1. chuchai.s@nhso.go.th
chuchai.sn@gmail.com
www.facebook.com/Morchuchai
1

2. 2

3. 3

4. 1.
2.
3.
4

5. 1.
(Indicators and Measurements)
2.
(National Health
Authority)
3.
(Health Service Provider
4.
5 (Healthcare

6. 5.
(National Health
Information)
6.
(Health Foreign Policy
Office)
7.
(Health Information
6 System and Network)

7. 9.
10.
11.
7

8. 1.
2.
(National
Health Information)
3.
8

9. 4.
5.
6.9

10. 7.
8.
9. 10

11. 10.
30
11. Reprocess)
12.
11

12. 1.
2.
Every Woman Every Child
(EWEC)
3.
4.
5.
12

13. 6.
7.
8.
13

14. :
(Globalization)
(Legal enforcement)
(Health System

17. -
12-
15
69-346บ ท
า /วัน
16
เส้ วา ย ก น-346บ ท
นค ม า จ า /วัน
14
12
10
8
6
4
2
0
2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550
17

18. 100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
25292531253325352537253925412542254325442545254725492550
18

19. 100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2529 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550

20. 3
25 6000000
- 5000000
20
-
4000000
15
3000000
10
2000000
5
1000000
0 0
20 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550

21. 3
60 %ครัวเรือ นกลางที่
นชั้ มีรถจักรย นต์ อ วเรือ งห
านย ต่ ครั นทั้ มด 14000000
ครัวเรือ ที่
น-จน มีรถจักรย นต์
านย
ครัวเรือน-กลางที่มีรถจักรย นต์
านย 12000000
50
ครัวเรือน-รวยที่
มีรถจักรย นต์
านย
ครัวเรือ งห ที่
น-ทั้ มด มีรถจักรย นต์
านย
10000000
40
8000000
30
6000000
20
4000000
10
2000000
0 0
21 2531 2533 2535 2537 2539 2541 2542 2543 2544 2545 2547 2549 2550

22. Generation 2010 2020 2030
Baby Boomer
- -
Gen X
-
-
Gen Y
-
Gen M
- 6,462 22,204

23. The Implications of
Social Media

24. What’s Social About Health Behavior?
 Asymptomatic Screenings
 Lifestyle Modifications
 Cessation of Addictive Behaviors
 Medical Regimen Compliance
 Precaution Adoption

25. m-Change and Obesity
 The appropriate model for obesity and weight
management is tailored information according to design
principles suggested by Social Cognitive Theory and the
Social Marketing Model.
 The health behaviors to target are self-monitoring of diet
and physical activity.
 The devices are Web-enabled “smart” cellular telephones
and wireless PDAs.
JT Tufano & BT Karras. Mobile eHealth Interventions for Obesity:
A Timely Opportunity to Leverage Convergence Trends. Journal
of Internet Medical Research 2005;7(5):e58).

26. Burden attributable to risk factors, 1999-2004
U s fes x
na e 9 %
.4 20
04
1 .8
3 %
A hl
lco o 8 %
.1 19
99
5 %
.8
T ba
o cco 5 %
.7
5 %
.1
B o pre s re
lo d s u 5 %
.5
5 %
.0
N t w a gh lm t
o e rin e e 4 %
.5
4 %
.2
O s
be ity 3 %
.7
3 %
.9
C o s ro
h le te l 2 %
.2
2 %
.3
F it &v gie
ru e s 1 %
.7
1 %
.4
P y ica in ctiv
h s l a ity 1 %
.3
1 %
.2
Illicit drugs 0 %
.9
3 %
.6
A po tio
ir llu n 0 %
.9
1 %
.4
Wte &s n tio
a r a ita n 0 %
.5
0 %
.7
Mln tritio - in s n rd
a u n t ta da 0 %
.3
0 %
.7
N t w a gs a lt
o e rin e tbe 0 %
.3
0 %
.4
Mln tritio - T a s n rd
a u n h i ta da 0 %
.2
0 %
.3
0 %
.0 2 %
.0 4 %
.0 6 %
.0 8 %
.0 1 .0
0 % 1 .0
2 % 1 .0
4 % 1 .0
6 %
%o to l b r e
f ta ud n

27. 2550
 35 10
2.4 50

5.4
 Sugar
 Oily fast food
 Salted snacks

28. HIV infections in Thailand
10,000,000
9,000,000
8,000,000
7,000,000
Current HIV Infections
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
1985 1990 1995 2000 2005 2010 2015 2020
Year
Source: Tim Brown
High-Risk Behaviors Changed Behaviors (Actual, Beginning 1990)

29. Atherosclerosis:
A Worldwide Challenge for the 21st Century
Mortality rate: 1999-2004
mortality rate by age group
1.00000
<1 1-
4
5-
9
-1
4
-1
9
-2
4
-2
9
-3
4
-3
9
-4
4
-4
9
-5
4
-5
9
-6
4
-6
9
-7
4
-7
9
-8
4
-8
9
10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85
0.10000
male1999
female1999
0.01000
male2004
female2004
0.00100
0.00010
year
“Cardiovascular disease accounts for 14.8 million deaths per year
worldwide”. W.H.O. report 1998

