Journal of Primary Care and Family Medicine (PCFM)

Predictors of Emergency Department Utilization Among Advanced Cancer Patients: Machine Learning Model Development and Internal Validation

2026-02-10T08:23:18+07:00

ABSTRACT

Background: In 2022, nearly 20 million people worldwide were living with cancer, projected to rise to 28.4 million by 2040. Advanced cancer patients experience multidimensional suffering while navigating fragmented healthcare systems, contributing to high costs and poor outcomes. Current palliative care referral tools focus on prognosis rather than predicting healthcare utilization needs. This study developed and internally validated machine learning models to predict subsequent Emergency Department utilization, with the ultimate goal of creating practical clinical tools to support proactive care decisions and early palliative care integration.

Methods: This retrospective cohort study with machine learning model development analyzed electronic medical records of advanced cancer patients referred to palliative care at Pathum Thani Hospital between January 2024 and June 2025. The study employed logistic regression with a machine learning development process to predict emergency care utilization. Performance was evaluated using AUROC, accuracy, calibration metrics, and DCA.

Results: Backward Elimination showed potential predictors for three-month subsequent emergency care utilization, including elderly status, malnutrition, presence of dyspnea, previous three-month hospitalization, functional status (PPS), adequate strong opioid prescribing, and ACP documentation. The internally validated model demonstrated moderate discriminative ability, accuracy, high specificity, and high calibration (low Brier score) with a low potential for overfitting between validation and test sets. Nevertheless, the model had low sensitivity, indicating it is more appropriate for a rule-in than a rule-out approach. The DCA showed net benefit over the treat-all and treat-no strategies at the harm-benefit treatment threshold probability > 10%.

Conclusion: This predictive tool enables proactive interventions, especially for emergency advanced care planning for patients most likely to require emergency services. However, this study requires ongoing development since it is limited to a single site and demonstrates low sensitivity. Further work is needed to establish external validation and assess real-world impact.

Keywords: palliative care, machine learning, healthcare utilization, Palliative Performance Scale, advanced care planning

Effect of Hypertensive Control by Primary Care Telemedicine Service in Urban Community of Nakhon Ratchasima

2025-06-18T15:43:43+07:00

ABSTRACT

Background: Hypertension is a major public health concern and remains inadequately controlled in many patients. Difficulties in accessing healthcare services may compromise continuity of care and treatment outcomes. Telemedicine has been increasingly implemented to improve healthcare accessibility and reduce hospital overcrowding; however, evidence regarding its effectiveness compared with conventional care in Thai primary care settings is still limited. This study aims to compare the effectiveness of telemedicine and conventional non-communicable diseases (NCD) clinic services in controlling blood pressure among patients with hypertension.

Methods: A randomized controlled trial (clinically controlled trial) was conducted to compare the average Systolic Blood Pressure (mean SBP), average diastolic blood pressure (mean DBP), and satisfaction with telemedicine services in patients aged 40-80 years with hypertension, in the Urban Community Health Center 2, Wat Pa Salwan, Maharaj Nakhon Ratchasima Hospital. The study was conducted between March 1, 2024, and October 31, 2024.

Results: A total of 52 participants received telemedicine services, and 52 participants received services from the NCD clinic. The blood pressure control results were not significantly different at the study endpoint with a 95% confidence level. Satisfaction scores were high in both groups, with 81.6% of telemedicine participants expressing willingness to continue using the service.

Conclusions: Hypertensive patients receiving telemedicine services achieved comparable blood pressure control to those attending the Chronic Disease Clinic. This supports the consideration of developing Telemedicine systems for efficiently managing chronic non-communicable diseases in primary care settings.

Keywords: Randomized controlled trial, blood pressure control, telemedicine, primary care services

Efficacy of Telemedicine in Non-Communicable Diseases at Primary Care Unit, Ratchaburi Hospital

2025-07-18T13:22:04+07:00

ABSTRACT

Background: Non-communicable diseases are increasingly prevalent. Telemedicine enhances the convenience and accessibility of healthcare services for patients. This study aims to evaluate the effectiveness of healthcare service delivery and follow-up using telemedicine in non-communicable diseases (NCD) patients.

