Journal of Phrae Public Health for Development - วารสารสาธารณสุขแพร่เพื่อการพัฒนา

Development of Quality of Intermediate Care Rehabilitation after Stroke, Community Hospitals Network, Phrae Province

2026-07-07T14:51:20+07:00

This research and development study aimed to develop and evaluate an intermediate care rehabilitation service system for stroke patients in the community hospital network of Phrae Province, Thailand. The study had two phases. Phase 1 included situation analysis and system development through focus group discussions with 38 personnel involved in stroke patient care. Phase 2 involved implementing and evaluating the system with patients who had intermediate-stage stroke, using a pre–post design with 30 participants in each group. Research instruments included the Barthel Index, the Thai version of the Stroke Rehabilitation Assessment of Movement, a length-of-stay record form, and a complication recording form during intermediate care. Additional questionnaires assessed feasibility and satisfaction with the developed system. Data were analyzed using descriptive statistic, chi-square test, Mann–Whitney U test, and Wilcoxon Signed Ranks test.

The research findings revealed that phase 1 of the research involved the development of a system consisting of 1) establishment of physical therapist case manager teams in community hospitals, 2) implementation of a Potential-Based Approach with standardized standing orders, and 3) a Line consult system for multidisciplinary consultation. In Phase 2, the post-development group demonstrated significantly better outcomes than the pre-development group (p < 0.05) across all major indicators, including discharge BI score (9.30 vs 6.20), maximum BI score (17.03 vs 13.33), BI effectiveness index (29.65% vs. 17.41%), and length of stay improvement (6.03 vs 3.70 days). STREAM scores also improved significantly (p < 0.00). Physical therapists reported high feasibility for implementation of the developed system (mean = 3.68, S.D. = 0.76) and the highest level of overall satisfaction (mean = 4.57, S.D. = 0.60).

Factors Associated with Success Suicidal Attempt, Wangchin District, Phrae Province

2026-03-11T14:12:12+07:00

Understanding the factors associated with suicide is essential for developing effective prevention strategies and providing timely support for individuals at risk. This retrospective cohort study aimed to investigate factors associated completed suicide among patients diagnosed with intentional self-harm (ICD-10 codes X60–X84) who received care at Wang Chin Hospital, Phrae Province, between 1 October 2014 and 30 September 2024. Medical records of 238 patients were reviewed. Descriptive statistics were used to summarize participants’ characteristics, and multiple logistic regression analysis was performed to identify factors associated with completed suicide, with a statistical significance level of 0.05.

The research findings revealed that among the 238 patients, 70 died by suicide and 168 survived a suicide attempt. The predictors of successful suicide in Wang Chin District, Phrae Province, using the 5-factor TK Model included: weak protective factors related to the lack of a warning and assistance system had a 14.16 times higher risk of successful suicide (95%CI = [3.30-60.80], p = 0.00). Males had a 13.37 times higher risk of successful suicide (95%CI = [4.80-37.26], p = 0.00). Failure in Surveillance had a 11.32 times higher risk of successful suicide 11.32 (95%CI = [2.14-59.91], p = 0.00). Causes of suicide included romantic disappointment/jealousy (7.03 times higher risk of successful suicide, 95%CI = [1.10-44.89], p = 0.04) and work-related stress increased the risk of successful suicide by 4.03 times (95%CI = [1.13-14.44], p = 0.03). Having underlying medical conditions increased the risk of successful suicide by 2.47 times (95%CI = [1.04-5.87], p = 0.04), and one year of age increased the risk of successful suicide by 1.04 times (95%CI = [1.01-1.07], p = 0.00). The TK Five-Factor Suicide Model explained 54.8% of the variance in completed versus non-completed suicide. These findings underscore the need for integrated suicide prevention strategies that strengthen surveillance and early warning systems, enhance risk screening, and promote community participation to improve the effectiveness of suicide prevention programs.

Risk Factors Affecting INR Control and Development of Patient Care Strategies for Warfarin Users at Sung Men Hospital, Phrae Province

2026-04-09T16:46:14+07:00

This action research aimed to identify the risk factors causing International Normalized Ratio (INR) levels to fall outside the target range among patients on warfarin therapy, while also developing systematic pharmaceutical care guidelines to optimize patient outcomes. The study monitored a group of 225 patients attending the Warfarin Clinic at Sung Men Hospital in Phrae Province between August 2024 and May 2025. Information was gathered through patient interviews, focus group discussions, and clinical INR records retrieved directly from the HOSxP system, with data subsequently analyzed using descriptive statistics.

The findings revealed that the primary triggers for unstable INR levels were dietary habits, medication non-adherence, and the inappropriate use of concomitant drugs, respectively. To address these challenges, a series of comprehensive pharmaceutical interventions was introduced. By identifying individual risk factors, closely monitoring drug-food interactions, and providing tailor-made nutritional and medication counseling, the clinic was able to offer more personalized support. Furthermore, maintaining regular INR check-ups and collaborating closely with physicians for precise dose adjustments led to a remarkable improvement; the proportion of patients achieving their target INR levels or Time in Therapeutic Range (TTR) rose significantly from 42.35% in August 2024 to 65.58% by May 2025.

Ultimately, these outcomes demonstrate that continuous and well-structured pharmaceutical care, paired with practical dietary advice, is essential for helping patients maintain stable INR levels. Not only does this proactive approach lower the likelihood of severe bleeding or dangerous blood clots, but it also enhances medication safety and elevates the overall quality of life for individuals living with warfarin therapy.

Development of a Management Model for Critical and Urgent Emergency Patients to Enhance Service Accessibility Within 60 Minutes at the Emergency Department, Nong Muang Khai Hospital, Phrae Province

2026-06-12T17:42:54+07:00

This research and development study aimed to: 1) analyze the situation and factors causing delayed service accessibility, 2) develop a management model for critical and urgent emergency patients by an interdisciplinary team, and 3) evaluate the effectiveness of the model on service accessibility within 60 minutes at the Emergency Department, Nong Muang Khai Hospital, Phrae Province. Guided by System Theory integrated with the PDSA quality cycle, the study was conducted across three phases. The sample consisted of 46 critical and urgent emergency patients. Research instruments included a Clinical Practice Guideline, Standing Orders, time-motion and incident logs, and satisfaction evaluation questionnaires. Data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation.

The results revealed that: 1) The situational analysis phase identified a critical bottleneck in the exit flow process (Exit Block), where the interval from physician disposition to actual emergency department departure averaged 46.13 minutes (S.D. = 39.61, Min = 3 mins, Max = 255 mins). The primary cause was clinical complexity 62.50%, compounded by delays in supporting systems. 2) The developed innovation, the NMK-ER Model, emphasized proactive patient flow management and visual management using color coding. And 3) After model implementation, the total length of stay decreased from 70.11 minutes (S.D. = 46.33) to 42.15 minutes. Service accessibility within 60 minutes increased from 56.52% to 86.96%. Regarding clinical outcomes, safety incidents, ER mortality, and critical medication errors were reduced to zero. The under-triage rate dropped to 2.17%. The overall satisfaction of stakeholders was at the highest level ( = 4.63, S.D. = 0.49).