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Hedayatipour M, Etemadi S, Hekmat SN, Moosavi A. Challenges of using evidence in managerial decision-making of the primary health care system. BMC Health Serv Res 2024; 24:38. [PMID: 38183009 PMCID: PMC10770934 DOI: 10.1186/s12913-023-10409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/30/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Managerial Evidence-Based Decision-Making [EBDM] in the primary is a systematic approach that directs the decision-maker in a conscientious, explicit, and judicious utilization of reliable and best evidence based on the professional experiences and preferences of stakeholders and patients from various sources. This study aimed to investigate the challenges primary healthcare managers encounter while undertaking decision-making processes. METHOD A systematic review was conducted in 2022 with the aim of identifying and collecting all qualitative articles pertaining to evidence-based decision-making in the primary healthcare system. To achieve this, a meticulous search was conducted using the relevant keywords, including primary health care and evidence-based decision making, as well as their corresponding synonyms, across the databases Web of Science, Scopus, and Pubmed. Importantly, there were no limitations imposed on the timeframe for the search. To carefully analyze and consolidate the findings of this systematic review, the meta-synthesis approach was employed. RESULTS A total of 22 articles were assessed in this systematic review study. The results revealed the main categories including evidence nature, EBDM barriers, utilizing evidence, decision-makers ability, organizational structure, evidence-based, EBDM support, communication for EBDM, evidence sides, EBDM skill development, public health promotion, and health system performance improvement. CONCLUSION The primary healthcare system is crucial in improving health outcomes and ensuring access to healthcare services for all individuals. This study explored the utilization of evidence-based EBDM within the primary healthcare system. We identified five key dimensions: causal, contextual, and intervening conditions, strategies, and consequences of EBDM as a core phenomenon. The findings will help policymakers and administrators comprehend the importance of evidence-based decision-making, ultimately leading to enhanced decision quality, community well-being, and efficiency within the healthcare system. EBDM entails considering the best reliable evidence, and incorporating community preferences while also exploiting the professional expertise and experiences of decision-makers. This systematic review has the potential to provide guidance for future reforms and enhance the quality of decision-making at the managerial level in primary healthcare.
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Affiliation(s)
- Marjan Hedayatipour
- Department of Healthcare Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Sina Etemadi
- Department of Healthcare Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Department of Healthcare Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | - Alisadat Moosavi
- Department of Medical Library & Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Gazki PR, Hekmat SN, Salajegheh M. Pathology and solutions for activities of medical education development offices. BMC Med Educ 2024; 24:14. [PMID: 38172838 PMCID: PMC10765657 DOI: 10.1186/s12909-023-05011-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND AIM Education development offices are one of the main branches of medical education centers for directing the educational performance of medical sciences universities to achieve educational goals. Due to their close presence and communication with educational environments, these offices are highly important. To effectively guide and empower these offices, it is necessary to analyze their current situation, identify the challenges, and provide solutions to address them. This study was conducted to identify the challenges and provide solutions for the activities of medical education development offices. METHODS This qualitative study was conducted in two stages, including 29 semi-structured interviews and a focus group discussion with experts in 2022 at Kerman University of Medical Sciences. The sampling method was purposive. The content analysis of data was performed based on conventional qualitative content analysis. RESULTS Data analysis resulted in the emergence of two main categories including challenges facing the activities of medical education development offices and solutions for improving the activities of these offices, and comprising some categories containing organizational structure factors, cognitive factors, communication factors, and motivational factors. CONCLUSION Education development offices are one of medical universities' main policymaking and quality control institutions. Efforts are being made to establish EDOs structures within the university. The formation of a clear and performance-based reward system for faculty members who are the managers of the EDOs is proposed. Improving interactions between EDOs and other parts of the university to coordinate activities, and exchange of experiences are highlighted.
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Affiliation(s)
- Parvin Rezaei Gazki
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahla Salajegheh
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran.
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Heidarzadeh A, Hedayati B, Sirous S, Huntington MK, Alvandi M, Arabi A, Farrokhi B, Nojomi M, Noori Hekmat S, Mirkazemi R. Financial challenges in the family physician programme in Iran: A systematic review of qualitative research. Malays Fam Physician 2023; 18:59. [PMID: 38026574 PMCID: PMC10664759 DOI: 10.51866/rv.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Introduction The family physician programme (FPP) was implemented nearly two decades ago as a major health reform. Since the health system and FPP function in a rapidly changing social and economic environment, successful expansion of the programme requires a detailed analysis of its multiple major challenges, including the crucial aspect of its funding system. This systematic review aimed to assess the challenges in the FPP relative to its financing. Method All published articles related to the FPP in Iran were included in this study. In particular, original qualitative studies published in English or Persian from 2011 to 2021 were included. In January 2022, international credible scholarly databases and Persian databases were searched. All selected articles were carefully studied, and the data were extracted using the sample, phenomenon of interest, design, evaluation and research type technique. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in preparing the study report. Results Among 491 articles retrieved from the search strategy, 50 met the inclusion criteria after their titles and abstracts were screened. Twenty-nine studies were excluded after their full texts were reviewed. A total of 11 eligible empirical studies were finally included. Based on the results, six broad categories (budget and funding, insurance system, tariffs, payments, accountability and injustice) were identified as financial challenges. Conclusion This study identified the challenges associated with financing among family physicians, and the results could provide guidance for policy-making in the expansion of the FPP.
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Affiliation(s)
- Abtin Heidarzadeh
- MD, MPH, Medical Education Research Center, Department of Community and Family Medicine. School of Medicine. Guilan University of Medical Sciences, Rasht, Iran
| | - Bita Hedayati
- MPH, Research Department, Farzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran, Iran
| | - Shadrokh Sirous
- MD, National Professional Officer and Unit Head, Universal Health Coverage/Health System, WHO Representative Office, Tehran, Iran
| | - Mark K Huntington
- MD, PhD, FAAFP Professor, Director, Sioux Falls, Family Medicine Residency program and founding Director, Pierre Rural, Family Medicine Residency program, University of South Dakota Sanford, School of Medicine, Vermillion, United States
| | - Mehdi Alvandi
- MD, Department of Public Administration, Faculty of Management, University of Tehran, Tehran, Iran
| | - Alireza Arabi
- Family Physician Specialist, National Center for Health Insurance, Research, Tehran, Iran
| | - Babak Farrokhi
- MD, MPH, Executive Deputy, National Director for Family Medicine, Undersecretary for Health Affairs, Health Network Administration Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Marzieh Nojomi
- MD, MPH, Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine. School of Medicine. Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Noori Hekmat
- PhD, Associate Professor of Health Services Management, Leadership and Management in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Roksana Mirkazemi
- BSc, MSc, PhD, Founder and Managing Director of Farzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran, Iran.
