Thammasat University Hospital Journal Online

The SPIN TUH Transitional Care Model for Heart Failure Patients to improve quality of life

2026-06-19T10:38:11+07:00

Background: Heart failure is a chronic condition associated with high rates of hospital readmission, particularly during the transition from hospital to home. This vulnerable transitional period often reflects gaps in continuity of care, leading to adverse clinical outcomes, reduced quality of life, and increased healthcare resource utilization. At Thammasat University Hospital, the 90-day readmission rate among patients with heart failure remained high, highlighting the need for a structured and comprehensive transitional care system.

Objectives: This study aimed to 1) reduce the 90-day hospital readmission rate among patients with heart failure to less than 10%, 2) increase the proportion of patients receiving guideline-directed medical therapy (GDMT) to more than 85%, and 3) improve patients’ quality of life to more than 90%.

Methods: The SPIN TUH Transitional Care Model for Heart Failure Patients was developed and implemented using the Plan–Do–Study–Act (PDSA) quality improvement framework in collaboration with a multidisciplinary healthcare team. Key components included structured discharge planning using a Heart Failure Discharge Checklist, post-discharge follow-up via telemedicine and telenursing within 72 hours and 7 days after discharge, and the provision of consultation and education for patients and caregivers through a Line Official Account. Educational materials and self-monitoring booklets were provided to enhance self-care knowledge and skills. Pharmacists, dietitians, and physical therapists were actively involved in post-discharge follow-up, with telephone monitoring used for patients unable to access mobile applications. Outcomes were evaluated using Objectives and Key Results (OKRs).

Results: Following implementation of the SPIN TUH Transitional Care Model, the 90-day hospital readmission rate decreased to 6.08%. All patients (100%) received guideline-directed medical therapy. The mean quality of life score among patients with heart failure increased to 94.77%.

Conclusion: The SPIN TUH Transitional Care Model effectively enhances continuity of care during the hospital-to-home transition for patients with heart failure. The model contributes to reduced hospital readmissions, optimized adherence to guideline-directed medical therapy, improved self-management, and significantly better quality of life. This structured, multidisciplinary transitional care approach represents a sustainable framework that may be adapted to improve outcomes for patients with chronic conditions in similar healthcare settings.

Development of an integrated Diabetic Ketoacidosis fast track system

2026-06-19T10:57:03+07:00

Background: Diabetic Ketoacidosis (DKA) is an acute, life‑threatening condition that can cause serious harm or death without timely, appropriate management. Consequently, the Thammasat Diabetes Center of Excellence developed the "DKA fast track " system. This initiative aims to ensure that DKA patients receive rapid and accurate treatment in accordance with established standards, to reduce treatment duration and mortality.

Objective: Attain "out of DKA" status within 18 hours in over 80% of diabetic ketoacidosis patients.

Materials and Methods: The DKA fast track system was designed to streamline care for DKA patients through staff training, clear protocols, and multidisciplinary teamwork. Developed features include enhanced screening and diagnostics, expedited lab reporting, efficient patient transfers, and systematic monitoring with continuous care guidelines.

Result: Faster screening, diagnosis, and treatment improved DKA outcomes. For mild to moderate DKA, 91.67% of patients recovered within 18 hours (time reduced from 15.43 to 9.18 hours). For severe DKA, 63.21% achieved recovery in 18 hours (from 18.08 to 15.56 hours). Labs reported 86.8% of results within 30 minutes. All DKA patients were transferred to wards within 30 minutes. The 28-day readmission rate was 1.92%, and mortality was 0%.

Conclusion: The success rate for achieving "out of DKA" status within 18 hours met the established goals in mild to moderate DKA. The development of the DKA fast track system enables rapid diagnosis and provides comprehensive care for DKA patients across all dimensions.

ผลของการจัดท่านอนต่อค่าความอิ่มตัวของออกซิเจนในเลือดในทารกเกิดก่อนกำหนด

2026-06-19T11:03:18+07:00

Background: This experiment study aimed to compare the effect of positioning on oxygen saturation in premature infants. This study was a quasi-experimental research.

Objective: The aim of compare the effect of positioning on oxygen saturation in premature infants who were admitted to neonatal intensive care unit.