Design: Quantitative research and retrospective study

Methods: This study reviewed medical records of patients with hypertension and type 2 diabetes mellitus at the Primary Care Unit. The patients were divided into 108 in the telemedicine group and 115 in the usual group. The study was performed from March 1, 2023 to March 31, 2024.

Results: The study was conducted in 233 patients. After twelve months of follow-up, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) showed no significant differences between the telemedicine group and the usual group. The FBS showed a greater statistically significant reduction in the telemedicine group than the usual group at 12 months. However, the HbA1C demonstrated no significant differences between the two groups. Moreover, the SBP and FBS after the 12 months of treatment were significantly reduced in the telemedicine group.

Conclusions: The effectiveness of telemedicine and usual service was not different in patients with NCD at the primary care unit. Telemedicine may be an alternative treatment option.

Keywords: telemedicine, hypertension, diabetic mellitus

The Effects of a Community-Based Model for Chronic Disease Management Integrating Village Health Volunteers and Telemedicine in Primary Care Units

2025-07-24T18:04:29+07:00

ABSTRACT

Background: This research was funded by the Health Systems Research Institute (HSRI). The Participatory Action Research for Primary Health System Development in Rayong Province aimed to develop a case-based care model in which Village Health Volunteers (VHVs) play a key role in patient care.

Design: Participatory action research (PAR)

Methods: The Study was conducted on 12 chronic patients through purposive sampling and individual care for 12 weeks. Evaluation of patients was performed before and after the implementation of the care model. Data were analyzed using descriptive statistics and the Wilcoxon Signed Rank Test.

Results: Pre- and post-analysis of the variables for the implementation of the care model showed no statistically significant differences in HbA1c, systolic blood pressure (SBP), or diastolic blood pressure (DBP). However, the post-intervention HbA1c levels showed a relatively high average rank difference, suggesting some improvement.

Conclusions: The development of a chronic disease care model with Village Health Volunteers (VHV) participation can effectively contribute to individual care. The model can be implemented in other Primary Care Units.

Keywords: Chronic Care Model, Village Health Volunteers, Primary Care Unit

Effectiveness of Telemedicine for Blood Pressure Control: A Retrospective Comparative Study at Phimai Hospital, Thailand

2026-04-07T08:33:21+07:00

ABSTRACT

Background: Hypertension is a major chronic health problem in Thailand, particularly in areas with limited access to healthcare services. The development of telemedicine has emerged as a promising alternative to improve healthcare accessibility and reduce the burden on the health system. This study aimed to compare the effectiveness of telemedicine with usual care in controlling hypertension at Phimai Hospital, Nakhon Ratchasima Province, Thailand.

Design: A retrospective comparative study was conducted.

Methods: Medical records of 424 patients with hypertension between October 2023 and September 2024 were analyzed. Follow-up outcomes, including blood pressure, body mass index (BMI), and heart rate, were analyzed using the Mann–Whitney U test and Wilcoxon signed-rank test.

Results: The results showed that follow-up parameters significantly decreased in both groups, particularly at the second follow-up, reflecting the effectiveness of consistent monitoring. Furthermore, intergroup comparisons demonstrated that both systolic and diastolic blood pressure decreased significantly more in the telemedicine group than in the usual care group.

Conclusions: These findings highlight the potential of telemedicine in improving hypertension control and support national policies promoting digital health systems, particularly in resource-limited settings. However, social, economic, and health behavioral factors should also be considered to ensure sustainable and long-term implementation of telemedicine services.

Keywords: hypertension, telemedicine, clinical effectiveness

The Effectiveness of Homecare Telemonitoring in Blood Sugar Control in Patients with Uncontrolled Type 2 Diabetes Mellitus: A Non-randomized Historical Controlled Trial

2026-02-16T08:43:49+07:00

ABSTRACT

Background: Uncontrolled type 2 diabetes mellitus (T2DM) remains a major public health problem. The homecare telemonitoring system is a community-based approach integrating local participation, in which village health volunteers perform fingerstick blood glucose monitoring for patients and send the results via the LINE application for real-time evaluation and feedback by a multidisciplinary team. This study aimed to evaluate the effectiveness of homecare telemonitoring by comparing the mean HbA1c level at 12 weeks with standard outpatient (OPD) care.

