Using risk-assessment sheet to improve effectiveness of health examination service.

BACKGROUND: Several techniques to improve compliance of physicians toward health examination guidelines of many countries were studied. However the method to improve compliance of Thai physicians toward Thailand's guidelines has never been studied. OBJECTIVES: To determine the effectiveness of using risk-assessment sheets to improve the compliance of physicians toward Thailand's health examination service guideline. MATERIAL AND METHOD: Risk-assessment sheets were constructed based on recommendations in Guide to Periodic Health Examination and Maintenance for Thai People. One hundred and two adult clients who came for health examination service from January to March 2003 were asked to fill in risk-assessment sheets and compared them with 103 recorded health examination report from the hospitals computer before the risk-assessment sheets were developed. RESULTS: Clients using the risk-assessment sheets group received recommended health examination significantly more than those in the non-using group (p < 0.01). In the using group, rates of providing chest x-ray, tumor markers and average number of laboratory investigations were statistically significant lower (p < 0.01) and contrary to the rate of Pap test was statistically significant higher (p < 0.016) than the non-using group. The average expenditure of the using-group was 41.3% lower than non-using group. CONCLUSION: Using a risk-assessment sheet in health examination statistically and practically increased the compliance of physicians toward health examination guidelines and reduced unnecessary expenditure.

Peak inspiratory flow rate and the ability to use the Turbuhaler in Thai children aged 3-7 years.

A Turbuhaler is a dry powder inhaler device commonly used by asthmatic patients. Its superiority over a metered-dose inhaler device includes easy technique, convenience in handling and absence of chloro fluoro carbon (CFC). However, the use of this device has some limitations in young children who may not be able to generate the inspiratory flow rate high enough to assure adequate medication delivery. Even though the Turbuhaler has been used in Thailand for many years, the study of inspiratory flow rate and the ability to use this device in Thai preschool children is lacking. In the present study, the authors aimed to evaluate the ability to use the Turbuhaler in Thai preschool children by measuring the peak inspiratory flow rate, peak inspiratory flow rate through the Turbuhaler as well as positive test of the Turbutester. Subjects included 468 Thai preschool children, aged 3-7 years old. They were assigned to perform the test with In-Check Dial, Mini-Wright Peak Flow Meter and Turbutester. The authors found that the ability to use the device correlated directly with age and children with age of 5 years or more could perform significantly better. Children weight of 20 kilograms or more, or a height of 113 centimeters or more were also able to generate adequate inspiratory flow rate for medication delivery. The authors concluded that children from the age of five years, or with a weight from 20 kilograms or a height from 113 centimeters were able to generate adequate inspiratory flow rate for effective medication delivery by the Turbuhaler.