Perspectives of pain specialists, patients, and family members on long-term opioid use for chronic non-cancer pain: a qualitative study.

BACKGROUND: Opioids are currently prescribed for chronic non-cancer pain (CNCP), and some patients use opioids continuously for long-term treatment. Stakeholders' awareness about long-term opioid therapy is essential for improving the safety and effectiveness of pain treatment. The purpose of this study is to explore the perspectives of pain specialists, patients, and family caregivers about long-term opioid use in CNCP management. METHODS: This study was a qualitative study and adhered to the COREQ guidelines. Pain specialists (n = 12), patients (n = 14), and family members (n = 9) were recruited to the study by purposive sampling at the Pain Clinic of Ramathibodi Hospital. Semi-structured interviews were recorded, verbatim transcribed, conceptually coded, and analyzed using Atlas.ti 8.0. RESULTS: All groups of participants described opioids as non-first-line drugs for pain management. Opioids should be prescribed only for severe pain, when non-opioid pharmacotherapy and non-pharmacological therapies are not effective. Patients reported that the benefits of opioids were for pain relief, while physicians and most family members highlighted that opioid use should improve functional outcomes. Physicians and family members expressed concerns about opioid-related side effects, harm, and adverse events, while patients did not. Patients confirmed that they would continue using opioids for pain management under supervision. However, physicians stated that they would taper off or discontinue opioid therapy if patients' pain relief or functional improvement was not achieved. Both patients and family members were willing to consider non-pharmacological therapies if potential benefits existed. Patient education, doctor-patient/family relationships, and opioid prescription policies were proposed to enhance CNCP management. CONCLUSION: Long-term opioid therapy for CNCP may be beneficial in patients who have established realistic treatment goals (for both pain relief and functional improvement) with their physicians. Regular monitoring and evaluation of the risks and benefits, adverse events, and drug-related aberrant behaviors are necessary. Integrated multimodal multidisciplinary therapies and family member collaborations are also important for improving CNCP management.

Health and long-term care of the elderly with dementia in rural Thailand: a cross-sectional survey through their caregivers.

OBJECTIVE: To describe the circumstances of the elderly with dementia and their caregivers' characteristics in order to examine factors related to activities of daily living (ADL) and household income to propose a long-term care policy for rural areas of Thailand. SETTING: A cross-sectional study at the household level in three rural regions of Thailand where there were initiatives relating to community care for people with dementia. PARTICIPANTS: Caregivers of 140 people with dementia were recruited for the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Socioeconomic characteristics including data from assessment of ADL and instrumental ADL and the Thai version of Resource Utilisation in Dementia were collected. Descriptive statistics were used to explain the characteristics of the elderly with dementia and the caregivers while inferential statistics were used to examine the associations between different factors of elderly patients with dementia with their dependency level and household socioeconomic status. RESULTS: Eighty-six per cent of the dementia caregivers were household informal caregivers as half of them also had to work outside the home. Half of the primary caregivers had no support and no minor caregivers. The elderly with dementia with high dependency levels were found to have a significant association with age, dementia severity, chance of hospitalisation and number of hospitalisations. Though most of these rural samples had low household incomes, the patients in the lower-income households had significantly lower dementia severity, but, with the health benefit coverage had significantly higher chances of hospitalisation. CONCLUSION: As the informal caregivers are the principal human resources for dementia care and services in rural area, policymakers should consider informal care for the Thai elderly with dementia and promote it as the dominant pattern of dementia care in Thailand.

Unique health identifiers for universal health coverage.