Design: Non-randomized historical controlled trial

Methods: This study was conducted among patients with uncontrolled T2DM at Phichit Hospital and Primary Care Units in Mueang Phichit District. The intervention group included 67 patients receiving homecare telemonitoring between January and June 2025, while the control group comprised 132 patients receiving OPD-based care with data retrospectively collected in 2023. Data were analyzed using multivariable Gaussian regression, adjusting for age, sex, body mass index, duration of diabetes, comorbidities, medication regimen, and baseline blood glucose levels.

Results: At 12 weeks, the homecare telemonitoring group had a significantly lower mean HbA1c compared with the OPD group (9.1 ± 1.7% vs. 10.1 ± 2.0%; adjusted mean difference = -1.0%, 95% CI -1.6 to -0.5). Similarly, the mean fasting blood glucose was significantly lower (158.1 ± 56.0 mg/dL vs. 193.6 ± 81.0 mg/dL; adjusted mean difference = -32.1 mg/dL, 95% CI -54.5 to -9.8).

Conclusions: Homecare telemonitoring was more effective than standard OPD care in improving glycemic control among patients with uncontrolled T2DM. This approach may serve as a feasible and effective strategy for diabetes management in community and primary care settings.

Keywords: type 2 diabetes mellitus, glycemic control, telemonitoring

Comparison of In-Hospital Costs in End-Stage Renal Disease Patients Who Received Comprehensive Conservative Management with Advanced Care Planning

2025-08-15T22:51:34+07:00

ABSTRACT

Background: End-stage renal disease (ESRD) is a major public health concern in Thailand, contributing to high healthcare costs, especially among patients receiving Renal Replacement Therapy (RRT). Advanced care planning (ACP) can reduce unnecessary interventions and align care with patient preferences, yet uptake among Thai ESRD patients remains low. This study aims to assess whether early ACP, initiated when Karnofsky Performance Status (KPS) >70, is associated with reduced in-hospital costs and first Emergency Department (ED) visits in ESRD patients receiving comprehensive conservative management (CCM) with ACP. .

Methods: A retrospective cohort study was conducted at Pathum Thani Hospital, including 102 ESRD patients who met SPICT criteria and were managed with CCM. Patients were classified into early ACP (KPS > 70) and late ACP (KPS ≤ 70) groups. Outcomes included six-month total in-hospital costs (primary) and first ED visits (secondary). Statistical analyses included the Mann–Whitney U test, generalized linear modeling (GLM), and Cox proportional hazards models.

Results: Among 102 patients who received CCM with ACP, 55 received early ACP. Median in-hospital costs were lower in the early ACP group (8,020 THB vs. 9,300 THB), though not statistically significant (p = 0.1128). However, the adjusted analysis showed a 27% cost reduction with early ACP (95%CI: 1%–46%, p = 0.043). The incidence of the first Emergency Department visit after ACP, between the two groups (4.49 visits per 100 person-months in the early ACP group versus 3.38 visits per 100 person-months in the late ACP group), showed no statistically significant difference (IRR 1.33, 95%CI: 0.57–3.06, p = 0.508). After adjusted analysis using the Cox proportional hazards model, no statistically significant difference was found either (HR 0.91, 95%CI: 0.36–2.30, p = 0.840).

Conclusion: Early ACP was associated with significantly lower treatment costs without increasing the number of first ED visits, suggesting it may be a cost-effective and safe strategy for conservatively managed ESRD patients. Larger studies and the incorporation of home-based palliative care are recommended.

Keywords: Supportive and Palliative Care Indicator Tool (SPICT), Karnofsky Performance Scale (KPS), comprehensive conservative management (CCM)

Prevalence and Factors Associated with Medication Non-Adherence Among Uncontrolled Type 2 Diabetes Patients: Primary Care Setting

2025-04-28T09:23:40+07:00

ABSTRACT

Background: Type 2 diabetes mellitus is a significant cause of severe complications. Non-adherence to medication is a critical factor contributing to poor glycemic control among patients with type 2 diabetes. Investigating medication adherence and its associated factors is essential for improving the quality of diabetes care. This study aimed to assess the prevalence of medication non-adherence and the factors associated with this non-adherence among patients with poorly controlled type 2 diabetes receiving care in primary healthcare settings.

