Journal of Primary Care and Family Medicine (PCFM)

Case Study: Care of Visually-Impaired Complex Illness Patient with Non-Communicable Disease by Community and Local Public Agency Participatory Model Based on Principles of Family Medicine

Ammara Anurapant — Thu, 26 Feb 2026 00:00:00 +0700

Background: Visual impairment can have a significant impact on a person’s well-being and quality of life. Adapting to living with visual impairment. holistic, multidimensional services were needed. This case describes caring for a patient with a complex illness, focusing on community and local public agency participation, including the role of health volunteers.

Case Report: A 32-year-old Thai female patient with diabetes and visual impairment was unable to work, living with her husband’s family. The patient was identified by a health volunteer visiting another patient. The health volunteer referred this new complex-illness patient to the health-care team in the Primary Care Unit. This patient required continuous care from the team. The patient and care team were involved in making decisions and prioritizing health problems together. The visual problem was the most concerning, leading to the addition of a rehabilitation course for the blind with support from the local public agency. Afterwards, the care team provided ongoing patient management using telemedicine.

Conclusions: Caring for a complex illness patient requires comprehensive care. This case shows that the role of the Family Physician and multidisciplinary team in the Primary Care Unit improves quality of life and well-being by using technology for proper management. Developing the potential of health volunteers and local public agency support patients can return to a better quality of life, taking care of themselves.

Keywords: diabetes, blind, participatory model, family care team

The Prevalence of Frailty and Glycemic Level Association in Elderly With Diabetes Mellitus Type 2 in Primary Care

Ratawan Saiya, Sorawat Sangkaew — Thu, 26 Feb 2026 00:00:00 +0700

Background: The proportion of elderly people in Thailand is rapidly increasing, with diabetes linked to higher frailty rates. A prior study found a U-shaped relationship between glycated hemoglobin levels and frailty risk in type 2 diabetes patients, but no similar studies have been conducted in Thailand. This study aimed to examine frailty prevalence and the association between glycemic control and frailty in the elderly with type 2 diabetes

Method: A cross-sectional study among older adults with diabetes was performed from five Primary Care Units at Hatyai Hospital. Physical frailty was assessed using the FRAIL scale. Data were analyzed using frequency distribution, Chi-square, and logistic regression.

Results: In a study of 350 subjects, physical frailty prevalence was 40.9%. The median blood sugar level in the frail group was significantly higher than in the non-frail group. Increased blood sugar levels were associated with frailty (AOR 1.0062, 95% CI 1.0007-1.0119).

Conclusions This study found high physical frailty in the elderly with type 2 diabetes, with higher sugar levels linked to frailty. In an aging society with limited resources, managing frailty in diabetic patients is crucial due to its commonality and strong association.

Keywords: physical frailty, elderly, diabetes mellitus type 2

Development of a Continuous Chronic Disease Management for Patients Using The Three-doctor Program in the Someplace Primary Care Cluster, Phra Nakhon Si Ayutthaya Province (2020–2022)

Niti Aromchuen — Thu, 26 Feb 2026 00:00:00 +0700

Background: Development of a care system for chronic patients using The Three-Doctor Program to care for and monitor patients at home. To compare the results of controlling diabetes and hypertension in normal treatment with the Three-Doctor Program.

Design: Retrospective Descriptive Study

Methods: Registered diabetic and hypertensive patients received voluntary home care provided by trained Village health volunteers and telemedicine.

Results: Diabetic and hypertensive patients were compared with those who received normal treatment, and the Three-doctor program treatment. Well-controlled blood sugar and blood pressure level 38.7%, 34.4% and 35.5%, 38.7%, respectively, were reported with no statistically significant differences.

Conclusions: Patients who received both types of care did not differ from each other, which reduced travel costs for patients.

Keywords: The Three-doctor Program, village health volunteers, diabetic, hypertension

Outcome of Telemedicine Care for Prisoners with Hypertension

Wechakorn Jatunarapit, Suralai Jongrakwong, Sorawat sangkaew — Thu, 26 Feb 2026 00:00:00 +0700

Background: Prisoners in Thailand face significant challenges accessing healthcare, particularly for chronic conditions like hypertension. Telemedicine offers a potential solution, but its comparative efficacy to usual care is not well established.f This study aims to compare blood pressure outcomes between prisoners with hypertension receiving telemedi-cine care (TC) and those receiving in-person usual care (UC). We also assessed the incidence of consultations for other health conditions and complications.

