Journal of Health Systems Research

Standard Requirements for Smoke-Free Hospital 2023 versus Program and Disease Specific Standard 2020: Differences and Similarities

Thu, 27 Jun 2024 00:00:00 +0700

In 2023, Thailand started collaborating to upgrade the smoke-free hospital standard to the program and disease specific standard (PDSS). A comparative study of the similarities and differences in these two standard requirements would be beneficial to hospitals planning to apply for the PDSS certification particularly nicotine addiction. This study compared the differences between the two standards in 3 areas: 1) application documents, 2) number and details of requirements, and 3) scoring for decision-making. The study found that 1) the documents requesting for the PDSS certification were higher in both number and items within the documents. 2) The number of requirements for the two standards were consistent but differed in detail. Smoke-free hospital standard was specific to the process and outcome of smoking cessation, but the PDSS focused on patient care process and key hospital system of interdisciplinary teamwork. 3) Both standards employed the same 1–5-point scoring guideline. The smoke-free hospital standard calculated scores of 1-7 criteria separated from criterion 8 and weighting for the overall scores without specified passing minimum score. The PDSS required part III-patient care process scores of higher than 3.0. For PDSS certification, hospitals should start from 1) establishing a multidisciplinary team, 2) creating an action plan for accreditation, 3) setting performance indicators and targets, to 4) promoting continuity quality improvement. For new hospitals, it may take at least 3 years to see results and care process improvements.

Assessment of Population Health Impacts from the Transfer of Sub-District Health Promoting Hospitals to the Provincial Administrative Organizations in 2023: Phase 1 Potential Warning Signs

Jiruth Sriratanaban, Noppcha Singweratham, Daoroong Komwong, Mano Maneechay — Thu, 27 Jun 2024 00:00:00 +0700

This mixed-method research aimed to identify early warning signs of fundamental changes associated with the transfer of Tambon (subdistrict) health promoting hospitals (THPH) to provincial administrative organizations (PAOs). The study focused on the health-related impact risks including changes in resource management, health service provision, and public health operations of THPH after the transfer. The research consisted of two parts. In the qualitative part, data collection involved interviews with key informants from provincial health offices, hospitals, THPHs, and PAOs in the 6 provinces case study strategically selected for in-depth analysis. Data were analyzed through content analysis. In the retrospective analytical-study part, pilot indicator sets and information along the cause-and-effect chains were synthesized with respect to the study framework. They linked measures of access, service utilization, healthcare quality, health outcomes, and care costs to early warning signs of health-related risks after the transfer. Using the databases collected by the National Health Security Office (NHSO), the data from the fiscal years 2018-2022 were utilized as the baseline data while the 2023 data were the first-year post-transfer.

Key findings from this study reveal that the evaluation framework for health impacts of the THPH transfer should include (1) health outcomes, (2) costs of care, (3) public health outcomes, (4) primary care access, (5) effectiveness or adherence to clinical practice guidelines and timely care, (6) alignment with public health activity frameworks and goals, and (7) resources and management models. This framework served as early warning indicators for monitoring post-transfer health impacts. Furthermore, statistical indicators on various aspects could reflect operational differences, trends of pre- and post-transfer to PAOs.

The Ministry of Public Health, NHSO, the Office of the Prime Minister (Committee for the Delegation of Authority to Local Administrative Organizations), and the Ministry of Interior (Department of Local Administration), as well as other related agencies, are recommended to collaborate in reviewing, planning, and designing a surveillance system to prevent and address health impacts on the population resulting from the transfer of THPHs to PAOs. Additionally, a review and redesign of a system for overseeing the local public health system should be in place.

Roles of Provincial Health Office and District Health Office after Transferring Sub-District Health Promoting Hospital to Provincial Administrative Organization

Thu, 27 Jun 2024 00:00:00 +0700

The transfer of sub-district health promoting hospitals to provincial administrative organizations alters the roles of provincial health office and district health office. This study aimed to investigate optimal roles of provincial and district health offices after the transfer and synthesize policy suggestions. Mixed methods were used. The qualitative data were gathered through semi-structured interviews and focus groups. The participants from 8 provinces, representing each region, covered experts, administrators of Ministry of Public Health, policy makers, chiefs of provincial and district health offices, and district chiefs officers. The quantitative data were collected using questionnaire. The data were analyzed with descriptive statistics. Policy suggestions were synthesized from the analysis of qualitative and quantitative data, and connoisseur meeting.

