Theses (Ph.D) - Social and Administrative Pharmacy / ดุษฎีนิพนธ์ - เภสัชศาสตร์สังคมและการบริหาร

Assessment of Service Quality in the Outpatient Department of Public Hospitals in Yangon, Myanmar

2025-08-15T20:01:59Z

Assessment of Service Quality in the Outpatient Department of Public Hospitals in Yangon, Myanmar; Assessment of Service Quality in the Outpatient Department of Public Hospitals in Yangon, Myanmar Yin Phyu Thin Services are intangible in nature and difficult to assess as compared to the products. Measuring the quality of intangible service products has become a great challenge for managers and technical staffs in the health services industry. In Myanmar, the network of hospitals and health centers provides preventive and curative services ranging from primary to tertiary care. The service quality of public hospitals can be affected due to an imbalance between supply and demand resulting in the decline of customer satisfaction level. The assessment of patients’ expectation and perception would be necessary for policymakers and government officials to reform and rebuild the operating system and service quality in public hospitals. Therefore, this research aims to assess service quality in the outpatient department of public hospitals in Yangon, Myanmar. The study employed the SERVQUAL framework, comprising five dimensions – namely tangible, reliability, responsiveness, assurance, and empathy – to evaluate the quality of services provided in the outpatient department of public hospitals in Yangon, Myanmar. After developing a questionnaire relevant to Myanmar culture, the data collection was collected from the Yangon region because this is the most crowded and has the highest population among the 15 states and regions. So, the 806 patients were asked from the outpatient department (OPD) of the hospitals of 18 primary, 2 secondary and 6 tertiary curative care levels. Based on data collection, the scores between the perception and expectation on service quality dimensions showed positive scores in all dimensions. The mean perception score exceeded the mean expectation score and it could explain that the patients were satisfied with perceived service quality. Moreover, the result showed that residence was significantly related to the tangible, reliability, responsiveness and empathy dimensions. The monthly income was significantly related to the reliability and responsiveness dimensions. The marital status was significantly related to the assurance dimension. The results emphasize the importance of understanding the local context and demographic characteristics when designing interventions or improvements in healthcare services. Understanding the underlying factors contributing to these variations could provide valuable insights for healthcare providers to enhance their service quality based on the specific needs of different patient groups. To validate the association between the observed and the latent variables, the measurement model was assessed by the first-order and second-order confirmatory factor analyses. Based on the fit indices, the second-order confirmatory factor model did not adequately represent the data. Therefore, it could not confirm the hypothesized two-factor model of service quality, where service expectation and perception were higher-order factors encompassing the individual five dimensions of service quality. Due to the diverse nature of service industries and the complexities inherent in healthcare services, it is needed to emphasize the importance of tailoring the SERVQUAL scale to each sector's specific needs, cultural context and national context.; -

Proposing the optimum Myanmar Good Pharmacy Practice (GPP) guidelines for local retail pharmacies

