Health Belief Model and parents' acceptance of the Pfizer-BioNTech and Sinopharm COVID-19 vaccine for children aged 5-18 years Old: A national survey.

BACKGROUND: During the COVID-19 pandemic, several vaccines received approval for children aged 18 or younger. Parents' decisions to accept vaccines play an important role in the success of vaccination campaigns. The Health Belief Model (HBM) may explain its association with vaccine acceptance. This study examined parents' Pfizer-BioNTech and Sinopharm vaccine acceptance for their children and its association with HBM. METHODS: A cross-sectional study was conducted in March 2022 using an online survey. Respondents were parents of children aged 5-18 in public and private schools. The multistage random sampling technique was used to choose schools and respondents. Multivariable analysis was conducted to examine the association between vaccine acceptance and HBM. RESULTS: The response rate was 55 %. Of 1,056 respondents, 80.1 % were female, with a mean age of 41, and 95.8 % were not health professionals. Pfizer-BioNTech had a greater acceptance rate than Sinopharm (90 % v.s. 36 %). The Multivariable analysis shows that perceived benefits (aOR = 25.30, 95 %CI = 10.02-63.89 and aOR = 17.94, 95 %CI = 9.56-33.66 for Pfizer-BioNTech and Sinopharm, respectively) and perceived barriers (aOR = 0.06, 95 %CI = 0.01-0.50 and aOR = 0.20, 95 %CI = 0.11-0.40 for Pfizer-BioNTech and Sinopharm, respectively) were associated with vaccine acceptance for both vaccines. Education was associated with Pfizer-BioNTech vaccine acceptance (aOR = 0.96, 95 %CI 0.71-1.29). CONCLUSIONS: The respondents were more confident in Pfizer-BioNTech than Sinopharm. Perceived barriers and perceived benefits were strongly associated with the respondents' vaccine acceptance for both vaccines. During epidemics and pandemics, the government needs vaccines with high efficacy and safety for a higher chance of parents' vaccine acceptance. Future research should examine vaccine costs as perceived barriers for a newly out-of-pocket developed vaccine.

Acceptance and willingness to pay under the different COVID-19 vaccines: A contingent valuation method.

BACKGROUND: The COVID-19 vaccine is recognized as a novel tool in the battle against COVID-19. Recently, there were several types of vaccines that have a different effectiveness and safety profile. Understanding the vaccine acceptance and willingness to pay (WTP) are essential to develop a strategic plan to increase the rate of COVID-19 vaccination uptake. OBJECTIVES: To assess the acceptance and WTP for a COVID-19 Vaccine in Thailand using the contingent valuation method (CVM). Additionally, to identify the factors that affect the acceptance and the amount of WTP for a COVID-19 Vaccine. METHODS: We conducted a cross-sectional survey using a payment card approach with open-ended questions during September 2021. Three hypothetical COVID-19 vaccines (Vaccines A, B, and C) in two scenarios were employed. Data were collected from 752 people. Multivariate logistic regression was performed to assess the predictors of vaccine acceptance. Multiple linear regression was used to analyze factors associated with the maximum amount WTP for a vaccine. RESULTS: Of 742 respondents, the highest acceptance was vaccine C (70.71%), followed by B (17.72%) and A (11.57%). Similarly, 53.87%, 41.44%, and 36.21% of the respondents expressed WTP for vaccine C, B and A, respectively. The maximum amount WTP for vaccine C was US$46, followed by B (US$35) and A (US$32). Factors affecting acceptance included monthly salary, region of residence, education, perceived risk of COVID-19 infection, knowledge and attitude about the COVID-19 vaccine. In addition, monthly salary, region of residence, education and knowledge on COVID-19 vaccine were related to maximum amount WTP. CONCLUSION: Acceptance and WTP depends on vaccine characteristics. Educational campaigns should be implemented to improve people's awareness, knowledge, and attitude towards COVID-19 vaccines to increase the vaccines' acceptance. To increase the rate of vaccination, the Thai government needs to allow freedom of choice on vaccines, while considering effectiveness and safety issues.

Potentially inappropriate medication use and the hospitalization rate among Thai elderly patients: a retrospective cohort study.

PURPOSE: To examine the association between potentially inappropriate medications (PIMs) use and the hospitalization rate in elderly Thai patients. METHODS: In this retrospective cohort study, we collected the electronic medical data of elderly patients aged 60 years and older who visited the outpatient department (OPD) at Thammasat University Hospital in Thailand in 2015. The patients were categorized into PIM and non-PIM users according to the Beers 2019 criteria. We calculated descriptive statistics for demographic variables. We also examined the association between PIM use and various different factors with hospitalization rate during follow-up using log-binomial regression. We calculated the relative risk for association between PIM use and other factors with the hospitalization rate. RESULTS: We collected data for a total of 32,261 patients. The majority of participants were female (59.65%) and had a mean age of 70.21 years (SD = 7.88). Overall, 63.98% of the patients (n = 20,641) were PIM users and 49.45% (n = 15,952) received polypharmacy (≥ 5 medications). The most common PIM prescription was proton-pump inhibitors, which were 27.51% of all medications prescribed. We found that PIM use increased the risk of hospitalization by 1.31 times (adjusted RR = 1.31, 95% CI: 1.21-1.41, p-value < 0.001). Other factors associated with a higher rate of hospitalizations included older age, male gender, polypharmacy, and a higher number of OPD visits. CONCLUSION: PIMs were commonly prescribed to the elderly in the OPD, and were significantly associated with subsequent hospitalization. The provision of an alternative drug list can help physicians avoid prescribing PIMs to the elderly. If PIMs prescription is unavoidable, physicians should closely monitor patients for drug-related problems and deprescribe PIMs when they are no longer indicated.

