PUBLISHED RESEARCHES IN THE YEAR 2009

Title: Studying & Monitoring the Development of the Transfer System of Public Health Centers to Local Government Organizations Researchers: Somphant Techaatik*, Payao Nakham** *Lecturer of Social Development Management Program, Faculty of Humanities & Social Sciences, Khon Kaen University
**

Independent researcher

Abstract This study utilized qualitative study papers and reports on the process of decentralizing health care. The study employed a quantitative method, using questionnaires on 8,199 villagers. It was aimed at understanding the process of the transfer organizations(LGOs). Specifically, the study focused on the process of setting up the transfer mechanism, monitoring the product and output, analyzing and summarizing the lessons learned, as well as providing policy recommendations relating to the mechanism and structure for transferring the PHCs to the LGOs. The research was conducted from September 2007 to October 2008. system of public health centers(PHCs) to a local government

Research results confirmed that the PHCs under study followed the mechanism and process of the transfer system to the LGOs. However, they encountered some difficulties pertinent to time constraints and communication problems at all levels. With respect to the product, we have discovered that there were four types of the transfer system : (1) the complete transfer of PHCs and personnel, (2) the complete transfer of PHCs and some personnel, (3) the transfer of some PHCs with all the personnel of those PHCs, (4) the transfer of some PHCs with some personnel. The majority of the PHCs employed the second type. Different types impacted the management of work, budget, personnel and materials differently. Relating to the output, we have learned that the ideas and paradigms of public

health decentralization to local areas were significant and made the transfer system efficient by generating peoples participation and coordinating consistently with the

network. In terms of policy and development strategy implemented at the local level, we have discovered that they emphasized the idea of service to all, stimulated proactive work, and improved policy, strategy and planning for public health and environment activities parallel to the development of the infrastructure. Also, we discovered some problems relating to the management of work, budget, personnel,

property, material, medicine and medical supplies following the imprecise rules and regulations issued by the Ministry of Public Health and the Ministry of Interior. ability, having organizational vision and management ability in the LGOs. Recommendations for transferring the PHCs to the LGOs are as follows. At the Factors contributing to the success of the transfer included cooperation, leadership

policy level, the national decentralization committee should have a clear integrated policy and establish a national coordinating body to be responsible for informing the provincial and district levels, it is necessary to have a proper academic supporting public of the value, ideas and benefits of public health decentralization. At the mechanism based on the participation of all parties concerned for monitoring and supporting the transfer of the PHCs to the LGOs smoothly and to communicate efficiently with all parties concerned during and after the transfer. At the community level, we suggest that the LGOs and the PHCs should abide by the principle of peoples participation, starting from local public organizations to local civil societies in decision-making for the transfer of the PHCs to the LGOs and in supporting community health development planning.

Key words: decentralization, Public Health Center, local government organization (Published in Journal of Health Systems Research Vol.3 No.1 Jan.-Mar.2009)

Title : Farmers Expectation Concerning Sustainable Occupation for Agricultural Development: Health Aspects
Researcher : Rakpracha Thisawech* * Social Development, Group 46, Kasetsart University Bangkhen Campus Abstract This research studied the expectation of agriculturists who had to build a

sustainable occupation for agriculture development that would protect natural resources and the environment , decrease the adverse effect of chemicals and produce safe food and a happy social condition, among other positive outcomes. It expectation of sustainable development. The sample comprised of 240 persons who were interviewed in order to collect data. The statistics were analyzed by percentage value, average, standard deviation, t-test , and one-way ANOVA. studied personal factors , the economy , and social aspects, compared with the

The study results found that most of the sampled household heads were males, aged 41 50 years, with a primary educational, lacking social position, living in their village for more than 5 years, and had been trained in agriculture by their parents. Farm size was 11 20 rais, family farm labor averaged 9 persons, the individuals had a yearly income of 50,000 99,999 baht, household expenses of 10,000 19,999 baht per year, made occupational investments of 20,000 - 40,001 baht per year, and were likely to be members of an agricultural group.

