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Kongkam L.,National Health Security Office | Sriratana S.,Ministry of Public Health
Human Resources for Health | Year: 2015

Background: In Thailand, the inequitable distribution of doctors between rural and urban areas has a major impact on access to care for those living in rural communities. The rural medical education programme 'Collaborative Project to Increase Rural Doctors (CPIRD)' was implemented in 1994 with the aim of attracting and retaining rural doctors. This study examined the impact of CPIRD in relation to doctor retention in rural areas and public health service. Methods: Baseline data consisting of age, sex and date of entry to the Ministry of Health (MoH) service was collected from 7,157 doctors graduating between 2000 and 2007. There were 1,093 graduates from the CPIRD track and 6,064 that graduated through normal channels. Follow-up data, consisting of workplace, number of years spent in rural districts and years within the MoH service, were retrieved from June 2000 to July 2011. The Kaplan-Meier method of survival analysis and Cox proportional hazards ratios were used to interpret the data. Results: Female subjects slightly outnumbered their male counterparts. Almost half of the normal track (48%) and 33% of the CPIRD doctors eventually left the MoH. The retention rate at rural hospitals was 29% for the CPIRD doctors compared to 18% for those from the normal track. Survival curves indicated a dramatic drop rate after 3 years in service for both groups, but normal track individuals decreased at a faster rate. Multivariate Cox proportional hazards modelling revealed that the normal track doctors had a significantly higher risk of leaving rural areas at about 1.3 times the CPIRD doctors. The predicted median survival time in rural hospitals was 4.2 years for the CPIRD group and 3.4 years for the normal track. The normal track doctors had a significantly higher risk of leaving public service at about 1.5 times the CPIRD doctors. Conclusions: The project evaluation results showed a positive impact in that CPIRD doctors were more likely to stay longer in rural areas and in public service than their counterparts. However, turnover has been increasing in recent years for both groups. There is a need for the MoH to review and improve upon the project implementation. © Pagaiya et al.

Owusu J.T.,ASPPH CDC Allan Rosenfield Global Health Fellow | Owusu J.T.,Centers for Disease Control and Prevention | Prapasiri P.,Centers for Disease Control and Prevention | Ditsungnoen D.,Centers for Disease Control and Prevention | And 5 more authors.
Vaccine | Year: 2015

BackgroundThe Advisory Committee on Immunization Practice of Thailand prioritizes seasonal influenza vaccinations for populations who are at highest risk for serious complications (pregnant women, children 6 months-2 years, persons ≥65 years, persons with chronic diseases, obese persons), and healthcare personnel and poultry cullers. The Thailand government purchases seasonal influenza vaccine for these groups. We assessed vaccination coverage among high-risk groups in Thailand from 2010 to 2012. MethodsNational records on persons who received publicly purchased vaccines from 2010 to 2012 were analyzed by high-risk category. Denominator data from multiple sources were compared to calculate coverage. Vaccine coverage was defined as the proportion of individuals in each category who received the vaccine. Vaccine wastage was defined as the proportion of publicly purchased vaccines that were not used. ResultsFrom 2010 to 2012, 8.18 million influenza vaccines were publicly purchased (range, 2.37-3.29 million doses/year), and vaccine purchases increased 39% over these years. Vaccine wastage was 9.5%. Approximately 5.7 million (77%) vaccine doses were administered to persons ≥65 years and persons with chronic diseases, 1.4 million (19%) to healthcare personnel/poultry cullers, 82,570 (1.1%) to children 6 months-2 years, 78,885 (1.1%) to obese persons, 26,481 (0.4%) to mentally disabled persons, and 17,787 (0.2%) to pregnant women. Between 2010 and 2012, coverage increased among persons with chronic diseases (8.6% versus 14%; p<. 0.01) and persons ≥65 years (12%, versus 20%; p<. 0.01); however, coverage decreased for mentally disabled persons (6.1% versus 4.9%; p<. 0.01), children 6 months-2 years (2.3% versus 0.9%; p<. 0.01), pregnant women (1.1% versus 0.9%; p<. 0.01), and obese persons (0.2% versus 0.1%; p<. 0.01). ConclusionsFrom 2010 to 2012, the availability of publicly purchased vaccines increased. While coverage remained low for all target groups, coverage was highest among persons ≥65 years and persons with chronic diseases. Annual coverage assessments are necessary to promote higher coverage among high-risk groups in Thailand. © 2014 The Authors.