Prevalence and Factors that Influence Potentially Inappropriate Medication Use among Thai Elderly in Primary Care Settings.

BACKGROUND: Older age increases the likelihood of chronic diseases and polypharmacy with the likelihood of potentially inappropriate medications (PIMs) in secondary and tertiary care levels, but in the primary care settings of Thailand there still is a need for more evidence. This study aimed to examine the prevalence of PIM in primary care settings, and to identify factors that influence the use of PIM. METHODS: A cross-sectional retrospective study was conducted in 2017. Eight primary care units from four regions of Thailand were randomly selected. People aged ≥ 60 years in the eight units were studied as participants. The List of Risk Drugs for Thai Elderly (LRDTE) was used as the reference. Multivariate logistic regression was carried out to identify factors that influence. RESULTS: A total of 4,848 patients aged ≥60 years with 20,671 prescriptions were studied. The mean age was 70.7±8.3 years for males, and 61.2% for females. A little more than 5% (5.1%) had ≥ 3 chronic diseases and 15.0% received polypharmacy (≥5 medications). The prevalence of prescriptions with PIMs was 65.9%. The most frequent PIMs were antidepressants: amitriptyline (28.1%), antihistamines: dimenhydrinate (22.4%) and chlorpheniramine maleate (CPM) (11.2%); and Benzodiazepines: lorazepam (6.5%). Three factors that significantly influenced prescribing of PIMs were polypharmacy (adjusted OR 3.51; 95% CI 2.81-4.32), having ≥3 chronic diseases (adjusted OR 1.44; 95% CI 1.04-2.01), and age ≥75 years (adjusted OR 1.18; 95% CI 1.01-1.38). CONCLUSION: More than two-thirds of elderly Thai patients in the primary care settings were prescribed PIMs. Multidisciplinary prescription review and PIM screening in patients aged ≥75 years who have ≥3 chronic diseases or polypharmacy should be implemented in primary care and supportive computerized PIMs alert system is needed.

Effect of a computerized decision support system on potentially inappropriate medication prescriptions for elderly patients in Thailand.

RATIONALE, AIMS, AND OBJECTIVES: The prescription of potentially inappropriate medication (PIM) is a global issue associated with increased adverse drug events, mortality, and health care expenditure. Computerized decision support system (CDSS) for the detection of PIM is a novel alert system in Thailand for reducing PIM prescriptions. The aim of this study was to evaluate the effect of a CDSS on PIM prescriptions for elderly patients in Thai community hospitals. METHODS: The study design comprised two phases with a duration of 12 months each: pre-CDSS implementation (October 2015-March 2016) and post-CDSS implementation (October 2016-March 2017). Medical services and prescription claims data from four hospitals were used to calculate the prevalence of PIM prescriptions among elderly patients aged 60 years and older. Chi-square tests were used to analyse changes in PIM prescriptions across hospitals post CDSS. RESULTS: The overall prevalence of PIM prescriptions post-CDSS implementation significantly decreased from 87.7% to 74.4%. The severity of mild and moderate PIMs was significantly reduced from 71.9% to 49.0% and from 64.5% to 48.7%, respectively. All hospitals had only one severe PIM, which was hyoscine. It was reduced from 4.7% to 1.5%, but the change was not significant (P = 0.74). The proportion of frequently prescribed PIMs in all PIM levels was significantly decreased, regardless of existing alternative medications. CONCLUSIONS: Specific CDSS for PIM in community hospital setting was associated with a reduction of PIM prescription in elderly patients. This CDSS can change physician's prescription behaviour to avoid inappropriate medications.

Applying the Lists of Risk Drugs for Thai Elderly (LRDTE) as a mechanism to account for patient age and medicine severity in assessing potentially inappropriate medication use.

BACKGROUND: Potential inappropriate medication (PIM) prescribing is a medication that puts patients at risk rather than having benefits. PIM use has been associated with hospitalization, morbidity, and mortality resulting from ADRs in elderly patients. The Lists of Risk Drugs for Thai Elderly (LRDTE) was developed as the new screening tool to identify PIMs use. The prevalence of PIM use using the LRDTE has not been determined in Thailand. PURPOSE: The main purpose of this study was to examine the prevalence of PIM use based on the LRDTE. In addition, this aimed to address the PIM problem by identifying factors that influenced PIM use among elderly patients in Thailand. METHODS: A retrospective cross-sectional descriptive study was conducted using the computerized database at four community hospitals in Thailand during fiscal year 2014. The LRDTE criteria were used as a screening tool for identifying the medicine items of PIM use. Descriptive statistics and multivariate logistic regression were used to identify common and Thai region-specific predictors of PIM use. RESULTS: Of a total of 13274 elderly patients, 79% were prescribed at least one PIM, as indicated by the LRDTE criteria. Amlodipine (32%), omeprazole (30%), and tramadol (18%) were the most commonly prescribed PIMs in elderly patients aged 60 years and older. Hospital and physician characteristics were identified as independent predictors after adjustment for patient and utilization factors. CONCLUSION: PIM use in Thai elderly patients was highly prevalent in community hospitals because the LRDTE criteria reflected clinical practice in Thailand. Hospital and physician factors were identified as region-specific factors that were highly associated with PIM use. Revision of hospital formularies and educational programs for physicians are needed to improve prescribing and avoid PIM use.