Journal of

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Background: The existed difference statistical indicators is necessary to measure the efficiency of the health organization and as an exact strategy, could be removed the developed problems in heath services sectors. Materials and methods: This is a descriptive research as a cross sectional study throughout obstetric and gynecology wards in the general hospital of RASOOL. The questionnaires and statistical Forms applied for data gathering. The methods were completed questionnaires, statistical Forms, face to face interviews and observation. The Delphi technique, standardized questionnaires and references’ text books used to determining the reliability and validity. Data analysis was done by using likret ranking. results: The results showed that some indicators, such as inpatient bed occupied rate (63%), bed turnover interval(5) & mean length of stay(4), patient per nurse(19), meanwhile service education(10),staff per active bed(1for 12), midwife per delivery bed(0), staff(50.9%) and patient satisfaction(89%) were lower than expected. Some indicators such as rooming in technique(100%), breast feeding(100%), patient information access from HIS system(100%), emergency and hostelling medicine access(100%), round and morning reports(100%), the mean admitted time in the ward(30 minutes), Infant and maternal mortality rate per total deliveries(0), and the percentage of trained patient(100%) were as expected. Some indicators such as expert physician per active bed (1 for 7) and C/S per total delivery ratio (69%) which was higher than expected, and the necessary data for calculating book & papers per assistant professor & non colonial infection rate were not found. Conclusion: Hospital indicators showed the performance of hospitals in the various bases. Therefore,the broad attentions to these indicators are necessary. Meanwhile, it should be compared them and to distinct time periods.

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Background: People give you an idea about variety of behaviors when confronting diseases. Different factors such as age, sex, economic and social situations have effect on its. Recognition of these behaviors helps politicians to deliver better services. This study aimed to identify health seeking behaviors of Zoroastrian residing in Yazd province due to advanced number of them in comparison to the other provinces.
Materials & Methods: This study is a cross sectional. The sample size was 196 cases which selected by using simple sampling method. The data was collected via the questionnaire, then data were analyzed by spss.11 software with two test of chi square and exact test of Fisher.
Results: The findings showed that 64.3% of the population was female whereas remaining 35.7% were male. 15.58% of participants were single, 76.5% married and the rest of them (7.7%) were widow. Data indicated that 4.1% of individuals were illiterate, 17.3% were high school , 51.3% had diploma, 23.5% had Bachelors degree and 3.6% had Masters Degree or Ph.D. 43.4% of studied population were unemployed and the rest of them (46.7%) were employed. 94.4% of participants had health insurance whereas 5.6% did not had uninsured card. The results showed that the following direct variables had relation with the following mentioned indirect variables sex with the action during the period of being sick, Place of born with reasons of neglecting sickness, marital status with action during the period of being sick, educational status with action during the period of being sick and referring to practitioner in different stages if sickness and using consultation of different groups, occupational status with the first place to get medical treatment, economical status with reasons of neglecting sickness and completion of treatment period and having health insurance with action during the period of being sick and using consultation of different groups.
Conclusion: Considering the fact that educational, occupational and economic status have relation with health seeking behaviors in individuals, developed in education and occupation status could be lead a chance to choose a better health behavior in people.

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Background: aging is a very sensitive period of life and paying attention to the problems and requirements of this period seems to be a social necessity. Improving medication for old patients is challenging and sometimes medication`s benefits are less than its disadvantages for the patient.Because of the numerous evidences of problems caused by medication in the elderly in the recent decade, many specialists and physicians have introduced tools and techniques for identifying these problems which are caused by medication and prescription of risky medicines.
Materials and Methods: Several methods, tools and criteria for assessment of quality of medication and medicine prescription in elderly have emerged since 1990.. We found out two categories of criteria reviewing the literature which are generally named as distinct criteria (criterion based) and implicit criteria (judgement based).
Result:The distinct category including Beers, Zhan, McLeod, Laroch and STOP/START criteria are all developed by a panel of experts and consensus in several stages. The second category of criteria concentrates on evaluation of clinical information.
Conclusion: All the tools and methods described in this study are used in Europe and in the USA which have limited market similarities with our country thereforedevelopment of tools for assessing prescription quality for the elderly in Iran is absolutely necessary.