Identifying everyone residing in a country, especially the poor, is an indispensable part of pursuing universal health coverage (UHC). Having information on an individuals' financial protection is also imperative for measuring the progress of UHC. This paper examines different ways of instituting a system of unique health identifiers that can lead toward achieving UHC, particularly in relation to utilizing universal civil registration and national unique identification number systems. Civil registration is a fundamental function of the government that establishes a legal identity for individuals and enables them to access essential public services. National unique identification numbers assigned at birth registration can further link their vital event information with data collected in different sectors, including in finance and health. Some countries use the national unique identification number as the unique health identifier, such as is done in South Korea and Thailand. In other countries, a unique health identifier is created in addition to the national unique identification number, but the two numbers are linked; Slovenia offers an example of this arrangement. The advantages and disadvantages of the system types are discussed in the paper. In either approach, linking the health system with the civil registration and national identity management systems contributed to advancing effective and efficient UHC programs in those countries.

Need for Internal Medicine Subspecialists in Thailand.

Background: Matching supply side of the Internal Medicine (IM) subspecialists to the demand for complex medical care at referral medical centers would lead to more efficient health system management and ultimately optimal clinical outcome. The second decade of the universal health coverage policy in Thailand has raised the awareness on how to reach equitable utilization goals of good quality medical services, while barriers of accession have been removed. More accurate evidence-based human resource planning is timely needed. Objective: To estimate the number of the ten subspecialists in internal medicine (neurologist, cardiologist, endocrinologist, gastroenterologist and hepatologist, nephrologist, hematologist, oncologist, rheumatologist, pulmonologist, and infectious disease specialist) needed for complex medical care based on the workload in the year 2013. Material and Method: The present study applied a needs assessment model with evidence-based approach. Claimed data of inpatients in the year 2013 from the three government insurance schemes (the Civil Servant Medical Benefit, the Social Security and the Universal Health Coverage schemes), and out-patient data from Universal Coverage System were used to estimate demand for subspecialists. The Human Resource Working Group of the Royal College of Physicians of Thailand agreed on the conceptual framework to estimate the need for ten subspecialists based on clinical activities of outpatient consultations, inpatient ward rounds and non-operating room procedures on medical cases of respective diagnosis related group with severe and catastrophic comorbidities and complications by the Thai-DRG version 5. Representatives from the Associations of IM subspecialties approved the lists of ICD-10 diagnosis and ICD-9-CM procedure codes specific to each subspecialist care and proposed assumptions on rates of consultations from other specialists. Surveys were done to subspecialists in 6 major provincial clusters and representatives from IM subspecialty Associations asking time spent on main activities of patient care. The number of full-time-equivalent (FTE) subspecialists needed was calculated by multiplying the clinical workloads measured in minutes spent for each activity (ward round, ward work, inpatient and outpatient consultations) to get the total time needed, then divided by the available time for clinical activity of one subspecialist. Results: From 5.9 million inpatient discharges in the year 2013, primary responsibility of patients in respective severe and catastrophic DRGs related to specific subspecialist workloads were summed up for teaching hospitals and regional hospitals ranging from as lowest the 2,849 cases for rheumatology to the highest 24,610 cases for gastroenterology and hepatology. The number of inpatient non-operating room procedures by ICD-9-CM as listed by IM subspecialty Associations ranged from 8 times for endocrinologists to 22,927 times for cardiologists for the whole year. Of ten subspecialists, the estimated numbers of cardiologist, nephrologist, neurologist, gastroenterologist and hepatologist, endocrinologist, oncologist, rheumatologist, hematologist, pulmonologist and infectious disease subspecialist needed at teaching and regional hospitals were 516, 241; 345, 144; 312, 143; 195, 124; 189, 45; 137, 170; 90, 47; 96, 111; 203, 87 and; 129, 44 respectively according to the workload recorded in the year 2013. The forecast FTE found the overall gap of discrepancy at 7 percent. If the distributions of these subspecialists in public and private hospitals were taken into account, the gap of discrepancy in public hospitals increased to 47 percent. Conclusion: The demand-based forecast for the number of subspecialist needed was made possible with assumptions on conceptual framework for case selection, the rates of consultation and time-spent related to activities of patient care. The estimated numbers of subspecialists were anticipated far from optimum since the workload in the year 2013 was derived as a consequence of pre-existing suboptimal infrastructure of healthcare system. In addition, the deficit of subspecialists may increase in the near future when highly efficient, non- or mildly invasive, time-consuming procedures of acute illness increase. Sustainable matching demand and supply of human resource for health needed further validations of these assumptions.