Methods: A cross-sectional study was conducted among patients with poorly controlled type 2 diabetes. Research instruments included a questionnaire divided into four sections: personal and clinical information, the Medication Adherence Scale in Thais (MAST)^®, a 2Q and 9Q depression assessment, and a record of the latest laboratory blood test results. Statistical analysis was performed using logistic regression.

Results: A total of 359 participants were included in the study, revealing that 88 individuals (24.5%) exhibited medication non-adherence. Factors associated with non-adherence include being single, divorced, or separated (OR 2.117, 95% CI 1.210-3.703), alcohol consumption (OR 1.950, 95% CI 1.101-3.453), and lack of strict dietary control (OR 1.837, 95% CI 1.019-3.313). household income of less than 15,000 THB/month (OR 0.393, 95% CI 0.208-0.742) and the use of both oral and injectable medications (OR 0.301, 95% CI 0.104-0.869).

Conclusion: Factors associated with medication non-adherence among poorly controlled type 2 diabetes patients receiving care in primary healthcare settings in Mae Sot District, Tak Province, encompass individual patient factors, social factors, and those related to diabetes treatment. Addressing this issue should consider a holistic and individualized approach, integrating various methodologies to enhance medication adherence, which is a crucial component in achieving successful diabetes management in primary care.

Keywords: medication non-adherence, medication adherence, type 2 diabetes, primary healthcare

Factors Predicting Hyperglycemic Preventive Behaviors of Diabetes Mellitus Patients

2025-07-02T11:58:12+07:00

ABSTRACT

Background: The situation of diabetes in Wang Noi District, Phra Nakhon Si Ayutthaya Province, shows that in 2022, 3,622 cases of diabetes were reported. The rising trend and increase of 9.56% compared to 2021 highlights the need to study predictive factors influencing preventive behaviors against hyperglycemia among diabetic patients who are unable to maintain proper blood sugar control.

Design: Cross-sectional and survey research

Methods: Questionnaires of sample groups were collected from registered uncontrolled Diabetes Mellitus Patients receiving treatment from Wang Noi Hospital, Wang Noi District, Phra Nakhon Si Ayutthaya Province. The sample size was 285 people.

Results: The overall level of health belief factors was high. The highest average score was Threat Perception. The lowest average score was the perception of risk opportunities. Behaviors to prevent overall hyperglycemia were at a moderate level; the highest average score was healthcare. The lowest averages score was for exercise. Factors of health beliefs and high blood sugar prevention behavior had a positive relationship with a statistical significance (p < 0.01)

Conclusions: The predictive variables predicted prevention behavior (Y). The factor affecting behavior to prevent high blood sugar is the perceived benefit of the behavior to prevent high blood sugar (β). = 0.29, p < 0.001), which has a prediction accuracy of 8.50 percent (R²= 0.08).

Keywords: diabetes mellitus patients, prevent a hyperglycemic, health beliefs

Prevalence and Factors Associated with Statin Prescription for Primary Cardiovascular Disease Prevention in Bangkhla Hospital

2025-08-18T08:32:51+07:00

Background: Cardiovascular diseases are preventable, with statins being an effective primary prevention strategy when indicated. However, the national database records lack relevant information, and no prior studies have been conducted at Bangkhla Hospital. Therefore, this study aimed to determine the prescription rate of statins when indicated, identify factors associated with statin prescribing, and examine the reasons for non-prescription.

Design: Analytic cross-sectional study

Methods: This study accessed patient database records at Bangkhla Hospital for individuals with indications for statin therapy as primary prevention in 2022. A minimum sample size of 310 patients was calculated. The primary outcomes of interest included the statin prescription rate among indicated patients, reasons for non-prescription in eligible individuals, and factors associated with statin prescribing. Data were analyzed using percentages, means, and standard deviations. Associations were examined using multiple logistic regression at a significance level of 0.05.

