Evaluation of drug-abuse treatment based on the continuous quality improvement concept.

At least 1.2 million Thai people are now addicted to drugs and more varied dangerous substances are entering Thailand. The objective of this study was to evaluate drug-abuse treatment based on the continuous quality improvement concept. A cross-sectional survey was conducted by using a questionnaire developed with the reliability of 0.8842. Respondents included 188 hospital directors from drug-abuse clinics situated all over the country, 33 service-providers and 305 clients, attending 3 governmental drug-abuse clinics and 1 private clinic in Bangkok. The results showed a high response rate, 77.1-100.0 per cent. The clients' satisfaction level was high and significantly associated with clinic visits, the expected outcome of stopping alcohol-drinking and completion of six-week detoxification treatment without significant association with stopping drug-use. The significant variables associated with clients' satisfaction were: clean and pleasant environment of the clinics, warm welcome to everybody, listening to clients without signs of being bored, difficult problems that occurring should be solved immediately and properly, clients' parents and relatives should receive appropriate counseling, and clients' co-illnesses should be also treated. Hospital directors and service providers' opinions on CQI-based drug-abuse treatment were not significantly different. The study raised quality awareness and further action on CQI was recommended for effective and efficient drug-abuse treatment.

Weight-control training-models for obese pupils in Bangkok.

The increased prevalence of obese children in schools in Bangkok from 12.7 to 14.3 per cent between 1986-1987, and the health risk of obesity of cardiovascular diseases, requires effective training models for behavior modification. The effects of 4 training models: problem-solving, lecturing, lecturing + reward and self-learning developed by the researchers, on the changes of knowledge and weight/height of 90 obese pupils, were compared with those of other 20 obese pupils in the control group. The comparison of height, weight and weight/height, including knowledge of the obese pupils, before training, between training and control groups, showed no significant difference. At the end of the 3-month training period, pupils' knowledge of obesity had increased significantly by all training models, without any difference among groups. The change of weight during the training period showed no significant difference, both within and among groups, except within the lecturing + reward group which had decreased significantly. At the end of 6 months' follow-up, the increase of weight/height (after-before), differed significantly, both within and among groups, with the highest increase in the control group, followed by self-learning, lecturing, problem-solving, and lecturing + reward. The weight-increase that had not differed significantly, was found in the problem-solving group only. If the percentages of the obese pupils whose weight/height were reduced, were considered, the highest reduction was in the problem-solving (31.8%), lecturing (28.6%), lecturing + reward (22.7%), and self-learning (20%). There was no obese pupil in the control group whose weight/height was reduced, throughout the study.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluative instrument based on patient's perception of health for the monitoring of primary medical care in rural areas in Thailand.

The evaluative instrument for the monitoring of primary medical care services in rural areas in Thailand, consisting of health risk, sickness-related dysfunction, health-specific coping index and health care of the patient's family, was developed and tested by 2,394 patients in the 4 regions. The patients had high health risk (70.8 +/- 14.0), high health-specific coping index (71.3 +/- 16.4), high health care of patient's family (76.1 +/- 10.0), and very low sickness-related dysfunction (13.4 +/- 15.6). The average time used for assessing the patients' perception of health was 37.9 minutes by sanitarians, 32.9 midwives, 29.9 by nurses and 24.8 by medical doctors. The reliability of the instrument was tested by paired interviewers; sanitarians and midwives, medical doctors and nurses, and was highly reliable for health risk and health-specific coping index. Language was the major obstacle in interviewing in the South.

PIP: An evaluative instrument designed to monitor primary health care services in rural Thailand was pretested on 2394 patients from district hospitals, health centers, and midwifery centers in all 4 regions of the country. The respondents, half of whom were agricultural workers, were most likely to suffer from perinatal disorders (25%), respiratory diseases (16%), and digestive disorders (15%). The evaluative instrument included items on health risk, sickness-related dysfunction in the preceding 6 months, health-specific coping strategies, and health care of the respondent's family. Factor analysis revealed that health risk and health-specific coping had eigenvalues exceeding 1. The Pearson correlation coefficients showed that health risk was positively associated with sickness-related dysfunction and health-specific coping styles, but negatively associated with health care of the family. In addition, there was an inverse association between health risk and both monthly family income and educational level. The mean health risk score was 64.1 in the South, 73.6 in the North, 70.9 in Central Thailand, and 73.1 in the Northeast. Health-related dysfunction was low in all regions and averaged 13.4 + or - 15.6. The average time required to complete the interview was 37.9 minutes for sanitarians, 32.9 minutes for midwives, 29.9 minutes for nurses, and 24.8 minutes for physicians. In the South, language was a major obstacle and the use of self- administered questionnaires should be considered. T-test findings indicated that the health risk and health-specific coping indices are highly reliable. The findings suggest that this instrument can be used effectively to monitor primary health care services from the district level down to the village level in rural Thailand.