Development of health literacy assessment scale for Thai stroke patients.

BACKGROUND: One important factor influencing the treatment and rehabilitation results for stroke patients is their level of health literacy. In order to acquire comprehensive information for appropriate treatment and rehabilitation programs that will promote the optimal possible health outcomes, health literacy assessment should be done in stroke patients from the earliest stages of stroke onset. OBJECTIVES: This research aimed to develop a health literacy assessment scale for Thai stroke patients and to evaluate the HL levels of those patients using that assessment scale. METHODS: A draft version of the scale has been developed based on the literature review and focus group discussions. After tryout, content validity, corrected item-total correlation and internal consistency were examined. A confirmatory factor analysis (CFA) was conducted in 400 patients with stroke to test the construct validity. RESULTS: The Health Literacy Assessment Scale for Thai Stroke Patients was successfully developed. The complete version featured 50 health literacy-related questions, along with seven demographic-related questions. This tool demonstrated good psychometric properties, including content validity (Item-objective congruence; IOC > 0.50), internal consistency (Cronbach's alpha = 0.951 to 0.955, overall = 0.94). Confirmatory factor analysis (CFA) also revealed good construct validity. CONCLUSIONS: The Health Literacy Assessment Scale for Thai Stroke Patients (HLS-Th) is measuring five components cover all health literacy aspects necessary for Thai stroke patient. This novel measurement scale is an accurate psychometric tool for assessing the level of health literacy among Thai stroke survivors.

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.

No Terminally Ill Patients with Non-cancer Received Palliative Care Services During Hospital Admission: A Cross-Sectional Study.

BACKGROUND: Terminally ill patients admitted to a hospital with noncancer conditions may miss palliative care (PC) service opportunities. This study aimed to examine the utilization of PC services among these hospitalized patients. METHODS: We conducted a cross-sectional study using the electronic medical records of noncancer patients admitted to internal medicine wards, intensive care units (ICUs), and cardiac intensive care units (CICUs). The patients meeting the Supportive and Palliative Care Indicators Tool (SPICT) criteria needed PC, and the patients who had advanced care plans or received PC consultations received PC services. We reported the proportions of patients with PC needs and PC services and their associated factors with the crude and adjusted odds ratios. RESULTS: Of 459 patients, 49.9% were female, and 92.6% were discharged alive. The mean age was 63 years old, and the average length of stay was 10 days. Additionally, 61.7% needed PC according to the SPICT criteria, but none of these patients received PC services. Patients with dementia/frailty, kidney disease, and heart disease had the highest rate of PC underutilization (100%, 96.8%, and 91.3%, respectively). Age, number of discharge medications, and length of stay were associated with needing PC, but some associations disappeared after the subgroup analysis. CONCLUSION: None of the terminally ill noncancer patients in our study received PC services. The patients with dementia/frailty, kidney disease, and heart disease underutilized the services. A long length of stay and many discharge medications were associated with the PC needs and can be used to assess the PC needs.

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.

Medication management at home in older patients with polypharmacy: In-depth interviews with home visits.

Background: Older patients with multiple non-communicable diseases (NCDs) usually require ≥5 concurrent medications or polypharmacy. Little is known about how patients manage medications at home. Objectives: This study qualitatively explored how older patients with polypharmacy manage medications at home in a primary care unit (PCU) in Pathum-Thani, Thailand. Methods: We conducted in-depth interviews in 2015 using a semi-structured questionnaire with 19 patients aged ≥60 years with polypharmacy and took photos of medication storage locations. The questionnaires asked about medication storage, sorting, and use. Transcripts were analyzed using thematic content analysis. Results: Of the 19 patients (mean age=69 years), 17 managed medications by themselves. The patients kept medications depending on their lifestyles. Newly received medications were kept separately from the remaining medications. Most patients used the remaining medications; yet, they did not look at the expiration dates. The remaining medications were kept, shared, thrown away, or returned to the PCU. All patients had a good attitude towards medications; yet, misunderstandings about medication administration and their outdoor activities were reasons for medication nonadherence. Conclusion: Older patients developed a system to store and organize medications at home. Management of remaining medications varied from patient to patient. Doctors should ask, not assume, elderly patients, to better understand how they manage medications at home. Future research should focus on if and how medication management at home affects medication adherence and health outcomes.

