research agenda in hpsr & community medicine
TRANSCRIPT
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แนวโนมและทศทางการวจยดานเวชศาสตรชมชนของประเทศไทย ผศ.นพ.บวรศม ลระพนธ
การสมมนาทางวชาเวชศาสตรชมชน คณะแพทยศาสตร มหาวทยาลยเชยงใหม 19 ก.ย. 59
Pix source: Supansa Tuewthaisong (PMAC 2015 World Art Contest)
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Outline
Pix source: online.wsj.com
Q1: การวจยดาน เวชศาสตรชมชน ไดแกอะไรบาง?
Q2: กลยทธในการจดกระบวนการศกษาวจยดานเวชศาสตรชมชน?
Q3: ปญหาและโจทยวจยททาทายของประเทศไทย
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การศกษาระดบหลงปรญญา การวจย และการบรการวชาการ ดานเวชศาสตรชมชน :
What & Why
Pix source: online.wsj.com
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Change Management in Higher Education
“สรรพสงตองมคณคาในการดารงอย”• ไมใชมเฉยๆ ตองพสจน• สอสารเองอาจไมนาเชอตองหาเพอนมาชวย สรางหลกฐาน/สารสนเทศยนยน
Source: Vicharn Panich. Keynote for DFC3 Learn & Share Session, August 4th, 2013; Pix source: http://th.wikipedia.org/
= “ทำและสอสาร”
“ทำอะไร? และสอสารอยางไร?”
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Change Agent Changes What?
• Thailand1970s – RuralHealth
Pix source:Pix source: www.si.mahidol.ac.th/th/department/surgery/dept_news_detail.asp?n_id=194&dept_id=19
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Thailand in 1960s
Pix Source: www.nationalguard.mil
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Change Agent Changes What?
• Thailand1970s – RuralHealth• Thailand2010s– ???
“ทำอะไร? และสอสารอยางไร?”
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Change Agent Changes What?
Pix Source: https://www.facebook.com/supachai.krobtrakulchai?fref=photo
Community Health
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Pix source: www.rdic.cdd.go.th/E-book/book_city.pdf
Change Agent Changes What?
Primary Health Care
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Pix source: www.bangkokhospital.com/
Change Agent Changes What?
Primary Care
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Source: Macagba, R. L. (1985). Hospitals and Primary Health Care: An International Study from the International Hospital Federation. In M. Hardie (Ed.), World-wide survey on the Role of Hospitals in Primary Health Care. London: International Hospital Federation.
Change Agent Changes What?
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Pix source: Acad Med. XXXX;XX:00–00. doi: 10.1097/ACM.0000000000000679
Change Agent Changes What?
Primary Care
Health Systems Innovation
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Pix: B Leerapan. Lutsen Mountain, MN. Oct 2009.
Patient Safety
Change Agent Changes What?
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Pix source: Sung et al. JAMA. 2003;289(10):1278-1287
Change Agent Changes What?
Translational Medicine
“T1” “T2”
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Pix source: คณะแพทยศาสตรศรราชพยาบาล (2558). รางขอเสนองบประมาณโครงการศนยความเปนเลศพนธกรรมเฉพาะบคคลและเวชพนธรกษ
Change Agent Changes What?
Informatics & Care Coordination
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Pix source: Lewis G. Sandy (2010). AcademyHealth 2010 Annual Research Meeting June 29, 2010
Change Agent Changes What?
Informatics & Care Coordination
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Middle-class,Urban Lifestyle
Source: http://www.facebook.com/www.jantrai
Change Agent Changes What?
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Pix Source: www.bangkokpost.com, www.kapook,com
Change Agent Changes What?
Middle-class,Urban Lifestyle
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Change Agent Changes What?
Thai UHCPix Source: www.hfocus.com
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Change Agent Changes What?
Pix Source: www.hfocus.org/contrast
Policy Debates
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Change Agent Changes What?
Pix Source: www.hfocus.org/contrast
Policy Debates
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Health System’s Performance
Pix source: WHO (2000). World Health Report 2000.
Change Agent Changes What?
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Change Agent Changes What?
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• Global Health Issues:
– PMAC2007: Improving Access to Essential Health Technologies: Focusing on Neglected Diseases, Reaching Neglected Populations
– PMAC2008: Three Decades of Primary Health Care: Reviewing the Past and Defining the Future
– PMAC2009: Mainstreaming Health into Public Policies
– PMAC2010: Global Health Information Forum
– PMAC2011: 2nd Global Forum of Human Resources for Health: Reviewing Progress, Renewing Commitments to Health Workers towards MDGs and Beyond
Pix source: www.pmaconference.mahidol.ac.th
Change Agent Changes What?