Results: A total of 2,343 patients met the study criteria, and population-based, non-random sampling data were analyzed. Among patients with indications for statin therapy as primary prevention at Bangkhla Hospital, 86.2% received statins within 90 days of indication. Statin prescription rates varied by indication: type 2 diabetes in patients aged ≥ 40 years: 94.7%, chronic kidney disease in patients aged ≥ 50 years: 90.4, patients aged ≥ 35 years with a 10-year Thai CV risk ≥ 10%: 85.6% and patients aged ≥ 21 years with LDL-C ≥ 190 mg/dL: 84.1%. Factors associated with statin prescribing included body mass index ≥ 25.0 kg/m², pre-existing dyslipidemia, warfarin use, higher HDL-C levels, age ≥ 21 years with LDL-C ≥ 190 mg/dL, and type 2 diabetes in patients aged ≥ 40 years.

Conclusions: In 2022, a total of 2,343 patients at Bangkhla Hospital met the criteria for statin therapy as primary prevention for cardiovascular disease, with 86.2% receiving statins. Factors associated with statin prescription included obesity, pre-existing dyslipidemia, warfarin use, higher HDL-C levels, age ≥ 21 years with LDL-C ≥ 190 mg/dL, and type 2 diabetes in patients aged ≥ 40 years. We recommend implementing a prescription alert system for statins in patients who meet the indications.

Keywords: statin, cardiovascular disease, primary prevention, factors

Effects of the People-Centered Healthcare Integration Program by the Family Care Team on HbA1C among Uncontrolled Type-2 Diabetes Mellitus Patients in the Primary Healthcare Unit, Ratchaburi Hospital

2025-10-14T09:13:41+07:00

ABSTRACT

Background: Type 2 diabetes mellitus is a major global public health problem. Uncontrolled blood glucose leads to chronic complications, and integrated care delivered by a family care team is a promising approach to diabetes management at the primary care level. This study examined the effects of a healthcare integration program centered around family care teams on HbA1C levels.

Design: This was a quasi-experimental study with a two-group repeated measures design

Methods: A sample of 80 patients with uncontrolled type 2 diabetes who were registered for treatment at the Primary Healthcare Unit of Ratchaburi Hospital were included. These patients had HbA1c levels greater than 7% for those aged 18 to 65 and more significant than 7.5% for those older than 65. Participants were assigned using multistage sampling into an experimental group (n = 40) and a control group (n = 40). The experimental group received a healthcare integration program focused on HbA1C levels, while the control group received usual care and a DM self-care booklet. The study measured outcomes at two time points: baseline and three months after follow-up. Data were analyzed using descriptive statistics, independent t-tests, and paired t-tests.

Results: Mean HbA1c and fasting blood sugar (FBS) levels significantly differed between the experimental and control groups after a three-month follow-up (p < 0.001). Additionally, mean scores for diabetes knowledge, attitudes toward diabetes, and self-care behaviors significantly differed between the experimental and control groups after a three-month follow-up (p < 0.001). Within the experimental group, mean HbA1c levels and fasting blood glucose levels significantly decreased post-intervention (p < 0.001), while diabetes knowledge, attitudes, and self-care behaviors significantly improved (p < 0.001).

Conclusions: The people-centered integrated care program delivered by a family care team effectively reduced HbA1C among uncontrolled type-2 diabetes mellitus patients. These results indicate the program’s suitability for diabetes management within primary healthcare units and recommend piloting the program in other units with similar contexts.

Keywords: type 2 diabetes mellitus, HbA1c, integrated health care, family medicine practice

Triglyceride to HDL-Cholesterol Ratio as a Predictor of Ischemic Stroke in Hypertensive Patients: A Case-Controlled Study

2026-02-02T09:12:41+07:00

ABSTRACT

Background: Stroke is preventable through risk factor control. One significant risk factor is high cholesterol, which is currently managed by controlling low-density lipoprotein cholesterol (LDL-C) levels. Recent studies have increasingly focused on factors contributing to atherosclerosis. Research has explored the association of the Triglyceride to high-density lipoprotein cholesterol (HDL-C) ratio with cardiovascular disease, finding that individuals with high Triglyceride levels and low HDL levels have an increased risk of developing cardiovascular disease.

Methods: This retrospective case-control study analyzed hypertensive patients treated at the Primary Care Unit of Chiangrai Prachanukroh Hospital between January 1, 2023, and December 31, 2023. Inclusion criteria comprised patients diagnosed with hypertension. Exclusion criteria were patients with a history of coronary artery disease or ischemic stroke before January 1, 2023, and those diagnosed with cardioembolic stroke. From a total pool of 5,808 individuals, 1,000 controls were selected via systematic random sampling, and 58 cases were identified. Data for the control group were derived from annual blood test results over the preceding three years, while data for the case group were taken from blood tests recorded on the date of stroke diagnosis. Statistical analysis was performed using logistic regression to compare stroke and non-stroke groups.