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GhorbaniNia R, Hekmat SN, Dehnavieh R, Bahaadinbeigy K, Arab-Zozani M. Presenting a Quaternary Prevention Model for the Rural Family Physician Program in Iran with an Interpretive Structural Modeling Approach. Int J Prev Med 2023; 14:108. [PMID: 37855013 PMCID: PMC10580201 DOI: 10.4103/ijpvm.ijpvm_116_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/27/2022] [Indexed: 10/20/2023] Open
Abstract
Background Due to its ethical approach and its protection of patients and their interests, quaternary prevention can increase the quality-of-service provision and decrease costs and the wastage of resources. The present study used interpretive structural modeling (ISM) to classify the effective factors and determine a quaternary prevention model for Iran's Rural Family Physician Program. Methods This study was a qualitative study with an ISM approach. Twenty-five health system experts and faculty members participated in the study. The interrelationships between the factors were determined using ISM, and after classification, the driving and dependence power of the factors were specified using MICMAC analysis. Results The 20 factors were classified into five levels. The results indicated that patient interest and vulnerable groups had the highest effectiveness, and officials' and policymakers' commitment to providing serious support for family physicians had the highest affectability. The factors were placed into the two groups of linkage and dependence based on the MICMAC analysis. Conclusions The new technologies are costly and sometimes only suitable for a specific group of patients. Costs and the issues of induced demand and defensive medicine necessitate a different view of health service distribution. The preventive and strategic view and the comprehensiveness of family physician services make quaternary prevention possible by providing high-risk and vulnerable groups with essential services based on patient needs and conditions with more benefit than harm.
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Affiliation(s)
- Rahil GhorbaniNia
- Faculty of Management and Medical Information Sciences, Department of Health Management and Policy and Economics, Kerman, Iran
| | - Somayeh Noori Hekmat
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Dehnavieh
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Masoud A, Dehnavieh R, Yazdi-Feyzabadi V, Poursheikhali A, Noori Hekmat S, Kazemi M, Moghadam MG. What is the mind map of the hospital's future changes in a developing country like Iran? A qualitative study. BMC Health Serv Res 2023; 23:732. [PMID: 37407977 DOI: 10.1186/s12913-023-09507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 05/05/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Hospitals have a vital role in the future of health systems with upcoming structure, resources, and process changes. Identifying the potential aspects of change helps managers proactively approach them, use the opportunities, and avoid threats. This study presents a mind map of future changes in Iranian hospitals to develop a base for further related studies or prepare evidence for interventions and future-related decisions. METHODS This study is a qualitative-exploratory one, conducted in two phases. In the first phase, in-depth and semi-structured interviews were conducted to identify future hospital changes over 15 years. The interviews were analyzed using the content analysis method and MAXQDA 2018 software and holding two expert panels to develop the mind map using the 2016 Visio software. RESULTS In the first phase, 33 interviews led to 144 change patterns. In the second phase, a mind map of changes was drawn according to experts' opinions with ten categories: structure and role, knowledge management and research, service delivery, health forces, political and legal, economic, demographic and disease, technological, and values and philosophy, and environmental. CONCLUSIONS Many changes affecting hospitals rooted in the past continue to the future, but the point is the increasing intensity and speed of changes. Healthcare systems need a systematic approach to monitoring the environment to be updated, agile and proactive. These monitoring systems are essential in providing evidence for Macro-level decision-makers.
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Affiliation(s)
- Ali Masoud
- Department of Healthcare Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Reza Dehnavieh
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Atousa Poursheikhali
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Department of Healthcare Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Mohammad Kazemi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Ghasemi Moghadam
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, University of Medical Sciences, Kerman, Iran
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Heidarzadeh A, Alvandi M, Hedayati B, Rezaei M, Abedi F, Madani ZH, Hekmat SN, Dadgaran I, Mirkazemi R. The Roles of the Nurses in Family Physician Team: A Qualitative Systematic Review. Iran J Nurs Midwifery Res 2023; 28:361-370. [PMID: 37694211 PMCID: PMC10484375 DOI: 10.4103/ijnmr.ijnmr_244_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 05/13/2023] [Accepted: 05/31/2023] [Indexed: 09/12/2023]
Abstract
Background There are various approaches in primary health care regarding the key role of nurses. This systematic review investigates the roles of nurses, as part of the family medicine team. Materials and Methods All published articles related to the role of nurses in the family medicine team from January 2000 to March 2022 were the subjects of this study. The eligibility criteria included original articles published in English or Persian in the last two decades. International credible scholarly databases (PubMed, Scopus, Magiran, IranMedex, and SID) were searched using keywords and syntax. Some of the keywords included "Family Health Nurse," "Nurses in Primary Care," "Family Medicine," "Family Physician Care Program," "General Physician Program," "Role," and "Nurse." Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) technique and reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results Of 147 identified publications by the search strategy, eight eligible empirical studies were included. The results showed that besides providing nursing care, nurses play vital roles in communication and teamwork, assessment, securing health services relevant to communities' needs, education, empowerment, clinical practice, health promotion, prevention, reflective research practice, and counseling. Conclusions This study identified different roles nurses could play in providing primary health care. These findings are helpful for the replanning or reform of primary health care in countries, which aimed to expand the Family Physician Program (FPP) in their countries, including Iran.
