RESUMEN
This study aimed to develop an instrument to measure the clinical learning climate of undergraduate medical education in Thailand. There were 3 stages of data collection. The first stage employed qualitative inquiry to identify key attributes of the learning environment. Stage 1 output was arranged into the items in the questionnaire for Stage 2 data collection. The validating process in Stage 2 resulted in the list of factors influencing the clinical learning climate with the degree of importance of each factor. The initial version of the learning climate measure was developed based on the findings from this stage. Stage 3 aimed to collect data for further refinement of the instrument. Item analysis and factor analysis were used to explore the constructs of the climate measure. The subscales were established using both statistical and qualitative factor analysis. The final output of this study is the 43-item learning climate measure for clinical phase (10 subscales). Finally, the psychometric properties of the instrument were discussed. The utility of the learning climate measure was recommended.
RESUMEN
The economic crisis in Thailand since 1997 has a major impact on all sections of the country including health care. There were several suggestions for reducing the drug expenditure budget including restriction of hospital formulary, generic prescribing and generic dispensing. At King Chulalongkorn Memorial hospital, the new hospital formulary was established and implemented in March 1998. The generic dispensing policy was also in place at the same time. This study aimed to evaluate the impact of the new implementation by comparing the prescription patterns in out patient departments (OPDs) of the hospital before and after the new hospital formulary implementation. The prescriptions from several OPDs were systematically stratified samplings 5 weeks before and 5 weeks after March 1st, 1998. The information from the prescriptions including drug category, drug name, amount of dispensed drug, drug cost, etc. was collected and analyzed. The total number of prescriptions and the average number of drug items/prescription before and after the implementation were similar (2,049 vs 2,052, and 2.52 +/- 0.048 vs 2.45 +/- 0.03 respectively). The total cost of the prescription, the cost/prescription and the cost/item seemed to be different (1,690,484 baht vs 1,282,343 baht, 844 +/- 54.04 vs 633 +/- 41.11 and 332.58 +/- 29.59 vs 255.29 +/- 19.98 respectively). After the implementation, physicians in the hospital increasingly prescribed drugs by generic name (37.1% vs 44.85%). Locally made drugs were also prescribed by physicians and received by patients more than before (9.56% vs 84.27% and 28.15% vs 60.72%, respectively). Anti-infective agents were studied in depth as they contribute to significant amount of drug expenditure. The total cost of prescribed anti-infective agents and the cost/prescription were increased after the implementation (223,529 vs 274,435 Baht and 585.38 +/- 102.84 vs 772.71 +/- 147.59). The increased cost mainly came from the cost of anti-HIV drugs. Our data indicate that the new hospital formulary may have played a part on the impact of drug expenditure reduction and may have changed the prescribing attitude of physicians in King Chulalongkorn Memorial Hospital.