Their expectations with regard to technology transfer, community business development for production, processing and marketing, plant and animal breeding modification were at a moderate level. However, those expectations with regard to technology support, soil, water and environmental resource development were at a high level. As for problems, operational guidelines and suggestions, the respondents revealed that there were many problems, such as quality of soil, lack of rain and

irrigation, plant and animal breeds, organic fertilizer, labor, knowledge of breed selection, products, markets, investment and governmental support. Agricultural institutes played only a minor role in agricultural occupation development. It was suggested that group members be allowed to participate, to submit their opinions, to plan and to make decisions. Keywords : expectation of the agriculturists, sustainable occupational

agricultural development, preservation protection of natural resources,

environmental preservation, reduction of chemical agricultural inputs, food safety (Published in Journal of Health Systems Research Vol.3 No.1 Jan.-Mar.2009)

Title : Experience with Public Health Decentralization : The Health Center Transfer Model

Researchers : Jaruayporn Srisasalux* Charay Vichathai* Rampai Kaewvichian * Health Systems Research Institute Bureau of Policy & Strategy, Ministry of Public Health Abstract

Public health decentralization has been a national agenda and compliant with

the 1997 Constitution of Thailand. In principle, the central administration of Ministry

of Public Health was responsible for decentralizing its part of public health programs and resources to local administrative organizations according to Decentralization Plan for Local Administration. The Ministry of Public Health established the Office for and a preparation facilitator for transferring public health programs and activities to local administrative organizations. In 2007, the Ministry of Public Health initiated a pilot project to transfer 22 health centers to 19 local administrative organizations in 16 provinces. The individual experiences of this project indicate that community Supporting Public Health Decentralization so that it could act as a policy coordinator

participation was necessary. Other important factors on part of local administrative organizations were their supplementary budgets for public health activities & positions and leadership of community development. Good relationship between investment, shortened command-control line, clearer pathway of health personnel health centers and local administrative organizations were undeniably helpful for the transferring processes. Lesson learned from this project were if the transferring processes, advantages, precaution and possible contingencies and solutions should be thoroughly made from policy to implementation level. Human resources for transferred public health programs must be carefully planned. Administrative & would carry out for more health centers, communication of the transfer vision,

Consultative Office at provincial level should be established to help solve out administrative inquiries and provide technical consultation from the starting point to monitoring and continuous evaluations. Then, the lessons learned and application from local levels would help support the better development. Keywords: decentralization, public health, health center transfer

(Published in Journal of Health Systems Research Vol.3 No.1 Jan.-Mar.2009)

Title : The expenditure of high cost drug and the difference of their use in various health insurance schemes in a regional hospital in north-eastern part, Thailand Researchers : Yupapun Munkratok , Vithaya Kulsomboon , Yupadee Sirisinsuk
* ** * ** **

Maharat Nakhon Ratchasima Hospital, Social Pharmacy Research Unit,

Faculty of Pharmaceutical Sciences, Chulalongkorn University Abstract

Background: Essential drugs in Subclass 4 are high cost drugs (HCD). Their

use was an important factor influencing pharmaceutical expenditure. Exploring drug items, extent of use, and the difference of their use among health insurance schemes would provide in-depth understanding of efficiency and equity of their use.

To identify the items of HCDs, to assess their impact on pharmaceutical expenditure, and to explore HCD users classified by age and type of health insurance schemes expenditure including top ten HCD in subclass 4 of Essential Drug List in three fiscal were the objectives of this study. Method: Retrospective data of overall drug year (2003-2005) were obtained from Hospital Inventory Database. Drug use data of top ten HCD in 2005 were obtained from Dispensing Database. The rates of the top ten HCD use per 1000 patients were classified by age and health insurance scheme including Universal Coverage Scheme (UC), Civil Servant Medical Benefit Scheme consecutive years (2003-2005), the six HCDs most highly used were human erythropoietin 4000 u. inj., atorvastatin 10 mg. tab., meropenem 1g