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Affiliation(s)
- Abtin Heidarzadeh
- Department of Community and Family Medicine, School of Medicine, Guilan University of Medical Science and Health Services, Rasht, Iran
| | - Mehdi Alvandi
- Department of Public Administration, Faculty of Management, University of Tehran, Tehran, Iran
| | - Bita Hedayati
- Farzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran, Iran
| | - Mostafa Rezaei
- Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farshid Abedi
- Birjand University of Medical Sciences, Faculty of Medicine, Infectious Diseases Research Center, Birjand, Iran
| | - Zahra Hamidi Madani
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Somayeh Noori Hekmat
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ideh Dadgaran
- Medical Education Research Center, Education Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Roksana Mirkazemi
- Founder and Managing Director of Farzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran, Iran
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Rahimisadegh R, Noori Hekmat S, Mehrolhassani MH, Jafari Sirizi M. Network analysis of Iranian's health insurance ecosystem before and after the introduction of Universal Health Insurance law. Glob Health Res Policy 2023; 8:16. [PMID: 37218002 DOI: 10.1186/s41256-023-00302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION The policy-making process in health reform is challenging due to the complexity of organizations, overlapping roles, and diversity of responsibilities. The present study aims to investigate and analyze the network of actors in the Iran health insurance ecosystem regarding the laws before and after the adoption of the Universal Health Insurance (UHI). METHODS The present study was done by sequential exploratory mixed method research, consisting of two distinct phases. During the qualitative phase, the actors and issues pertaining to the laws of the Iranian health insurance ecosystem from 1971 to 2021 were identified through a systematic search of the laws and regulations section of the Research Center of the Islamic Legislative Assembly website. Qualitative data was analyzed in three steps using directed content analysis. During the quantitative phase, in order to draw the communication network of the actors in Iran's health insurance ecosystem, the data related to the nodes and links of the networks was collected. The communication networks were drawn using Gephi software and the micro- and macro-indicators of network were calculated and analyzed. RESULTS There were 245 laws and 510 articles identified in the field of health insurance in Iran from 1971 to 2021. Most of the legal comments were on financial matters and credit allocation, and the payment of premiums. The number of actors before and after the enactment of the UHI Law was 33 and 137, respectively. The Ministry of Health and Medical Education and the Iran Health Insurance Organization were found the two main actors in the network before and after the approval of this law. CONCLUSIONS Adopting a UHI Law and delegating various legal missions and tasks, often with support to the health insurance organization, have facilitated the achievement of the law objectives. However, it has created a poor governance system and a network of actors with low coherence. Based on the results of the study, it is suggested to reduce actor roles and separate them for better governance and to prevent corruption in health insurance ecosystem. Introducing knowledge and technology brokers can be effective in strengthening governance and filling the structural gaps between actors.
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Affiliation(s)
- Rohaneh Rahimisadegh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Somayeh Noori Hekmat
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehrolhassani
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Salajegheh M, Hekmat SN, Malekpour-afshar R. Identification of alternative topics to diversify medicine, dentistry, and pharmacy student theses: a mixed method study. BMC Med Educ 2023; 23:110. [PMID: 36782213 PMCID: PMC9923902 DOI: 10.1186/s12909-023-04031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The impact of medicine, dentistry, and pharmacy student theses on public health is a crucial concern for policymakers in medical science universities. If student theses correspond to the needs of society, they can significantly affect students' scientific and practical abilities and lead to the provision of more efficient health services. This study aimed to identify alternative topics to diversify medicine, dentistry, and pharmacy student theses. METHODS This mixed method study with an exploratory sequential design was conducted at Kerman University of Medical Science from February to June 2021. The qualitative component entailed a focus group of faculty members (n = 16) and students (n = 4) to extract alternative topics to diversify medicine, dentistry, and pharmacy student theses. The quantitative component included a questionnaire based on emerging subjects and literature review to evaluate the extracted alternative topics. Qualitative data were analyzed using conventional content analysis and quantitative data were analyzed descriptively. RESULTS A total of 20 key participants took part in the focus group meeting, and from 20 questionnaires, 15 were returned with a response rate of 75%. A list of 18 alternative topics was generated and five categories were identified: individual development, research, education, healthcare, and social services. CONCLUSIONS The gap between what we know and what is seen in practice is quite large in medical and health-related professions. Alternative topics for medicine, dentistry, and pharmacy student theses contribute to turning knowledge into practice.
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Affiliation(s)
- Mahla Salajegheh
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, 7616913555, Haft-Bagh Highway, Kerman, Iran
- Department of healthcare management, policy and economics, Faculty of management and medical information sciences, Kerman university of medical sciences, Kerman, Iran
| | - Reza Malekpour-afshar
- Pathology and Stem Cells Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Hekmat SN, Haghdoost AA, Zamaninasab Z, Rahimisadegh R, Dehnavieh F, Emadi S. Factors associated with patients' mobility rates within the provinces of Iran. BMC Health Serv Res 2022; 22:1556. [PMID: 36539751 PMCID: PMC9764717 DOI: 10.1186/s12913-022-08972-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The absence of a referral system and patients' freedom to choose among service providers in Iran have led to increased patient mobility, which continues to concern health policymakers in the country. This study aimed to determine factors associated with patient mobility rates within the provinces of Iran. METHODS This cross-sectional study was conducted in Iran. Data on the place of residence of patients admitted to Iranian public hospitals were collected during August 2017 to determine the status of patient mobility within each province. The sample size were 537,786 patients were hospitalized in public hospitals in Iran during August 2017. The patient mobility ratio was calculated for each of Iran's provinces by producing a patient mobility matrix. Then, a model of factors affecting patient mobility was identified by regression analysis. All the analyses were performed using STATA14 software. RESULTS In the study period, 585,681 patients were admitted to public hospitals in Iran, of which 69,692 patients were referred to the hospital from another city and 51,789 of them were admitted to public hospitals in the capital of the province. The highest levels of intra-provincial patient mobility were attributed to southern and eastern provinces, and the lowest levels were observed in the north and west of Iran. Implementation of negative binomial regression indicated that, among the examined parameters, the distribution of specialist physicians and the human development index had the highest impact on intra-provincial patient mobility. CONCLUSION The distribution of specialists throughout different country areas plays a determining role in patient mobility. In many cases, redistributing hospital beds is impossible, but adopting different human resource policies could prevent unnecessary patient mobility through equitable redistribution of specialists among different cities.