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• Global Health Issues:
– PMAC2012: Moving Towards Universal Health Coverage: Health Financing Matters
– PMAC2013: A World Against Infectious Diseases: Cross-sectoralsolutions (“One Health”)
– PMAC2014: Transformative Learning for Health Equity
– PMAC2015: Global Health Post 2015 Accelerating Equity
– PMAC2016: Priority Setting for Universal Health Coverage
Pix source: www.pmaconference.mahidol.ac.th
Change Agent Changes What?
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Source: www.nejm.org/doi/full/10.1056/NEJMp1510082?query=featured_home&
Change Agent Changes What?
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What Exactly Is Community Medicine?
Q: What do you mean by Community Medicine?
①Health Assessment/Interventions in Community Settings
②Preventive Medicine: Occupational Med, Travel Med, etc.
③Health Promotion at the Population Level
④Healthcare Management, Healthcare Organization Study, Health Policy Analysis, Health Systems Governance
⑤EBM/Epidemiology/Biostatistics, Qualitative Research, Modeling, MMR, Decision Science, Economic Evaluation
= “Health Systems, Population/Global Health”
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What Exactly Is Community Medicine?
CareDeliveryDesign&
SystemsMgmtSDH&
HealthPromotion
ClinicalMedicine
KM&ResearchMethodology
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Different Levels of Health Systems
Pix source: de Savigny & Adam (2009); Reich & Takemi (2015)
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การศกษาระดบหลงปรญญา การวจย และการบรการวชาการ ดานเวชศาสตรชมชน :
What & How
Pix source: online.wsj.com
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Understandingpopulation health
Assessing/Analyzingpopulation health
Improvingpopulation health
RACM3XX:Community Health and Primary Health Care
RAID6XX:Practicum in Healthcare Management
RAID5XX:Health Promotion inClinical Practices and in
National/Global settings
RAID4XX:Health Promotion & Healthcare Management
in Community Hospital Settings
• Epidemiology
• Sociology• Anthropology
• Systems Thinking
• Preventive Med
• Patient Safety• Research Methods
(QUAN/QUAL/MMR)
• Org Theory
• Org Behavior• Systems
Engineering• Informatics• EBM
• Political Economy
• Health Law• Health Economics
• Health Technology Assessment
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Post-grad Training: HowHealth Promotion at the Individual
Health Level
• Preventive
medicine
specialties
Health Promotionat the Population
Health Level
• Practices of
community
health
• Health policies
Healthcare Management
• Healthcare
governance
• Quality and
patient safety
• Informatics
• HTA
Research Methodology
• QUAN
• QUAL
• MMR
Postgrad?:• MD
Residency
• Master’s• PhD
• Post-doc
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Evidence-informed Health Policy-making in Thailand
Source: Green & Bennett (2007). Sound choices: enhancing capacity for evidence-informed health policy. 2013/7/15
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What Are Our Academic Services?
• WhyWisdom
• HowKnowledge
• What,Who,When,WhereInformation
• Number,Text,Picture,Sound,etc.Data
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New Health Research Mapping?
Source: Hoffman et al. (2012). A Review of Conceptual Barriers and Opportunities Facing Health Systems Research to Inform a Strategy from WHO.
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New Health Research Mapping?
Source: Hoffman et al. (2012).
Ø Differentkindsofknowledgeneeded?
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MD Training in Quality & Patient Safety
Pix source: www.who.int/patientsafety/en; de Savigny & Adam (2009); Scheerens and Bosker (1997)
“Undergrad?” “Postgrad?”
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Pix source: www.hms.harvard.edu/hfpsq/
MD Training in Quality & Patient Safety
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Source: www.hopkinsmedicine.org/armstrong_institute
MD Training in Quality & Patient Safety
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Source: residency.medicine.duke.edu/duke-program/training/management-and-leadership
MD Training in Quality & Patient Safety
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• วว., อว. เวชศาสตรปองกน – สาขาเวชศาสตรปองกน (แขนงระบาดวทยา)– สาขาเวชศาสตรปองกน (แขนงเวชศาสตรการบน)– สาขาเวชศาสตรปองกน (แขนงเวชศาสตรปองกนคลนก)– สาขาเวชศาสตรปองกน (แขนงสาธารณสขศาสตร)– สาขาเวชศาสตรปองกน (แขนงสขภาพจตชมชน)– สาขาเวชศาสตรปองกน (แขนงอาชวเวชศาสตร)– สาขาเวชศาสตรปองกน (แขนงเวชศาสตรการเดนทางและการทองเทยว)
Residency Training in Preventive Med
Source: http://www.tmc.or.th/train05_1.php
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Pix source: www.facebook.com/piyawan.limpanyalert
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Master’s/PhD in Health Policy
Source: http://healthpolicy.fas.harvard.edu/curriculum/
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Master’s/PhD in Health Policy & Systems Research
Source: http://www.sph.umn.edu/academics/programs/phd/hsrpa/
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Source: http://globalhealth.washington.edu/education-training/phd-gh
Master’s/PhD in Global Health
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Beyond New Degree Programs?