(CSMBS), and Social Security Scheme (SSS) were compared. Results: In the three inj,

imipenem/cilastatin 500 mg/vial IV, cefoperazone/salbactam 1g inj and clopidogrel 75 mg. tab. Top ten HCD use in the hospital consumed 45.6, 50.5, and 68.8 millions baht in 2003, 2004 and 2005 respectively. Expenditure of erythropoetin 4000 u., atorvastatin 10 mg., clopidogrel 75 mg. and meropenem inj. 1g increased every year. In 2005, 63.8% or 46.8 millions baht of the expenditure of top ten HCD was in CSMBS. These items were the drug used for chronic diseases including

erythropoietin, atorvastatin, clopidogrel. and mycophenolate. HCD spending in UC was 32.3% or 23.6 millions baht and it was only 1% in SSS. In UC, the drug items mainly used were anti-infectious drugs including meropenem, imipenem/cilastatin and cefoperazone/salbactam. The rate of use of atorvastatin and clopidogrel per 1000 patients in aging group in CSMBS were 20.08 and 6.47 respectively. In UC, they were only 0.05 and 1.45 respectively. The rate of use of meropenem per 1000 patients in every age group in UC was greater than in CSMBS. Discussion : The impact of HCD use on pharmaceutical expenditure is quite high since only 10 HCDs HCD use based on the insurance schemes. Further studies should be focused on the contained 18-20 % of overall pharmaceutical expenditure. There is a difference on

evaluation of HCDs use, the effective measures to control HCD use, and the method to balance equity of HCD access among health insurance schemes. Keywords: high cost drug, health insurance, expenditure

(Published in Journal of Health Systems Research Vol.3 No.2 Apr.-Jun.2009)

Title : A Systematic Review and Meta-Analysis of the Efficacy of Statins available in Thailand in Reducing Acute Coronary Syndrome and Stroke Events

Researchers : Yupin Tamteeranon

1

1,2

, Usa Chaikledkaew , Panarasri Khonputsa ,

1,2 3 2

Health Intervention & Technology Assessment Program(HITAP), Faculty of

3

Yot Teerawattananon

Pharmacy, Mahidol University, Setting Priorities using Information on CostEffectiveness (SPICE) Project Abstract efficacy of statins available in Thailand (i.e., atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin) in reducing acute coronary syndrome (ACS) and stroke trials (RCTs) of statins were studied. The clinical trials on an electronic Medline database were searched. The efficacy studies of statin monotherapy compared with placebo or other statins on the occurrence of fatal and non fatal ACS and stroke were included. Odds ratio (OR) and its 95% confidence interval (CI) were used as the summary efficacy of statins. Indirect comparison random effect meta-analysis using Bayesian approach and WinBUGS14 software program were applied. Twenty nine RCTs were consisted of 26 studies comparing statins with placebo, one Results: Objectives : This study was a literature review of the assessing the clinical

events. Methods : A systematic review and meta-analysis of randomized controlled

study comparing statins with no treatment, one study comparing statins with usual care, and the other comparing atorvastatin with pravastatin. For ACS events, the relative risk reduction (RRR) of simvastatin was 42% (OR=0.58, 95%CI=0.51-0.65), the RRR of atorvastatin was 41% (OR=0.59, 95%CI=0.51-0.70) and the RRR of pravastatin was 26% (OR=0.74, 95%CI=0.66-0.83). For stroke events, the RRR of simvastatin was 26% (OR=0.74, 95%CI=0.66-0.83), the RRR of atorvastatin was 19% (OR=0.81, 95%CI=0.72-0.93) and the RRR of pravastatin was 14% (OR=0.86, 95%CI=0.75-0.97). However, fluvastatin did not significantly reduce ACS (OR=0.37, 95%CI=0.11-1.05) and stroke events (OR=0.85, 95%CI=0.46-1.55). The efficacy study of rosuvastatin on decreasing ACS and stroke events was not yet available.

Conclusion: The available evidences indicated that simvastatin, atorvastatin and pravastatin significantly reduced ACS and stroke events. Keywords: statin, ACS, stroke, meta-analysis

(Published in Journal of Health Systems Research Vol.3 No.2 Apr.-Jun.2009)

Title: Health Equity and Human Rights of the Stateless Hill Tribes in Thailand Researchers: Boonma Soontaraviratana Narongsak Noosorn Supasit
* **

Pannarunothai
* ** ***

***

Chaiyong Kamrat

****

Loei Provincial Public Health Office. Public Health Faculty. Naresuan University. Faculty of Medicine. Naresuan University. Public Health Faculty. Mahasarakarm University.

