Provider-initiated HIV counseling and testing of out patients at community hospitals in Thailand: an economic evaluation using the Markov model.

Background: Provider-initiated HIV counseling and testing (PIHIVCT) is an important intervention that improves the access to care to HIV-infected patients and subsequently contributes to the success of national HIV/AIDS control efforts. However, in Thailand, the cost-effectiveness of this program is unknown. Objective: Determine the incremental cost-effectiveness ratios (ICER) in terms of Thai Baht per Quality Adjusted Life Year (QALY) of PIHIVCT for outpatient department (OPD) patients in community hospitals of Thailand compared with the current practice. Methods: A model-based health economic evaluation study was conducted based on results from cluster randomized controlled trials in 16 community hospitals of Thailand. The Markov model and the probabilistic sensitivity analysis were used. One-thousand two-hundred seventy-seven HIV-infected patients completed questionnaires on their household expenditure and quality of life using the visual analog scale. Results: In social perspectives, the PIHIVCT program increased a patient’s life span by 5.18 days or 4.15 qualityadjusted days per OPD case and the ICER was 63,588 Baht per QALY gained. The subgroup analysis showed that the PIHIVCT program would be cost-effective for cases younger than 50 years if the ceiling threshold of willing to pay equaled the per capita Gross Domestic Product (GDP). However, this intervention would be cost-effective for all cases of 13-64 year old if the ceiling threshold equaled three times of GDP. Conclusion: The provider-initiated HIV counseling and testing program for OPD patients is more cost-effective than the current practice and should be implemented in health care setting in Thailand.

Shift work and type 2 diabetic patients' health.

OBJECTIVE: To compare the health between type 2 diabetic patients doing day work and shift work. MATERIAL AND METHOD: Two hundred and forty workers (120 day workers, 120 shift workers) aged 30-60 years were selected from the Social Security Clinic in five hospitals in Bangkok and its vicinity. All participants in the present study filled out the questionnaires that included questions for detecting hypoglycemic symptoms, Thai GHQ--12 questionnaires, and Suanprung Stress Test--20 questionnaires. Fasting blood glucose during the last six months, blood pressure during the last six months, and body mass index (BMI) were collected from the patient's medical records. All results were collected and compared between day workers and shift workers. RESULTS: Good glycemic control was significantly higher in day workers versus shift workers (28.3% vs. 15.8%). A higher proportion of shift workers had hypoglycemic symptoms and abnormal mental health compared to day workers. CONCLUSION: Shift work may have a negative effect on type 2 diabetic patients' health. Consequently, type 2 diabetic shift-worker needs more attention from physicians and employers at their work place.

Utilize the modified Delphi technique to develop trauma care indicators.

OBJECTIVE: Develop performance indicators reflecting the quality of trauma-patient-care in the emergency room and hospitalization within the first 48 hours. MATERIAL AND METHOD: A two-round Delphi technique was conducted. A panel of 11 expert surgeons experienced in the fields of trauma care was consulted. The panel was initially asked to rate performance indicators that reflected the quality of trauma care given in the emergency department setting and hospitalization in the first 48 hours using a 5-point on visual analogue scale. The statement of indicators that was collected from the first round was analyzed and necessary changes were before resending to the same experts. Each indicator statement was considered consensus if the expert's opinion rating was 4 or 5 for more than 70% (8 out of 11 experts). RESULTS: Fifty-three performance indicators were proposed in four domains of trauma care in emergency room and four domains of trauma care in hospitalization within 48 hours. Altogether 35 indicators reached consensus reflecting quality of trauma performance after two rounds. Twenty-one of these were trauma care indicators in emergency room and 14 were trauma care indicators in hospitalization within 48 hours. CONCLUSION: Twenty-one indicators of quality of trauma care in the emergency room and 14 in the hospitalization within 48 hours have been developed. They will be used as the tool by specialist for quality evaluation in the next phase.

Longevity of Thai physicians: phase 2 and policy implications.

