mail: m_ditapol@hotmail.com Department of Statistics, Faculty of Science, Kasetsart University

Abstract:The Knowledge Discovery in Database (KDD) has been extensively used through data

mining, a statistics and computer sciences, to organize the crucial useful data into knowledge base

form for further research purpose. The data classification is a techniques applied by the KDD tovarious fields and medical research. The primary purpose of this study was aimed to applications and

compare the performance of the 3 decision-tree algorithms, including ID3, C4.5, and CART, whichhave currently become famous in sorting data. The results would be expected to support the screeningprocess and to be used as guidelines for primary diagnosis. The medical record of 7,327 out-patientsat the Pranakorn Sri Ayutthaya Hospital during 2004-2006 was examined. The results havedemonstrated that algorithm C4.5 which percentage split method was used to divide the data into70:30 was 99.41% accurate in respect of no selection of variables. The Kappa was 0.9881. Sensitivitywas 99.31% while specificity 99.50%. Positive predictive value (PPV) was 99.40% while negativepredictive value (NPV) was 99.41, ROC area was 99.70%, regarded as the most effective classifier.

On the other hand, it found that algorithm ID3 which percentage split method was used to divide thedata into 70:30 was 95.85% accurate in case of selection for variables. The Kappa was 0.8821.Sensitivity was 91.55% while specificity was 97.22%. Positive predictive value (PPV) was 90.25%while negative predictive value (NPV) was 97.52%, ROC area was 97.60%. The results indicated thatthere was no significant difference in classifying patients data in both cases (Selection of variables,no selection of variables). However, in case of the selection of variables, lesser variables were used,resulting in time and cost saving. The algorithm ID3 produced higher performance in classifyingpatients data in respect of the selection of variables.

Keywords:Data Classification, Decision Tree, Diseases of the Respiratory System, Diagnosis(Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

Title: Decision making on patient compensation related to adverse events

Researchers: Pattapong Kessomboon*, Nusaraporn Kessomboon**,Supasit Pannarunothai***, Amorn Premgamone**Faculty of Medicine, Khon Kaen University, **Faculty of Pharmaceutical Sciences,Khon Kaen University, ***Faculty of Medicine, Naresuan University

Abstract Adverse events occurred in health service settings lead to more lawsuits than everbefore. The new patient compensation Bill is expected to resolve patient-providerconflicts. It will be designed to cover all groups of Thai people with acceptable claim

process and amount of compensations.

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Objective: To study decision making processes on compensation for injuredpatients under the Article 41 of the National Health Security Act 2002.

Method: This was a descriptive study. The reasons used by committees in

making decisions on whether to pay or not pay the victims conducted under thearticle 41 were analyzed and compared with the compensation criteria set out by theNational Health Security Office. Altogether, 1,276 claims during 2003 - 2008 wererecruited for the study.

Results: Among 1,276 claims, compensations were paid out for 1,049 cases(82.2%) and 227 cases (17.8%) were not paid. The main reason for payingcompensation was that it was an unavoidable situation (76.5%). However, the

reason above was not in accordance with the criteria for compensation. There wereonly 27.1 % of claims that were in accordance with the criteria saying that the injurieswere related to medical errors or mistakes or substandard care. The main reason fornot paying compensation was that the adverse events were the results of diseaseprocesses (61.6%). This was in accordance with the criteria.

Conclusion: Inconsistency and unclear decision making on patientcompensations were found. Two cases with the same kind of injury might be paid ornot paid. This might motivate patients to bring the case to court.

Key words: criteria for decision making, adverse event, medical service, patient compensation(Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

Title: Good Governance Index for Health Systems Research Management Unit:Case of HealthSystem Research Institute

Researchers: Decharut Sukkumnoed1, Rungthip Sukkumnoed2

1 Lecturer, Faculty of Economics, Kasetsart University2 Researcher, Healthy Public Policy Foundation

AbstractThe project of developing good governance index is a part of developing the research

management system in Health Systems Research Institute (HSRI) and its research alliances.Objectives of this project are 1) to define the framework of monitoring and evaluating the projectadministration in accordance with good governance practices 2) to develop good governance index 3)to study the appropriateness of the developed index and barriers for index perceived 4) to set a

guideline to gather essential data for project performance evaluation which is based on goodgovernance principle of research management team in health system.

The process of this project begins with 1) reviewing theories, concepts, and research reportsrelated to good governance practices and its index both domestically and internationally 2)interviewing experts from related disciplines, and research managements 3) developing and testingquestionnaire and then analyzing data 4) using the drafted good governance index to conduct internalpilot test with HSRI 5) reviewing index and modifying it to be more suitably.