Material and methods: Base on the inclusion criteria. 27 babies of gestational age less than 37 weeks were eligible for entry in to study. Infants were studied in 3 position between supine, side-lying and prone positions. Each of them was initially kept in supine 5 minutes for prepare then kept First position in supine for 120 minutes after 5 min for rest. Then in side-lying and prone positions, respestively. During this period, SpO₂ parameters were record every 30 min and data were analyze. Statistical analysis used were descriptive, Kolmogorov-Smirnov, Shapiro-Wilk and Friedman Test.

Result: The result showed that were significant differences in SpO₂ in supine, side-lying and prone positions p-value = .049 and were significant differences in SpO₂ in supine, side-lying positions at 30 min p-value= .016. However, the Average of SpO₂ in prone position is highest in all three positions (97.82, SD=1.63).

Conclusion: The prone position most effectively promotes arterial oxygen saturation and is appropriate for the care of preterm infants in the neonatal intensive care unit.

Improving the Quality of Pediatric Palliative Care: From Compassion to Sustainable Care

2026-06-19T11:07:48+07:00

Background: The development of a pediatric palliative care system using the Plan–Do–Study–Act (PDSA) approach, in collaboration with a multidisciplinary team, resulted in more systematic, comprehensive, and continuous care. The model incorporated individualized assessments of patients’ problems and needs, structured family meetings, and comprehensive advance care planning. Patients received effective symptom management, particularly for pain, which could be controlled within four hours. This led to a significant reduction in in-hospital mortality. Additionally, the average length of hospital stay and healthcare costs decreased, along with a lower rate of readmission. Family satisfaction was high, reflecting the effectiveness of the care system in significantly improving the quality of life of both patients and their families.

Objectives: 1. To develop a structured pediatric palliative care model and 2. To improve the quality of life of pediatric patients and their families.

Methods: This quality improvement initiative applied the Plan–Do–Study–Act (PDSA) framework. Patients and families were assessed by a multidisciplinary team to identify needs and develop individualized care plans. Family meetings facilitated communication, shared decision-making, and advance care planning. Coordination between hospital and home was emphasized to ensure continuity of care.

Results: The most common symptoms were dyspnea, pain, and drowsiness (71%, 57%, and 38%, respectively). All patients had access to opioid medications, and 88.9% achieved pain control within four hours. Family meetings and advance care planning were conducted for all patients. The in-hospital mortality rate decreased to 37%, and the average length of stay decreased to 23 days. The 28-day readmission rate was 4.76%. The average healthcare cost per admission decreased to 315,434.18 THB. Family satisfaction reached 98.8%.

Conclusion: The PPC care model improved symptom control and continuity of care, reduced in-hospital mortality, length of stay, and healthcare costs, and increased family satisfaction with care.

Bilateral ovarian coexistence of mature cystic teratomas and endometriomas: a unique case report

2025-12-11T15:23:18+07:00

Ovarian mature cystic teratomas (MCTs) and ovarian endometriomas represent highly prevalent benign ovarian lesions in women of reproductive age. While their individual occurrence is common, the ipsilateral coexistence of both lesions within the same ovary is rare, and their bilateral ovarian coexistence has not been found. A 33-year-old nulligravid woman presented with a gradually enlarging pelvic mass. Serum tumor markers, CA125 and CA19-9, were elevated. Imaging studies revealed bilateral ovarian masses consistent with MCTs, with a suspected collision tumor on the left ovary. The patient underwent bilateral salpingo-oophorectomy. Histopathology confirmed the presence of MCTs and endometriomas in both ovaries. Multiple cystic follicles were also observed bilaterally. Based on the available literature, this study describes the first documented case of bilateral ovarian coexistence of mature cystic teratomas and endometriomas, supported by detailed macroscopic and microscopic findings.

Artificial intelligence technology with holistic health: A Systematic Review

2025-12-11T13:35:47+07:00

Background: In an era of rapid technological advancement, Artificial Intelligence (AI) has become a key driver of transformation across various sectors, especially in the field of holistic health, which encompasses physical, mental, social, and spiritual well-being. AI enhances the diagnosis, treatment, and prevention of diseases through big data analytics and machine learning, along with the development of personalized health programs. Both international and domestic data highlight the increasing application of AI in healthcare systems, such as diagnostic imaging, mental health screening using chatbots, and telemedicine systems. AI helps alleviate the workload of healthcare professionals and improves access to high-quality healthcare services sustainably.

Objective: The objective of this study is to present an approach for integrating AI into the promotion of holistic health.