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Affiliation(s)
- Somayeh Noori Hekmat
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- grid.412105.30000 0001 2092 9755Health Modeling Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Zamaninasab
- grid.412105.30000 0001 2092 9755Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rohaneh Rahimisadegh
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Dehnavieh
- grid.412105.30000 0001 2092 9755Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samira Emadi
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Rahimisadegh R, Mehrolhassani MH, Jafari Sirizi M, Noori Hekmat S. The analysis of National Health Accounts and financial communications network in Iran health insurance ecosystem. BMC Health Serv Res 2022; 22:1552. [PMID: 36536357 PMCID: PMC9764588 DOI: 10.1186/s12913-022-08921-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND One of the major reforms in the health system of any country is the financing reform. Network analysis as a practical method for investigating complex systems allows distinguishing prominent actors in the relation networks. Leading to the identification of the effective actors and key links between them, the analysis of financial networks helps policymakers to implement reformations by providing appropriate evidence. This study aimed to design and analyze the network of National Health Accounts (NHA) and the cost network in the Iran health insurance ecosystem. METHODS The present study is a network analysis study based on the data from NHA, and both cost and referral rates that was conducted in 2021. Data, which was for the years 2014 to 2018 and related to NHA, was collected from the Statistical Center of Iran, and cost data and referral rates, which were both related to Basic Insurance Organizations (BIOs), were collected from statistical yearbooks. To analyze the network and identify the key actors, macro indicators, such as network size and density, and micro indicators, such as centrality indicators and the combined importance index, were used. RESULTS In the financing of the health system in Iran, insurance organizations, as agents and sources of financing, do not have a very good position, so direct payments have become a key element in the network of NHA. Providing treatment-oriented services is quite prior. Regarded to health services, hospitals and outpatient services, such as pharmacies and physicians are the key elements of cost and referral rates respectively. CONCLUSION Consisting of several organizations with different insurance policies and being supervised under different ministries, Iran's health financing system lacks a coherent structure. It is suggested to create a coherent insurance system by creating a single governance system and paying more attention to health-oriented instead of treatment-oriented services. The health insurance ecosystem has become a health-oriented system to reduce the direct payments as well as cost management.
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Affiliation(s)
- Rohaneh Rahimisadegh
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehrolhassani
- grid.412105.30000 0001 2092 9755Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Somayeh Noori Hekmat
- grid.412105.30000 0001 2092 9755Health Foresight and Innovation Research Center,Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Salajegheh M, Hekmat SN, Macky M. Challenges and solutions for the promotion of medical sciences faculty members in Iran: a systematic review. BMC Med Educ 2022; 22:406. [PMID: 35619090 PMCID: PMC9134687 DOI: 10.1186/s12909-022-03451-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The faculty promotion system is expected to benefit the faculty, institute, and profession and lead to the sustainable and comprehensive development. This present systematic review aims to investigate the challenges and solutions for the promotion of medical sciences faculty members in Iran. METHOD This study was a systematic review conducted by searching in PubMed, Scopus, Eric, Web of Science, Cochrane, SID, Magiran, and https://irandoc.ac.ir/line with Persian and English terms in the period from 2015 to 2020. Study selection and data extraction were performed independently by reviewers. RESULTS Thirteen articles were included. Challenges and solutions for the promotion of medical sciences faculty members were reviewed and grouped into five main categories: 1. The general regulations for the promotion of faculty members, 2. Cultural, disciplinary, and social activities, 3. Educational activities, 4. Research-technology activities, and 5. Scientific-executive activities. CONCLUSION Despite several modifications to regulations for the promotion of medical sciences faculty members in Iran, this process still encounters challenges because of its complex nature. This article provides tips to policymakers on regulations of promotion for educational activities.
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Affiliation(s)
- Mahla Salajegheh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medical Education, Education Development Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-Bagh Highway, Kerman, Iran
| | - Maryam Macky
- Environmental Health Engineering, Department of Environmental Health, Kerman University of Medical Sciences, Kerman, Iran
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12
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Mohamadi E, Kiani MM, Olyaeemanesh A, Takian A, Majdzadeh R, Hosseinzadeh Lotfi F, Sharafi H, Sajadi HS, Goodarzi Z, Noori Hekmat S. Two-Step Estimation of the Impact of Contextual Variables on Technical Efficiency of Hospitals: The Case Study of Public Hospitals in Iran. Front Public Health 2022; 9:785489. [PMID: 35071166 PMCID: PMC8770937 DOI: 10.3389/fpubh.2021.785489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamination and management that is very important for any healthcare system for having an efficient system. Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals. Methods: This was a quantitative and descriptive-analytical study conducted in two steps. First, we measured the efficiency score of teaching and non-teaching hospitals by using the Data Envelopment Analysis (DEA) method. Second, the relationship between efficiency score and contextual factors was analyzed. We used median statistics (first and third quarters) to describe the concentration and distribution of each variable in teaching and non-teaching hospitals, then the Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province population, population density, and the number of beds per hospital). Results: On average, the efficiency score in non-teaching hospitals in 31 provinces was 0.67 and for teaching hospitals was 0.54. Results showed that there is no significant relationship between the efficiency score and the number of hospitals in the provinces (p = 0.1 and 0.15, respectively). The relationship between the number of hospitals and the population of the province was significant and positive. Also, there was a positive relationship between the number of beds and the area of the province in both types of teaching and non-teaching hospitals. Conclusion: Multilateral factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its context should be developed. It is necessary to pay attention to contextual factors and organizational architecture to improve efficiency.
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Affiliation(s)
- Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Mehdi Kiani
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirhossein Takian
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Majdzadeh
- Community Based Participatory Research Centre and Knowledge Utilization Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Hamid Sharafi
- Department of Mathematics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.,University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Somayeh Noori Hekmat
- Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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13
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Bazyar M, Noori Hekmat S, Rafiei S, Mirzaei A, Otaghi M, Khorshidi A, Mohammadnejad S, Tahmasebi S, Amarloei A, Jalilian M. Supply-and-demand projections for the health workforce at a provincial level from 2015 to 2025 in Ilam, Iran. Proceedings of Singapore Healthcare 2021. [DOI: 10.1177/2010105820943239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Human resources are the key component of health systems. It is critical to have the right number of human resources at anytime and anywhere in the health system. This article aims to help local health decision makers to identify potential gaps between the future supply and demand of human resources and to make necessary changes in medical training processes to fill the gap. Methods: An eight-stage process was applied to project the supply and demand of health workers in Ilam province in 2025 for the following fields: public health, environmental health, general medicine, dentistry, pharmacy, nursing and midwifery. To estimate the demand for human resources, a mainly population-based model (manpower-to-population ratio) was applied. A modified version of the Australian dynamic stock and flow model was used to predict the supply of new recruits in 2025. The potential surplus or shortfall in the health workforce was calculated by comparing the supply and demand in 2025. Results: The demand and supply projections for the chosen fields were estimated respectively as: general medicine 457, 709; pharmacy 131, 86; dentistry 86, 251; nursing 949, 1657; midwifery 24, 247; public health 182, 211; and environmental health 92, 225. Conclusions: The current trend of medical graduates will meet the need for human resources in 2025, and there is no need to increase medical student admission. The Education Deputy of Ilam Medical University should take into account the health needs of its catchment area in medical educational processes and training new health-care staff.
