Using the evidence-based medicine and evidence-based management to minimise overuse and maximise quality in healthcare: a hybrid perspective

Evidence Based Dentistry among Dentists in Low and Middle Income Countries: A Systematic Review

Purpose of this systematic review was to bring together studies of evidence-based practice among dentists in low- and middle-income countries, where its use has been reported to be limited. The protocol was registered in PROSPERO. Methodology: We searched the evidence (in English only) from medical databases including PubMed, EBSCO, The Cochrane Library, CINAHL, ScienceDirect, HINARI summon, and SCOPUS and Web of Science via Research4Life, grey literature, hand search from relevant articles, and augmented results on Google scholar. Published reports were retrieved from relevant websites and organizations. Studies included those that looked at key factors that facilitate or hinder Evidence Based Dentistry (EBD), as well as outcomes in terms of: knowledge, attitudes and skills of EB practice among dentists; and the methodology used and their relevance in future EBD strategies. Main focus was on dentists, as practitioners and faculty members. Studies on students and non-dental personnel were excluded. Findings: A total of 4568 records were retrieved and five potentially relevant articles were selected after title/abstract screening. Two articles were excluded after full text screening, and therefore Three papers were included in this review. The studies report limited knowledge, unsatisfactory attitude towards EBD and lowpractice of EBD and use of scientific evidence databases. None of the studies reported implementation of EBD nor evaluation thereof. The main barriers that constrained application of EBD ranged from lack of interest to infrastructural limitations. Originality: The current review showed that there is a need to strategised implementation of EBD in this region.

Overcoming Resistance to Big Data and Operational Changes Through Interactive Data Visualization

Research has shown that the use of big data can modify operational processes in organizations. However, little research has been conducted on overcoming resistance to the process changes needed for adoption of big data technologies. In this article, we address this gap in the literature by investigating the impact of interactive data visualization on decision-making around operational process changes with big data. Our goal is to demonstrate how the choice of visualization of workflow and operational processes impacts decisions to embrace real-time, big data technology. To do so, we conduct a case study of patient/provider interactions in a large health care practice and compare the initial state with a revised workflow using a big data, real-time analytics platform. We then investigate the impact of the data visualization strategy on decision-making to implement operational changes caused by big data. The study demonstrates that interactive data visualization of operational processes can be an enabler in overcoming organizational resistance to big data technologies in a change-resistant organization. The concomitant benefit is that big data analytics is placed directly into the hands of primary decision makers.

Future Development Through the Past: Pathology of the Financing Dimension of Iran's Health Transformation Plan

BACKGROUND

In Iran, during the years, the budgeting model used for healthcare funding is affected by factors such as global oil prices and fluctuation in the exchange rates. So, developing or continuing to implement a plan in the health system depends on the current and future global and local economic trends.

OBJECTIVE

To analyze the future of the recent significant reform called Health Transformation Plan (HTP), started on June 15, 2014, in the light of potential financial barriers and challenges.

METHODS

Face-to-face interviews were conducted with health policymakers at different levels of the health system, health researchers, health insurance officers, and faculty members. Also, published and unpublished documents about HTP in the country and worldwide were reviewed. Data analysis was done using a qualitative inductive content analysis approach and assisted by qualitative data management software.

RESULTS

Instability of financial resources and allocation of gross domestic product (GDP) to the HTP in the traditional way is a challenge in continuing this policy reform. Also, the bureaucratic procedures in allocation and distribution of funds, the discrepancy between health insurance funds and affiliated units of Ministry of Health and Medical Education (MoHME) especially Medical Sciences Universities (MSU), the lack of purchaser-provider split, inappropriate payments and compensation mechanisms, and dependence of MSU on especial revenues are the main challenges that threaten the future of HTP in Iran.

CONCLUSION

Given the current situation, where the country's funding resources are often unpredictable, it seems that such funding challenges will lead to poor HTP results. Therefore, the continuance of such a high cost-based plan requires the strategies and policies to ensure raising additional funds through various types of innovative financing to overcome challenges.

Balancing Overuse and Underuse in the Iranian Healthcare System: A Force Field Theory Analysis

Background

Overuse and underuse of healthcare services occure within population, organizations and even patients around the world. Producing a balance between these two can increase efficiency, service quality and patient satisfaction. It also decrease extra costs. The aim of this study was to identify forces for change and forces against change for generating balance between overuse and underuse to achieve right care.

Methods

This study was conducted in five steps: 1) describe our plan or proposal for change; 2) identify forces for change; 3) identify forces against change; 4) assign forces; and 5) analyze and apply. We used purposive sampling strategy. The number of participants in the expert panel were eight. Each participant signed informed consent form before starting the study (Ethical code: IR.TBZMED.REC.1396.908).

Results

The driving factors for balancing overuse and underuse were education, preparing clinical guideline and standard protocols, resource allocation, using evidence-based medicine, evidence-based management and evidence-informed policy making approaches and social prescribing. The restraining factors for balancing overuse and underuse were conflict of interest issues, payment systems, paternalism and medicalization, patients and physicians' side problems and culture of consumerism in the community. The total scores for and against change were 14 and 17, respectively.

Conclusion

It seems that the emphasis on education and training in this field is essential for physicians, patients and all people in the community. Also, making reforms in payment systems and changing the rules and regulations in this area could be major drivers.

Nurses' Perspectives on the Impact of Marketing Mix Elements (7Ps) on Patients' Tendency to Kind of Hospital

BACKGROUND

Marketing mix (7Ps) is a critical concept in healthcare management and health marketing. Hence, this study was conducted to investigating the role of 7Ps on patients' disposition to the kind of hospital from nurses' perspectives.

METHODS

A cross-sectional study design was used in 2015. The study was conducted in one state in Iran (Mazandaran). The statistical population included nurses (n=235) in public and private hospitals were selected randomly through the list. Data were collected by questionnaire and were analyzed using SPSS software (version 22).

RESULTS

The results showed that 38.6 percent of nurses were males and the others (61.4 percent) were females. Their mean age was 31.0±7.1 years, and the majority of them belonged to the 30-40 age group. The mean work experience of them was 11.42±6.5 years. The findings showed that there were significant differences between nurses' perspectives in public and private hospitals about the effect of 7Ps elements on patients' tendency to the public and private hospitals (p<0.05).

CONCLUSIONS

According to the results, the officials of public hospitals should take more attention to the elements like product, place, promotion, people, physical assets and process management more than the past because these elements cause that the patients are disposed to the private hospitals while the government make more investment in public hospitals.