Materials and methods: This research adopts a systematic documentary research method to answer the research question. Data were systematically collected from three major academic databases (TCI, Google Scholar, and Journals Ranked Q1-Q3 in Scopus and Web of Science) based on selection criteria, focusing on documents published between 2014-2024 that link AI with the four dimensions of holistic health. A total of 45 articles were selected for detailed analysis and synthesis of findings.

Results: AI plays a significant role in all aspects of holistic health. In physical health, AI is used to analyze medical images, assist in disease diagnosis, and monitor patient conditions accurately. In mental health, AI has been developed through applications and chatbots that effectively assess stress, depression, and provide initial guidance. In social health, AI helps reduce disparities through telemedicine systems, which enhance access to healthcare services for people in remote areas. For spiritual health and Intellectual Health, AI supports programs for meditation, mindfulness, and self-reflection, promoting inner peace and connection to life values.

Conclusion: The integration of AI in the holistic health system enhances healthcare across physical, mental, social, and spiritual dimensions, improving the accuracy of disease diagnosis and treatment, supporting mental health management, and reducing disparities in social and healthcare.

Effects of a Discharge Planning Program Combined with Fatigue Management on Self-Care-Self-Efficacy, Fatigue, and Post Stroke Recovery among Patients with acute stroke

2025-12-22T14:33:55+07:00

Background: Stroke is a major cause of disability that requires continuous care. With appropriate rehabilitation initiated during the acute phase, patients can achieve improved self-care ability. However, fatigue is a significant barrier that reduces the effectiveness of rehabilitation. Therefore, integrating discharge planning with systematic fatigue management is critically important.

Objective: To examine the effects of a Discharge Planning Program Combined with Fatigue Management on Self-Care-Self-Efficacy, Fatigue, and Post Stroke Recovery.

Material and methods: This quasi-experimental study with repeated measures and a control group included 50 acute stroke patients, divided equally into experimental and control groups (25 each). Outcome measurements were assessed at baseline, Week 4, and Week 12. Instruments used included a general and clinical data form, Self-Care Self-Efficacy Scale (SCSEs), Fatigue Severity Scale (FSS), Barthel Activities of Daily Living (ADL), and Modified Rankin Scale (mRS), with reliability coefficients of .913, .949, .885, and 1.00 respectively. Data were analyzed using descriptive statistics, Chi-square tests, t-tests, and repeated measures ANOVA.

Results: The participants ranged in age from 42 to 80 years (Mean = 61.10, SD = 9.90).
The results showed that the experimental group had significantly higher mean scores for SCSEs and ADL than the control group (F₁,₄₈ = 7.484; p < .01 and F₁,₄₈ = 0.071; p < .001, respectively). In addition, the experimental group had significantly lower mean scores for FSS and mRS than the control group (F₁,₄₈ = 26.771; p < .001 and F₁,₄₈ = 0.021; p < .01, respectively).

Conclusion: The study found that the program enhanced patients’self-care confidence, reduced fatigue, and promoted recovery. Therefore, systematic implementation of the program, together with capacity building of healthcare personnel, can improve the effectiveness of post stroke rehabilitation.

Knowledge and renal complication prevention behaviors among diabetic patients attending the diabetes clinic at a subdistrict health promoting hospital in Phuket Province

2025-12-25T16:12:12+07:00

Background: The incidence of diabetes is continuously increasing, leading to various health complications, particularly diabetic kidney disease, which adversely affects patients’ quality of life. Appropriate knowledge and health care behaviors among diabetic patients can contribute to the prevention of renal complications.

Objective: To examine the level of knowledge and preventive behaviors regarding renal complications, and to investigate factors associated with renal complication prevention behaviors among diabetic patients attending the diabetic clinic at Sri Sunthon subdistrict health promoting hospital, Thalang District, Phuket Province.

Material and methods: A descriptive cross-sectional study. The sample consisted of 87 diabetic patients without renal complications. Participants were purposively selected from the medical records of diabetic patients. The instruments were a questionnaire comprising personal information, knowledge, and renal complication prevention behaviors. Data were analyzed using frequency, percentage, mean, standard deviation, Chi-square test, and Fisher's exact test. The level of statistical significance was set at .05.

Result: The results showed that 48.28% of the participants had a moderate level of knowledge ( = 9.51, SD = 2.10). Preventive behaviors toward renal complications among 70.11% of the participants were also at a moderate level ( = 67.59, SD = 10.78). Sex, educational level, occupation, and history of receiving information on renal complication prevention were factors significantly associated with renal complication prevention behaviors (p-value < .05).