****

Abstract: These mixed methodology research was conducted to assess health equity within a human rights framework comparing situations among three groups in Thailand in order to close the gap between these groups. The sample included 789

subjects (Thai, Hill Tribe and Stateless Hill Tribe) from 10 provinces in the north of Thailand. The tool for comparison was the benchmark of fairness for assessing health that present the research result to 17 expertises to suggest for the policy. The research was studies from December 2006 to august 2007. Results revealed a significant differences among three population groups on 7 care reform. Data analysis by ANOVA, Z-score and fulfill by qualitative data. After

out of the 9 benchmarks (all at p<.001). The non- significant different benchmarks were efficiency and quality of care (p=.170) and administrative efficiency (p=.227). With regards to Z score analysis, the Thai National citizens (Group 1) had the highest scored (Z = .3293), the hill tribe with Thai national citizenship(group 2) had the

average scored (Z=.1275) and the stateless hill tribes(group 3) had the lowest scored (Z=-.3885). Recommendations from experts to bridge the gap included budget allocation to fit with population, health care standards, the laws reforms and decentralization of health service to the local governments. In conclusion, this research suggested that the Thai government should close

the inequity gap by policy mix that affects every population group in Thailand. The establishment of equity with regards to basic health care will promote human rights humanitarian efforts elsewhere. concerns within Thailand and will serve as an example for the promotion of

Keywords: Human Rights, Health Equity, Stateless Hill Tribes Research Institute (HSRI)

Supported by Health Insurance System Research Office (HISRO) for Health Systems (Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009)

Title: Quality Development of Patient Care Team by Integrated Case

Conference in Sung Noen Hospital, Nakhon Ratchasima Province, 2008 Researchers: Nilnetr Veerasombat* et al. *Sung Noen Hospital, Nakhon Ratchasima Province Abstract

The purpose of this action research was to solve clinical risks in patient care

by professional health care teams. Researchers and participants were heath personnel in Sung Noen community hospital; including the hospital director, physicians, pharmacists, registered nurses, laboratory technicians, radiology

technicians, physical therapists, psychologists and ayuravedic doctors. The study

was divided into 3 steps; 1) situation analysis: by analyzing clinical risk incident report and former preventive measures 2) implementation: by setting up integrated physicians as the leader who set up a case conference once a month. 3) monitoring case conferences i.e. integrated patient care by professional health care team with and evaluation: by participants of conference meeting, using questionnaires created by quality development center; evaluating new preventive measures and clinical practice guidelines (CPG) released and enabled to practice. The study was conducted during October 2007 to December 2008, total 18 months. It was found that clinical risk incident report in 2007 was higher in coverage, especially the patient care topic, but repeated incidents were still periodically reported, lack of root cause analysis (RCA) of clinical risk in time and discontinuity of preventive measure practices. Integrated case conference in high level clinical risk topics with physicians as the leader was set up to analyze root cause analysis (RCA) of patient care process. The results were new preventive measures and new clinical practice guidelines that were more practical which promoted quality in patient care team. This study showed that integrated case conference could be effectively conducted in community hospitals. (Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009) Keywords: quality development, patient care team (PCT), case conference

Title: A Study on the Four Dimensions of Health Researcher:Vichai Chokevivat * *Institute for the Development of Human Research Protection Abstract

An attempt to include spiritual health into WHO definition of health has

been made since 1980. It was proposed by member states of WHO in Eastern Finally the Executive Board of WHO has concluded to propose amendment of the