The result of this study has indicated that two crucial conceptual frameworks of index

development has emerged and they are comprised of 1) conforming to six good governance practicesincluding Rule of Law, Transparency, Worthiness, Participation, Quality, Accountability and 2)

applying six good governance practices to five steps of the research management process.The outcome of evaluating Health Systems Research Institute (HSRI)s good governance

practices has been depicted that overall in the organizational level HSRI has high good governancepractices. When considered in the perspective of five research management process, the process of

gathering and allocating resources gains the highest level of engaging good governance practices andis followed by the process of planning the research management as a second. Other research

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Delphi method was used by sending questionnaires to experts for two times. There were 17 expertscompleted the two times questionnaires. Levels of agreement were calculated as median, mode and

inter-quartile range. The results showed that the experts agreed that it was possible to have

community pharmacy to play role in treatment and play role in health promotion and diseaseprevention in a community. The medians of agreement levels were between 4 5 from 5 Likertsscale and the inter-quartile ranges were narrow. In treatment role, a community pharmacy would havefunctions and activities in drug dispensing for common illnesses, refilling prescriptions for chronicdiseases, and providing counseling to patients. In health promotion and disease prevention role, acommunity pharmacy would have functions and activities in screening for risk of chronic diseases,referring a high risk patient to physicians, promoting and making concern of appropriate drug usages,

providing advices regarding nutrition and exercises, campaigning for smoking cessation and reducingalcohol consumption, and co-ordinating with local authority to promote community health.

Key words: accredited pharmacy, community pharmacy, primary care provider, role andfunction of community pharmacy

(Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

Title: The Effects of Direct Billing System on Prescribing Patterns in Civil Servant MedicalBenefit Scheme

Researchers: Piyameth Dilokthornsakul1, Nathorn Chaiyakunapruk1,2,3, Piyarat Nimpitakpong11Center of Pharmaceutical Outcome Research, Faculty of Pharmaceutical Sciences,

Naresuan University2 School of Pharmacy, University of Wisconsin-Madison, USA3 School of Population Health, University of Queensland, Australia

Abstract: Introduction: In 2006, the reimbursement system for the Civil Servant Medicalbenefit Scheme(CSMBS) in Thailand was changed to direct billing system. It was unknownhow this new system affected drug expenditures and the number of drug supply given tobeneficiaries. This study aims to assess the effects of direct billing system on prescribingpatterns in terms of the number of months of coverage per prescription and over possession.

Method: This study was undertaken with retrospective cohort approach. We used thedata recorded in database of a university hospital in northern part of Thailand. We undertook

the data on all patients with CSMBS who came to out-patients department between Oct 1,2005 and Mar 31, 2007. Mean cost of medication, the number of months of coverage perprescription and medication possession ratio (MPR) of five highest costs of oral medicationwere calculated in one year before and after the system was changed.

Results: Out of 43,897 patients seeking outpatient care at the hospital, 15,632 (36%)were under CSMBS. Eighty-eight percent (13,785/15,632) received medications during visit.The total cost of medication increased from 2 million to 4 million bahts in one year.Glucosamine, atorvastatin, rosiglitazone, clopidogrel and diacerein were highest used in terms

of cost. The average number of months of coverage based on these medications increasedfrom 1.29 to 1.48 months per prescription. Percentage of prescribing more than 3 months, was

slightly increased from 1.82 to 2.43. Three out of five MPRs were higher after system waschanged (Relative risk ranged on 1.192.32).

Conclusion: The direct billing system may affect prescribing patterns as indicated bytrend of the increased number of months of coverage per prescription and higher medication

possession ratio. Further evidence remains needed. Policy makers need to consider all

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relevant and important consequences associated with the new system prior to policy decisionmaking.

Key words: direct billing system, civil servant medical benefit scheme, prescribing patterns,over-possession(Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

VOLUME 4 No.2

Title: Database of Health Technology Assessment: Development and ImplicationsResearchers: Nattiya Kapol*, Surasit Lochid-amnuay*, Rapeepan Chalongsuk*,

Pagamas Maitreemit*, Yaowalak Amrumpai*, Namfon Sribundit**Faculty of Pharmaceutical Sciences, Silpakorn University

AbstractHealth technology assessment is an important tool for policy decision makers to allocate

health resources efficiently. Though, the accessibility and knowledge in health technology assessment

are barriers for research utilization. The health technology assessment database has developed inThailand to retrieve related research and disseminate to targeted users. The development was divided

into 3 phases 1) developed database structure by focus group method from decision makers, healthpractitioners, and academic/ researchers, 2) searched and recorded research in the database, and 3)dissemination and evaluation of the database use. The database was available online atwww.db.hitap.net starting in January 2008. The results revealed that the database included 471 fulleconomic evaluation studies, 155 randomized controlled trial studies, and 106 quality of life studies.The evaluation of the database use in January 2009 showed that most users are most satisfied with up-to-date articles, the usefulness of the database, and the database service that meet the expectations.