Health financing lessons from Thailand for South Africa on the path towards universal health coverage.

Five years after the release of its Green Paper on National Health Insurance (NHI),years after the institution of NHI pilot sites and following the recent release of the White Pa 4 per on NHI, South Africa (SA) needs to move beyond the phase 1 plans of policy making and healthening activities to phase 2 - putting into place the legal and institutional frameth system strengworks and systems for implementation of its universal health coverage (UHC) system. In doing so, SA can draw on considerable practical lessons from other countries' reforms in managing UHC with favourable equity outcomes over the past decade. We outline some potentially significant lessons from the Thai health financing system for SA.

Hospitalizations of Diabetes Ambulatory Care Sensitive Condition - Universal Coverage Scheme at a Referral Hospital in Bangkok, Thailand: Five-Year Cross-Sectional Study.

Background: Universal coverage (UC) scheme covers most of the population in Thailand (76.3%) and diabetes (DM) was the most prevalent ambulatory disease in most health care centers. Rajavithi Hospital is designated as one of the top referral hospital in Bangkok. Objective: To examine the trend of avoidable hospitalization related to diabetes in the UC patients who registered at Rajavithi Hospital. Results: This cross-sectional study collected data from electronic medical record from Rajavithi Hospital and the National Health Security Office (NHSO). DM and related diseases based on a list of diagnosis codes (ICD-10) were selected as an ambulatory care sensitive condition (ACSC) to reflect the avoidable hospitalization. Outpatient and inpatient data between 2007 and 2011 were studied. The ACSC rate was calculated by number of hospitalizations on DM and related conditions divided by number of the DM patients visited as ambulatory care. Conclusion: The avoidable hospitalization for DM patients registered at Rajavithi Hospital was stable during the five years of the study. Future study on avoidable hospitalization should cover admissions to other hospitals and DM related conditions. Further studies should investigate the reasons of avoidable hospitalization.

Epidemiology of Age-Related Macular Degeneration among the Elderly Population in Thailand.

OBJECTIVE: To estimate the prevalence and associated factors of age-related macular degeneration (AMD) in Thailand. MATERIAL AND METHOD: This cross-sectional survey was undertaken in 2010. Five provinces were selected and people aged 50 years and over were invited for eye examination. Demographic and health behaviors and data from eye examination equipment were registered. Ophthalmologists graded AMD as early or late based on fundus color photograph and image from optical coherence tomography. Logistic regressions were analyzed to establish associationfactorsfor AMD. RESULTS: Of the 7,043 participants, AMD wasfound in 862 people (12.2%), with more than half (53.1%) found in both eyes. Most cases (94.3%) were early dry, 1.8% early wet, 3.4% late dry, and 0.7% late wet AMD. Factors positively associated with AMD were age (OR 1.03, 95% CI 1.02-1.04), diabetes mellitus (OR 1.20, 95% CI 1.03-1.39), and consumption of yellow vegetable (OR 2.32, 95% CI 1.23-4.39). Factors that conversely associated with AMD were consumption of green vegetable (OR 0.51, 95% CI 0.33-0.79), physical exercise (OR 0.67, 95% CI 0.51-0.87), high bloodpressure (OR 0.75,95% CI 0.63-0.89), and heavy drinking habit (OR 0.45, 95% CI 0.26-0.75). CONCLUSION: The prevalence of AMD in Thai population age 50 and over was 12.2%. More than half (53.1%) of the cases were found in both eyes, but few at severe stages. The present study confirmed age and DM as positive associated factors, and green vegetable, exercise as negative associated factors. Further research should investigate the effects of hypertension, yellow vegetable, and alcohol drinking on AMD.

Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand.