Mediterranean Region. There were both proponents and opponents of the proposal. definition of health from that the state of complete physical, mental and social well-being and not merely the absence of the disease or infirmity to the dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity. However, the proposal did not become the same as stated in the preamble of the Constitution of WHO. In Thailand there was a

resolution at the World Health Assembly. Thus the definition of health remains the movement to include the spiritual health into the definition of health during the campaign on health system reform in the last decade. Such movement brought about strong controversy rooted from some leading Buddhist organizations which rejected the spiritual dimension as a concept influenced by theist paradigm which intellectual well-being as the fourth dimension of health. The Health Act B.E. 2007

is opposite to Buddhism. Finally, the consensus has been reached to accept the term has then defined health as the state of human being which is perfect in physical, mental, spiritual and social aspects all of which are holistic in balance There are still some problems in the new definition of health concerning the exact meaning of proposed not to try to reach consensus in this issue which is very complicate, since way of development of the four dimensions of health as an example. The people in different faith can freely develop or extend their means on the basis of their own faith. Key words : Four Dimensions of Health, Spiritual mental and spiritual well-being especially when translates into English. This paper the four dimensions have covered all aspects of health. It also proposed Buddhist

(Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009)

Title: Usage of Herbal Alternatives to Modern Medicine in Lampang Hospital & Community Hospitals in Lampang Province

Researchers: Pairat Harinawan*, Wanna Damnoensawat* , Prayuth Srikajang ,

*

Lampang Provincial Health Office,

Nuchnapang Maneewong*

Koh Ka District Health Office, Lampang

Province Abstract

This descriptive study was aimed to compare the cost of herbal medicine

replacing conventional medicine for treatment of 5 health conditions in 5-year period (2002 2006). The study was performed between May 2007 to August 2008. The study samples were 65 health care workers and 260 clients in regional hospitals and

12 community hospitals in Lampang province. The research instruments used consisted of 1) record of the cost for herbal medicine and conventional medicine treatment of 5 health conditions : irritable bowel syndrome, sore throat (nonfor herbal medical order, 3) satisfication form for herbal medicine uses. The data was conventional medicine by t-test and analyzed clientss satisfication by Chisquare. infectious) constipation, Herpes, and musculoskeletal / joint diseases 2) questionaire analyzed by descriptive statistics, compared the cost of herbal medicine replacing The results indicated that the cost of most herbal medicine compared

with conventional medicine for 5-health-condition treatment in Lampang province was increased during the studied period. The cost of Turmeric increased from 85,717 Baht in 2002 to 551,272 Baht in 2006, Andrographis increased from 28,152 Baht to 138,681 Baht, Senna alata leaves increased from 2,797 Baht to 27,104 Baht, montanum increased from 14,243 Baht to 298,446 Baht. The comparative cost of herbal medicine during the year 2002 2006 was significantly increased (P<.05), except that of Zingiber montanum was not significantly increased. (P=.074) order,

Clinacantus nutans leaves increased from 3,490 Baht to 18,101 Baht and Zingiber

Concerning the health care workers perception on herbal medicine

Andrographis 63.1 %, Senna alata leaves 40 %, Clinacantus nutans leaves 41.5% and Zingiber montanum 58.5 %. The main reasons for the decision to order was perceived of drug indication. For the clientss satisfication for using herbal medicine replacing conventional medicine, we found that the clients had experienced in using Turmeric 68.5 %, Andrographispaniculata 70 %, Candelabra bush

we found that the samples had experienced in ordering Turmeric 75.4 %,

15.4 %,

Clinacantus nutans 29.6 % and Zingiber montanum 69.2 %. The satisfication was highly significant (P<.001), the reasons for satisfication was dued to knowing indication and having experiences in using then.

Andrographis,

From our study results the uses of herbal medicine used: Turmeric, Senna alata leaves, Clinacantus nutans leaves and Zingiber

montanum replacing conventional medicine in regional hospital and 12 community

hospital of Lampang province from 2002 2006 were increased. The increasing rate dued to supportive policy in herbal medicine used in public health center, performing workers by placing herbal medicine stickers at the drug payment stations. Key words: herbs, Hospitals in Lampang Province (Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009) herbal medicine educational meeting, and the reminding strategy of health care

Title: Potentials and Readiness of tri-parties on the development of the community health system in 12 sub-districts Researchers: Supattra Srivanichakorn , Kasem Vechasuthanon , Winai Leesmith ,
1 1 2