Methods: A randomized controlled trial was conducted from August 2023 to August 2024 in a Southern Thailand prison. Prisoners with uncomplicated hypertension were randomized into the TC and UC groups. The TC group received remote consultations via telehealth, while the UC group received in-person consultations. Blood pressure was measured at baseline and at months two, four, and six. T-tests compared blood pressure levels, and a linear regression with Generalized Estimating Equations assessed changes over time.

Results: We recruited 108 individuals (54 TC, 54 UC). Differences in systolic (SBP) and diastolic (DBP) blood pressure were found between TC and UC at months two, four, and six (mean differences: SBP -0.2, 4.3, and 0.8 mmHg; DBP 2.5, 3.3, and 3.1 mmHg). Changes in SBP and DBP over time were not statistically significant (p = 0.193, 0.151). The number of consultations on other conditions and complications did not show significant differences (p = 0.102, 0.279).

Conclusions: Telemedicine and in-person care effectively reduce blood pressure in prisoners, with no significant differences between the two. Telemedicine offers prisoners accessible healthcare, overcoming barriers to traditional in-person care.

Keywords: telemedicine, hypertension, prisoner, inmate, access to care

The Diagnostic Accuracy of the 14-Question for a Dementia Screening Tool for Thai Elderly in Primary Care Setting

Arissara Siriwiriyakul, Basmon Manomaipiboon — Thu, 26 Feb 2026 00:00:00 +0700

Background: The 14-question tool is recommended as a Thai dementia screening tool for the elderly populations in the community by public health volunteers. However, no information was identified about the tool’s diagnostic properties. To study the accuracy, time required to complete the tool, and factors associated with the accuracy of the 14 questions

Design: Cross-sectional Study of a Diagnostic Test

Methods: Three hundred and twenty elderly patients aged 60 years and over were evaluated for general characteristic information, 14 questions, functional assessment, neuropsychological evaluation, and standard clinical diagnosis. The DSM-5 diagnostic test was used as the gold standard to classify the elderly patients into normal, minor neurocognitive disorder, and major neurocognitive disorder.

Results: The sensitivity of the 14-question screening tool was 31.5%, the specificity was 83.6 and the AuROC was 0.58. The average assessment duration was four minutes and six seconds. Low-level education interfered with the accuracy of the tool. The new cut-point criteria for the tool, with more accuracy, is a total score of more than 20 or less than 20. Patients were given more than two points in questions 1 and 11.

Conclusions: 14-question tool has low accuracy for use as a dementia screening tool. The tool should be further reviewed for its method of use in further studies.

Keywords: screening tool, primary care setting, dementia, elderly

Factors Associated with Healthcare Access Among the Elderly at Ban Huai Kasian Noi Sub-District Health Promoting Hospital Noen Hom Sub-District Mueang District, Prachin Buri Province

Wirunda Pongprom, Natha Methabutsayathon — Thu, 26 Feb 2026 00:00:00 +0700

Background: Comprehensive elderly care is a key proactive policy of the Ministry of Public Health. This study aimed to examine factors associated with healthcare accessibility among the elderly in the service area of Ban Huai Kasian Noi Health Promoting Hospital, Prachin Buri Province.

Design: A cross-sectional Survey

Methods: The sample consisted of 193 elderly individuals from eight villages, selected through simple random sampling with proportional allocation. Simple random sampling was then conducted using a lottery method without replacement. The research instrument was a questionnaire (IOC = 0.67–1.00, α = 0.896). Data were analyzed using descriptive statistics and inferential statistics, including the chi-square test, Fisher’s exact test, and Pearson’s correlation coefficient.

Results: Healthcare accessibility among the elderly was at a moderate level (40.42%). Factors significantly associated with healthcare accessibility (p < 0.05) were chronic diseases, attitudes toward health services, and social support. Both attitudes toward health services and social support showed low-level positive correlations (r = 0.163 and r = 0.156, respectively).