This article presents a comparative analysis of socio-economic disparities in relation to treatment-seeking strategies and healthcare expenditures in poor neighbourhoods within larger health systems in four cities in India, Indonesia and Thailand. About 200 households in New Delhi, Bhubaneswar, Jogjakarta and Phitsanulok were repeatedly interviewed over 12 months to relate health problems with health seeking and health financing at household level. Quantitative data were complemented with ethnographic studies involving the same neighbourhoods and a number of private practitioners at each site. Within each site, the higher and lower income groups among the poor were compared. The lower income group was more likely than the higher income group to seek care from less qualified health providers and incur catastrophic health spending. The study recommends linking quality control mechanisms with universal health coverage (UHC) policies; to monitor the impact of UHC among the poorest; intervention research to reach the poorest with UHC; and inclusion of private providers without formal medical qualification in basic healthcare.

Catastrophic health expenditure in an urban city: seven years after universal coverage policy in Thailand.

Abstract. This study explored the burden of household out-of-pocket health expenditure on urban inhabitants with different socio-economic status and health insurance schemes in Nakhon Sawan Municipality. This study employed a cross sectional survey by using a structured questionnaire. Health personnel from six primary care units interviewed a representative of the sampled households. Sampled households were selected by a two-stage random sampling technique. Descriptive statistics were used to describe general household characteristics, and Mantel-Haenszel odds ratio was used to explain the relationships between factors and catastrophic health expenditure. From 406 sampled households, there were 1,421 household members and 340 individuals who reported illness within the last month. The poor and non-poor groups reported hypertension, diabetes, and the common cold as the most common ailments. Most patients sought care at a regional hospital and then primary care units, drug stores, and private hospitals, respectively. Household out-of-pocket medical costs were most frequently paid to drug stores and to private clinics. The direct non-medical costs were mostly paid for transportation and food. Factors related to catastrohpic health expenditure were the Civil Servant Medical Benefit Scheme (CSMBS) cardholder, use of public hospital, private hospital, and clinic. Furthermore, catastrophic expenditures were related to non-medical costs and time loss for indirect cost. Catastrophic rates of the poor were 12.5 and 30.4% from direct and non-medical cost, respectively. The rates for the non-poor were lower.

Cost of acute and sub-acute care for stroke patients.

BACKGROUND: Stroke is an important health problem that imposes socioeconomic burdens. OBJECTIVE: To explore provider costs and to examine predictive factors for cost of acute and sub-acute inpatient services for stroke patients. MATERIAL AND METHOD: The present study design was prevalence-based cost-of-illness with micro-costing approach. Subjects were 407 first episode stroke patients. Patient costs were prospectively recorded from July 2008 to March 2009. RESULTS: The average cost per admission was 32,372 Baht. The cost of acute phase was higher than that of sub-acute phase. Moreover; costs were significantly different among disability levels. Predictors of cost in acute phase included surgery, hemorrhagic pathology, and length of stay (adjusted R2 = 0.755; p < 0.001). Additional predictors of costs in sub-acute phase included initial Barthel index, gender, rehabilitation treatment, and the hospital (adjusted R = 0.748; p < 0.001). CONCLUSION: Cost of stroke was influenced by patient characteristics, pathology, treatments, and phases of care that should be considered in reimbursement system policy.

Using utilisation data to estimate future demand for medical internists: the impact of demographic demand driver in Thailand.