2024-05-15T20:11:45Z

Proposing the optimum Myanmar Good Pharmacy Practice (GPP) guidelines for local retail pharmacies; Proposing the optimum Myanmar Good Pharmacy Practice (GPP) guidelines for local retail pharmacies Saw Thi Dar The present study was aimed to develop optimum Good Pharmacy Practice (GPP) guidelines for local retail pharmacies by inclusion of multiple-stakeholders in designing the implementation cycle and then propose these optimum guidelines to policy-makers to support the process of policy implementation. Therefore, a cross-sectional descriptive study using quantitative and qualitative methods was employed to investigate the situations of current pharmacy services and find out the contents for implementation of GPP guidelines in Myanmar context through participation of stakeholders. The pharmacy business is significantly increased number in recent decade to respond customers’ demands and they are found to be shared values among customers, patients and their partners like pharmaceutical companies. However, from the professional point of view, their pharmacy practices are acceptable for pharmaceutical services and far acceptable for pharmaceutical care. Regarding the GPP principles and its scope, the vast majority of stakeholders have neither heard nor familiar with the terms and it was found to be beyond their interest and knowledge. Therefore, this study found that the GPP implementation might be a bit challenge in practical ways with diverse understanding on principles of GPP and limited abilities of pharmacy staffs to follow it. Moreover, it was realized that pharmacies are barely profit business rather than a channel for care giving. As a result, stakeholders’ collaboration is fragmented and disconnected in new regulations of pharmacy practice. The government should bring all multiple-stakeholders together before seeding the principles of GPP and evaluate the process with a system thinking lens and promote dynamic networks of diverse stakeholders. Therefore, this study finds out the pragmatic agenda for policy to implement GPP guidelines for retail pharmacies in Myanmar. 7 main strategies composing 33 strategic plans are proposed to approach the seeding of GPP principles and implementing the GPP guidelines. They are; 1. Education and training on understanding the meanings of GPP and risks of safety, 2. Management for Human Resource, 3. Effective communication and collaboration to implement GPP standards, 4. Persuasion, support and encouragement to follow GPP standards, 5. Governance and regulations, 6. Sustainable processes for GPP implementation and 7. Changing Mindsets.; The present study was aimed to develop optimum Good Pharmacy Practice (GPP) guidelines for local retail pharmacies by inclusion of multiple-stakeholders in designing the implementation cycle and then propose these optimum guidelines to policy-makers to support the process of policy implementation. Therefore, a cross-sectional descriptive study using quantitative and qualitative methods was employed to investigate the situations of current pharmacy services and find out the contents for implementation of GPP guidelines in Myanmar context through participation of stakeholders. The pharmacy business is significantly increased number in recent decade to respond customers’ demands and they are found to be shared values among customers, patients and their partners like pharmaceutical companies. However, from the professional point of view, their pharmacy practices are acceptable for pharmaceutical services and far acceptable for pharmaceutical care. Regarding the GPP principles and its scope, the vast majority of stakeholders have neither heard nor familiar with the terms and it was found to be beyond their interest and knowledge. Therefore, this study found that the GPP implementation might be a bit challenge in practical ways with diverse understanding on principles of GPP and limited abilities of pharmacy staffs to follow it. Moreover, it was realized that pharmacies are barely profit business rather than a channel for care giving. As a result, stakeholders’ collaboration is fragmented and disconnected in new regulations of pharmacy practice. The government should bring all multiple-stakeholders together before seeding the principles of GPP and evaluate the process with a system thinking lens and promote dynamic networks of diverse stakeholders. Therefore, this study finds out the pragmatic agenda for policy to implement GPP guidelines for retail pharmacies in Myanmar. 7 main strategies composing 33 strategic plans are proposed to approach the seeding of GPP principles and implementing the GPP guidelines. They are; 1. Education and training on understanding the meanings of GPP and risks of safety, 2. Management for Human Resource, 3. Effective communication and collaboration to implement GPP standards, 4. Persuasion, support and encouragement to follow GPP standards, 5. Governance and regulations, 6. Sustainable processes for GPP implementation and 7. Changing Mindsets.