However, the variety of research articles should be determined to meet the users needs in the future.Key words: Database, Health Technology Assessment, Economic Evaluation(Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Research Questions for Tobacco Control: Document Analysis and Experts opinionsResearchers: Siriwan Pitayarangsarit *,**, Suwatthana Praikean*, Prapapun Iamanun*,

Sarinya Laohapanpong*, Haris Taveeputtana* and Siripen Arunpraphan**Tobacco Control Research and Knowledge Management Center (TRC)

** International Health Policy Program (IHPP), Ministry of Public Health, Thailand

Abstract

Policy linked research is identified by the countrys problems and concerns. The purpose of

this study is to evaluate the missing knowledge in tobacco control in Thailand and to examine the

significant research questions needed for tobacco control policy. Two methods: Framework of

Analysis and Documentary Research were employed to evaluate the scope of needed research, the

method of comparison to the WHO Framework Convention on Tobacco Control (FCTC), by selecting

equivalent topics related to Thai society. The next step was collecting the previous research evidence

such as research report and meeting papers. Those collected documents were evaluated to identify

gap of knowledge using a focus group discussion in order to bring forward specific research

questions.

Seven main areas for tobacco control were identified as relevancy to current tobacco control

situation in Thailand and needed to advance more evidence: (1) The surveillance system of tobaccoconsumption and tobacco industry (2) Tobacco control tax measures and trade agreements, (3) The

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alternative model of services for smoking cessation (4) Control for various tobacco products (5)

Communication for behavior and social changes (6) Situation of roll your own cigarettes (7)

Evaluation of the effectiveness of the tobacco control measures.

This analysis suggested that research prioritization for tobaccos control research could use theWHO Framework Convention on Tobacco Control (FCTC) as a framework of analysis. The selected

components could be adjusted for country specific that should guide effectively investing in specific

tobacco research to solve the countrys specific problems.

Keywords:Research questions, Tobacco control,Framework of analysis(Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

TiTle: Development of Local Recipes for the Elderly

Researchers: Pasamai Egkantrong*, Orapin Banjong*, Atitada Boonpraderm*, Gene Charoonruk*

Institute of Nutrition, Mahidol University

Abstract

This study aimed to identify and develop nutritious local Thai recipes for healthy elderly,based on their nutrient requirements. Community leaders were identified and were asked to identifycommunity cooks within their communities. A list of 201 local dishes was identified through in-depthinterviews performed among 74 local food experts. From the list, 40 dishes that had the potential toimproving their overall nutritious quality, for instance adjusting meat and vegetable quantity and

substituting coconut cream with cereal cream and/or soy milk were selected. The recipes wereadjusted and the dishes were tested for sensory acceptability by the elderly in their communities.Mixed dish recipes provided the highest average energy content (319 Kcal per serving), whileNamprik and non-coconut cream curry provided the lowest energy content (89 Kcal per serving).

Noodle soup with chicken had the highest content (6 mg). Thai rice noodle in sweet chili sauce (Kanom JeenNam Prik), Thai rice noodle in spicy sauce (Kanom Jeen Nam Ya), steamed snake headed fish with MorindaCitrifolia Linn (Noni) Leaves (Hor Mok Pla Chon Bai Yor), and Namprik had the highest fiber, iron andvitamin A content. Since cereal cream and/or soy milk, which contain appropriate fat content, was

used instead of coconut cream in this study, these recipes may help to decrease risk of chronic non-communicable diseases in elderly.