Tassanee Yana , Onanong Direkbussarakom , Pattara Sanchaisuriya , Raviwan

1 3 4

Paokanha ,
5 1

Pongtep Suthirawuth , Sirinat Nipaporn , Praksa Bookboon

6 7 2

Hospital - Kamphangphet Province, Northern Health Regional Training Center,

3

Institute of Community base Health Care Research & Development, Klong Khlung
4 5

North-Eastern Health Systems Research Institute,

6

University, Southern Health Systems Research Institute, Naresuan University

7

Faculty of Nursing Burapha

Phitsanuloke Province Abstract

This study research is about the situation, potentials and readiness of local

government organization, community and networking of health service units in the out the improvement of the direction and the role on networking of tri-parties caring

primary health care level, which works as partnership for local health. This will bring of the community health system. The study, thus, emphasizes on the process of both the quantity and quality approaches. The selection of the study area using purposive method, distribution of 4 regions, 2 provinces per region, which are included on both the primary area in the transferring of the mission of the primary health care unit to

the local government organization and the experienced areas of on working together total of 12 sub-districts. The method of using qualitative study composed of the questionnaire on the guidelines for interview and focus group discussion which all method has passed and tested by professionals. On the study of potentials and the questionnaire by setting up the scale regarding the criteria and use of descriptive analysis. readiness of the local government organization using the quantitative study from

network of health services composed of the policy dimension and the supportive system to health service provider which still have the limit structure especially on has worked together more clearly even to some of study area which has the opinion

The study resulted on significant situation, capacity, and readiness of the

the provincial level. While on district and sub-districts level, the clearing structure of principle or policy regarding the transfer of mission on health service to local government organization differently. However, the number of health service working period on health have a positive impact to the works as partners joining on provider, the capacity on knowledge, and the experience including the duration of operational because of individual relationship important but there is still lack of the supporting system for capacity development of health officer working on community and local area to be more effectiveness. However, most of health personnel have understanding on management and use of information in order to report in the level area level. Capacity and the readiness of community depend on the variety, the role, including the level of acceptance to health service unit and the local government community such as the project that community has started focus on community to

of working unit more than using the information for planning to solve problems in the and strengths of the community leader and the development groups in community organization in the area. The reflection on joining and the strengthening of management, joining of beneficial, and bring about good governance. However, there might be condition in the development of urban or industrial community which have specific working context. The concrete negotiation on health from community still has limited. There might be in some area which has the management on funding

differently in array to the improvement of health but most of them is set up to receive supportive funding more so as to request or negotiation for the benefits of community. Capacity and the readiness of the local government organization regarding the structure found most from the study area will have specific unit regarding the health issue, and it has capacity on the management. The entire study unit has been accepted from the community regarding the local politics. However, the power on getting local revenue and generating income has difference regarding the size of organization. For the expenses on health development of the area it has participation on the universal coverage in the area still limited, on both the policy setting in the area in order to bring about the universal coverage for all people in including the role of service monitoring and practice management. responsibility area, the involvement of providing, purchasing health services, The important suggestion on the part of health service network, community,

about 6.64% of total expenses especially from the study area found that the

local from the study compose of 1) support for learning local mechanism of the

working together for health 2) promote the improvement of the capacity building of

each sector clearly and continuously concerning their capacity and ability. 3)

develop

information system for planning, implementing, and monitoring and evaluation.

mechanism

and

supporting

system

such

as

management

system,

researcher team other key stakeholders to increase the effectiveness of working in order to bring about the community health system are; 1) modifying the goal of the

Moreover, suggestions on the study raised from the meeting among

development from transferring of the mission on health to the local government organization in order to promote concept and the process on partnership 2) advocating policy mechanism and organizational management at the district and development among health sector, local government organization, and community provincial for developing public policy on health, concerning social marketing and public communication on health 3) supporting clear and continuous capacity strengthening for local government upon the specific context, patterns could be database development for interesting case studies, organizing appropriate activities for learning process on networking issues of all sectors. unit, community, community health Key words: potentials and readiness, local government organization, health service (Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009)

Title: Alcohol Consumption and Violence against Women in Khon Kaen Province Researchers: Pongdech Sarakarn*, Yaowaret Kammanat** Health, Khon Kaen University.

* Department of Biostatistics and Demography, Faculty of Public ** One Stop Crisis Center, Khon Kaen Hospital.