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Affiliation(s)
- Mohammad Bazyar
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Iran
| | - Somayeh Noori Hekmat
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sima Rafiei
- Department of HealthCare Management, School of Health, Qazvin University of Medical Sciences, Iran
| | - Amin Mirzaei
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Iran
| | - Masoomeh Otaghi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Iran
| | - Ali Khorshidi
- Department of Epidemiology, Faculty of Medicine, Ilam University of Medical Sciences, Iran
| | - Sara Mohammadnejad
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Iran
| | - Samane Tahmasebi
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Iran
| | - Ali Amarloei
- Department of Environmental Health Engineering, Faculty of Health, Ilam University of Medical Sciences, Iran
| | - Mohsen Jalilian
- Department of Public Health, Faculty of Health, Ilam University of Medical Sciences, Iran
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14
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Goudarzi R, Tasavon Gholamhoseini M, Noori Hekmat S, YousefZadeh S, Amini S. The effect of Iran's health transformation plan on hospital performance: Kerman province. PLoS One 2021; 16:e0247155. [PMID: 33596262 PMCID: PMC7888626 DOI: 10.1371/journal.pone.0247155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/03/2021] [Indexed: 11/18/2022] Open
Abstract
Iran has performed Health Transformation Plan (HTP) from 2014 to obtain its defined goals. This study assesses and compares university and non-university hospitals' efficiency and productivity in Kerman provinces, Iran. The data of 19 selected hospitals, two years before and two years after Health Transformation Plan, was collected in this cross-sectional study. These data included the variables of physician and nurse number, and active beds as inputs and bed occupancy rate and inpatient admission adjusted with the length of stay as outputs. Data Envelopment Analysis method used to measure hospital efficiency. Malmquist Productivity Index is used to measure the efficiency change model before and after the plan. The efficiency and effect of the plan on hospitals' efficiency and productivity were assessed using R software. The results indicated that all hospitals' average efficiency before the HTP was 0.843 and after the HTP was increased to 0.874. However, it was not significant (P>0.05). Productivity also had a decreasing trend. Based on the DEA method results, it was found that university and non-university hospitals' efficiency and productivity did not increase significantly after the HTP. Therefore, it is recommended that attention be paid to hospitals' performance indicators regarding how resources are allocated and decisions made.
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Affiliation(s)
- Reza Goudarzi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Tasavon Gholamhoseini
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- * E-mail:
| | - Somayeh Noori Hekmat
- Somayeh Noori Hekmat, Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Setareh YousefZadeh
- Setareh YousefZadeh, Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeed Amini
- Faculty of Health, Saeed Amini, Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
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15
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Rahimisadegh R, Haghdoost AA, Emadi S, Noori Hekmat S. Assessing the performance of hospitals before and after the implementation of Iran's Health Sector Evolution Plan (HSEP) using the Pabon Lasso model. Med J Islam Repub Iran 2021; 35:23. [PMID: 34169035 PMCID: PMC8214040 DOI: 10.47176/mjiri.35.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 12/07/2022] Open
Abstract
Background: The health sector evolution plan was implemented in 2014 in government hospitals across the country as a part of the universal health coverage achievement programs. This study assessed the performance of hospitals before and after the implementation of this plan, using the Pabon Lasso model. Methods: The population of this study consisted of the hospitals of the country in the 2013-2015 time frame; overall, 874 hospitals (94.5% of the population) were included in the study. In order to assess performance, we used the Pabon Lasso model and hospital performance indicators (Average Length of Stay, Bed Turnover, and Bed Occupancy Rate). The data were collected from the Hospital Information System and provincial deputies of curative affairs and were then analyzed using the descriptive indicators of mean, frequency, and median in SPSS 22. Also, Paired Student T-test and ANOVA were used to compare the performance of different groups of hospitals before and after the implementation of the health sector evolution plan. Results: The implementation of the health sector evolution plan has led to a significant improvement in the three performance indicators in the hospitals of the country. Before the implementation of the health sector evolution plan, the most inefficient, inefficient, fairly efficient, and most efficient zones included 31%, 18%, 17%, and 33% of the studied hospitals, respectively. However, the implementation of the health sector evolution plan changed the percentages to 29%, 21%, 20%, and 30%, respectively. Teaching hospitals, which are governmental and are mostly located in capital cities of the provinces, were overall more inefficient than non-teaching hospitals. Conclusion: The number of the most efficient and most inefficient hospitals has decreased, and the number of average performance hospitals has increased after the implementation of the health sector evolution plan. Therefore, the health sector evolution plan has not led to an overall increase or decrease in the performance of hospitals but has reduced the difference in the performance of hospitals. Equal support of government hospitals along with financial protection against health expenses, improves the performance indicators of hospitals and reduces performance differences among them.
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Affiliation(s)
- Rohaneh Rahimisadegh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- Health Modeling Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samira Emadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences. Kerman, Iran
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16
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Mohamadi E, Olyaee Manesh A, Takian A, Majdzadeh R, Hosseinzadeh Lotfi F, Sharafi H, Jowett M, Kiani MM, Hosseini Qavam Abadi L, Fazaeli AA, Goodarzi Z, Sajadi HS, Noori Hekmat S, Freidoony L. Technical efficiency in health production: A comparison between Iran and other upper middle-income countries. Health Policy and Technology 2020. [DOI: 10.1016/j.hlpt.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Sajadi HS, Goodarzi Z, Takian A, Mohamadi E, Olyaeemanesh A, Hosseinzadeh Lotfi F, Sharafi H, Noori Hekmat S, Jowett M, Majdzadeh R. Assessing the efficiency of Iran health system in making progress towards universal health coverage: a comparative panel data analysis. Cost Eff Resour Alloc 2020; 18:20. [PMID: 32612458 PMCID: PMC7324989 DOI: 10.1186/s12962-020-00215-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Building upon decades of continuous reforms, Iran has been implementing various initiatives to reach universal health coverage (UHC). Improving efficiency is a crucial intermediate policy objective for UHC. Therefore, this article aimed to measure the efficiency and productivity changes of the Iranian health system in making progress towards UHC during 2010-2015 in comparison with 36 selected other upper-middle-income countries. METHODS We used panel data to measure the variations in technical efficiency (TE) and total factor productivity (TFP) through an extended data envelopment analysis (EDEA) and Malmquist productivity index, respectively. General government health expenditure (GGHE) per capita (International dollar) was selected as the input variable. Service coverage of diphtheria, tetanus and pertussis; family planning; antiretroviral therapy; skilled attendants at birth; Tuberculosis treatment success rate; and GGHE as % of total health expenditure (THE) were considered as output variables. The data for each indicator were taken from the Global Health Observatory data repository and World Development Indicator database, for 6 years (2010-2015). RESULTS The TE scores of Iran's health system were 0.75, 0.77, 0.74, 0.74, 0.97, and 0.84 in the period 2010-2015, respectively. TFP improved in 2011 (1.02), 2013 (1.01), and 2014 (1.30, generally). The overall efficiency and TFP increased in 2014. Changes made in CCHE per capita and GGHE/THE attributed to the increase of efficiency. CONCLUSION There is a growing demand for efficiency improvements in the health systems to achieve UHC. While there are no defined set of indicators or precise methods to measure health system efficiency, EDEA helped us to draw the picture of health system efficiency in Iran. Our findings highlighted the essential need for targeted and sustained interventions, i.e., allocation of enough proportion of public funds to the health sector, to improve universal financial coverage against health costs aiming to enhance the future performance of Iran's health system, ultimately. Such tailored interventions may also be useful for settings with similar context to speed up their movement towards improving efficiency, which in turn might lead to more resources to reach UHC.