Conclusion: Relevant agencies can utilize these findings to plan and develop appropriate programs or activities for providing education and promoting health behaviors for diabetic patients to prevent renal complications. Implementation should consider differences in gender, educational level, occupation, and receiving information on renal complication prevention.

Relationship Between Knowledge and Stroke Risk Behaviors Among Hypertensive Patients at Phayao Hospital: A Cross-Sectional Analytical Study

2025-12-11T10:33:58+07:00

Background: The relationship between knowledge about disease and behavioral changes among patients with chronic non-communicable diseases remains unclear, particularly due to the limited number of studies conducted in Thailand.

Objective: To study the relationship between knowledge and stroke risk behaviors among patients with hypertension.

Methods: This cross-sectional analysis collected data from patients with hypertension in Phayao Hospital. Data was collected in June 2025 using a questionnaire divided into three parts: (1) general information, (2) knowledge about stroke, and (3) stroke risk behaviors. The relationship between knowledge and stroke risk behaviors was analyzed using linear and logistic regression controlled for gender, age, marital status, occupation, education level, income, comorbidities, and family history of illness.

Results: Among 378 respondents, 73% demonstrated a high level of knowledge about stroke, while 84.4% exhibited moderate risk behaviors for stroke. However, there was no statistically significant relationship between knowledge level and risk behaviors for stroke, regardless of whether the analysis was performed using linear regression (adjusted unstandardized beta coefficient in the high-knowledge group compared to the low-knowledge group was .01 [95% CI: −0.14, 0.17]). The logistic regression (adjusted odds ratio for moderate-to-high risk behaviors in the high-knowledge group compared to the low-knowledge group = 2.08 [95% CI: 0.40, 10.76]).

Conclusion: This study did not find a relationship between knowledge level and risk behaviors for stroke among patients with hypertension. Further large-scale study is required to confirm these findings.

Development of an information system Development and evaluation of an information system for rational antibiotic prescribing: A case study at Thammasat University Hospital

2025-12-03T10:03:59+07:00

Background: Rational Drug Use (RDU) is a cornerstone of the National Drug Policy aimed at ensuring patient safety. However, the evaluation of rational antibiotic prescribing at Thammasat University Hospital currently faces limitations regarding the comprehensiveness of evaluative factors. These include indications, dosage, duration, administration routes, monitoring and reporting, system accessibility, and timeliness.

Objective: To develop and assess the performance of a clinical information system designed for rational antibiotic use evaluation.

Material and methods: This study follows a Research and Development (R&D) design, divided into three distinct phases. Phase I involved a situational analysis to identify existing problems and system requirements. Phase II focused on the development and pilot testing of the system. In Phase III, the system’s efficiency and user satisfaction were evaluated via questionnaires distributed to three expert evaluators: two infectious disease specialists and one clinical pharmacist, all of whom serve on the Infection Prevention and Control Committee at Thammasat University Hospital. Data were analyzed using descriptive statistics.

Result: The Information System for Rational Antibiotic Use Evaluation categorizes users into two primary groups: Evaluators, who have access to data entry for assessment and a dashboard for monitoring results; and Administrators, who manage evaluator profiles and access comprehensive monitoring dashboards. The system demonstrated high performance across three domains: data quality, reporting format, and operational efficiency, achieving an overall highest level (Mean ± SD, 4.38 ± 0.85). Furthermore, overall user satisfaction was reported at a highest level (Mean ± SD, 4.24 ± 1.03).

Conclusion The developed system enhances operational efficiency in promoting rational antibiotic use by providing essential data to support informed decision-making for clinical guideline development. Additionally, it streamlines inter-professional communication among relevant healthcare providers.

Factors Affecting to Breast Cancer Screening among Women, Chaiyaphum Province

2025-11-10T10:21:25+07:00

Background: Breast cancer is a major public health problem and a leading cause of morbidity and mortality among women worldwide. Early detection can cure and reduce mortality. Multiple factors influence women’s participation in breast cancer screening.

Objectives: To examine breast cancer screening practices and factors affecting breast cancer screening among women in Chaiyaphum Province.