Keywords: Elderly, Local recipe, Participatory Action Research

(Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

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Title: Health impacts from open-pit mining project: scope and guideline forinvestigation of possible impacts

Researchers: Chudchawal Juntarawijit*, Yuwayong Juntarawijit, Sivaporn Aungwattana**

Nongyao Udomvong**, Jitnatee Kaney***, Nootchayong Yaowapanon***,Monvipa Sirihorachai*****Faculty of Agriculture, Natural Resources and Environment, Naresuan University,**Faculty of Nursing, Chiang Mai University,*** McCormick Faculty of Nursing, Payap University,**** Chiangmai Provincial Public Health OfficeAbstract

Lignite mining may post several health impacts but at present, there was no guideline toinvestigate those effects. This study was aimed to set up scope and guideline for investigation ofpossible health impacts from open-pit mining project, using the participatory approach frompublic and other stakeholders.. Results from literature review on possible health impacts, anddata on the living styles of the affected community were used to identify the possible health

impacts. Public and other stakeholders were allowed to join the study and provide suggestionsfor public scoping.It was found that there were four aspects of possible health impacts: physical, mental, social, and

spiritual health. Physical health impacts were: accidents and injuries from mining andtransportation; effects from noise; diseases and effects from air pollution; diseases and effects

from water pollution; effects from explosion; and labor migration and communicable diseases.Mental health impacts were expected from stress and anxiety. Social health impacts were likelyfrom effects to community life style; effects from community migration and resettlement; andeffects from depletion of forest and agriculture land. Spiritual health impacts were likely fromeffects from aesthetic changes and loss of loyalty to and connection with the locality; and effectsfrom losing their spiritual haven.

Key words: Health impact, open-pit mining, HIA, coal mine, coal, Wieng Haeng

(Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Budget Impact Analysis of Incorporating of Community Pharmacy into Universal

Health Coverage in Thailand

Researchers: Nusaraporn Kessomboon*, Surasit Lochid-amnuay, Waraporn Poungkantha,Weerasak Putthasri

*Faculty of Pharmaceutical Sciences, Khon Kaen University,Faculty of Pharmacy, Silapakorn University,International Health Policy Program

AbstractThere are some practical models of community pharmacy provision in Thailand that coordinated

with the hospitals in providing care for stable diabetes and hypertension. This study aimed to estimate

budget impact of incorporating of community pharmacy into Universal Coverage in providing care for

stable diabetes and hypertension. Firstly secondary data were reviewed to estimate supply and

demand of community pharmacy services. Unit cost analysis of the community pharmacy activities

were performed using the activity based costing technique. Finally, the budget impact analysis was

estimated under the model of refill medication at the community pharmacy. The timeframe of this

study was January to September 2009. The result showed that the budget impact of community

pharmacy in providing medication refill for stable diabetes varied between 182 to 1,044 baht per

patient or 194,740-1,117,080 baht per hospital. Regarding the budget impact for medication refill instable hypertension, the average expenditure was 182-1,098 baht per patient or 242,242-1,461,438

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baht per hospital. It can be concluded that the community pharmacy be a part of integrated package of

care for people with long-term conditions such as stable diabetes and hypertension. However,

financial incentive is required to meet additional costs and to connect community pharmacies to the

Universal Coverage. Co-payment may be used in this program to prevent inappropriate utilization.Key words: Budget impact, Community Pharmacy, Universal Health Coverage, Co-payment

(Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Relationship between Information Received and Satisfaction of Health Personnel inHealth Security System in 6 Provinces Upper Northeast, Thailand.

Researchers: Preeda Taearak*, Wanrapee Samanachangphueg**National Health Security Office

AbstractNational Health Security Office (NHSO) region 8 Udon thani surveyed health personnel in 6

provinces included Loei, Nongbualampoo, Nongkhai, Udon Thani, Sakonnakhon and NakhonPhanom province aimed to evaluate the understanding of the benefits, information and their

satisfaction in health security system. The result revealed that pharmacist and dentist knew about thebenefits in health security system at 76.9 percent which was less than other health profession. Mostpersonnel received information about health security via television (68.1 percent). For radio, thepopularity of song, news and general events was almost the same proportion at 31.5, 30.2 and 26.5percent respectively. The most popular period was 06.00 to 08.00 am. (37.1 percent). 62.6 percent ofhealth personnel did not read newspaper. Personnels satisfaction in health security was 8.15 out of 10score and general personnel had highest satisfaction at 8.5 score. The least satisfaction belonged to thepharmacist at 7.37 score. The study found that the satisfaction of the personnel positive related to

knowledge in health benefits in health security system and satisfaction in the media from nationalhealth security office. Internet is also an interesting route as it is easy and efficient to communicate to

target population.Suggestion is that NHSO should perform the specific public relation strategies and work more

specific to each group of health personnel. The low level of information that personnel had receivedshould be paid more attention. The formal letter is still the main route to provide information to healthpersonnel. The alternative route of information should be used more especially newsletter to creategood attitude to national health security system continuously with the enough quantity, style and

content should conform to the taste of the personnel.Key words: health security, information, satisfaction

(Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Iodine status in sampling population in Chiengmai, Lumphun, Lumpang, andMaehongson during FY2007-2009