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.

Medication Management at Home in Older Patients with Polypharmacy: In-depth Interviews with Home Visits

Background: Older patients with multiple non-communicable diseases (NCDs) usually require ≥5 concurrent medications or polypharmacy. Little is known about how patients manage medications at home. Objectives: This study qualitatively explored how older patients with polypharmacy manage medications at home in a primary care unit (PCU) in Pathum-Thani, Thailand. Methods: We conducted in-depth interviews in 2015 using a semi-structured questionnaire with 19 patients aged ≥60 years with polypharmacy and took photos of medication storage locations. The questionnaires asked about medication storage, sorting, and use. Transcripts were analyzed using thematic content analysis. Results: Of the 19 patients (mean age=69 years), 17 managed medications by themselves. The patients kept medications depending on their lifestyles. Newly received medications were kept separately from the remaining medications. Most patients used the remaining medications; yet, they did not look at the expiration dates. The remaining medications were kept, shared, thrown away, or returned to the PCU. All patients had a good attitude towards medications; yet, misunderstandings about medication administration and their outdoor activities were reasons for medication nonadherence. Conclusion: Older patients developed a system to store and organize medications at home. Management of remaining medications varied from patient to patient. Doctors should ask, not assume, elderly patients, to better understand how they manage medications at home. Future research should focus on if and how medication management at home affects medication adherence and health outcomes. (AU)

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.

Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications.

BACKGROUND: Most older adults with comorbidities in primary care clinics use multiple medications and are at risk of potentially inappropriate medications (PIMs) prescription. OBJECTIVE: This study examined the prevalence of polypharmacy and PIMs using Thai criteria for PIMs. METHODS: This study was a retrospective cross-sectional study. Data were collected from electronic medical records in a primary care clinic in 2018. Samples were patients aged ≥65 years old with at least 1 prescription. Variables included age, gender, comorbidities, and medications. The list of risk drugs for Thai elderly version 2 was the criteria for PIMs. The prevalence of polypharmacy and PIMs were calculated, and multiple logistic regression was conducted to examine associations between variables and PIMs. RESULTS: Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively. Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI 2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively). CONCLUSION: Prescriptions with PIMs were high in the primary care clinic. Describing unnecessary medications is crucial to prevent negative health outcomes from PIMs. Computer-based clinical decision support, pharmacy-led interventions, and patient-specific drug recommendations are promising interventions to reduce PIMs in a primary care setting.

Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria.

OBJECTIVE: The primary objective was to examine potentially inappropriate medications (or PIMs) in the elderly using three different criteria: Beers 2015, STOPP version 2, and Winit-Watjana (for Thai elderly patients). The secondary objective was to examine PIM-related factors. METHODS: This is a retrospective cross-sectional study. Eligible patients were aged ≥65 years in a primary care unit. Demographic data, medical prescriptions in the past year, clinical data and diagnoses were collected from electronic medical records. PIMs, including the use of ≥2 medications, were identified using the three criteria. Descriptive and analytical statistics were conducted. The type I error was 0.05. Multiple logistic regression analysis was used to examine associations between PIMs and other factors. RESULTS: A total of 400 patients were recruited, and 1,640 prescriptions were reviewed. The median age was 70.5 years, and the median numbers of diseases, medications, and prescriptions were 3 (interquartile range or IQR=2), 11 (IQR=20), and 3 (IQR=4), respectively. Of all the patients, 213 (53.3%) showed a use of ≥5 medications, and 301 (75.3%) were prescribed PIMs. Of the 1,640 prescriptions, 60% had at least one PIM. The Winit-Watjana criteria, Beers 2015 criteria and STOPP version 2 identified 66.8%, 59.0% and 40.3% of the patients receiving PIMs, respectively. Approximately 16% of the patients showed at least one potential drug-drug interaction. The use of duplicate drug classes accounted for the highest proportion of potential drug-drug interactions (41.3%). Polypharmacy (odds ratio or OR 3.93, 95% confidence interval or 95%CI 2.17-71.2) and the presence of ≥4 diseases (OR 2.78, 95%CI 1.39-5.56) were associated with PIMs. CONCLUSIONS: PIMs are common among the elderly patients in primary care in Thailand. Prescriptions of the elderly with polypharmacy or multiple concurrent diagnoses should be reviewed for PIMs because they have a high chance of receiving PIMs.

Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria

Objective: The primary objective was to examine potentially inappropriate medications (or PIMs) in the elderly using three different criteria: Beers 2015, STOPP version 2, and Winit-Watjana (for Thai elderly patients). The secondary objective was to examine PIM-related factors. Methods: This is a retrospective cross-sectional study. Eligible patients were aged ≥65 years in a primary care unit. Demographic data, medical prescriptions in the past year, clinical data and diagnoses were collected from electronic medical records. PIMs, including the use of ≥2 medications, were identified using the three criteria. Descriptive and analytical statistics were conducted. The type I error was 0.05. Multiple logistic regression analysis was used to examine associations between PIMs and other factors. Results: A total of 400 patients were recruited, and 1,640 prescriptions were reviewed. The median age was 70.5 years, and the median numbers of diseases, medications, and prescriptions were 3 (interquartile range or IQR=2), 11 (IQR=20), and 3 (IQR=4), respectively. Of all the patients, 213 (53.3%) showed a use of ≥5 medications, and 301 (75.3%) were prescribed PIMs. Of the 1,640 prescriptions, 60% had at least one PIM. The Winit-Watjana criteria, Beers 2015 criteria and STOPP version 2 identified 66.8%, 59.0% and 40.3% of the patients receiving PIMs, respectively. Approximately 16% of the patients showed at least one potential drug-drug interaction. The use of duplicate drug classes accounted for the highest proportion of potential drug-drug interactions (41.3%). Polypharmacy (odds ratio or OR 3.93, 95% confidence interval or 95%CI 2.17-71.2) and the presence of ≥4 diseases (OR 2.78, 95%CI 1.39-5.56) were associated with PIMs. Conclusions: PIMs are common among the elderly patients in primary care in Thailand. Prescriptions of the elderly with polypharmacy or multiple concurrent diagnoses should be reviewed for PIMs because they have a high chance of receiving PIMs

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Health Services Provided at the Primary Care Network of the Faculty of Medicine, Thammasat University.