Conclusions: Proactive interventions should be implemented for elderly groups with chronic diseases to foster positive attitudes. Additionally, establishing support networks to assist with transportation and health information is essential to enhance healthcare accessibility

Keywords: healthcare access, attitudes toward healthcare services, social support, elderly

Factors Associated with Influenza Vaccination Among Muslim Older Persons in Sateng Subdistrict, Mueang District, Yala Province

Sulaiman awae, Nawasiri Siriprasert, Narin Techanirattisai — Thu, 26 Feb 2026 00:00:00 +0700

Background: Influenza in older adults can be severe and lead to complications, and vaccination can help reduce the severity. A small proportion of Muslims receive influenza vaccinations. This research aims to study the factors associated with receiving influenza vaccination among Muslim elderly individuals.

Design: Cross-sectional Analytical Study

Methods: Data on influenza vaccinations were obtained from Muslim Older Persons in Sateng Subdistrict, Mueang District, Yala Province.

Results: A total of 166 samples were divided into 107 in the vaccinated group and 59 in the unvaccinated group. The relationship between various factors on influenza vaccination was found by multivariate logistic regression analysis with significance (p < 0.05), including personal factors including history of influenza infection, experience from people around that vaccination can reduce severity, personal experience that vaccination can reduce severity, and history of influenza vaccinations (aOR 5.8, 95% CI 1.31-25.64). In addition, social factors included receiving advice from healthcare workers and receiving information about influenza vaccination through various media (aOR 16.65, 95%CI 4.32-64.17).

Conclusions: Factors related to receiving influenza vaccinations among Muslim older persons include both individual and social factors. Specific religious or cultural beliefs were not significantly associated with vaccination choice.

Keywords: factor, influenza vaccine, vaccination, older persons

The Characteristics of Medical Professionalism Preferred by the Patients: A Study in a Tertiary Care Teaching Hospital in Thailand

Thu, 26 Feb 2026 00:00:00 +0700

Background: Professionalism is a crucial component of the medical profession. Patients have various expectations, including knowledge, skills, communication, ethics, and personality. However, there is still a lack of in-depth studies in Thailand. The objectives of this research were: 1) to investigate the priorities of professional attributes that patients value, 2) to apply the research findings to the development of medical curricula, and 3) to design a curriculum that aligns with professional standards.

Design: A cross sectional analytical study

Methods: Four hundred outpatients from the Police General Hospital responded to a questionnaire, which was divided into two sections. The first section collected general demographic data, while the second section used a 5-point Likert scale to assess physicians’ attributes in four areas: knowledge, skills, ethics, personality, and communication.

Results: Patients placed the highest importance on the physician’s personality (mean score: 4.3687), followed by ethics (4.2519), communication (4.2456), and knowledge/skills (4.2362). ANOVA analysis showed that personality was significantly important (p < 0.05), while other areas showed no significant differences.

Conclusion: Patients prioritize a physician’s personality the most, followed by ethics, communication, and knowledge/skills, respectively. This reflects the necessity for development in this area within medical training curricula. The findings of this research can be used as a guideline for curriculum developers or those involved in the design of undergraduate medical programs that emphasize professionalism and effectively meet patients’ needs.

Keywords: professional attributes, patient satisfaction, physician, tertiary care hospital

Prevalence of Pneumonia Patients Eligible to Participate in the Hospital at Home Ward at Nan Hospital, Nan Province

Nantikan Plasuwan, Valika Rattanachun, Lujisak Voradechvittaya — Thu, 26 Feb 2026 00:00:00 +0700

Background: The concept of home care is gaining increased attention as it reduces the burden on hospitals and improves patients’ quality of life. In Thailand, the Department of Medical Services, Ministry of Public Health have developed guidelines and standards for Home care in 2022. This approach offers an alternative for inpatient services, aiming to enhance patients’ quality of life during treatment, reduce complications associated with hospital stays, and decrease bed occupancy and overcrowding in hospitals. This study aims to evaluate the number of pneumonia patients who meet the Step-Down criteria according to the Home care guidelines and standards of the Department of Medicine, Ministry of Public Health, at Nan Hospital, Nan Province

Methods: Retrospective descriptive analysis using data collected from medical records and electronic databases of patients diagnosed with pneumonia who received inpatient care from August 1, 2022, to June 30, 2023. The study focused on patients residing within the Mueang Nan District and within 20 kilometers of Nan Hospital. Data were analyzed using descriptive statistics and Chi-Square tests to determine the relationship between various factors and eligibility for home-based care.