Abstract study two topics: first was to find the relationship between couples alcohol consumption questionnaire was used to elicit data from 47 women, who experienced violence and came to seek help at the One Stop Crisis Center of Khon Kaen Hospital and 94 and the violence against the wives. A structured interview This matched case-study, conducted in Khon Kaen Province, aimed to

controls, who were women living in the same neighborhood and were in the 5-year age range with the case group. It was found that the women who did not drink 95%CI=1.10-16.62) as likely to experience violence while those who also drank and alcohol but had husbands who drank were 4.27 times (adjusted OR=4.27, had drinking husband were 8.55 times (adjusted OR=8.55, 95%CI=1.75-41.90) as

likely, compared to non-drinking couples. Heavy alcohol consumption (more than 5 glasses on a drinking occasion) (adjusted OR=4.17, 95%CI=1.14-15.28) and associated with the increased odds of violence. In conclusion, alcohol consumption is important activate factor for violence against women in family. Keywords: alcohol consumption, violence against women and domestic violence substance use (adjusted OR=3.97, 95%CI=1.04-15.07) were found to be significantly

(Published in Journal of Health Systems Research Vol.3 No.4 Oct.-Dec.2009)

Title :

Experiences of hospitals on claims for compensation related to adverse events

Researchers: Pattapong Kessomboon , Nusaraporn Kessomboon , Supasit

* **

Pannarunothai , Amorn Premgamone

*** * **

Khon Kaen University, Abstract :

Faculty of Medicine, Khon Kaen University, Faculty of Pharmaceutical Sciences,

***

Faculty of Medicine, Naresuan University

When an adverse event has occurred, the patient or relative would

bring the case to court or submit a claim for compensation from the National Health

Security Office (NHSO). A study on the trend relating to claims for compensation can provide useful information for the design of a new and better system. Objective: To study experiences of hospitals relating to claims for compensation due to adverse events. Method: This was a descriptive study. Two hundred and thirty hospitals were events occurred in 2008.

surveyed for their experiences on patient claims for compensation due to adverse 21.0% of the hospitals had ever experienced patient claims for compensation due to Results: The response rate was 70%. It was found that

adverse events. Community hospitals have a higher chance of claims than general/regional hospitals (23.4% vs 15.7%, respectively). Most of the cases were related to pregnancy and delivery (43.1%). The median amount of claims was 200,000 Baht. The highest was 15,000,000 Baht. The median amount of the money received was 100,000 Baht. The main source of compensations was from the NHSO (49.0%). Among the claims, 13.3% brought the cases to court. Community hospitals have a higher chance of claims brought to court than general/regional hospitals experienced patient claims for compensation. Most were related to pregnancy and

(14.3% vs 10.0%, respectively). Conclusion: Twenty one percent of hospitals

delivery. The money received was smaller than claims. Some brought the cases to court lawsuit. Key words: hospital, claim for compensation, adverse event, court

lawsuit

(Published in Journal of Health Systems Research Vol.3 No.4 Oct.-Dec.2009)

Title: Perspective of the administrators on bringing community pharmacy to provide services under the National Health Security Scheme

Researchers: Wiwat Arkaravichien* Jeerisuda Khumsikiew* Duangtip Hongsamoot** Pimolsri Sangkar** Phayom Sookaneknun*** * Faculty of Pharmaceutical Sciences, Khon Kaen University ** Food and Drug Administration, Ministry of Public Health *** Faculty of Pharmaceutical Sciences, Mahasarakham University Abstract