Background: Health care network of Faculty of Medicine, Thammasat University is one of Contracting Unit for Primary Care (CUP) under Thai Universal Coverage (UC) scheme. It comprises four primary care units (PCUs): Khukhot Subdistrict Health Promoting Hospital (KSHPH), Lamsamkaeo Municipality Health Center (LMHC), Khukhot Municipality Health Center (KMHC), and Thammasat Health Center (THC, also acted as CUP).A primary objective of this research was to study health service indicators of these four health centers. Material and Method: A retrospective study was performed. Data between January 1, 2014 and December 31, 2014 were collected. Following indicators for health service quality were collected and analyzed: 1) numbers of patients visiting PCU/number of patients visiting CUP (OP visit), 2) charge on drugs and medical supplies for outpatient services, 3) newborn and children under five mortality, 4) maternal mortality, 5) low birth weight 6) nutrition status of children under five, 7) diabetes mellitus (DM) patients with Hemoglobin A1C, low density lipoprotein, urine microalbumin tests, diabetic retinopathy screening, and feet examination, 8) hypertension (HT) patients with lipid profile, urine protein and fasting blood sugar tests, 9) controlled DM patients, and 10) controlled HT patients. Results: OP visit of KSHPH, LMHC, and KMHC were 0.22, 0.19, and 0.05, respectively. Charge on drugs and medical supplies for services of KSHPH, LMHC, KMHC, and THC were 102.39, 91.47, 162.04, and 463.85 baht/visit, respectively. There was no newborn, children-under-five and maternal deaths. Percentages of low birth weight of KSHPH, LMHC, KMHC, and THC were 14.3, 14.3, 0, and 9.1%, respectively. Percentage of children under aged five with underweight of KSHPH, LMHC, KMHC, and THC were 12.6, 12.0, 5.6, and 9.1%, respectively. Percentages of children under aged five with overweight of KSHPH, LMHC, KMHC, and THC were 3.7, 22.2, 1.9, and 12.8%, respectively. Percentages of DM patients with HbA1c test of KSHPH, LMHC, KMHC, and THC were 95.4, 87.6, 74.3, and 90.8%, respectively. Percentages of DM patients with LDL tests of KSHPH, LMHC, KMHC, and THC were 98.5, 90.0, 75.7, and 81.5%, respectively. Percentages of DM patients with urine micro albumin tests of KSHPH, LMHC, KMHC, and THC were 6.9, 3.3, 10.0, and 10.2%, respectively. Percentages of DM patients with DR screening of KSHPH, LMHC, KMHC, and THC were 0, 18.7, 0, and 22.6%, respectively. Percentages of DM patients with feet examination of KSHPH, LMHC, KMHC, and THC were 0, 18.7, 0, and 22.7%, respectively. Percentages of HT patients with lipid profile tests of KSHPH, LMHC, KMHC, and THC were 90.8, 73.2, 60.2, and 92.2%, respectively. Percentages of HT patients with urine protein tests of KSHPH, LMHC, KMHC, and THC were 7.3, 17.3, 0.4, and 7.8%, respectively. Percentages of HT patients with FBS screening of KSHPH, LMHC, KMHC, and THC were 92.2, 84.3, 61.0, and 78.1%, respectively. Percentages of controlled DM patients of KSHPH, LMHC, KMHC, and THC were 54.8, 57.9, 54.8, and 61.4%, respectively. Percentages of controlled HT patients of KSHPH, LMHC, KMHC, and THC were 75.7, 19.3, 35.7, and 66.3%, respectively. Conclusion: Several health service indicators need to be improved including: low OP visit, low birth weight, high underweight and overweight among children under aged five, low coverage of urine micro albumin, DR screening, and feet examination among DM patients, low coverage of urine protein among HT patients, and high percentage of uncontrolled DM and HT patients.

What are the health needs, familial and social problems of Thai migrants in a local community in Australia? A focus group study.

This study explored the health needs, familial and social problems of Thai migrants in a local community in Brisbane, Australia. Five focus groups with Thai migrants were conducted. The qualitative data were examined using thematic content analysis that is specifically designed for focus group analysis. Four themes were identified: (1) positive experiences in Australia, (2) physical health problems, (3) mental health problems, and (4) familial and social health problems. This study revealed key health needs related to chronic disease and mental health, major barriers to health service use, such as language skills, and facilitating factors, such as the Thai Temple. We concluded that because the health needs, familial and social problems of Thai migrants were complex and culture bound, the development of health and community services for Thai migrants needs to take account of the ways in which Thai culture both negatively impacts health and offer positive solutions to problems.

The application of the parallel track model in community health promotion: a literature review.

The parallel track model is one of the several models that are used in health promotion programmes that focus on community empowerment. It is unique in that it explicitly incorporates an empowerment approach with a top-down health programme. Since its development in 1999-2000 the model has been used in various health programmes in both developed and developing countries. The aim of this review is to examine the nature and extent of the application of this model and its contribution to promoting health. A review of the literature published between 2000 and 2011 was conducted. Nine results matched the inclusion criteria and revealed that the model has been mostly applied to disadvantaged communities to address health determinants, such as poverty and health literacy. This review found that the model had a positive impact on specific health outcomes such as health literacy and community capacity. We concluded that the parallel track model has the most potential for building capacity for community health promotion and appears to be the least useful for interventions focusing on health behaviour change within a limited time frame.