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Background: Patients are the raison d'etre of the hospitals therefore satisfying their needs and expectations is one of the most important duties of the hospitals. Consequently in recent decades patient satisfaction has been considered as a reliable measure for studying the quality of care and treatment. Hence in the present study, documents related to patient satisfaction in Iran was surveyed and the overall level of satisfaction was estimated using meta-analysis.
Materials and Methods: Articles on patient satisfaction were identified by searching different data bases using appropriate key words. Twenty six studies were extracted after applying inclusion criteria measures. The results were analyzed using Meta-analysis commands in STATA11 software.
Results: 14058 cases were surveyed in this 26 studies by meta- analysis. Based on the random-effect model the patient overall satisfaction percentage was estimated at 70.5 (CI:63.3-77.6) though based on fixed effect model.
Conclusion: The scale of patient satisfaction in Iran is in a proper level compared to other countries. Additionally, there has been an increasing trend in patient satisfaction in recent years, which might be attributable to measures such as using different methods of quality improvement, customer orientation and customer reverence.

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Background: This research aims to design and implement a software with the ability to identify patients who are facing the risk of pulmonary embolism and deep venous thrombosis instantly as well as the ability to send timely reminders for any prophylactic action. The main target is introduce a clinical decision- support system which could finally lead to preventing mortality and handicap cases caused by embolism and thromboses in patients who are confined to bed in hospitals. Materials and Methods: The software was designed using the Visual Basic.Net and SQL Server database. Afterwards the software was installed in the largest educational hospital of Kerman and a survey was conducted amongst the physicians using multiple questionnaires and interviews. Finally, the data were analyzed using the SPSS software. Results: The average score was 21.16 for the physicians and 20.76 for the nurses. T-Test results show that there is no significant difference between the total average score of the physicians and that of the nurses. Conclusion: The results have shown that both groups (physicians and nurses) have a positive viewpoint about the software therefore using the clinical decision support system can be effective in reducing the occurrence of pulmonary embolism and deep venous thrombosis through sending timely electronic alerts to the medical staff.

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Background: A method of performance assessment is required to improve Productivity and reduce hospital costs . Pabon Lasso diagram is known as a tool for performance assessment. The current study is aimed to assess and compare Kerman province`s hospitals performance by using Pabon Lasso diagram. Materials & Methods: This descriptive and cross-sectional study was conducted retrospectively between 2008 and 2010. All hospitals of Kerman province in three groups of public, social security and private were selected by census method (N=23). The data were gathered from statistics unit and entered into SPSS 18.0. Three indicators include bed occupancy rate, bed turnover and average of length of stay were calculated and then hospitals` performance were analyzed by Pabon Lasso diagram. Results: In first two years, seven and eight hospitals out of twenty-three and in third year nine hospitals out of twenty-two located in third zone of the model (desired productivity) respectively. Among all hospitals, regarding number and ownership type, social security hospitals had better performance in 2008. Additionally Public hospitals had better performance than others in 2009 and 2010,. Conclusion: Public hospitals had better performance.Although studied hospitals` performance experienced growing trend, only one third of the them had desired performance. It can be caused by changing the provided services type from inpatient to outpatient services.It seems that Considering type of ownership and assessing past trend of 3 studied indicators concurrently is necessary for Planning for development of a broader range of inpatient services and diversified medical services based on province`s need.

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Abstract Background: EMS technicians are faced with numerous stressful situations during a working day. These mental tensions may significantly effect on delivered services quality actually. This situation can be considered as a threaten risk for people who use the EMS. This study aimed to determine the most common stressful factors influencing the EMS technicians in Kerman. Materials Methods: In this cross-sectional study 140 EMS technicians participated. Sampling method was census and data collection was done by using a valid and reliable nursing tension factors questionnaire. Data analyzing was performed by SPSS software version 19 using Pearson correlation coefficient, Spearman and regression tests. Results: The most and least common stressful factors were patient care (Mean=3.24) and environmental tension (Mean=2.64) respectively. Regression analysis revealed significant relation between age and environment tension factors (β = -0.155, p=0.034,) and managerial stressful factors had significant relation with gender (β= -2.955, p= 0.047) and educational level of EMS technicians (β= -0.23,p=0.05). Conclusion: Patient care and personal factors cause stressful situations among EMS technicians. Therefore, it is recommended emergency managers to provide strategies toward decreasing job stress in order to improve the quality of working life and organizational commitment to help EMS technicians.