Researchers: Sumet Ongwandee*, Hathairat Thongkhew*, Wanruedee Kijjaroenrungroj#,

Darawan Sakhulvong, Khulrat Chaibhom

* Maehongson Provincial Health Office# Chiengmai Provincial Health OfficeLumphun Provincial Health Office

Lampang Provincial Health Office

AbstractIodine deficiency had several effects on health, particularly concerning the development of

brain in fetus and early childhood. Regarding the past few decades, a situation was mitigated whenconsidering a total goiter rate in children. In a mild degree of deficiency; thus, no obviously physical

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effect was seen but impaired mental function. The north and northeastern were the highest risk areas.This descriptive study was aimed to review iodine status of population in Chiengmai, Lumphun,

Lumpang, and Maehongson by analyzing secondary data during Fiscal Year 2007-2009 and was

framed under the manual Assessment of Iodine Deficiency Disorders and Monitoring TheirElimination of WHO.It was found that a proportion of households using adequately iodized salt was progressively

over 90% in every province except Maehongson. Thyroid function assessment by a screening TSHlevel in newborn, that was over 11.2 mu/L, in Chiengmai, Lumphun, Lumpang, Maehongson was12.73%, 7.84%, 10.29%, 15.83% respectively and the incidences of thyroid hormone deficiency were1:2,297, 1:1,665, 1:2,468, 1:3,058 respectively as well. Total goiter rate was below 5% in every

province. A level of iodine in urine in pregnancy in Maehongson was 50.89% equally insufficient andin primary school pupils in Lumphun was 52.38% equally more than adequate. In conclusion, fourprovinces were indicated mild iodine deficiency areas but their situation had gotten better. Iodinedeficiency prevention was required more attention of policy makers. Proper IQ development byadequate iodine intake should be designated as one of the national strategies on children capacity

building. Right knowledge building on a benefit of proper iodine intake to people should be installed.Social responsibility of salt manufacturers, as well, was required and legal measures were necessary,if otherwise.

Key words: Indicator, Iodine, Chiengmai, Lumphun, Lumpang, Maehongson(Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Effects of rocking chair on bowel function in patients with gynecological abdominal

surgery

Researchers: Uaiporn Pattrapakdikul * , Orathai Chayapiwat *

*Nursing Service Department, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla

University

Abstract

An abdominal operation has effects on gastrointestinal (GI) motor activity. Postoperative carefor early recovery of GI motility is recommended. The purpose of this quasi-experimental researchwas to studythe effects of rocking chair on bowel function in patients with gynecological abdominalsurgery. The framework of this study based on the effect of mechanical pressure and relaxationtechnique affected on GI tract. The sample of 60 abdominal hysterectomy patients were drawn bycarefully selected criteria from a patient population admitted for abdominal hysterectomy during Juneto October 2008. The patients were randomly assigned into 2 groups: the experimental group whoambulated by rocking chair exercised and the control group who did not. The collected data consisted

of 4 parts: demographic, treatment, bowel function and patient satisfaction. The experimentalinstruments were rocking chair and stethoscope. The bowel function was measured 16 hours aftersurgery. The experimental group who were assigned to ambulate by rocking chair exercised for 45minutes and the control group who did not. Data were collected and analyzed by using mean, standard

deviation and independent t-test. We compared the different by 2 - test and independent t-test.

The results revealed that numbers of bowel sound and belching were statistically significant

difference (p = 0.001and 0.01 respectively).The days of passing flatus and feces were not difference.The 53.3 % of patients had high satisfaction and 90%of patients had no dizziness.

We suggest that the postoperative abdominal surgery patients should be ambulated withrocking chair. The outcome of our study theoretically applies to the others surgical patients.

Keywords: rocking chair, bowel function, abdominal surgery(Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

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Title: Postpartum care through Thai traditional medicine in Amnat Charoen province

Researchers: Somying Pumtong*, Lalita Wirasathien, Worapan Sitthithaworn,Apichat Rungmekarat, Ornlaksana Paeratakul

*Department of Clinical Pharmacy and Social Pharmacy, Faculty of Pharmacy, Srinakharinwirot UniversityDepartment of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmacy, Srinakharinwirot UniversityAmnat Charoen Provincial Public Health OfficeDepartment of Pharmaceutical Technology, Faculty of Pharmacy, Srinakharinwirot University

AbstractThe objective of this qualitative research was to investigate and compile the knowledge of