The findings revealed that the roles of both offices remained the same as before with some new operations to solve the consequences of the transfer. 1) In transition phase: the provincial health offices operated as the prior roles following the 2019 Primary Care System Act, and advised district health offices for readiness preparation transitioning the district health offices’ competencies to be the academic offices. However, the roles of district health office by the ministerial regulations should be modified. 2) At completion phase; the provincial health offices operated as the prior roles with some role changes according to the modified roles of the district health offices. These modified roles involved upgrading the district health offices to be the academic offices with enhanced regulator’s competencies, and quality accreditation of primary care settings. The district health offices’ modified roles included consultants and the evidence-based information providers, regulators of primary care service quality and improving health consumer protection system.

Policy Gap of Workplace Non-Communicable Disease Risk Factor Prevention and Control in Thailand

Thu, 27 Jun 2024 00:00:00 +0700

The objective of this study was to identify gaps, barriers, and challenges of risk factor prevention policy on non-communicable diseases in workplace in Thailand. This study used qualitative approach by reviewing policy recommendations from international organizations in comparison with policies in Thailand. In-depth interviews with policy stakeholders were also conducted to identify policy gaps, barriers, and challenges of implementation. The study findings revealed that no national policy framework of healthy workplace and the integration of health promotion (HP) and occupational safety and health (OSH) could be seen. Also, there was no guideline for financial incentive development for employers to promote healthy workplace. Additionally, potential barriers on policy implementation were explored, including lack of alignment between key policy agencies (such as Ministry of Public Health and Ministry of Labor), limitations of law enforcement, lack of linkage on individual health data in workplace, and inefficient monitoring and evaluation of health outcomes among workers in workplace. Therefore, policy recommendations are proposed to the Ministry of Labor and the Ministry of Public Health to consider the integration of HP with OSH in the workplace, develop a national policy framework of worker health and incentive measures to encourage small and medium enterprises in implementing policy at workplace. In addition, the central cross-sectoral data integration for health should be in place.

Establishing a Quality Certification System for Diagnostic Radiology Laboratory in Thailand

Raevadee Siritunyanont, Songphon Chamdit, Buppa Wongyot — Thu, 27 Jun 2024 00:00:00 +0700

The Bureau of Laboratory Quality Standards of the Ministry of Public Health (MOPH) had established a quality certification system for diagnostic radiology laboratory (DRLab), namely MOPH X-ray 2562, since 2019. This study aimed to determine the appropriate processes and to evaluate the implementation of the established certification system by using descriptive statistics and one-way ANOVA. The research included three parts: (1) the creation of DRLab standards with 10 main topics containing 114 checklist items; (2) the development of a certification system, including quality documents, assessor training, and operational procedures in order to provide certification services for DRLabs in Thailand; (3) the implementation of the certification system with 245 DRLabs of 5 provider groups (community hospitals, general hospitals, regional hospitals, academic hospitals under Ministry of Public Health, and hospitals of the Bangkok Metropolitan Administration). Sixty-three percent of the total DRLabs (245) were found to have nonconformities of less than 10 requirement items. The satisfaction questionnaire revealed that 70.2% were satisfied with the highest satisfaction rate being 88.0%. The average satisfaction levels of DRLabs among 5 groups showed no significant difference (p > 0.05 by one-way ANOVA). The established certification system could be applied to certify diagnostic radiology laboratories throughout the country to promote quality system of safe, efficient, and standardized services to both recipients and providers.

Feasibility Study of Newborn Screening for Inborn Errors of Metabolism by Tandem Mass Spectrometry

Thu, 27 Jun 2024 00:00:00 +0700

This study aimed to investigate the feasibility of the inclusion of the expanded newborn screening for inborn errors of metabolism using tandem mass spectrometry (TMS or MS/MS) in the benefit package of Thailand’s universal coverage scheme (UCS). A mixed-method approach was employed, including survey data, and in-depth interviews. The study participants were healthcare providers who were involved in providing screening and care for the patients in six healthcare facilities and 15 medical personnel and scientists. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data respectively. The study found that in 2021, there were two MS/MS equipment providing services for up to about 60,000 cases per year, while 14 MS/MS were needed to cover all newborn populations in the country within 2026. Therefore, it is necessary to install 12 more MS/MS equipment. It was also found that the rare disease centers or healthcare facilities that could provide screening, diagnosis, and treatments were not evenly available in all regions of Thailand. The facilities were concentrated in Bangkok areas and the number of service personnel was small. In the future, the national neonatal screening center and relevant sectors should develop a comprehensive plan to facilitate, supervise, and monitor the installation, technology transfer, and expansion of the MS/MS technology to cover the whole country.