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Background: Hospital as core of health and care system requires an effective leadership style and suitable strategy for organizational differences and conflict’ solving. Main goal of this study is to survey of relationship between leadership style and strategy of conflict management among chief executive officers of Urmia hospitals. Materials and Methods: This analytical-descriptive cross-sectional study was implemented in Urmia hospitals in 2013. Study population of the research includes thirty top managers in ten hospitals of Urmia. Data gathered through three questionnaires (personal and job characteristic leadership style with method of Fiedler LPC and conflict management). Data analyzed through SPSS software, mainly by Chi 2, Kruskal–Wallis and Spearman's Rho tests. Results: Results showed that Leadership style had significant statistical relationship with average of managers work experience (p=0.040). Also age and strategy of control had significant statistical relationship (p=0.01). Leadership styles and strategies of conflict management weren’t significantly with other descriptive variables such as (position, level of education, marriage situation, work experience, managerial studies and second job). Leadership styles and strategy of conflict management weren’t significant relationship, finally. Conclusion: Since that the determination of leadership style and methods of dealing with conflict management in hospitals is important, it is recommended that ever done comprehensive research on the effects of other factors such as organizational culture, social culture, character on leadership style and conflict management.

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Background: Waste of health care centers is particularly important due to their major role in spreading various diseases and environmental pollution. Consequently, considering function of  non-hazardous waste devices in hospitals seems vital. This study is aimed to assess function of non-hazardous non-incineration devices of waste in Kerman educational hospitals and Sirjan hospitals

Materials &Methods: This experimental study had been conducted between March and September in year 2013 at the engineering research center of environmental health affiliated with Kerman university of medical sciences. Physical, chemical and biological function of devices was examined. Mechanical function had been examined by monitoring and recording mechanical index through thermometers and registers of devices. Chemical and biological function had been examined by indicator strip and biological indicator strip respectively.

Results: Among hospitals in which the survey had been carried out, 96.3%, 85.3% and, 84% of non- hazardous waste devices had efficient function from mechanical , biological and chemical viewpoints respectively.

Conclusion: As the results show, mentioned waste devices are unable to decontaminate hospital waste from hazardous materials chemically and biologically. Although mechanical process is efficient enough by providing required temperature and time , hospitals waste are not yet defined non-hazardous. Thus the final functional assessment is identified as poor outcome.

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Background: Patient safety is one of main indicators in quality control of health services. The most prevalent threatening cause of patient safety is medical errors especially medication errors. This study aimed at assessing the rate and type of nurses’ medication errors.

Materials and Methods: This study was a descriptive – analytical one which performed in a non-public hospital in East North Country. The studied hospital has 180 active beds in the fields such as general surgery, obstetrics and gynecology, infants, cardiology, angiography, CCU, ICU, and NICU. Due to limited population, all the nurses in the hospital (97 nurses) were participated in the study. The instrument was a self-designed questionnaire which was composed of two main parts (demographic data and medication errors information). Its reliability and validity was confirmed. Data were analyzed by SPSS software version 15 using t- test and ANOVA.

Results: Among the studied nurses, 76 nurses (78.3%) were female and 21 (21.7%) were male. The mean of age and work experience of participants were 29.3 and 8.7 respectively. The most frequent of medication errors included medication without prescription 136(23.7%), lack of attention to medical complications 134(23.4%), Giving the medication at the wrong time 128(22.4%). The lowest common of medication errors reported as using expired date medication4(0.7%), wrong medication 5(0.9%) and  non administered medication 6(1.1%).

Conclusion: The nursing managers should be consider more attention to reduce medication errors by implementing Training classes, improving nurse's processes and promoting attitudes towards importance of patient safety.

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Background: Physiotherapy information system is one of health information systems which used to increase the efficiency and effectiveness of physiotherapy department. Studies have revealed due to usability problems, users' interaction with some information systems is complicated. This study aimed at evaluating users' interaction problems with physiotherapy information system.

Materials and Methods: This study was a cross-sectional and descriptive one which performed using heuristic evaluation method; the users' interaction problems of a physiotherapy system among 105 hospitals were identified, classified and rated based on their severities by three evaluators. Data were gathered using a data collection form designed in Excel software.

Results: In this study, 82 unique interactive problems identified which majority of them 28% (n=23) were related to unconformity of system design with real world conventions with major mean severity of the problems. The lowest numbers were related to the problems including lack of guidance, system documentation and error prevention with major and minor severity respectively.

Conclusion: A number of systems, which are used in many health care centers such as assessed system in this study suffer from several problems which endanger user interaction about the systems can lead to error and patients' harm. To identify and eliminate this type of problems, it is recommend that usability evaluation of these systems to be carried out regularly to enhance users' satisfaction, workflow improvement and patient safety. 

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Background: Chronic renal failure disease is considered as a health problem . Because of their high prevalence and economic burden on the society, health system managers consider to the disease as a public health concern.  This study aimed at comparing the cost-effectiveness of long-term dialysis treatments and kidney transplant using DALY index.

Materials and Methods:This cross-sectional study was designed to compare the cost-effectiveness of two methods such as long-term hemodialysis and kidney transplant using Disability Adjusted Life Years (DALY) in Afzalipour Hospital of Kerman in 2012. The decision tree model and TreeAge software were used for data analysis. In this research, costs and effects were studied from the patient perspective.