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Affiliation(s)
- Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Global Health & Public Policy, Department of Management Sciences & Health Economics, School of Public Health, Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Efat Mohamadi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- National Institute for Health Research, Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamid Sharafi
- Department of Mathematics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Somayeh Noori Hekmat
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Matthew Jowett
- Department of Health Systems Governance & Financing, World Health Organization, Geneva, Switzerland
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Community-Based Participatory-Research Center,and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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18
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Pourabbasi A, Akbari H, Akhvan AA, Haghdoost AA, Kheiry Z, Dehnavieh R, Rahimi H, Noori Hekmat S, Larijani B. Analysis of Iran's National Medical Education Evolution and Innovation Plan using the Michelle and Scott's model of policymaking. J Adv Med Educ Prof 2019; 7:20-26. [PMID: 30697545 PMCID: PMC6341452 DOI: 10.30476/jamp.2019.41041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/28/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Lack of a clear policy for the development of health human resources has created inconsistencies. These imbalances are threats to the health system to achieve its goals. Therefore, the development of human resources through proper performance of higher education health system is an important part of the policy development process of the health sector. The present paper aims to introduce the methods applied for the compilation of evolution and innovation program of medical sciences training as well as the most important directions for evolution and innovation. METHODS In this study, we evaluated the methodology for designing packages of Iran's higher education health system evolution and innovation. For this purpose, the evaluation of the policy process was conducted based on Michelle and Scott's policy process models. This policy evaluation model starts by problem identification and definition and continue by agenda setting, policy formation, legitimation, implementation, evaluation, and policy modification, using the proper feedback. Qualitative content analysis method was used as a research method for subjective interpretation of the content of the text data. RESULTS Twelve policies, 68 strategies and their translation in the health system were adopted in a comprehensive plan for higher health education. Eleven practical packages were also developed in order to implement these policies as packages for reform and innovation in medical education. These packages were organized based on the IPOCC pattern. CONCLUSIONS The lack of a comprehensive look at each project or program could bring about irreparableness consequences. However, the MoHME of Iran, relying on the integration of health higher education with health care system and comprehensive method used for transformation and innovation plan in the field of health higher education could take an important step towards improving the nation's health.
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Affiliation(s)
- Ata Pourabbasi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Akbari
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, Iran
| | - Amir Ahmad Akhvan
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Kheiry
- Innovation Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamed Rahimi
- Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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19
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Masoud A, Noori Hekmat S, Dehnavieh R, Haj-Akbari N, Poursheikhali A, Abdi Z. An Investigation of Prescription Indicators and Trends Among General Practitioners and Specialists From 2005 to 2015 in Kerman, Iran. Int J Health Policy Manag 2018; 7:818-827. [PMID: 30316230 PMCID: PMC6186487 DOI: 10.15171/ijhpm.2018.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/17/2018] [Indexed: 11/12/2022] Open
Abstract
Background: The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost-effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015.
Methods: This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase.
Results: Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend.
Conclusion: Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients’ misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines.
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Affiliation(s)
- Ali Masoud
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noori Hekmat
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Naser Haj-Akbari
- Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Atousa Poursheikhali
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
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20
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Hashemi H, Haghdoost AA, Haji-Aghajani M, Janbabaee G, Maher A, Noori Hekmat S, Javadi AM, Rahimisadegh R, Emadi S, Rajabalipour MR, Haghighi H, Dehnavieh R, Ferdosi M, Khademi G, Mehralhasani MH, Sabermahani A, Bezanjani KN, Iranpour A, RashidiNejad H, Samadani FM, Maki M, Kalantari B, farrokhyar N, Rouhanizadeh H, Falakbaz M, Allahyari H, Fathalian MT, Khajehmirzaei AR, Jannati A, Derakhshani J, Rezapour A, Eftekhari J, Khaterneshanian fam P, Kazemi M, Mohammadi M, Rastbin P, Pirhayati B, Souri E, Torabipour A, Keshvari M, Alikhani N, Salehi L, Moradi M, Aghajaniyan S, Hedayati A, Kargar M, Sharifi L, OmraniKhoo H, Poursamad A, Amrolahi boyuki N, Zarei Z, Sahraei Z, Keshavaez A, Sadeghi M, Abdollahi Sabet S, Taiari K, Koohpayehzadeh J, Moazam E, Dehghani Tafti A, Forghani Dehnavi SS, Rezaei Barownaghi M, Jafari H, Foroghifar S, Arefnejad M, Ebrahimipou H, Sedaghat M, Mehdipoor S, Mollajafari F, Forouzan R, Meskini Mood S, Sharifpour S, Adel A, Nirouand S, Ghaznavi GR, Zamanzadeh R, Etesam K, Dalili M, Jafari Siriz M, Omidifar R. A Successful implementation of an idea to a nationally approved plan: Analyzing Iran's National Health Roadmap using the Kingdon model of policymaking. Med J Islam Repub Iran 2018; 32:46. [PMID: 30159297 PMCID: PMC6108245 DOI: 10.14196/mjiri.32.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts' viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran's health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.