Old Paradigm New Paradigm
Relying on interest and capacity of individual faculty members
Building an organizational capacity
อ.ไพบลย - Health Systems Perforamnce, Road Safety, EMSอ.วชย -- The Thai National Health Examination Surveyอ.วชช -- NCD, Health Promotion
• Fellowship in Injury Prevention• Evaluation Research Fellowship• Fellowship in Cohort Study• Fellowship in HIV/ADIS P&P• Fellowship in NCD P&P
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Food-for-Thought
Pix source: online.wsj.com
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• “ขอไดเปรยบของการวจยในมหาวทยาลย คอการมนกศกษาระดบบณฑตศกษาเปนกำลงสำคญ”
• “บณฑตศกษา โดยทวๆ ไปม 3 แบบ:1) เพอสรางนกวจยหรอสรางนกสรางความร ตองเลอกชกจง
นกศกษาทมสตปญญาสงมาเรยน และตองจางเรยน
2) เพอสรางผมความรเพมขนจากระดบปรญญาตร
3) เพอใหได “กระดาษ” แสดงวทยฐานะไวเชดชหนาตา”
Source: วจารณ พานช (2539). บรหารงานวจย: แนวคดจาดประสบการณ; Pix source: http://th.wikipedia.org/
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• “แนวคดอกอยางทผมไมคอยเหนดวย คอ พวกเราชอบเปดสอนปรญญาโทและปรญญาเอกเรวเกนไป ถาอาจารยเรายงไมมวชาการทเขมแขงกไมตองรบเปดปรญญาโทและปรญญาเอก เพราะวาจะเปนบาป อาจารยจบใหมตองพฒนาตวเองใหแขงกอน โดยทำวจยและลงพนทเปนหลก ไมใชจดการสอนเปนหลก ถาไมระวงเรองน อาจเปนการสนสดความสามารถทางวชาการตงแตเรมตงตว”
Source: วระศกด จงสววฒนวงศ (2550). แนวคดและทศทางการพฒนาสถาบนการศกษาสาธารณสข; Pix source: www.manager.co.th/campus/
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“มหาวทยาลยทวไปโดยทวไปมกอยากใหเดกจบออกไปหางาน
แตทนเราประกาศศกดาเลยวา เราสรางคนใหออกไปสรางงาน มนจะตกงานกเรองของมน แตในความเปนจรงเราสรางใหมนม
ความคดสรางสรรค คอใหเขาพบตวเขาเอง” --สกร เจรญสข
Source: artbangkok.com; Pix Source: sarakadee.com
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“If I had asked people what they wanted, they would have said faster horses.”
--Henry Ford
Pix source: en.wikipedia.org/wiki
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Pix: B Leerapan. Lutsen Mountain, MN. Oct 2009.
• เรากำลงอยทไหน? (Where are we now?)
• เรากำลงเดนทางไปทไหนและเมอไหร?
(Where are we going to, and when?)• เราจะเดนทางไปสจดหมายไดอยางไร?
(How are we going there?)
• เราตองทำอะไรบางทจะไปถงจดหมาย?(What do we need to do to be there?)
• รไดอยางไรวาเราไปถงจดหมายปลายทางแลว? (How do we know if we arrive there?)
การเรยนและการทำงานเปรยบเสมอนการเดนทาง
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การสะทอนประสบการณสวนตว
Self-ReflectionPix source: B Leerapan, Rayong , Dec 2013
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Pix source: www.facebook.com/Openworlds/photos/
ชวตทมคณคาและมความหมาย Begin with the End in Mind
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Pix source: www.noogenesis.com/pineapple/blind_men_elephant.html
John Godfrey Saxe's ( 1816-1887) version of the famous Indian legend
ทานมองเหนตวอะไร? “What has you seen?”
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Pix source: www.simoncamilleri.com/the_truth_of_the_elephant/
การคดเชงระบบ Systems Thinking