Results: Among the study population, 58 patients (5.8% of the sampled group) were diagnosed with ischemic stroke. When the Triglyceride-HDL ratio of the control group was divided into quartiles, patients in the highest quartile (Q4: 3.35–5.13) showed an adjusted odd ratio (OR) of 7.17 (95% CI: 2.34–21.94, p < 0.001) compared to those in the lowest quartile (Q1: 0–1.40).

Conclusions: A Triglyceride-HDL ratio exceeding 3.35 is significantly associated with an increased likelihood of ischemic stroke. This ratio may serve as a supplementary factor, alongside other traditional risk factors, to identify high-risk hypertensive patients who require intensive risk management to prevent future strokes. However, further prospective studies are recommended to track patients with high ratios over time to establish a definitive causal relationship.

Keywords: triglyceride-HDL ratio, ischemic stroke, cardiovascular disease

A Study of the Effectiveness of a Health Behavior Modification Program for the Prevention of Cervical Cancer among Women at Risk in the Catchment Area of Ban Thiandat Subdistrict Health Promoting Hospital, Ban Mai Subdistrict, Sam Phran District, Nakhon Pathom Province

2026-05-07T12:25:27+07:00

ABSTRACT

Background: Cervical cancer remains a major public health problem among Thai women, while the uptake of cervical cancer screening remains low. This study aimed to evaluate the effectiveness of a health behavior modification program on health belief perceptions, screening intention, and cervical cancer screening uptake among women at risk.

Methods: A quasi-experimental two-group pretest–posttest design was conducted from January to April 2025 at Ban Thiandat Subdistrict Health Promoting Hospital, Nakhon Pathom Province. Sixty women aged 30–60 years who had not undergone cervical cancer screening within the previous five years were recruited and equally assigned to an intervention group and a control group. The intervention group participated in a four-week health behavior modification program. Data were analyzed using descriptive statistics, Independent t-test, Paired t-test, and Chi-square test.

Results: After the intervention, the experimental group demonstrated a statistically significant improvement in health belief scores. Perceived susceptibility and perceived severity of disease were significantly higher than those of the control group, while perceived barriers to cervical cancer screening were significantly lower (p < 0.05). Furthermore, screening intention was significantly higher than that of the control group (p < 0.001), and the cervical cancer screening uptake rate was significantly higher than that of the control group (p = 0.010).

Conclusions: The health behavior modification program effectively improved health beliefs, reduced perceived barriers, and increased cervical cancer screening uptake among women at risk. Implementation of this program in primary care settings is recommended.

Keywords: cervical cancer, screening, health belief, behavior modification

Digital Health Interventions: Essential Tools for Healthcare Delivery in Primary Care Settings

2026-06-30T13:53:14+07:00

Digital Health Intervention (DHI) หรือการประยุกต์ใช้เทคโนโลยีดิจิทัลเพื่อสนับสนุนการดูแลสุขภาพ กำลังได้รับความสนใจเพิ่มขึ้นในฐานะเครื่องมือที่ช่วยเพิ่มประสิทธิภาพของบริการปฐมภูมิ โดยเป้าหมายของ DHI ในบริบทของบริการปฐมภูมิ มิได้จำกัดอยู่เพียงการนำเทคโนโลยีมาใช้ในกระบวนการดูแลรักษาเท่านั้น แต่ยังมุ่งเสริมสร้างการเข้าถึงบริการสุขภาพ ความต่อเนื่องของการดูแล คุณภาพและความปลอดภัยของบริการ ตลอดจนการมีส่วนร่วมของผู้ป่วย ครอบครัว และชุมชนในการดูแลสุขภาพของตนเอง นอกจากนี้ DHI ยังควรมีบทบาทในการลดความเหลื่อมล้ำทางสุขภาพและเพิ่มประสิทธิภาพของระบบบริการ โดยเฉพาะในพื้นที่ที่มีข้อจำกัดด้านทรัพยากรหรือการเข้าถึงบริการสุขภาพ