Materials and methods: This study employed a cross-sectional analytical study. The sample consisted of 396 women aged 40–69 years residing in Chaiyaphum Province, selected using multistage random sampling. The research tools were questionnaires, including knowledge about breast cancer, perception of the severity of breast cancer, perception of the risk of developing breast cancer, expectations of the outcome of breast cancer screening, expectations of breast cancer screening capacity, and social support. The instruments demonstrated reliability coefficients of 0.74, 0.86, 0.77, 0.82, 0.87, and 0.79 respectively. Data were collected from August to October 2024. Descriptive statistics and logistic regression analysis were used to analyze the data.

Results: (1) A total of 47.98% of participants had previously undergone breast cancer screening. (2) The factors significantly associated with breast cancer screening were: Age 50 – 59 years (AOR = 2.09, 95% CI = 1.21–3.62); Having an underlying disease (AOR = 1.80, 95% CI = 1.09–2.96); High outcome expectancy (AOR = 2.92, 95% CI = 1.66–5.17); High self-efficacy (AOR = 2.15, 95% CI = 1.34–3.44); Moderate social support (AOR = 2.58, 95% CI = 1.56–4.28); and High social support (AOR = 4.96, 95% CI = 2.58–9.52).

Conclusion: Community nurses can take factors such as age, underlying diseases, outcome expectancy, outcome self-efficacy, and social support can be applied in the development of activities to promote breast cancer screening.

The effects of a health education program on behavior modification for the prevention of liver fluke infection and cholangiocarcinoma among village health volunteers in Kanthararom District, Si Sa Ket Province

2026-01-26T11:18:42+07:00

Background: Liver fluke infection and cholangiocarcinoma remain major public health problems in northeastern Thailand, requiring proactive community-based prevention strategies. Developing a health education program tailored to the local context is therefore essential to enhance knowledge, awareness, and sustainable preventive behaviors.

Objective: To examine the effects of a health education program on knowledge, health beliefs, preventive behaviors, and the rate of liver fluke egg detection.

Material and Methods: This quasi-experimental study was conducted among 80 village health volunteers in Kanthararom District, Si Sa Ket Province. Participants were randomly assigned into an experimental group (n = 40) and a comparison group (n = 40). The intervention consisted of a health education program, and data were collected using a structured interview questionnaire. Data were analyzed using descriptive statistics (frequency, percentage, mean, standard deviation) and inferential statistics (Paired t-test, Independent t-test, McNemar’s test, and Chi-square test). Statistical significance was set at 0.05.

Results: After the intervention, the experimental group demonstrated significantly higher mean scores in knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action, self-efficacy, and preventive practices compared with both baseline and the comparison group (p < 0.001). Perceived barriers significantly decreased (p < 0.001). Additionally, the prevalence of liver fluke eggs in the experimental group decreased from 100.0% to 10.0% (p < 0.001), whereas no significant change was observed in the comparison group.

Conclusion: The health education program based on the Health Belief Model was effective in improving preventive behaviors against liver fluke infection and cholangiocarcinoma among village health volunteers. The program can be effectively applied to populations living in high-prevalence areas, particularly those with raw fish consumption behaviors.

Association of Adversity Quotient and Negative Life Event, and Stress Level of Community Public Health Students

2025-12-18T13:40:37+07:00

Background: Mental health issues among Thais are steadily increasing, particularly within the youth demographic where high stress levels are prevalent. Failure to adapt to these challenges may lead to depression and potential suicide in the future.

Objective: To assess the stress levels of community public health students and to examine the relationships between student stress and individual factors, adversity quotient (AQ), negative life events, and access to counseling services.

Material and method: A descriptive research study. The sample consisted of 300 community public health students from years 1-4 in the first semester of the academic year 2067. Individual factors, Adversity Quotient, Negative life events, stress, and access to counseling services were studied using Nominal logistic regression statistics.

Result: The results revealed that the majority of students experienced high stress levels (44.7%). Regarding potential factors, 50.3% reported a moderate adversity quotient, 46.0% experienced low levels of negative life events, and 33.7% had moderate access to counseling services. Factors significantly associated with stress included financial status and negative life events; students with insufficient monthly income were 1.98 times more likely to experience high stress than those with sufficient income (p<.001). Furthermore, students facing low and moderate levels of negative life events were 4.57 and 8.52 times more likely to experience high stress, respectively, compared to those with the lowest level of negative life events (p<.001).

Conclusion: Students experienced high levels of stress, with low monthly income and negative life events identified as significant associated factors. Consequently, proactive mental health screening systems and counseling services should be developed, alongside the establishment of emergency scholarship programs and financial management training to support students.