Severity and Associated Factors of COVID-19 Infection among Pregnant and Postpartum Women: A Cross-Sectional Study in Thailand

Thu, 27 Jun 2024 00:00:00 +0700

Background: COVID-19 posed a significant global health crisis, affecting millions worldwide, with pregnant women being particularly susceptible to severe illness and mortality. Pregnant individuals infected with COVID-19 were more likely to require intensive care and invasive ventilation compared to non-pregnant individuals. This study aimed to investigate the severity of COVID-19 in pregnant and postpartum women in Thailand and its associated factors.

Methodology: This cross-sectional quantitative study utilized data from the National Pregnant Women and 6-Week Postpartum Women COVID-19 Infection Report System, Health Promotion Bureau, Department of Health, from December 1, 2020, to May 31, 2022. The outcome was the level of severity of COVID-19 infection (no or mild symptoms, and moderate to severe symptoms) among pregnant and postpartum women. The exposures were participants’ characteristics, including age, nationality, COVID-19 vaccination status, and gestational age when infection was assessed. Multivariable logistic regression was used to examine the associations between these characteristics and COVID-19 severity.

Results: The study recruited 12,579 pregnant or postpartum women infected with COVID-19 in Thailand. Most participants experienced no or mild symptoms (87.0%), while the rest had moderate to severe symptoms (13%). Pregnant women with higher age (≥35 years) had the highest likelihood of severe symptoms (adjusted odds ratio: AOR = 1.79, 95%CI: 1.44, 2.24), and non-Thai participants had a significantly higher likelihood of severe symptoms compared to Thais (AOR = 1.17, 95%CI: 1.03, 1.34). Pregnant women who received three doses of the COVID-19 vaccine had the lowest likelihood of severe symptoms (AOR = 0.16, 95%CI: 0.10, 0.27). Participants being infected during the third trimester of pregnancy had a higher likelihood of severe symptoms (AOR = 1.52, 95%CI: 1.22, 1.90).

Conclusion: This study offers significant insights into the severity of COVID-19 among pregnant and postpartum women in Thailand. Despite most participants experiencing no or mild symptoms, it was imperative for the public to implement preventive measures to reduce the risk of severe symptoms and optimize care for this vulnerable group. Moreover, the study identified the influence of maternal age, nationality, COVID-19 vaccination status, and timing of infection on COVID-19 severity. The findings revealed important implications for the implementation of preventive strategies and the optimization of healthcare services for pregnant women during the COVID-19 pandemic.

Private Dental Clinic Management Experiences during the COVID-19 Crisis in Bangkok, Thailand: A Qualitative Study

Thu, 27 Jun 2024 00:00:00 +0700

This study aimed to describe the experiences of private dental clinic providers in Bangkok managing their clinics during the COVID-19 crisis and to propose suggestions. A qualitative study was conducted. Nineteen private dental clinics were purposive recruited through snowball sampling to get various characteristics of clinic and were in-depth interviewed with semi-structured questionnaire. Content analysis was used to analyze the data. The study found that all dental clinics faced challenges in patient management due to various regulations, such as, COVID-19 screening was required before providing dental care, clinic environment and chair-side practices should reduce aerosol particles by improving ventilation system, air conditioning with HEPA (high efficiency particulate air) filters and extraoral suction (EOS). Personal protective measures such as isolation gowns, face masks especially double surgical masks, N95 respirators, or combinations of both, were emphasized. The study also revealed that some clinic owners felt the regulations were excessive or impractical, especially the ventilation systems. It was suggested that clear and feasible guidelines, with appropriate support to comply with strict dental clinic standards were needed to maximize benefits to the public and dental professionals. Overall, the study highlighted the importance of dental clinic safety measures during the COVID-19 crisis and the need for ongoing support and regulation to ensure public safety and the continuation of dental services.