Abstract
In response to the COVID-19 pandemic crisis over the past two years, the Ministry of Public Health had implemented several measures and policies to lower the risk of contracting the coronavirus and enhance the safety of health services for both patients and health care workers. The alleviation of hospital’s overcrowding situations was one of the most significant policies being the impetus for the mailed-order medication system (MOMS), the system offering a continued access to medication services for patients at homes. This study aimed to examine the situations, strengths, weaknesses, opportunities, threats, and the quality of the MOMS among patients with diabetes mellitus before and during the COVID-19 pandemic, and to establish policy recommendations for the future MOMS. This research had employed the Mixed Method Approach and adapted the World Health Organization's Six Building Blocks as the research framework to evaluate the MOMS in diabetic patients before and during the COVID-19 pandemic situation in the six public hospitals throughout Thailand. Data were collected between January and December 2021, using semi-structured interviews with senior officials from the Ministry of Public Health, professional councils, hospitals’ staff, and mailing operators. Interviews and self-administered questionnaires about satisfaction towards the MOMS were applied to diabetic patients who received the mail-order medication service. Content validity was determined by 5 experts. The range of Index of Item-Objective Congruence was 0.60-1.00. The items that had scores lower than 0.5 were revised. Cronbach alpha of satisfaction questionnaire was 0.91. Qualitative data were analyzed using the Content Analysis Method and quantitative data were examined through frequency and percentage distribution. The study found that prior to the outbreak of the COVID-19 pandemic, four out of six hospitals had already distributed medications to minimize hospital overcrowding situations using the MOMS. Nonetheless, because of the COVID-19 pandemic, all six hospitals supplied all diabetic patients regardless their health insurance entitlements with the MOMS as their major mean to serve patients both within and beyond the hospital's catchment areas. Each hospital's MOMS was the integration of the multidisciplinary efforts involving the use of patient records and technologies to assist both patients and medical staff, such as scheduling a check-up or drug pickup date through an application or using the telepharmacy and the telemedicine systems to examine and explain drug use to patients, or to inquire about a variety of health issues interactively. On average, patients with stable diabetic symptoms were prescribed medication every two to three months and were asked to revisit their physicians once or twice a year. The mailed-order medication service fee was between 50 and 100 baht and the delivery took one to two days on average, and two to three days for remote areas. The MOMS was able to help the hospitals to reduce the number of outpatient department capacity by 20 to 30 percent, lowered the burden of pharmacists and related staff during rush hours, decreased patient waiting time for medications by 10 to 20 percent, and was able to save travel expenses for patients. For all six hospitals, the MOMS had just a small number of errors such as unsuccessful or misplaced deliveries. When patients received their parcels, mailed-order medication physically arrived in decent conditions, since the foil packaging was unbroken, and the quantities matched with their original prescriptions at hospitals. Overall, more than 95 percent of diabetic patients were satisfied with the MOMS. Policy recommendation is that although the MOMS helps improve patient’s access to and coverage of health services, particularly in times of crisis, there are additional restrictions on medications that are not pills. This may necessitate temperature control and special transport and delivery procedures. In addition, patients should not be responsible for the incurred cost of mailed-order medication; rather, the government should cover such charges by allowing each health insurance fund to be responsible for disbursing the cost of medication delivering fee according to the health insurance entitlements of patients. Also, the professional councils, the Ministry of Public Health, the National Health Security Office, and mailing operators must explicitly define the practical standard for the MOMS. Additionally, pre-existing healthcare networks in communities, such as community hospitals, sub-district health promoting hospitals, drugstores, and village health volunteer networks should be employed as alternatives to assist in the delivery of medicines according to community needs.