DEVELOPMENT OF A REGULATORY GUIDELINEFOR CELL THERAPY MEDICINAL PRODUCTS IN THAILAND

2023-12-27T20:08:02Z

DEVELOPMENT OF A REGULATORY GUIDELINEFOR CELL THERAPY MEDICINAL PRODUCTS IN THAILAND; การพัฒนาแนวทางการกำกับ ดูแล ควบคุม ผลิตภัณฑ์เซลล์บำบัดที่เหมาะสมกับประเทศไทย Treatment approaches have evolved rapidly and are being increasingly customized to specific diseases or particular patients, leading to the emergence of Advanced Therapy Medicinal Products (ATMPs). These ATMPs entail cell therapy medicinal products. These are emergence of new products. The objective of the research was to develop guidelines for the regulation of cell therapy medicinal products in Thailand, both in terms of use within medical institutions and drug registration. The research was a qualitative study conducted from March to September 2021. Three parts of the study included 1. Review of literature and related documents 2. Interviews with 34 key informants using a semi-structured questionnaire. Key informants were purposively selected from researchers or physicians conducting the study using cell-based therapy and regulators of these products and manufacturers and importers who are licensed with the Drug Act B.E. 2510 (1967). 3. Formulation of the guideline of cell therapy medicinal products to verify from all stakeholders, both in terms of use within medical institutions and drug registration, as well as sent the summary of the recommendations to the interviewees for reconsideration. The results found that: 1. To ensure patient safety using cell-based therapy within medical institutions, specific requirements for this service should be established including those for qualification of physicians providing the service, manufacturing site, standard of laboratory, medical institutions, medical practices, cell therapy medicinal products, and monitoring of the use of cell-based therapy 2. ATMPs: cell therapy medicinal products are different from other chemical or traditional biological drugs. Therefore, different regulations are developed, including the need to submit conditional approval with a Risk Management Plan, consideration without samples for testing before marketing authorization, certification of lot release, and retain samples. In particular, the autologous product is limited quantities and specific patients. Moreover, risk-based: SMP level 1 follow-up is applied. The extensive safety and efficacy post-marketing process should be carried out for two years, following which it should be maintained until lifelong. Additionally, Thai Food and Drug Administration (FDA) freely able to tailor-made following up procedure of patients in order to better protect patients. The regulation for providing services using ATMPs: cell therapy medicinal products in Thailand require collaboration from various organizations, such as the Department of Health Service Support, Thai FDA, Department of Medical Sciences, The Medical Council, and relevant Royal Colleges to ensure patient access and safety. However, cost-effectiveness evaluation to care for patients who untreatable previously standard therapy is ultimately recommendations for further research studies.; -

Development of Palliative Care Model Using Thai Traditional Medicine for Treatment of End-stage Liver Cancer Patients in Thai Traditional Medicine Hospitals

2023-12-03T20:11:17Z

Development of Palliative Care Model Using Thai Traditional Medicine for Treatment of End-stage Liver Cancer Patients in Thai Traditional Medicine Hospitals; - Current cancer modern medical treatment in mainly a treatment for inhibition of hepatocellular carcinoma proliferation in different stage, however, liver cancer is the still most diseases with high incidence and mortality rate. Moreover, modern medical treatment has several side effects. Thai traditional medicine is an alternative for the treatment of end-stage liver cancer patients.This research aimed to develop a palliative care model using Thai Traditional Medicine (TTM) for treatment of end-stage liver cancer patients in TTM Hospitals. Five TTM hospitals implemented the model comprised of 1) Thai Traditional and Integrated Medical hospital 2) Uthong hospital 3) Wattana Nakhon hospital 4)Khun Han hospital and 5)Sawang Daen Din Crown Prince Hospital. The methods were conducted in 3 phases including 1) the study of situations, problems, and obstacles in the care of end-stage liver cancer patients in TTM hospitals, 2) the development of the model of palliative care for end-stage liver cancer patients with TTM, and 3) the implementation and assessment of the possibility of using a palliative treatment model for liver cancer patients with TTM at TTM hospitals. The results showed that the palliative care model for end-stage liver cancer patients composed of 1) the roles of healthcare professional team 2) treatment of end-stage liver cancer patients guidelines 3) holistic care guidelines, and 4) guidelines for referral system and home visit. The model was applied to TTM hospitals with 3 different platforms, which were stand alone, paralleled and integrated services. After the implementation, the evaluations were conducted in 3 groups of participants; healthcare team, patients and caregivers. Data were analyzed by descriptive statistics such as frequency, percentage, mean, standard deviation and compare the evaluation score between before and after implementation with paired t-test statistics. Regarding possibility evaluation, all health care providers agreed that the palliative care model using TTM for treatment of end-stage liver cancer patients was possible at a high level for implementation. The satisfaction of health care team and the patients’ symptom were significantly changed after the implementation. Clinical outcomes in physical and mental aspects of patients were improved significantly (p<0.05). Patients and their caregivers’ satisfaction toward palliative care services were at highest level (M=4.38;SD=0.46) and (M=4.22;SD=0.38); respectively. In conclusion, the developed palliative care model using TTM for treatment of end-stage liver cancer patients can be implemented in the TTM Hospitals. The TTM model should be adjusted according to resources and policy of each hospital. However, outcome evaluation for testing the effectiveness of the model in the long term is highly recommended for further study.; -