Effect of a Wooden Tongue Depressor Technique Targeted Resistive Exercise in Enhancing Tongue Elevation Pressure for Older Adults: A Randomized Controlled Trial

2025-12-22T12:58:29+07:00

Background: Oral sarcopenia is a significant risk factor for dysphagia. While the Iowa Oral Performance Instrument (IOPI) is effective for rehabilitation, its high cost limits accessibility. This study evaluated a low-cost wooden tongue depressor tool using a fixed-fulcrum lever system to improve tongue function in older adults.

Objective: To evaluate the efficacy of a calibrated wooden tongue depressor technique for enhancing tongue pressure and endurance.

Methods: A randomized controlled superiority trial was conducted with 41 participants aged 50 and older (intervention n=23, control n=18). The intervention group also performed twice-daily training for 8 weeks using a wooden tool calibrated to 60% of their maximum tongue pressure (MTP). Outcomes included MTP and endurance tongue pressure (ETP) measured by IOPI. Statistical analysis compared change scores from baseline.

Results: After 8 weeks, the intervention group showed significantly greater ETP improvement than the control group (p = .008). Mean MTP improvement in the intervention group (3.35 kPa) was higher than in the control group (0.21 kPa). Within-group improvement for the intervention group approached significance
(p = .054).

Conclusion: The wooden tongue depressor technique effectively improves tongue endurance. This accessible, low-cost tool provides a practical alternative for home-based rehabilitation to prevent the progression of oral frailty.

Physician: Offenses Against Professional Ethics and The Exercise of Rights under Administrative Law

2025-12-18T13:53:03+07:00

Practicing medicine, doctors should comply with professional ethics in order to build trust in service recipients according to the expectations of society. The actions of doctors who violate ethics have resulted in society wanting to investigate more violations of medical ethics, both by filing complaints with professional organizations and by filing lawsuits with the Administrative court.

The Medical Council is a professional organization responsible for overseeing practitioners. In case the complaint is grounded, an ethics subcommittee will be established. The investigation results of the subcommittee will be reported to the Medical Council Committee along with recommendations for disciplinary actions, which may include warnings, on the proposal to impose ethical penalties. probation, suspension or revocation of professional license.

In the case of the petitioner or the respondent who is affected by the rights under the ethical decision of the Medical Council and considers that the decision is incorrect, the result of the investigation can be filed with the Administrative Court within 90 days from the date of knowing the cause of action without appealing the order. Studies have found that, in principle, the decisions of the Administrative Court generally do not change the orders issued by the Medical Council, unless the order is unlawful.

Dermatological Adverse Events from Cancer Therapy: A Clinical Perspective in the Thai Context

2025-12-22T13:46:33+07:00

Cancer treatments, including chemotherapy, targeted therapy, immunotherapy, and radiotherapy, frequently induce dermatological adverse events (DAEs) that significantly impact patients' quality of life and treatment adherence. This review article, tailored for the Thai context, aims to provide a comprehensive overview of common DAEs, their prevention and management, specific considerations for prevalent cancers (lung, breast, colon), and practical guidance on daily skin care, hair management, and evidence-based supplements. The article highlights the relevance of these toxicities to common cancer types encountered in Thailand and addresses frequently asked patient questions regarding skincare routines, hair dyeing, hair implantation, and the use of vitamins or supplements, emphasizing evidence levels from PubMed or Scopus. Proactive management and a multidisciplinary approach involving both oncologists and dermatologists are crucial for mitigating DAEs and optimizing patient outcomes in cancer care.

Managed Entry Agreements for Pharmaceuticals

2026-01-29T15:42:16+07:00

The Managed Entry Agreement (MEA) is an agreement between the drug company and the payer that aims to enhance patients’ access to new and expensive drugs. This agreement is divided into two types, including the financial-based agreement and the performance-based agreement. The financial-based agreement aims to limit the budget impact through controlling the drug cost. This agreement is widely used because of its simplicity and uncomplicated nature. However, this agreement lacks transparency because the details contained in the agreement are confidential, causing a conflict of interest for some competitors. The performance-based agreement is based on the therapeutic effectiveness of drugs in the real world and aims to maximize utilization of new drugs and to address uncertainty about the effectiveness of new drugs. This agreement is a good practice, but complicated, and the cost of implementation is high. However, health-system decision-makers should be careful in the selection of a proper managed entry agreement to ensure efficient budgeting and equal access to drugs for patients.