Abstract
Background: The “30-Baht Treatment Anywhere with a Single ID Card” policy, launched in 2024,
leverages digital health to challenge equitable access to care. Policy success, however, depends not
only on its design but on the implementation capacity of service facilities.
Objective: To assess determinants of policy adoption and implementation through changes in
outpatient service utilization at the Sawanpracharak Hospital pilot site.
Methods: A convergent parallel mixed-methods design was employed between May–August 2025.
The qualitative strand used purposive sampling to recruit 14 staff from 7 professional groups for individual
in-depth interviews via a semi-structured interview guide developed from the consolidated framework
for implementation research (CFIR) version 2.0. Thirty-five qualitative of 43 CFIR constructs, with quantitative
weekly time-series data for outpatient visits were analyzed for type 2 diabetes (E11) and hypertension
(I10–I15) patients, comparing 2024 (36 weeks) against a 2019–2023 (240 weeks) baseline using
one-sample t-test, Welch’s t-test, Cohen’s d, Bootstrap 95% CI (10,000 resamples), and Wilcoxon signedrank
test.
Results: Qualitatively, 71.4% of the assessed constructs (25/35) were facilitators of policy implementation.
Key enablers included adaptability (+2), leadership engagement (+2), staff self-efficacy and
stage of change (+2), and structured implementation processes including planning, executing, and reflecting
(+2). Four structural barriers (–2) were identified: evidence quality, cost, available resources, and
workflow compatibility. Quantitatively, outpatient utilization in 2024 increased significantly. Diabetes
visits rose +19.8% (from 870 to 1,042 visits/week; Cohen’s d = 1.040, p < 0.001) and hypertension visits
rose +16.9% (from 1,450 to 1,695 visits/week; Cohen’s d = 0.896, p < 0.001), both exhibiting large and
robust effect sizes confirmed by sensitivity analyses. However, I10–I15 showed non-significant increase
from the 2-year baseline (p = 0.100), suggesting a pre-existing secular trend.
Conclusion: The implementation success reflected the alignment between organizational capability—
people and processes—and structural support at the policy level. The four main barriers lay
beyond hospital control, the nationwide scale-up required prior fix on reimbursement gaps, operational
costs, and compatible digital system–workflow. Nevertheless, the single-site design limited generalization
including high digital capacity of the pilot hospital. The quantitative analysis of aggregate-level data could
not effectively control for secular trends or external confounders.