The demand for medical doctors can be estimated in many ways. The most challenging approach is the model based on population demand and anticipated contextual factors. The eighth national medical education meeting of Thailand in 2009 called for the need to estimate future demand for medical specialists in Thailand to proper plan for postgraduate trainings of royal colleges of medical specialists. This research was to estimate future demand for medical internists in 2021 in Thailand using utilisation data as the proxy of population demand for medical care. Inpatient data of 2009 from the universal coverage and the civil servant medical benefit schemes were grouped into the Thai diagnosis related group version 5. Age-sex specific utilisation rates by DRG or Major Diagnostic Category (the first two digits of DRG) were matched to the workloads of the specialists in internal medicine. Assumptions were made for comprehensively predicting the demand. Different proportions of time were allocated to fulfill inpatient care, outpatient consultations, academic meetings and administrative function for doctors at community hospitals, general hospitals and regional hospitals including teaching activities for doctors at teaching hospitals. The population pyramid of 2021 was used to forecast future demand taking account of casemix utilisation by each age-sex stratum in 2009. The results show the effects of demographic changes on the number of internists needed. Female reproductive age adults in 2021 need fewer internists than female reproductive age adults in 2009. The elderly in 2021 need an additional of 60 to 70 percent more internists than the elderly of 2009. Overall demands for the internists increase 34 percent over 12 years, while the growths of the population over 14 years and of the elderly populations are 11 and 64 percent respectively. Further fine-tuning of the model for forecasting demand for subspecialty especially the gerontologist is warranted to check for consistency of distribution of subspecialties within the internal medicine. Future policy research is needed for managing production and distribution of the required medical specialists according to needs in different geographical areas.

Coordinating care and treatment for cancer patients.

Survival following a diagnosis of cancer is contingent upon an interplay of factors, some non-modifiable (e.g., age, sex, genetics) and some modifiable (e.g., volitional choices) but the majority determined by circumstance (personal, social, health system context and capacity, and health policy). Accordingly, mortality and survival rates vary considerably as a function of geography, opportunity, wealth and development. Quality of life is impacted similarly, such that aspects of care related to coordination and integration of care across primary, community and specialist environments; symptom control, palliative and end-of-life care for those who will die of cancer; and survivorship challenges for those who will survive cancer, differs greatly across low, middle and high-income resource settings. Session 3 of the 4th International Cancer Control Congress (ICCC-4) focused on cancer care and treatment through three plenary presentations and five interactive workshop discussions: 1) establishing, implementing, operating and sustaining the capacity for quality cancer care; 2) the role of primary, community, and specialist care in cancer care and treatment; 3) the economics of affordable and sustainable cancer care; 4) issues around symptom control, support, and palliative/end-of-life care; and 5) issues around survivorship. A number of recommendations were proposed relating to capacity-building (standards and guidelines, protocols, new technologies and training and deployment) for safe, appropriate evidence-informed care; mapping and analysis of variations in primary, community and specialist care across countries with identification of models for effective, integrated clinical practice; the importance of considering the introduction, or expansion, of evidence-supported clinical practices from the perspectives of health economic impact, the value for health resources expended, and sustainability; capacity-building for palliative, end-of-life care and symptom control and integration of these services into national cancer control plans; the need for public education to reduce the fear and stigma associated with cancer so that patients are better able to make informed decisions regarding follow-up care and treatment; and the need to recognize the challenges and needs of survivors, their increasing number, the necessity to integrate survivorship into cancer control plans and the economic and societal value of functional survival after cancer. Discussions highlighted that coordinated care and treatment for cancer patients is both a ' systems'challenge and solution, requiring the consideration of patient and family circumstances, societal values and priorities, the functioning of the health system (access, capacity, resources, etc.) and the importance assigned to health and illness management within public policy.

Economic Evaluation of Rehabilitation Services for Inpatients with Stroke in Thailand: A Prospective Cohort Study.

