Health Research in Thailand:A Gap Analysis

Krit Pongpirul, MD.International Health Policy Program (IHPP-Thailand)

doctorkrit@gmail.com

Outlines for Gap Analysis

Trend (2544 vs 2546) Global Situations National Agencies Observations Proposals

Trend (2544 vs 2546)

2544 vs 2546

24%

53%

18%

5%

Diseases of the Organs Health Problems

Enabling Mechanisms others

12%

53%

27%

8%

Global Situations

Global Situations

Methodology Medline Search using Medical Subject Headings

(MeSH) on July 5th, 2005 Comments from today’s expert panel

Medical Subject Headings (MeSH)

MeSH is the system designed and used by the National Library of Medicine (NLM) for assigning subject headings to books and journals articles in the medical sciences.

MeSH Tree Structure 11. Anatomy [A] 2. Organisms [B] 3. Diseases [C] 4. Chemicals and Drugs [D] 5. Analytical, Diagnostic and Therapeutic Techniques and Equipment [E] 6. Psychiatry and Psychology [F] 7. Biological Sciences [G] 8. Physical Sciences [H] 9. Anthropology, Education, Sociology and Social Phenomena [I] 10. Technology and Food and Beverages [J] 11. Humanities [K] 12. Information Science [L] 13. Persons [M] 14. Health Care [N] 15. Geographic Locations [Z]

MeSH Tree Structure 2 Diseases [C]

Bacterial Infections and Mycoses [C01]+ Virus Diseases [C02]+ Parasitic Diseases [C03]+ Neoplasms [C04]+ Musculoskeletal Diseases [C05]+ Digestive System Diseases [C06]+ Stomatognathic Diseases [C07]+ Respiratory Tract Diseases [C08]+ Otorhinolaryngologic Diseases [C09]+ Nervous System Diseases [C10]+ Eye Diseases [C11]+ Urologic and Male Genital Diseases [C12]+ Female Genital Diseases and Pregnancy Complications [C13]+ …

MeSH Tree Structure 3

Health Care [N] Population Characteristics [N01]+ Health Care Facilities, Manpower, and Services [N02]+ Health Care Economics and Organizations [N03] + Health Services Administration [N04]+ Health Care Quality, Access, and Evaluation [N05]+

Thai vs Global

13%

57%

30%

Diseases of the Organs Health Problems

Enabling Mechanisms

32%

49%

19%

Kendall’s tau-b = -0.19 (p=0.04); Spearman’s rho = -0.31 (p=0.02)

1.Diseases of the OrgansNo MeSH MeSHTotal MeSH% Mrank Total46 Total46% Trank

1 Reference Values / Biomedical Research

126,795 1.61 16 33 8.38 4

2 Cardiovascular Diseases 1,184,425 14.99 2 28 7.11 53 Respiratory Tract Diseases 654,963 8.29 4 17 4.31 104 Liver Diseases 272,577 3.45 13 3 0.76 175 Kidney Diseases / Sudden Death 290,836 3.68 11 15 3.81 116 Gastrointestinal Diseases 470,618 5.96 7 8 2.03 147 Skin Diseases 505,506 6.40 6 7 1.78 168 Nervous System Diseases 1,255,508 15.89 1 24 6.09 79 Endocrine System Diseases 468,234 5.93 8 19 4.82 8

10 Hematologic Diseases 303,332 3.84 10 12 3.05 1311 Musculoskeletal Diseases 521,780 6.61 5 38 9.64 312 Otorhinolaryngologic Diseases 192,223 2.43 14 18 4.57 913 Eye Diseases 283,599 3.59 12 25 6.35 614 Mouth Diseases 158,027 2.00 15 83 21.07 115 Immune System Diseases 798,386 10.11 3 14 3.55 1216 Urinary Tract Diseases 402,453 5.09 9 8 2.03 1517 Anesthesiology 10,495 0.13 17 42 10.66 2

Kendall’s tau-b = -0.039 (p=0.820); Spearman’s rho = -0.036 (p=0.887)