Vejakama P.,Ramathibodi Hospital | Vejakama P.,Bundarik Hospital | Thakkinstian A.,Ramathibodi Hospital | Ingsathit A.,Ramathibodi Hospital | And 2 more authors.
BMC Nephrology | Year: 2013

Background: The role of small solute clearance on mortalities in patients with CAPD has been controversial. We therefore conducted a study with 3 years' follow up in adult patients who participated in the CAPD-first policy. Methods. There were 11,523 patients with end-stage renal disease who participated in the CAPD-first policy between 2008 and 2011. Among them, 1,177 patients were included in the retrospective cohort study. A receiver operating characteristic curve was applied to calibrate the cutoffs of tKt/V, rKt/V and tCrcl. Kaplan-Meier and Cox-regression models with time varying covariates were applied to estimate overall death rate, probability of death and prognosis, respectively. Results: The cutoffs of rKt/V and tKt/V were 0.25 and 1.75, respectively. The Cox regression suggested that the higher these clearance parameters, the lower the risks of death after adjusting for covariables. The risks of death for those above these cutoffs were 57% (HR = 0.43, 95% CI: 0.31, 0.60) and 29% (HR = 0.71, 95% CI: 0.52, 0.98) lower for rKt/V and tKt/V, respectively. Age, serum albumin, hemoglobin, systolic blood pressure, and ultra-filtration volume significantly affected the mortality outcome. Conclusions: Our study suggested that the cutoffs of 0.25 and 1.75 for rKt/V and tKt/V might be associated with mortality in CAPD patients. A minimum tKt/V of 1.75 should be targeted, but increased dialysis dosage to achieve tKt/V > 2.19 adds no further benefit. Serum albumin, hemoglobin, SBP, and UF volume are also associated with mortality. However, our study may face with selection and other unobserved confounders, so further randomized controlled trials are required to confirm these cutoffs. © 2013 Vejakama et al.; licensee BioMed Central Ltd.

PubMed | Red Cross, Bamrasnaradura Infectious Diseases Institute, National Health Security Office, Thai AIDS Society and 6 more.
Type: | Journal: AIDS research and therapy | Year: 2015

New evidence has emerged regarding when to commence antiretroviral therapy (ART), optimal treatment regimens, management of HIV co-infection with opportunistic infections, and management of ART failure. The 2014 guidelines were developed by the collaborations of the Department of Disease Control, Ministry of Public Health (MOPH) and the Thai AIDS Society (TAS). One of the major changes in the guidelines included recommending to initiating ART irrespective of CD4 cell count. However, it is with an emphasis that commencing HAART at CD4 cell count above 500 cell/mm(3) is for public health, in term of preventing HIV transmission and personal benefit. In tuberculosis co-infected patients with CD4 cell counts 50 cells/mm(3) or with CD4 cell counts >50 cells/mm(3) who have severe clinical disease, ART should be initiated within 2 weeks of starting tuberculosis treatment. The preferred initial ART regimen in treatment nave patients is efavirenz combined with tenofovir and emtricitabine or lamivudine. Plasma HIV viral load assessment should be done twice a year until achieving undetectable results; and will then be monitored once a year. CD4 cell count should be monitored every 6 months until CD4 cell count 350 cells/mm(3) and with plasma HIV viral load <50 copies/mL; then it should be monitored once a year afterward. HIV drug resistance genotypic test is indicated when plasma HIV viral load >1,000 copies/mL while on ART. Ritonavir-boosted lopinavir or atazanavir in combination with optimized two nucleoside-analogue reverse transcriptase inhibitors is recommended after initial ART regimen failure. Long-term ART-related safety monitoring has also been included in the guidelines.

Kohl III H.W.,University of Texas Health Science Center at Houston | Craig C.L.,Canadian Fitness and Lifestyle Research Institute | Craig C.L.,University of Sydney | Lambert E.V.,University of Cape Town | And 4 more authors.
The Lancet | Year: 2012

Physical inactivity is the fourth leading cause of death worldwide. We summarise present global efforts to counteract this problem and point the way forward to address the pandemic of physical inactivity. Although evidence for the benefits of physical activity for health has been available since the 1950s, promotion to improve the health of populations has lagged in relation to the available evidence and has only recently developed an identifiable infrastructure, including efforts in planning, policy, leadership and advocacy, workforce training and development, and monitoring and surveillance. The reasons for this late start are myriad, multifactorial, and complex. This infrastructure should continue to be formed, intersectoral approaches are essential to advance, and advocacy remains a key pillar. Although there is a need to build global capacity based on the present foundations, a systems approach that focuses on populations and the complex interactions among the correlates of physical inactivity, rather than solely a behavioural science approach focusing on individuals, is the way forward to increase physical activity worldwide.

PubMed | National Health Security Office, Chiang Mai University and University College London
Type: Journal Article | Journal: The lancet. HIV | Year: 2016