Thai traditional medicine for postpartum care in Amnat Charoen, a province in the Northeastern partof Thailand. Data collection was done through individual and group interviews of folk doctors,including herb doctors, midwives, shamans, traditional massage therapists (n=43) and health care

professionals from all hospitals (n=7), along with on-site observations. The study was undertakenbetween May 2009 and April 2010.It was evident that the inherited traditional medicine/folk medicine regarding midwifery and

postpartum care has long been practiced in the area of Amnat Charoen up to present. The knowledgeand wisdom in this particular area have passed from generation to generation, i.e. from ancestors toyounger family members, via story telling, traditional practice, and mentor system. In the past, childlabor was typically performed by a traditional midwife. Several postpartum care regimens would thenbe employed after childbirth, e.g. Yu-Gum or Yu-Fai (body warming using heat/fire), herbal bathing,along with many other religious rites. Various medicinal plants, either of single or multiple formulas,have been used for mothers for the purposes of body cleansing, evacuation of amniotic fluid from theuterus, and stimulation of lactation. In addition, some plants are used as blood tonics or laxatives for

nursing mothers. A number of herbs have already been investigated for their chemical constituents

and related pharmacologic actions, however, some have not yet been studied thus their activitiesremained unknown or questionable. It was found that folk medicine/traditional medicine has beenintegrated harmoniously with modern medicine in the current practice of postpartum care ingovernment hospitals in Amnat Charoen. It was also quite apparent that the government policy onThai traditional medicine has played a major role in expanding both number and quality of traditionalhealth services available in every level of health care settings.

Key words: postpartum care, Thai traditional medicine

(Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

VOLUME 4 No.3

Title: Renal function among gout patients in Nongjik Hospitol, Pattani Province

Researcher: Nealanad Cheyor**Nongjik Hospital, Pattani Province

Abstract

This descriptive research determined the prevalence of renal impairment and drug usein gout patients in Nongjik Hospital , Pattani province. Medical records of the patients from October2008 to December 2009 were reviewed. The estimated glomerular filtration rate (eGFR) wascalculated by the MDRD equation. Frequency, percentage, mean and standard deviation were used toanalyse the data. Chi-square test was used to compare between proportions. Multiple logistic

regression was used to determine association between prevalence of eGFR < 60 ml/min/1.73 m 2. Themajority of patients were male. The average age was 64 years old. Most patients had co-morbid

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diseases. Most of them received allopurinol and colchicine. A significant proportion of patients withchronic kidney disease stage 4 and 5 received colchicine without dose adjustment. About 58.2 % of

patients had eGFR < 60 ml/min/1.73 m2 and 81.7 % of such patients suffered hypertension. Age was

the only significant factor associated with eGFR < 60 ml/min/1.73 m

2

by multiple logistic regressionanalysis Screening of renal function among gout patients is important for early detection of renalimpairment. The finding was also useful for dose adjustment of drugs prescribed for the patients,which could prevent or slow the end stage renal disease.

Keywords : gout, glomerular filtration rate, renal impairment

(Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010)

Title: DETERMINATION OF HEALTH POLICY AND SYSTEM RESEARCH TOPICS INTHAILAND

Researchers: Songyot Pilasant*, Yot Teerawattananon**Health Intervention and Technology Assessment Program (HITAP)

AbstractHealth policy and system research (HPSR) is crucial for strengthening health systems. In caseswhere resources are limited, research topic prioritization is an important process to ensure the effective useof the available resources and to help acquire research topics that are relevant and also addressstakeholders' concerns. Foreseeing the benefits of introducing a prioritization process, the Health SystemsResearch Institute (HSRI) and its affiliates organized the HPSR topic prioritization seminar 2010, aimingat a list of national prioritized research topics with the hope that list will be used to support policydecisions in Thailand.

This is a research and development study which employed participatory observation,brainstorming and questionnaire surveys. A total of 247 organizations were identified as stakeholders.Ninety of these participated in the prioritization process. At the beginning of the process, 120 HPSR topicswere proposed by 66 organizations. Of these topics, 15 were prioritized. It was found that topics that arerelated to (1) disease with a high burden and (2) service delivery, are likely to be included in a priority list.In addition, results from a self-administered survey demonstrated that 93% of stakeholders stronglysupported the process and expressed their interest to participate in similar events if conducted in the future.