30. DALYs ranks in 1999 and 2004
Males
Year 2004 Year 1999
R ank Disease DALYs('000) % % DALYs('000) Disease
1 HIV/AIDS 645 11.3 17.2 960 HIV/AIDS
2 Traffic accidents 584 10.2 9.2 511 Traffic accidents
3 S troke 332 5.8 4.8 268 S troke
4 Alcohol dependence/harmful use 332 5.8 4.4 248 Liver cancer
5 Liver and bile duct cancer 280 4.9 3.0 168 Diabetes
6 C OP D 187 3.3 2.9 164 Ischaemic heart disease
7 Ischaemic heart disease 184 3.2 2.8 157 C OP D (emphysema)
8 Diabetes 175 3.1 2.8 156 Homicide and violence
9 C irrhosis 144 2.5 2.7 148 S uicides
10 Depression 137 2.4 2.5 138 Drug dependence/harmful use
Females
Y ear 2004 Y ear 1999
R ank Disease DALY s('000) % % DALY s('000) Disease
1 S troke 313 7.4 9.4 373 HIV/AIDS
2 HIV/AIDS 291 6.9 7.1 281 S troke
3 Diabetes 271 6.4 6.8 267 Diabetes
4 Depression 191 4.5 3.7 145 Depression
5 Ischaemic heart disease 142 3.4 3.0 118 Liver cancer
6 Traffic accidents 125 3.0 3.0 118 Osteoarthritis
7 Liver and bile duct cancer 124 3.0 2.9 115 Traffic accidents
8 Osteoarthritis 118 2.8 2.9 113 Anaemia
9 C OP D 115 2.7 2.8 110 Ischaemic heart disease
10 C ataracts 111 2.6 2.4 96 C ataracts

31. social morbidity

32. Chronic Conditions


-




33. Full Integration: Population Based and Chronic
Care Case Based Model
HEALTH IMPROVEMENT
DISEASE MANAGEMENT
Lifestyle interventions
Disease
Low risk At risk Early Signs Symptoms Disease
Management
Preventive Services Case Management
Screening
Primary and Secondary Acute Disease
Prevention treatment Management
HEALTH MANAGEMENT
POPULATION-BASED CASE-BASED

34.  2554-2563

2553-2555

35. Effective coverage of diabetes
100%
80%
60%
40%
20%
0%
treat controlled
2004
2009
2004
2009
2004
2009
2004
2009
2004
2009
2004
2009
2004
2009
2004
2009
treat uncontrolled
45-59 60-69 70-79 80+ 45-59 60-69 70-79 80+ know but not treat
male female not aware
Effective coverage of diabetic services
Source: NHES (2004, 2009)

36. : (PPIS)
OBMI
PHT
OWAIST
STROKE
HT
PDM
DM
36

37. 2552-2555 9
DM & DM with HT (NHES 51-52)
3,000,000
2 498 491
2 527 629
2 351 763 2 459 78 88.
2,500,000
1 50
77.
68
2,000,000
71.
38 จำนวน ผป.เบำหวำน ทีเข้ำถึ ง
่
5 เปรียบเทียบกับอัตรำควำมชุก
1,500,000 จำนวนผป.เบำหวำนทีเข้ำถึ งบริกำร
่
1,000,000
500,000
-
ปี 2552 ปี 2553 ปี 2554 ปี 2555
 DM UC 6.9 %
: 12, 18 files

38. -
(%) (%) (%)
Fasting Plasma Glucose
- mg/dL
HbA1c
HbA1c < 7%
− FPG 70-130 mg/dL HbA1c < 7%
− FPG <70/>130 mg/dL HbA1c < 7% 21
Lipid profile
LDL < 100 mg/dL
≤ mmHg
Albumin Protein
Microalbuminuria ACE inhibitor
ARB

39. -
(%) (%) (%)
2
3
4
5
−
−
16 Diabetic Retinopathy *

40. DM/HT
2553-2555 NHSO
- NCD Board System
Manager Team
- DM/ HT
- DM/HT Case Manager
- DM HT Chronic care model
-
-
/
- DM HT
- DM/HT
/
- DM/HT
- DM HT
- DM/HT

41. Chronic Care Model
Epping-Jordan, J E et al. Qual Saf Health Care 2004;13:299-305

42. Community-based health care
7. 1.
Health Sufficiency 2.
Promotion Economy Considerate
6. Better Society
Strong
Diseases Community
Community
control health 3.
5. 4. Treatment
Care for Care for of common
Elderly Chronic Diseases diseases

43. Excellent Center
Tertiary Medical Care
Tertiary Referral Center
Care
( Care) SecondaryCare
Special
Medical Ca
Referral System
Secondary Care
Primary Medical Care
( Care)
General Practice
Primary Care Family Practice, NP
( Care) Primary Health Care
Self-Care Managem
Holistic Integrated
Continuous
Care Care Care

44. NGO
Clinical & functional outcomes

45. 21 : AEC
World Health Report: 2008

46. 2554
Primary Care
On top payment
1.
2.
3.
4.
PCA

47. 1 2 3 4 5 6 7 8
1
2
3
4
5
6
7
8
9
10
11
12

48. /
-
:
9000
8000
7718
7424
7000
6000 5508
5000
3935
4000
3000 2689
2000
888
1000
0
2549-50 2551 2552 2553 2554 2555
7,718 .25%)
56 65 %)

49. 1.
2.
3.
4.
10