Early infant diagnosis of HIV is crucial for timely initiation of antiretroviral therapy (ART) in infected children who are at high risk of mortality. Early infant diagnosis with dried blood spot testing was provided by the National AIDS Programme in Thailand from 2007. We report ART initiation and vital status in children with HIV after 7 years of rollout in Thailand.Dried blood spot samples were collected from HIV-exposed children in hospitals in Thailand and mailed to the Faculty of Associated Medical Sciences, Chiang Mai University, where HIV DNA was assessed with real-time PCR to establish HIV infection. We linked data from children with an HIV infection to the National AIDS Programme database to ascertain ART and vital status.Between April 5, 2007, and Oct 1, 2014, 16046 dried blood spot samples were sent from 8859 children in 364 hospitals in Thailand. Median age at first dried blood spot test was 21 (IQR 18-25) months. Of 7174 (81%) children with two or more samples, 223 (3%) were HIV positive (including five unconfirmed). Of 1685 (19%) children with one sample, 70 (4%) were unconfirmed positive. Of 293 (3%) children who were HIV positive, 220 (75%) registered for HIV care and 170 (58%) initiated ART. Median age at ART initiation decreased from 142 months (IQR 102-256) in 2007 to 61 months (42-92) in 2013, and the number of children initiating ART aged younger than 1 year increased from five (33%) of 15 children initiating ART in 2007 to ten (83%) of 12 initiating ART in 2013. 15 (9%) of 170 children who initiated ART died and 16 (32%) of 50 who had no ART record died.Early infant diagnosis with dried blood spot testing had high uptake in primary care settings. Further improvement of linkage to HIV care is needed to ensure timely treatment of all children with an HIV infection.None.

PubMed | National Health Security Office, Ministry of Public Health, Khon Kaen University and International Health Policy Program IHPP
Type: Journal Article | Journal: Health policy and planning | Year: 2015

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser-provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite annual budget.

Phongsuphap S.,Mahidol University | Pongsupap Y.,National Health Security Office
Computing in Cardiology | Year: 2011

The main objective of this study is to investigate patterns of heart rate variability during concentration meditation to understand its effects on health. Our method consisted of three major stages: Signal acquisition, Feature extraction, and Classification. The input signals are RR interval signals which were collected from 105 subjects. By K-mean clustering method, the signals could be classified into 3 clusters corresponding to state of quiet mind (Samadhi state), intermediate state, and normal state. The results indicate that meditation and ordinary quiet sitting have significantly different effects on Autonomic Nervous System. In addition, it should be noted that meditation has different effects on health depending on frequency of the resonant peak that each meditator can achieve. © 2011 CCAL.

Phongsuphap S.,Mahidol University | Pongsupap Y.,National Health Security Office
IEEE International Conference on Fuzzy Systems | Year: 2014

This paper proposes a method for evaluating responsiveness of health systems. The method is based on a fuzzy model, which can tackle uncertainty of survey data, and perform corresponding to the way that human being makes decisions and adjustments. To measure responsiveness of health systems, we have defined five fuzzy sets for two input variables: score of direct experience of using health service and score of anchoring vignette, and five fuzzy sets for one output variable: responsiveness score which is defined as the difference between score of direct experience of using health service and score of vignette. The twenty-five fuzzy rules are derived from the analysis of input and output variables association. Mamdani style inference technique is used to compute a crisp value of average responsiveness score for each component of health systems, and the overall average responsiveness score is computed by using the weight average method. The data of seven components based on WHO framework were collected from 4,446 outpatients of three schemes of health care systems in Thailand consisting of Civil Servant Medical Benefit Scheme (CSMBS), Social Security Scheme (SSS), and Universal Coverage Scheme (UCS). Results showed that CSMBS got the highest average responsiveness score followed by SSS which got a slightly higher average responsiveness score than UCS, but there are some variations in each of seven components. The proposed method of responsiveness evaluation can provide concise information both in terms of quantitative and qualitative measures, which can be used as a policy implication to assist government and health system policy makers in improving and providing the more suitable heath care services. © 2014 IEEE.

Dhanakijcharoen P.,National Health Security Office
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2011

Universal coverage (UC) scheme is a reformed national healthcare insurance that has been set up since the year 2002 and covers more than 80% of Thai population who are self-employed and do not work as government employees. Initially, this scheme offered only basic and comprehensive healthcare while renal replacement therapy (RRT), the financial cost of which was high, was not included. Without the support from the government healthcare insurance, the patients and their families will become insolvency. The benefit of peritoneal dialysis (PD) over hemodialysis (HD) has been shown in terms of medical expenses and cost-effectiveness. The "PD First" policy in Thailand has been implemented on January 1st 2008 as a model of initial treatment of end stage renal disease (ESRD) patients under the UC scheme. During the year 2008-2011, 12,753 cases, 6,177 were male and 6,576 were female, registered in this modality. The technical survivals at 1, 2 and 3 years were 92, 85 and 80%, respectively while the patient survivals were 79, 66 and 57% at 1, 2 and 3 years, respectively. The hematocrit level had been significantly increased from 25.9 +/- 5% in October 2009 to 28.0 +/- 5% in October 2010. The Peritonitis rate was decreased from 20.7 per patient months during the year 2009 to 25.8 per patient months at the year 2011 and the exit-site infection rate was 1 episode per 40.7 patient months. Currently, there are 111 PD centers that service for ESRD patients nationwide. There are strong supports from The National Health Security Office, The Nephrology Society of Thailand, The Dialysis Nurse Association, The Kidney Foundation of Thailand The Ministry of Public Health, The Thai Kidney Patient Association, Chulalongkorn University, Thai Red Cross Society, community, and social network, all of which are the major factors to guarantee the salutary outcomes in the future.

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