Key words: health topics determination, health priorities, health systems management, health policy

(Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010)

Title: Legislation and Health PromotionResearchers: Hathaichanok Sumalee*, Siriwan Pitayarangsarit*, Jiraboon Tosanguan*

*Office of International Health Policy Program (IHPP)Abstract

In Thailand, there has been a number of legislations which concerns health promotion

including the National Health Act (B.E.2550), and the Supporting Fund for Health Promotion Act(B.E.2544). Most important of all is the Thai Constitution, B.E. 2550 which guarantees the rights ofindividuals on this issue as followed: 1) rights to public health and welfare services; 2) rights to

access information on certain activities and/or programs which may affect their environment, healthand quality of life; and 3) rights to be protected from environmental health hazards. Furthermore, the

Constitution also states that health policies must emphasize on health promotion which would leadsustainable healthiness of the population, and local government should be given the responsibility andauthority in the management and provision of public services for the local people. Even though, otherrelated laws, which concern the roles of local government in public health service provision, may nothave included health promotion as one of the responsibilities of local government, however, theresponsibilities of local governments could be extended. Legislation such as the Public Health Act(B.E.2535), and Tambon Council and Tambon Administrative Organization Act (B.E.2537) have

given powers to the ministers in charge to allocate extra responsibility to local government as allowedby that law. Especially the latter has given the tambon administrative organization the role to manage

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basic environmental control services which is relevant to the function of health promotion. In the 2 nd

Action Plan and Protocol for Decentralization to Local Government, has clearly stated that health

promotion responsibility, along with basic health services and disease control are to be the

responsibilities of the local government with a certain level of readiness. These will be transferredtogether with funding, the existing staff and infrastructure (health center). However, as localgovernment needs to undergo assessment and other processes in the devolution of health center, thereis a need for specifying the roles of local government in health promotion in order to clarify the issueand to make the roles conform to the health promotion strategy.

Key words : Law , Role of Local Administrative Organization , Health Promotion(Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010)

Title: Policy Options on Medical Injury Compensation Fund for ThailandResearchers: Siriwan Pitayarangsarit *, Hathaichanok Sumalee*

*Office of International Health Policy Program (IHPP)

AbstractThe implication or unwanted outcome from health services, either it was unavoidable or from

negligence, can lead to damages and conflicts between providers and patients. Consequently, this canhave an impact on the health service delivery system which the faith and credibility has beendeteriorating. The current compensation mechanism which is done through the judicial system cannotenhance the good relationship between the providers and patients, while the no-fault basiccompensation, which the affected patients are entitled according to article 41 of the National HealthSecurity Act of B.E. 2545, can alleviate their distress to a degree but the law only cover patients in the

Universal Coverage Scheme. This has led to the idea of drafting new laws to extend this protection toall Thai patients. As a result, the authors have summarized the policy options and the pros and cons of

each option in order to inform the public, create symmetry of information between different groups ofstakeholders, and empower the society to assess the feasibility and long-term impact of the policy

options by themselves. This study found that non-judicial no-fault compensation for affected patientsis widely accepted and adopted in many countries (such as the Scandinavian and New Zealand) underthe principle which emphasize on the responsibility of the party who afflict the damage beforeproving right or wrong. There are two different sources of fund for no-fault compensation: 1) fundscollected from providers; public hospitals, through health funds which are mainly from taxation, andprivate hospitals which they pay directly; and 2) contribution from people proportionately to their

income with a certain level of income ceiling and the government contribute for the low-income orunemployed people. Also the providers may also need to contribute (as in New Zealand). It is theauthors opinion that Thailand should adopt the no-fault liability policy which can help reducing theconflicts between patients and providers, and non-judicial mechanism should be developed forprovision of full compensation, which if the patient accepted, no further lawsuit can be filed. Thiswould allow the affected patients to be compensated in a timely manner. Regarding the funding

source, we propose to use the health funds model which the government contributes for the publichospital and the private hospitals contribute themselves. The estimation for compensation is about

341-679 million baht per year with an average 5-10 Baht per capita. The discussion by thestakeholders on the topic would allow the facts to be revealed to the public who can then participate inthe policy-making process more effectively. One should beware that if the quality of health servicedelivery system is poor and the problems are mostly caused by complications or the system itself,then the amount of compensation paid for these damages will be higher than the compensation fordamages caused by the practitioners and hence this would lead to rising cost. Furthermore, the no-fault compensation process should also be protective of the providers reputation and try to giveencouragement and feedback in order for them to improve their performance.