1.Diseases of the Organs

12

3

4

5

6

7

89

10

11

12

13

14

15

16

17

0

2

4

6

8

10

12

14

16

18

0 2 4 6 8 10 12 14 16 18

Global Ranks

Thai

Ran

ks

Kendall’s tau-b = -0.039 (p=0.820); Spearman’s rho = -0.036 (p=0.887)

1.Diseases of the Organs

Thai Mouth Diseases Anesthesiology Musculoskeletal Diseases Reference Values /

Biomedical Research Cardiovascular Diseases Eye Diseases Nervous System Diseases Endocrine System Diseases

Global Nervous System Diseases Cardiovascular Diseases Immune System Diseases Respiratory Tract Diseases Musculoskeletal Diseases Skin Diseases Gastrointestinal Diseases Endocrine System Diseases

2.Health ProblemsNo MeSH MeSHTotal MeSH% Mrank Total46 Total46% Trank

1 Epidemiology 8,731 0.26 21 58 3.26 92 Hereditary Diseases 313,908 9.40 3 6 0.34 243 Communicable Diseases 9,628 0.29 19 114 6.41 54 Chronic Diseases 152,511 4.57 5 11 0.62 235 Accidents 78,914 2.36 9 23 1.29 196 Neoplasms 1,582,694 47.41 1 38 2.14 147 Environmental Health 13,875 0.42 16 53 2.98 118 Nutrition 154,431 4.63 4 84 4.72 79 Reproductive Health 1,582 0.05 25 55 3.09 10

10 Mental Health 8,672 0.26 22 113 6.36 611 Technology Assessment 6,114 0.18 24 24 1.35 18

12 Radiology 391,948 11.74 2 38 2.14 1513 Traditional Medicine 14,177 0.42 15 278 15.64 215 Rehabilitation 149,452 4.48 6 18 1.01 2016 Pharmacology 19,500 0.58 12 180 10.12 317 Diagnostic Reagent Kits 12,072 0.36 18 172 9.67 418 Drug Control 9,108 0.27 20 59 3.32 819 Forensic Medicine 60,574 1.81 10 3 0.17 2520 Molecular Biology 16,121 0.48 14 282 15.86 121 Human Genome 6946 0 23 25 1.4060742 1722 Primary Health Care 40179 1 11 12 0.6749156 2223 HIV 112185 3 8 40 2.2497188 1324 Thalassemia 13044 0 17 14 0.7874016 2125 Substance-Related Disorders 144670 4 7 43 2.4184477 1226 Occupational Medicine 16987 1 13 35 1.9685039 16

Kendall’s tau-b = -0.197 (p=0.168); Spearman’s rho = -0.349 (p=0.087)

2.Health Problems

1

2

3

4

5

6

7

8

9

10

11

12

13

15

16 17

18

19

20

21

22

23

24

25

26

0

2

4

6

8

10

12

14

16

18

20

22

24

26

0 2 4 6 8 10 12 14 16 18 20 22 24 26

Global Ranks

Thai

Ran

ks

Kendall’s tau-b = -0.197 (p=0.168); Spearman’s rho = -0.349 (p=0.087)

2.Health ProblemsThai Molecular Biology Traditional Medicine Pharmacology Diagnostic Reagent Kits Communicable Diseases Mental Health Nutrition Drug Control Epidemiology Reproductive Health Environmental Health Substance-Related Disorders HIV

Global Neoplasms Radiology Hereditary Diseases Nutrition Chronic Diseases Rehabilitation Substance-Related Disorders HIV Accidents Forensic Medicine Primary Health Care Pharmacology Occupational Medicine

3.Enabling Mechanisms

No MeSH MeSHTotal MeSH% Mrank Total46 Total46% Trank1 Health Policy 44,477 0.92 11 10 1.09 92 Health Services 949,351 19.56 2 14 1.53 83 Health Facilities / Health

Manpower / Health Personnel 636,212 13.10 3 166 18.12 3

4 Medical Education 80,125 1.65 9 2 0.22 125 Health Economics 334,147 6.88 4 38 4.15 56 Behavioral Sciences / Health Promotion 158,019 3.25 5 274 29.91 1

