Wanitkun N, Batterham R, Vichathai C, Leetongin G, Osborne R H
Faculty of Nursing Mahidol University, Bangkok.
Chronic Illn. 2011 Mar;7(1):31-44. doi: 10.1177/1742395310389495. Epub 2011 Feb 22.
Thailand has a history of implementing innovative and proactive policies to address the health needs of its population. Since 1962 Thailand has implemented initiatives that led to it having a health system characterized by a primary care focus, decentralization and mechanisms to maximize equity and universal access to basic care at the local level. Thai health structures initially evolved to meet challenges including infectious and developmental diseases and later HIV. Early in the 21st century chronic illness rapidly became the greatest cause of morbidity and mortality and the question has arisen how Thailand can adapt its strong health system to deal with the new epidemics. This article describes an effort to reorient provincial health services to meet the needs of the increasing number of people with diabetes and heart disease. It describes measures taken to build on the equity-promoting elements of the Thai health system. The project included; a situational analysis, development and implementation of a chronic disease self-management intervention implemented by nurses and alignment of provincial health services. The self-management intervention is currently being evaluated within a clustered randomized control trial. The evaluation has been developed to fit with the focus on equity in relation to both selection criteria and the outcomes that are being assessed.
泰国在实施创新和积极主动的政策以满足其民众的健康需求方面有着悠久的历史。自1962年以来，泰国实施了一系列举措，使其拥有了一个以初级保健为重点、权力下放以及具备在地方层面最大限度实现公平和普及基本医疗服务机制的卫生系统。泰国的卫生结构最初是为应对包括传染病、发育性疾病以及后来的艾滋病毒等挑战而演变的。在21世纪初，慢性病迅速成为发病和死亡的最大原因，于是出现了泰国如何调整其强大的卫生系统以应对这些新流行病的问题。本文描述了一项重新调整省级卫生服务方向以满足越来越多糖尿病和心脏病患者需求的努力。它描述了在泰国卫生系统促进公平的要素基础上所采取的措施。该项目包括：形势分析、由护士实施的慢性病自我管理干预措施的制定与实施以及省级卫生服务的调整。目前正在一项整群随机对照试验中对自我管理干预措施进行评估。该评估的制定是为了符合在选择标准和所评估结果方面对公平的关注。