Keywords: Policy Option, Funds, Medical Injury, health service delivery system(Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010)

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This study examined the efficiency of resource use in the three health insurance schemes -Universal Coverage (UC), Social Security Scheme (SSS), and Civil Servant Medical Benefit Scheme

(CSMBS) - by analyzing length of stay (LOS) and early readmission rate in Diabetes mellitus (DM)

patients, used as the tracer for efficiency use of resource and quality of service respectively. The datacame from claims that hospitals servicing all three major health insurance schemes have to send forreimbursement. The aim of the analysis was to compare the effects of insurance schemes and otherfactors on resource use, LOS as a proxy for resource use and on quality as proxied by the readmissionrate within days after discharge. The analysis compares three conditions of DM requiring hospital

admission: acute complications, chronic complications, and DM without complication to prove thatthere were no difference of quality of service in patient condition especially acute complicationcondition.

The study found that CSMBS patients had longer LOS than UC and SSS. This implied theefficient use of resource of SSS and UC compared to CSMBS patients. However, SSS had nodifference in early readmission within days after discharge while UC had higher rate of

readmission in chronic and without complication condition.

Key words : length of stay, readmission, universal health coverage system(Published in Journal of Health Systems Research Vol.4 No.4 Oct.-Dec.2010)

Title: Resolution on Managing Overweight and Obesity in the 11th National Economic &Social Development PlanResearchers: Sirinya Phulkerd*, Thaksaphon Thamarangsi*

*Office of International Health Policy Program (IHPP)Abstract

Obesity is a global epidemic affecting both the developing and developed worlds alike.Overweight and obesity has also been found to be on the rise amongst Thailands male and female

population. Moreover this is considered as a leading health risk factor in Thai population. Tacklingoverweight and obesity in Thailand has lead to the formation of a Resolution on ManagingOverweight and Obesity which has finally been endorsed by the National Health Commission, and

was also approved as part of the Thai national agenda by the Cabinet in 2010. Meanwhile, the Officeof the National Economic and Social Development Board (NESDB) has been developed the 11 th

National Economic and Social Development Plan (NESDP) as a strategic plan for nationaldevelopment in the next five years. The aim of this study is to analyze the consistency between theResolution and the 11th NESDP. The study results will be useful in formulating the National ActionPlan for overweight and obesity as well as in reflecting the drafting and approval process of the 11 th

NESDPComparatively, the key approach for the national development of the 11 th NESDP focuses on

individual-level defensive approach such as the promotion of education in the Thai population.Meanwhile, not only does the Resolution focus on a defensive approach, but also an offensive

approach, with a wide array of regulatory interventions such as tax, pricing, nutrition and foodlabeling and food marketing restrictions. The strategies of the 11th NESDP, for example tradeliberalization, discourage regulatory interventions in curbing overweight and obesity by whichunhealthy foods have an increasing access to the market. Though preventive approaches that affecttrade agreement and liberalization are proposed, they will be implemented after market access bythese foods. It seems clear from literature that the international trade issues need to be considered inthe context of public health including improving diets and health education. The implementation ofboth defense and offense approaches, for example the promotion of education with food and nutrition

labeling intervention may increase the effectiveness of improving healthy behaviors.Key wordsResolution on Managing Overweight and Obesity, the 11th National Economic and Social

Development Plan,defensive approach, offensive approach,trade liberalization(Published in Journal of Health Systems Research Vol.4 No.4 Oct.-Dec.2010)

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Title: Indicators and Health Effect Monitoring of People Living Nearby Mae-Moh Power PlantResearchers: Chudchawal Juntarawijit * Akeau Unahalekhaka ** Yuwayong Juntarawijit **

* Faculty of Agriculture, Natural Resources and Environment, Naresuan University

** Faculty of Nursing, Chiang Mai UniversityAbstractMae-Moh Power Plant and Mae-Moh Coal Mine may cause environmental and health effects.

However, at present, there is no surveillance system to monitor health effects of people living nearbythe power plant. This study aimed to identify indicators and health impact study to monitor healthstatus of people living nearby the power plant. Coal mining and power plant process were reviewed,together their related pollutants and possible health impacts of each substances. Study on health

effects of people living nearby coal-fired power plant was reviewed. Practical health indicators andresearch methodology were suggested and reviewed by expert and stakeholder. It was found that Mae-Moh Coal Mine and Mae-Moh Power Plant might produce several health hazards including airpollutant, water pollution, noise, accidence and nuisance. Health indicator that should be monitoredwere: 1) emergency room visits, 2) hospital visit and service requested, 3) mortality monitoring, 4)

pulmonary function of school children, 5) lung function of adults with respiratory problems, 6)chronic obstructive pulmonary disease cases, 7) pneumoconiosis among coal worker, and 8) stressand annoy due to environmental problems.

Key words: health impact, surveillance system, Mae-Moh, power plant, coal mining(Published in Journal of Health Systems Research Vol.4 No.4 Oct.-Dec.2010)

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