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Surawit A, Pongkunakorn T, Manosan T, Mongkolsucharitkul P, Chamnan P, Suvarnabhumi K, Puangpet T, Suta S, Pumeiam S, Pinsawas B, Ophakas S, Pisitpornsuk S, Utchin C, Mayurasakorn K. Factors influencing optimal diabetes care and clinical outcomes in Thai patients with type 2 diabetes mellitus: a multilevel modelling analysis. BMJ Open 2024; 14:e079415. [PMID: 38702083 PMCID: PMC11086275 DOI: 10.1136/bmjopen-2023-079415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Increasing levels of poor glycaemic control among Thai patients with type 2 diabetes mellitus (T2DM) motivated us to compare T2DM care between urban and suburban primary care units (PCUs), to identify gaps in care, and to identify significant factors that may influence strategies to enhance the quality of care and clinical outcomes in this population. METHODS We conducted a cross-sectional study involving 2160 patients with T2DM treated at four Thai PCUs from 2019 to 2021, comprising one urban and three suburban facilities. Using mixed effects logistic regression, we compared care factors between urban and suburban PCUs. RESULTS Patients attending suburban PCUs were significantly more likely to undergo eye (adjusted OR (AOR): 1.83, 95% CI 1.35 to 1.72), foot (AOR: 1.61, 95% CI 0.65 to 4.59) and HbA1c (AOR: 1.66, 95% CI 1.09 to 2.30) exams and achieved all ABC (HbA1c, blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C)) goals (AOR: 2.23, 95% CI 1.30 to 3.83). Conversely, those at an urban PCU were more likely to undergo albuminuria exams. Variables significantly associated with good glycaemic control included age (AOR: 1.51, 95% CI 1.31 to 1.79), T2DM duration (AOR: 0.59, 95% CI 0.41 to 0.88), FAACE (foot, HbA1c, albuminuria, LDL-C and eye) goals (AOR: 1.23, 95% CI 1.12 to 1.36) and All8Q (AOR: 1.20, 95% CI 1.05 to 1.41). Chronic kidney disease (CKD) was significantly linked with high triglyceride and HbA1c levels (AOR: 5.23, 95% CI 1.21 to 7.61). Elevated HbA1c levels, longer T2DM duration, insulin use, high systolic BP and high lipid profile levels correlated strongly with diabetic retinopathy (DR) and CKD progression. CONCLUSION This highlights the necessity for targeted interventions to bridge urban-suburban care gaps, optimise drug prescriptions and implement comprehensive care strategies for improved glycaemic control, DR prevention and CKD progression mitigation among in Thai patients with T2DM. The value of the clinical target aggregate (ABC) and the process of care aggregate (FAACE) was also conclusively demonstrated.
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Affiliation(s)
- Apinya Surawit
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyaporn Pongkunakorn
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thamonwan Manosan
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pichanun Mongkolsucharitkul
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Parinya Chamnan
- Department of Social Medicine, Sunpasithiprasong Hospital, Ubon Ratchathani, Thailand
| | - Krishna Suvarnabhumi
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thanapat Puangpet
- Department of Social Medicine, Samutsakhon Hospital, Samut Sakhon, Thailand
| | - Sophida Suta
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sureeporn Pumeiam
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bonggochpass Pinsawas
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suphawan Ophakas
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sananon Pisitpornsuk
- Division of Nursing, Siriraj Primary Care Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalita Utchin
- Division of Nursing, Siriraj Primary Care Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Korapat Mayurasakorn
- Population Health and Nutrition Research Group, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Suvarnabhumi K, Jorajit S, Dechpichai W, Ativitthayaporn J. Expert consensus on core topics of sustainable development online learning module for family physicians: a Delphi study. BMJ Open 2022; 12:e061407. [PMID: 36581405 PMCID: PMC9806043 DOI: 10.1136/bmjopen-2022-061407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Medical institutions must provide learning experiences that enhance the knowledge and perspectives of sustainable development (SD) to prepare trainees of family medicine to become competent global citizens. The aim of this study was to develop an SD online learning module for trainees of family medicine. DESIGN This mixed-methods study was conducted from January 2020 to May 2021, beginning with a literature review concerning Sustainable Development Goals (SDGs) and Education for Sustainable Development in medicine. In-depth interviews were held to assess the relevant needs of family medicine training, followed by a two-round Delphi survey with experienced educators (N=21) in family medicine to refine and achieve consensus on the appropriate SDG topics for family physicians. SETTING All residency training programmes in Thailand. PARTICIPANTS Members of the Residency Training Committee, Royal College of Family Physicians of Thailand. RESULTS The literature review and in-depth interviews identified 12 topics of SD that were required for family physicians. The first round of the Delphi survey was concluded by identifying seven core topics with additional suggestions. In the second round, a consensus was obtained among the experienced educators regarding seven core topics as (1) a definition of SD, (2) principles of SD, (3) SDG, (4) a new concept of SD, (5) SD in the context of Thailand, (6) SD and principles of family medicine and (7) SD and family practice. These core topics were grouped within three main objectives and three submodules. CONCLUSIONS An online learning module of SD for family physicians was developed using modified Delphi method. This included three submodules as (1) concept and principles of SD, (2) SDG and (3) SD and its integration with family practice. This online learning module will provide additional resources for trainees of family medicine and Thai family physicians to expand their knowledge and perspectives of SD.
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Affiliation(s)
| | - Sujitra Jorajit
- Faculty of Education and Liberal Arts, Hatyai University, Hatyai, Songkhla, Thailand
| | - Wan Dechpichai
- Faculty of Education and Liberal Arts, Hatyai University, Hatyai, Songkhla, Thailand
| | - Jarus Ativitthayaporn
- Faculty of Education and Liberal Arts, Hatyai University, Hatyai, Songkhla, Thailand
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Suvarnabhumi K, Sowanna N, Jiraniramai S, Jaturapatporn D, Kanitsap N, Soorapanth C, Thanaghumtorn K, Limratana N, Akkayagorn L, Staworn D, Praditsuwan R, Uengarporn N, Sirithanawutichai T, Konchalard K, Tangsangwornthamma C, Vasinanukorn M, Phungrassami T. Situational analysis of palliative care education in thai medical schools. Palliat Care 2013; 7:25-9. [PMID: 25278759 PMCID: PMC4147768 DOI: 10.4137/pcrt.s12532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective The Thai Medical School Palliative Care Network conducted this study to establish the current state of palliative care education in Thai medical schools. Methods A questionnaire survey was given to 2 groups that included final year medical students and instructors in 16 Thai medical schools. The questionnaire covered 4 areas related to palliative care education. Results An insufficient proportion of students (defined as fewer than 60%) learned nonpain symptoms control (50.0%), goal setting and care planning (39.0%), teamwork (38.7%), and pain management (32.7%). Both medical students and instructors reflected that palliative care education was important as it helps to improve quality of care and professional competence. The percentage of students confident to provide palliative care services under supervision of their senior, those able to provide services on their own, and those not confident to provide palliative care services were 57.3%, 33.3%, and 9.4%, respectively. Conclusions The lack of knowledge in palliative care in students may lower their level of confidence to practice palliative care. In order to prepare students to achieve a basic level of competency in palliative care, each medical school has to carefully put palliative care content into the undergraduate curriculum.
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Affiliation(s)
| | - Non Sowanna
- Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Darin Jaturapatporn
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Chiroj Soorapanth
- Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis, Bangkok, Thailand
| | | | - Napa Limratana
- Faculty of Medicine, KhonKaen University, KhonKaen, Thailand
| | | | - Dusit Staworn
- Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Naporn Uengarporn
- Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand
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