Results: Eighty-five out of 396 pneumonia patients attended the Step-Down criteria for home-based care, representing a prevalence of 21.46% of all patients. Factors influencing eligibility included age, gender, marital status, chronic diseases, physical condition, bedridden status, COVID-19 infection, and death in the hospital.

Conclusion: The Home care guidelines and standards from the Department of Medicine, Ministry of Public Health, can be applied to pneumonia patients at Nan Hospital, Nan Province. This approach will provide patients with an alternative to inpatient care, reduce bed occupancy rates, and alleviate hospital congestion. Additionally, it will contribute to more appropriate and efficient resource management at the hospital in the future.

Keywords: homeward, pneumonia

Factors Related to People’s Participation in Prevention and Control of Dengue Fever in Nasai Subdistrict, Li District, Lamphun Province

porntipa Anuniwat, Natha Methabutsayathon — Thu, 26 Feb 2026 00:00:00 +0700

Background: Public participation is a key mechanism for sustainable dengue fever prevention and control. This study aimed to identify factors associated with people’s participation in dengue prevention and control in Nasai Subdistrict, Li District, Lamphun Province.

Design: Cross-sectional survey

Methods: The sample consisted of 342 residents aged 20 years and older who had resided in the area for at least one year, selected through simple random sampling. The research instrument was a questionnaire with an Index of Item-Objective Congruence (IOC) between 0.67-1.0. The Cronbach’s alpha coefficients for parts two to four were 0.721, 0.744, and 0.756, respectively. Data were analyzed using descriptive statistics, Chi-square test, and Pearson’s correlation coefficient.

Results: Participation in dengue fever prevention and control among the people was at a low level (57.31%). When considering each aspect, participation in implementation was the highest (56.73%), followed by participation in evaluation (14.33%), participation in benefits (13.16%), and participation in decision-making (4.39%). Regarding related factors, age had a low-level negative relationship with participation (r = -0.213, p < 0.05). Social support had a moderate-level positive relationship with participation (r = 0.476, p < 0.05).

Conclusion: Age and social support are factors associated with people’s participation in dengue fever prevention and control. Activity models should be developed to focus on every stage of participation, especially providing opportunities for people to participate in decision-making. In addition, social support mechanisms in the community should be strengthened to encourage the elderly to participate more in dengue fever prevention and control.

Keywords: participation, people, dengue fever prevention and control, social support, attitude

Paradigm Shift Towards Type 2 Diabetes Remission: Precision Medicine and Integrated Care

Satang Supapon — Thu, 26 Feb 2026 00:00:00 +0700

เรากำลังอยู่ในยุคของการเปลี่ยนผ่านกระบวนทัศน์การรักษาโรคเบาหวาน จากการรักษาตามอาการสู่เป้าหมายการทำให้โรคสงบ (DM Remission) ในอดีต โรคเบาหวานชนิดที่ 2 (T2DM) มักถูกนิยามว่าเป็นโรคเรื้อรังที่ดำเนินไปอย่างต่อเนื่องและไม่สามารถรักษาให้หายขาดได้ อย่างไรก็ตาม ข้อมูลทางวิชาการล่าสุดชี้ให้เห็นว่าภายในปี 2045 จะมีผู้ได้รับผลกระทบจากโรคนี้สูงถึง 629 ล้านคนทั่วโลก ซึ่งสร้างภาระทางเศรษฐกิจและสาธารณสุขอย่างมหาศาล

ปัจจุบันมุมมองทางการแพทย์ได้เปลี่ยนไปอย่างสิ้นเชิง โดยมองว่า "การทำให้โรคสงบลง" (Remission) เป็นเป้าหมายที่สามารถบรรลุได้จริงและเป็นเป้าหมายสูงสุดเพื่อลดอัตราการเจ็บป่วย เพิ่มคุณภาพชีวิต และรักษาการทำงานของเซลล์ตับอ่อน (β-cell)