Study the concept and the perspective of the administrative person can reflex

the direction of development. This research aimed to study the concept and perspective of the administrators regarding the issue of attempt to bring community study was conducted by in-dept interview the responsible administrators on the pharmacy to provide services under the National Health Security Scheme (NHS). The matter of pharmacys status, possibility to recruit pharmacy into the NHS, the direction of development for pharmacy, value of pharmacy in the NHS, stakeholders and factor of success to push pharmacy into the system. Data was gathered and analyzed by content analysis. The results showed that the administrators agreed with the idea of incorporate community pharmacy in to the NHS, but the standard of

practice and the quality of service had to fulfill with NHSs criteria first. It had to have a clear status and positioning of the community pharmacy in the system. Reimbursement of the service had to be specified. The administrators saw the value of bringing private pharmacy to join the services as it increased the accessibility of the patients. The accredited pharmacy may be an option to increase patients accessibility to health. To be success, the administrators said that every stakeholder had to aim the benefit to a patient as patient centered. Security Scheme, Accredited pharmacy

had to take part in his own roles according to the context. However, every partner Key words: Network of accredited pharmacies, Pharmacy in the National Health (Published in Journal of Health Systems Research Vol.3 No.4 Oct.-Dec.2009)

Title: The outcomes of tuberculosis control in special-high-risk populations in northern Thailand: an observational study Researchers:
th

Attapon Cheepsattayakorn*, Ruangrong Cheepsattayakorn**

th

*10 Zonal Tuberculosis and Chest Disease Center, Chiang Mai, 10 Office of Disease Prevention and Control, Department of Disease Control, Ministry of Public Health, Thailand Thailand **Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai,

Abstract:

Objectives: To evaluate and review the tuberculosis situation in various Methods: Data of various tuberculosis-high

tuberculosis-high-risk populations, various periods of time and general tuberculosis control outcomes in northern Thailand. risk populations were analyzed from the DOTS database and special project papernorthern Thailand in various periods of time.

based record systems for various tuberculosis-high risk populations in the areas of showed 30% and 60% of multidrug-resistant tuberculosis with cure of less than 60% Results: The 2003 and 2004 reports

of the registered cases. The 2004 report revealed that tuberculosis was the most common opportunistic infection (38.9%) among HIV- seropositive/AIDS cases. Reports of isoniazid therapy for tuberculosis prevention among HIV-seropositive/AIDS population showed that 78% of them had not developed tuberculosis at the end of the 24 and
th

37.1%

month since starting therapy. The 2005 report demonstrated that only 3.2 of the suspected-childhood tuberculosis cases were

diagnosed

tuberculosis and latent infection, respectively. There was no statistically significant the general tuberculosis population, analyzed from the 2003 report (Pearson changes or improvement of the treatment outcomes(sputum conversion rates, default rates, death rates, and treatment success rates), compared between 2003

correlations between the types of the patient observers and the cure rates among correlation coefficients > 0.01, 2-tailed). There was also no statistically significant

and 2004(p > 0.01). Conclusions: This finding indicates that it still not be wellpopulations in these areas. Recording and reporting systems for childhood of this high-risk population.

developed DOTS programme implementation for various tuberculosis-high- risk tuberculosis cases in this area still not well-developed contribute to underreporting Key words: Tuberculosis, outcomes, high-risk populations, northern Thailand (Published in Journal of Health Systems Research Vol.3 No.4 Oct.-Dec.2009)

Title: The Third Wave of Health Care Reforms in Thailand Researcher:Pongpisut Jongudomsuk* Abstract Health care reform movements in Thailand occur during three main overlapping periods. The first wave of health care reform movements focused on wave focused mainly on reform of health care financing mechanisms. The third wave has shifted its focus to strengthening primary care. This paper is aimed to explore the third wave of health care reform movements in Thailand using literature and increasing geographical coverage of health care infrastructure while the second

*Health Systems Research Institute, Thailand

document review. It was found that among five areas of reform initiatives to strengthen primary care, there was an imbalance of investment in primary care infrastructure and capacity building of health staff. Insufficient number of health centre staff with their limited capacity is the major constraint affecting performance

improvement of health centre. Development of referral system has been a neglected development area and could threaten confidence of people in primary care. Although financing reform improves financial status of health centre, it still needs continuous development to promote responsibility and productivity of health centre staff towards their registered population. Finally, there is a need to develop and adapt promote it to be well recognized by the general public as well as physicians. New concept and practice of family medicine to fit with country specific context and to challenges for the development of primary care in Thailand include its governance system under the context of health care devolution and health services provision for chronic patients and the elderly. Key words: health care reform, primary care (Published in Journal of Health Systems Research Vol.3 No.4 Oct.-Dec.2009)