OBJECTIVE: Rehabilitation can restore function and prevent permanent disability in patients with stroke. There is, however, only one study on cost-effectiveness of rehabilitation in Thailand. Our objective was to evaluate the cost-utility of rehabilitation for inpatients with stroke under Thai settings. METHODS: This was a prospective observational cohort study with a 4-month follow-up in two regional hospitals. The sample consisted of 207 first-episode stroke inpatients divided into rehabilitation and unexposed groups. Rehabilitation services during the subacute and nonacute phase were the intervention of concern. Main outcomes were patient's Barthel index for functional status and the EuroQol five-dimensional questionnaire as utility scores. A microcosting approach was employed considering a societal perspective. Effectiveness was defined as the improvement in functional status and quality-adjusted life-year (QALY). We used a longitudinal logistic model and multiple regressions. Cost-effectiveness ratios per QALY gained were presented. A probabilistic sensitivity analysis was conducted to estimate the uncertainty range. RESULTS: Compared with the unexposed group, the Barthel index and QALY of patients with rehabilitation were significantly improved (P < 0.010). The incremental cost-effectiveness ratio of rehabilitation services for patients with stroke was 24,571 baht per QALY. Cost-effectiveness acceptability curves suggested that the rehabilitation services were likely to represent good value for money at the ceiling ratio of 70,000 baht per QALY (compared with the threshold of 1 time per-capita gross domestic product per QALY gain or 100,000 baht per QALY). CONCLUSION: The rehabilitation services for stroke survivors were cost-effective under the Thai health care setting.

Prevalence of low back pain among rice farmers in a rural community in Thailand.

OBJECTIVE: To determine the prevalence of low back pain (LBP) among rice farmers in a rural community in Phitsanulok, Thailand. MATERIAL AND METHOD: A cross-sectional survey was conducted among 283 rice farmers in Wangnamkhu subdistrict, Muang district, Phitsanulok province, a rural community in Lower Northern Thailand. Face-to-face interviews with a structured closed-end questionnaire were performed to collect information on the presence of LBP in lifetime, within the last 12 months prior to and at the time of the present study. RESULTS: The lifetime, 1-year (12-month) and point prevalence rates of LBP were 77%, 56% and 49%, respectively. No relationship between age and LBP was found. However women (61%) had significantly greater 1-year prevalence than men (51%). Ninety-five percent of LBP rice farmers were chronic (experiencing pain longer than 12 weeks) with a mean duration of 292 weeks (5.6 years). CONCLUSION: The prevalence of LBP among Thai rice farmers is high. Further research should investigate risk factors among this group of the population to design appropriate preventive measures.

HIV prevention with positives and disclosure of HIV status: practice and views of Thai healthcare providers.

OBJECTIVE: The present study provides information from health care providers about sexual practices of and preventive and disclosure counseling for People Living with HIVand AIDS (PLWHA). MATERIAL AND METHOD: A survey of health care providers attending HIV prevention workshops was undertaken using self-administered and anonymous questionnaires. RESULTS: Of 678 respondents, 72% were nurses. Ninety-six percent agreed that they had duty to provide prevention services and measures. However, less than half (46%) had enough time for counseling. Asking health providers to estimate different aspects of sexual practice in their patients, the highest chosen band estimation was 'unsafe sex' (21-40%), 'partner disclosure' (41-60%) and 'abstinence' (0-10%). When patients did not disclose their HIV status to partner most health care providers kept HIV serostatus of patient confidential from their sexual partners. The main reasons for not notifying were patients 'rights and fear of adverse effects on patients. Some (9%) did notify the patient's partner directly or indirectly. The main notification reasons were for preventing HIV transmission and recognizing the partner's right to be informed. Seventy percent agreed that a law should require disclosure of HIV status to husband, wife, or intimate partner. CONCLUSION: Health care providers supported the 'Prevention with Positives' strategy. HIVstatus disclosure is a continuing ethical dilemma since there are conflicts of principle between confidentiality of patients and right to healthy life of their partner Improved or new interventions are needed to prevent HIV transmission with consideration of both rights of PLWHA and of HIV risk reduction for sexual partner.

New casemix classification as an alternative method for budget allocation in thai oral healthcare service: a pilot study.

This study aimed to develop a new casemix classification system as an alternative method for the budget allocation of oral healthcare service (OHCS). Initially, the International Statistical of Diseases and Related Health Problem, 10th revision, Thai Modification (ICD-10-TM) related to OHCS was used for developing the software "Grouper". This model was designed to allow the translation of dental procedures into eight-digit codes. Multiple regression analysis was used to analyze the relationship between the factors used for developing the model and the resource consumption. Furthermore, the coefficient of variance, reduction in variance, and relative weight (RW) were applied to test the validity. The results demonstrated that 1,624 OHCS classifications, according to the diagnoses and the procedures performed, showed high homogeneity within groups and heterogeneity between groups. Moreover, the RW of the OHCS could be used to predict and control the production costs. In conclusion, this new OHCS casemix classification has a potential use in a global decision making.

eHealth in Thailand: the current status.