7 Medical Informatics 107,577 2.22 7 20 2.18 68 International Health Problems 12,389 0.26 12 1 0.11 139 Ethical Issues 96,121 1.98 8 8 0.87 10

10 Legislation 47,917 0.99 10 5 0.55 1112 Healthcare Quality Assessment 137,306 2.83 6 215 23.47 213 Total Quality Management 7,595 0.16 13 149 16.27 414 Health Care Evaluation

Mechanisms 2,243,501 46.21 1 14 1.53 7

Kendall’s tau-b = 0.297 (p=0.160); Spearman’s rho = 0.432 (p=0.141)

3.Enabling Mechanisms

12

3

4

5

6

7

8

910

12

13

14

0

2

4

6

8

10

12

14

0 2 4 6 8 10 12 14

Global Ranks

Thai

Ran

ks

Kendall’s tau-b = 0.297 (p=0.160); Spearman’s rho = 0.432 (p=0.141)

3.Enabling Mechanisms

Thai Behavioral Sciences / Health

Promotion Healthcare Quality

Assessment Health Facilities / Health

Manpower / Health Personnel Total Quality Management Health Economics Medical Informatics Health Care Evaluation

Mechanisms

Global Health Care Evaluation

Mechanisms Health Services Health Facilities / Health

Manpower / Health Personnel Health Economics Behavioral Sciences / Health

Promotion Healthcare Quality

Assessment Medical Informatics

National Agencies

National Agencies

Sources Priority setting report to NRC & NHF Feedback from expert panel in September 2004 Academic institutions were not included

Agencies National Research Council (NRC) Thailand Research Fund (TRF) Health Systems Research Institute (HSRI) National Center for Genetic Engineering and Biotechnology

(Biotec) Ministry of Public Health (MOPH)

Diseases of the OrgansRank

MeSH NRC TRF HSRI Biotec

MOPH

1 Mouth Diseases

2 Anesthesiology

3 Musculoskeletal Diseases

4 Reference Values / Biomedical Research

5 Cardiovascular Diseases X

6 Eye Diseases

7 Nervous System Diseases X

8 Endocrine System Diseases

9 Otorhinolaryngologic Diseases

10 Respiratory Tract Diseases

11 Kidney Diseases / Sudden Death

12 Immune System Diseases

13 Hematologic Diseases

14 Gastrointestinal Diseases

15 Urinary Tract Diseases

16 Skin Diseases

17 Liver Diseases

Health Problems 1

Rank MeSH NRC TRF HSRI Biotec

MOPH

1 Molecular Biology X

2 Traditional Medicine X X X

3 Pharmacology X

4 Diagnostic Reagent Kits X X

5 Communicable Diseases X X X

6 Mental Health

7 Nutrition

8 Drug Control X X

9 Epidemiology

10 Reproductive Health

11 Environmental Health

12 Substance-Related Disorders

13 HIV X X

Health Problems 2

Rank MeSH NRC TRF HSRI Biotec

MOPH

14 Neoplasms X X

15 Radiology

16 Occupational Medicine X

17 Human Genome

18 Biomedical Technology Assessment X

19 Accidents X X

20 Rehabilitation

21 Thalassemia X X

22 Primary Health Care

23 Chronic Diseases

24 Hereditary Diseases X

25 Forensic Medicine

Enabling Mechanisms

Rank MeSH NRC TRF HSRI Biotec

MOPH

1 Behavioral Sciences / Health Promotion

2 Healthcare Quality Assessment

3 Health Facilities / Health Manpower / Health Personnel

X X

4 Total Quality Management

5 Health Economics

6 Medical Informatics X X

7 Health Care Evaluation Mechanisms

8 Health Services X X X X

9 Health Policy X X X

10 Ethical Issues

11 Legislation

12 Medical Education

13 International Health Problems

Observations

Wide & many gaps still exist Past & Present Global situation Thai situation

Limitations of quantitative approach No systematic research database

Proposals

Further qualitative approach MeSH-based research database Further inter-disciplinary collaboration