This is Phase 2 of the authors study on long-lived Thai physicians. After obtaining quantitative data from Phase 1, the authors approached 11 male and 5 female physicians whose ages were older than general population's life expectancy. The authors conducted an in-depth interview using semi-structured questions asking about their life, work, lifestyle, and relevant factors. Then the authors synthesized the factors influencing longevity. The authors found that they are genetic, financial stability/security, trying to be disease-free by increasing positive lifestyle (such as exercise) and decrease negative lifestyle (such as drug addict, alcohol consumption), mind-set to be non-attachment (either doing nothing or busy doing everything), and being mentally ready to die. The authors also proposed policy implications for Thai physicians and people accordingly.

Healthy workplace indicators in Thailand: phase 2 (a pilot study).

This study was a result of the second phase of a two-phase research project. In the previous phase, the draft of healthy workplace indicators was developed by means of literature review and soliciting of expert opinion. There were 46 indicators divided into 6 different groups. This phase of the project was a quantitative cross-sectional descriptive study which aimed at exploring the opinion of employers and occupational health officers (OHOs) of the enterprises towards the pilot set of healthy workplace indicators. The field data collection was conducted by means of a postal survey. Questionnaires were sent to 180 workplaces in Samutprakarn province. The response rates of employers and OHOs were 66.7 per cent (n = 120) and 68.3 per cent (n = 123), respectively. It was found that the majority of the enterprises had a workplace health promotion policy (59.3%), had health promotion activities (60.2%), did not have designated personnel responsible for health promotion (69.1%), had a health promotion budget (53.7%), were large scale enterprises (61.0%), and did not have a mother enterprise in foreign country (81.3%). In general, the mean scores of the opinions of employers and OHOs toward indicators in the appropriateness aspect were high. For the achievability aspect, there were 9 indicators which less than half of the employers thought they could achieve, and 10 indicators that less than half of the OHOs thought they could achieve. The opinion of employers and OHOs differed significantly in 4 indicators in the appropriateness aspect and 1 indicator in the achievability aspect. In conclusion, both the employers and OHOs considered most of these indicators appropriate for the enterprises and most indicators were achievable and useful as a guideline and evaluation tool for workplace health promotion.

Situation analysis of occupational and environmental health laboratory accreditation in Thailand.

The objective of this study was to analyze the current situation of laboratory accreditation (LA) in Thailand, especially on occupational and environmental health. The study integrated both quantitative and qualitative approaches. The response rate of the quantitative questionnaires was 54.5% (226/415). The majority of the responders was environmental laboratories located outside hospital and did not have proficiency testing. The majority used ISO 9000, ISO/IEC 17025 or ISO/ EEC Guide 25, and hospital accreditation (HA) as their quality system. However, only 30 laboratories were currently accredited by one of these systems. Qualitative research revealed that international standard for laboratory accreditation for both testing laboratory and calibration laboratory was ISO/IEC Guide 25, which has been currently revised to be ISO/IEC 17025. The National Accreditation Council (NAC) has authorized 2 organizations as Accreditation Bodies (ABs) for LA: Thai Industrial Standards Institute, Ministry of Industry, and Bureau of Laboratory Quality Standards, Department of Medical Sciences, Ministry of Public Health. Regarding LA in HA, HA considered clinical laboratory as only 1 of 31 items for accreditation. Obtaining HA might satisfy the hospital director and his management team, and hence might actually be one of the obstacles for the hospital to further improve their laboratory quality system and apply for ISO/IEC 17025 which was more technically oriented. On the other hand, HA may be viewed as a good start or even a pre-requisite for laboratories in the hospitals to further improve their quality towards ISO/IEC 17025. Interviewing the director of NAC and some key men in some large laboratories revealed several major problems of Thailand's LA. Both Thai Industrial Standards Institute and Bureau of Laboratory Quality Standards did not yet obtain Mutual Recognition Agreement (MRA) with other international ABs. Several governmental bodies had their own standards and accreditation systems, and did not accept other bodies' standards and systems. This put a burden to private laboratories because they had to apply and get accredited from several governmental bodies, but still had to apply and get accredited from international ABs especially for those dealing with exports. There were only few calibration laboratories, not enough for supporting the calibration required for the equipment in testing laboratories' LA. Purchasing proficiency testing specimens from abroad was very expensive, and often got into troubles with the customs duty procedures. The authors recommend some strategies and activities to improve laboratory accreditation in Thailand. Improvement in occupational and environmental health laboratories would essentially be beneficial to laboratory accreditation of other areas such as clinical laboratory.