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Affiliation(s)
- Hassan Hashemi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ghasem Janbabaee
- Department of Hematology-Oncology, Gastrointestinal Cancer Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Maher
- Department of Health Policy, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Noori Hekmat
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Amir M. Javadi
- Executive director, Iranian healthcare information Observatory, Researcher of Noor Ophthalmology Research Center, Tehran, Iran
| | - Rohaneh Rahimisadegh
- Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samira Emadi
- Research Center for Health Services Management, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahamad Reza Rajabalipour
- Supervisor of Public Health Department in School of Public Health in Bam University of Medical Sciences, Bam, Iran
| | - Hajar Haghighi
- Research Center for Health Services Management, Future Studies Research Center in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Dehnavieh
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman,
Iran
| | - Masoud Ferdosi
- Health Management and Economics Research Center (HMERC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Khademi
- Assistant Director of Medical Accident and Emergency Management Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hossein Mehralhasani
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Asma Sabermahani
- Research Center for Health Services Management, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kaveh Nouhi Bezanjani
- Master of Public Administration, Research Center for Health Services Management, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abedin Iranpour
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamidreza RashidiNejad
- Research Center for Modeling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Moeen Samadani
- Department of Statistics, Deputy of Curative Affaire, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Maki
- Department of Environmental Health, School of public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Behzad Kalantari
- MD, Department of Planning, Deputy of Curative Affaire, MOHME, Tehran, Iran
| | - Nahid farrokhyar
- Department of Planning, Deputy of Curative Affaire, MOHME, Tehran, Iran
| | - Hamed Rouhanizadeh
- Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran
| | - Monireh Falakbaz
- Department of Statistics, Deputy of Curative Affaire, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Mohammad Taghi Fathalian
- Management of Diseases, Diagnosis & Treatment Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Reza Khajehmirzaei
- MD, vice-chancellery of treatment, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ali Jannati
- Iranian Center of Excellence in Health Management (IceHM), School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Derakhshani
- Health Information Officer, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Rezapour
- Human Resources. Head of Hospital Administration and Clinical Services Excellence. Ardabil University of Medical Sciences, Ardabil, Iran
| | - Jamal Eftekhari
- Department of clinical affairs, Urmia university of medical sciences, Urmia, Iran
| | - Parisa Khaterneshanian fam
- Head of hospital administration and clinical services excellence. Treatment dept. Faculty of medical sciences and health services, Maragheh. Maragheh, Iran
| | - Mahmoud Kazemi
- Department of Statistics, Deputy of Curative Affaire, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Mohammadi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Payam Rastbin
- Department of Statistics, Deputy of Curative Affaire, medical university of Kurdestan, Iran
| | - Bahareh Pirhayati
- Expert Statistics, Unit of Statistics, Ilam University of Medical Science,
Ilam, Iran
| | - Elahe Souri
- Deputy of Curative Affaire, Hamadan University of Medical Science, Hamadan, Iran
| | - Amin Torabipour
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Keshvari
- Department of Health Services Management, School of Medical Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Alikhani
- Faculty of Management and Economics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Lobat Salehi
- Head of The Policy and Strategic Planning Division, the Chancellor and Chief Executive Office, Shiraz University of Medical Sciences
| | - Mohammad Moradi
- Senior expert in the policy-making and planning center of Shiraz University of Medical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | - Leila Sharifi
- Nursing Director of Bandar Abbas University of Medical Sciences, Iran
| | - Habib OmraniKhoo
- Department of Public Health, Faculty of health, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Noraste Amrolahi boyuki
- Head of Administrative Affairs and Human Resources Department of Treatment, Alborz University of Medical Science, Alborz, Iran
| | - Zahra Zarei
- Qum University of Medical Sciences. Qum. Iran
| | - Zohre Sahraei
- Vice-Chancellor in Treatment Affairs, Qazvin University of Medical Science, Qazvin, Iran
| | - Abdollah Keshavaez
- Vice-Chancellor in Treatment Affairs, Qazvin University of Medical Science, Qazvin, Iran
| | | | - Somayae Abdollahi Sabet
- Department of Community Medicine, Faculty of Medicine Zanjan University of Medical Sciences, Zanjan, Iran
| | - Katayon Taiari
- Deputy of Curative Affaire, Saveh university of medical sciences, Saveh. Iran
| | - Jalil Koohpayehzadeh
- Preventive Medicine & Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Moazam
- Cancer Prevention Research Center, Isfahan University of Medical Science, Iran
| | | | | | | | - Hossein Jafari
- Department of Statistics, Deputy of Curative Affaire, Rafsanjan University of Medical Sciences, Rafsanjan,
Iran
| | - Somayeh Foroghifar
- Department of Statistics, Deputy of Curative Affaire, Bam University of Medical Sciences, Kerman, Iran
| | - Masoud Arefnejad
- Department of Statistics, Deputy of Curative Affaire, Zabol University of Medical Sciences, Zabol, Iran
| | - Hossein Ebrahimipou
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Sedaghat
- Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Mehdipoor
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Mollajafari
- Vice- Chancellor’s Office in Treatment Affairs, Health Economy, Standard and Health Technology Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Forouzan
- Deputy of Curative Affaire, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Saeed Meskini Mood
- Deputy of Curative Affaire, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Amin Adel
- Department of management sciences and health economics, school of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shabnam Nirouand
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholam Reza Ghaznavi
- Department of Statistics, Deputy of Curative Affaire, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Reza Zamanzadeh
- North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Khatereh Etesam
- The Coordination Office for Insurance, Tariffs and Standards, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahdieh Dalili
- The Coordination Office for Insurance, Tariffs and Standards, Kerman University of Medical Sciences, Kerman, Iran
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Noori Hekmat S, Dehnavieh R, Norouzi S, Bameh E, Poursheikhali A. Is There Any Relationship between Mental Health and Driving Behavior of Taxi Drivers in Kerman? Glob J Health Sci 2016. [DOI: 10.5539/gjhs.v9n2p294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
<p>Traffic accidents are the main reason of disability and the second reason of mortality in Iran. Therefore finding out the effective factors is vital. The aim of this study is to examine the relationship between mental health and taxi drivers’ behavior in Kerman. This is a cross-sectional descriptive research in which Manchester driving behavior questionnaire (MDBQ) and “general health questionnaire (GHQ)” were used. The questionnaires were distributed between 186 taxi drivers during February and March 2015. Our study was conducted in the province of Kerman in the east south of Iran. We used descriptive methods as well as t-tests, chi-square tests, and logit models for data analysis. The data analysis showed that the driving behavior of Kermanian taxi drivers is good (0.481±4.13) and the mental health situation of them is partly good (0.662±3.61). The Pearson’s correlation test showed overall driving behavior score is correlated positively with mental health score (r=0.83, P=0.000). Also there were positive correlations between all driving behavior dimensions and mental health dimensions at a level of significance of 0.005. The result of Chi-Square Test showed that there the younger drivers and who had less driving experience had higher mental health score. Single drivers and who had less education, which had faced with financial loss in their previous accidents, which had lose their driving license for a while, higher driving behavior score compared to the others (P<0.05). By some improvement actions in driver’s mental health, we can effect on their behavior. And by proper driving behaviors, we can avoid from some mortalities, disabilities and heavy costs on society.</p>