The World Health Organization (WHO) defines eHealth as the use of information and communication technologies (ICT) for health. Thailand is one of the leading countries in emerging and developing economy that the use of ICT applications is pervasive including eHealth. However, the status of eHealth in Thailand hasn't been assessed. Employing the WHO global Observatory for eHealth development model and its instrument, this study describes the uptake of eHealth foundations and the extent of eHealth applications and services implemented in the country. A group of the nation 18 eHealth experts met and evaluated country eHealth status and provided recommendations. The results show that the development of the country's eHealth foundations is inadequate and need to be the priority for national eHealth development.

Sexual practice among Thai HIV-infected patients: prevalence and risk factors for unprotected sex.

Positive prevention which focuses on prevention of HIV transmission from those already infected to those uninfected is an important issue for HIV prevention. A self-administered questionnaire on sexual practice survey of HIV-infected patients attending HIV clinics was undertaken. Of the 1160 patients, 53% knew their HIV status after being ill and 59% believed that they got infection from their regular sexual partner. In 3 months prior to the survey, 18% reported unprotected sex. Unprotected sex significantly decreased in people having adequate condoms but increased in those who believed that their sexual partners were already infected. Effect of disclosure of HIV status on unprotected sex depended on whether patients were men or women. Non-disclosure HIV-positive men claimed to have less unprotected sex than their counterpart, HIV-positive women. Factors related to unprotected sex should be addressed and sexual health must be integrated and promoted in HIV health care.

Casemix classification payment for sub-acute and non-acute inpatient care, Thailand.

BACKGROUND: There is a need to develop other casemix classifications, apart from DRG for sub-acute and non-acute inpatient care payment mechanism in Thailand. OBJECTIVE: To develop a casemix classification for sub-acute and non-acute inpatient service. MATERIAL AND METHOD: The study began with developing a classification system, analyzing cost, assigning payment weights, and ended with testing the validity of this new casemix system. Coefficient of variation, reduction in variance, linear regression, and split-half cross-validation were employed. RESULTS: The casemix for sub-acute and non-acute inpatient services contained 98 groups. Two percent of them had a coefficient of variation of the cost of higher than 1.5. The reduction in variance of cost after the classification was 32%. Two classification variables (physical function and the rehabilitation impairment categories) were key determinants of the cost (adjusted R2 = 0.749, p = .001). Validity results of split-half cross-validation of sub-acute and non-acute inpatient service were high. CONCLUSION: The present study indicated that the casemix for sub-acute and non-acute inpatient services closely predicted the hospital resource use and should be further developed for payment of the inpatients sub-acute and non-acute phase.

Comparison of physical fitness between rice farmers with and without chronic low back pain: a cross-sectional study.

OBJECTIVE: To compare physical fitness between rice farmers with chronic low back pain (CLBP) and a healthy control group. MATERIAL AND METHOD: Sixty-eight rice farmers with CLBP were matched according to age and sex with healthy farmers. All subjects underwent nine physical fitness tests for body composition, lifting capacity, static back extensor endurance, leg strength, static abdominal endurance, handgrip strength, hamstring flexibility, posterior leg and back muscles flexibility and abdominal flexibility. RESULTS: There was no significant difference between CLBP and healthy groups for all tests, except the static back extensor endurance. The back extensor endurance times of the CLBP group was significantly lower than that of the control group (p = 0.002). CONCLUSION: Static back extensor endurance is the deficient physical fitness in CLBP rice farmers. Back extensor endurance training should be emphasized in both prevention and rehabilitation programs.