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Hekmat SN, Dehnavieh R, Behmard T, Khajehkazemi R, Mehrolhassani MH, Poursheikhali A. Evaluation of Hospital Information Systems in Iran: A Case Study in the Kerman Province. Glob J Health Sci 2016. [DOI: 10.5539/gjhs.v8n12p95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
<p>The Hospital Information system (HIS) is a comprehensive solution that offers complete data integration for different administrative levels in hospitals. To the extent that this system is close to its aim, the efficiency and quality of health care would increase in hospitals. The performance of HIS systems in 13 hospitals in Kerman province that they were evaluated based on four major criteria of ownership, location, education and software design. Seven hospitals were located in the capital city of Kerman province. According to teaching status of hospitals, four were teaching and based on their ownership three were public. The checklist of Iranian ministry of health and medical education, containing 20 indexes were used to evaluate each hospital’s HIS system in three main supportive, diagnosis and clinical sectors. Spearman correlation coefficient was used to assess the association between major sectors. The highest score (mean±SD) was observed in laboratory information systems (88.19±13.69), resource management (84.47±8.94), and registration information systems (84.47±18.06); the lowest scores were for telemedicine (45.58±3.86), staff information and timing systems (40±16.64), and decision support systems (23.6±4.97). The total score of HIS software was positively correlated with all its three components. There were strong positive correlations between all three components. The three factors of decision support systems, staff information systems and telemedicine have an important role in providing solutions for non-structured management problems and for leading decision-makers to insights, improving human resource management and solving the problem of access to services. Thus, based on the survey findings, those three factors need to be improved in the Iranian hospital information system.</p>
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Dehnavieh R, Mirshekari N, Ghasemi S, Goudarzi R, Haghdoost A, Mehrolhassani MH, Moshkani Z, Noori Hekmat S. Health technology assessment: Off-site sterilization. Med J Islam Repub Iran 2016; 30:345. [PMID: 27390714 PMCID: PMC4898854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 11/14/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Every year millions of dollars are expended to equip and maintain the hospital sterilization centers, and our country is not an exception of this matter. According to this, it is important to use more effective technologies and methods in health system in order to reach more effectiveness and saving in costs. This study was conducted with the aim of evaluating the technology of regional sterilization centers. METHODS This study was done in four steps. At the first step, safety and effectiveness of technology was studied via systematic study of evidence. The next step was done to evaluate the economical aspect of off-site sterilization technology using gathered data from systematic review of the texts which were related to the technology and costs of off-site and in-site hospital sterilization. Third step was conducted to collect experiences of using technology in some selected hospitals around the world. And in the last step different aspects of acceptance and use of this technology in Iran were evaluated. RESULTS Review of the selected articles indicated that efficacy and effectiveness of this technology is Confirmed. The results also showed that using this method is not economical in Iran. CONCLUSION According to the revealed evidences and also cost analysis, due to shortage of necessary substructures and economical aspect, installing the off-site sterilization health technology in hospitals is not possible currently. But this method can be used to provide sterilization services for clinics and outpatients centers.
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Affiliation(s)
- Reza Dehnavieh
- PhD, Associate Professor, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Nadia Mirshekari
- MSc Student, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Sara Ghasemi
- MSc Student, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Reza Goudarzi
- PhD, Assistant Professor, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - AliAkbar Haghdoost
- PhD, Professor, Research Center for Modelling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mohammad Hossain Mehrolhassani
- PhD, Associate Professor, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Zahra Moshkani
- MSc Student, Research Center for Modelling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Somayeh Noori Hekmat
- PhD, Assistant Professor, Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Abstract
INTRODUCTION Patients' health and safety is not only a function of complex treatments and advanced therapeutic technologies but also a function of a degree based on which health care professionals fulfill their duties effectively as a team. The aim of this study was to determine the attitude of hospital committee members about teamwork in Kerman hospitals. METHODOLOGY This study was conducted in 2014 on 171 members of clinical teams and committees of four educational hospitals in Kerman University of Medical Sciences. To collect data, the standard "team attitude evaluation" questionnaire was used. This questionnaire consisted of five domains which evaluated the team attitude in areas related to the team structure, leadership, situation monitoring, mutual support, and communication in the form of a 5-point Likert type scale. To analyze data, descriptive statistical tests, T-test, ANOVA, and linear regression were used. RESULTS The average score of team attitude for hospital committee members was 3.9 out of 5. The findings showed that leadership had the highest score among the subscales of team work attitude, while mutual support had the lowest score. We could also observe that responsibility was an important factor in participants' team work attitude (β = -0.184, p = 0.024). Comparing data in different subgroups revealed that employment, marital status, and responsibility were the variables affecting the participants' attitudes in the team structure domain. Marital status played a role in leadership; responsibility had a role in situation monitoring; and work experience played a role in domains of communication and mutual support. CONCLUSIONS Hospital committee members had a positive attitude towards teamwork. Training hospital staff and paying particular attention to key elements of effectiveness in a health care team can have a pivotal role in promoting the team culture.
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Affiliation(s)
- Somayeh Noori Hekmat
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Dehnavieh
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rohaneh Rahimisadegh
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Kohpeima
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Jahromi Kohpeima Jahromi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Dehnavieh R, Ebrahimipour H, Molavi-Taleghani Y, Vafaee-Najar A, Noori Hekmat S, Esmailzdeh H. Proactive risk assessment of blood transfusion process, in pediatric emergency, using the Health Care Failure Mode and Effects Analysis (HFMEA). Glob J Health Sci 2014; 7:322-31. [PMID: 25560332 PMCID: PMC4796474 DOI: 10.5539/gjhs.v7n1p322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/25/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction: Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. Methodology: This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts’ panel views via the interview and focus group discussion sessions. Results: The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ (“Theory of Inventive Problem Solving.”) Conclusion: The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency.
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Affiliation(s)
- Reza Dehnavieh
- Research Center for Health Services Management, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Hekmat SN, Tourani S, Haghdoost AA, Ebrahimipo H, Mehrolhass MH, Dehnavieh R. Beneficial and Adverse Effects of the Integration of Medical Education and Health Service in IR. Iran; A Delphi Exercise. J of Medical Sciences 2013. [DOI: 10.3923/jms.2014.21.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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