Results: The cost of a kidney transplant was 165 million Rials, effectiveness of a kidney transplant was 4.40 DALY, chronic dialysis cost was 1.283 billion Rials and its effectiveness was 6.52 DALY. Cost-effectiveness ratio for dialysis was 196 million Rials per DALY and this ratio is 37 million Rials per DALY for a kidney transplant respectively. According to the findings, kidney transplant is more cost effective than dialysis.

Conclusion: This study suggests kidney transplant over dialysis due to its better quality of life and more life expectancy. The results can help out the government to decide about the more resource allocation to kidney transplant programs. The method in this research can be applied to measure the cost-effectiveness of other organs transplantation.

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Background: Suitable budget allocation of organizational activities can deliver the resources distribution, enabling operational monitoring and providing expected access to the cost results. The aim of this study was to calculate the cost of final units in one of the Armed Forces Hospitals.

Materials and Methods: One of the Armed Forces Hospitals selected in 2013.Data gathered from all cost centers to costs calculation and evaluated based on theory of Activity-Based Costing analysis. General wards and intensive care units, operating rooms, dental, emergency and dialysis were considered as final units. Cost calculation performed using Excel software version 2007.

• Total cost of hospital was 244,416 million rails in 2013 which direct and indirect allocated costs were 52% and 48%, respectively. The CCU, surgery ward, ICU and operating rooms had the highest and clinics and dental had the lowest in case of costs. More than 50 percent of the direct costs of all the units have been spent on manpower except the operating room. After labor costs, medication costs accounted for the largest percentage of direct spending units.

Conclusion: Paying attention to human resources in terms of number and distribution of all units especially in the final units, also considering medications use particularly in middle units and consumables in overhead ones especially can be result in reduction and adjusting hospital costs.

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Background: Today, due to the diversity of organizational structure and culture, the diversity is one of the basic principle in crisis management.Crisis management consists of six components including flexibility, inclusion, trust, risk perception, adaptability and equity.This study aimed at investigating the managers' perception about components of crisis management in hospitals affiliated to Tehran and Iran University of Medical Sciences.

Materials and Methods: This study was a cross-sectional one. A questionnaire was used to collect data using five likert scale. Validity and reliability of questionnaire assessed by content validity and Cronbach's alpha coefficient. Sixty six questionnaire were collected. Data analysis was performed by SPSS software using ANOVA and independent t-test.

Results: The highest and the lowest level of managers' perception were inclusion and equity(3.19 ± 0.51) and adaptability(2.73 ± 0.75), respectively. There was a statistical significant difference between crisis management components with gender and job type. The highest level of importance was regarded to inclusion and mutual trust between personnel and managers, and  the lowest level was related to flexibility in hospital crisis management .

Conclusion: Employees in diverse positions have different definitions of adaptability in crisis. It is necessary to perform further research and educate hospital manager’s duties. 

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Background: Many hospitals of Iran make use of their therapeutic capacities in order to attract medical tourists and increase revenue and efficiency of their affiliated hospitals. This issue has major benefits for hospital and tourists. This study assessed the potential of medical tourists' attraction in a military hospital in Tehran.

Materials and Methods: This was a descriptive- analytical one which used secondary data to analyze. Data gained from quality improvement and finance offices, recipients of service and health information management units from the first of 2014 to the first semester of 2015. Strategic plan document were used to analyze the opportunities and strengths points.

Results: The mean of studied hospital performance indicators like bed occupancy rate, length of stay, Bed turnover, rate of admissions to bed, mortality and bedsores rates, nosocomial infections, medication error, patients' rights and patient satisfaction were  4.68 ,  3.3,  5.1 , 6.6 ,  5.2, 1,  69, 9.74 , 70 percent respectively. The strengths points of the studied hospital were diverse expertise, updated equipment and minimum waiting time.

Conclusion: Because of skilled man power, physical resources and especially modern equipment, the hospital does not need huge investment in medical tourists' attraction. This issue will increase admission, productivity and satisfaction of clients and staff.

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Background: Physical and verbal violence against hospital personnel is very critical problems that could influence the quality of clinical and nursing cares. Today, problem prevention and identification of related factors with domestic violence against women have been considered as a health priority in many countries. Therefore, due to the importance of this issue, this study aimed to determine related factors with domestic violence against women in educational hospitals affiliated to Isfahan University of Medical Sciences.
 
Materials and Methods: This cross-sectional study was a descriptive-analytical one which conducted on 836 female employees using census method. Data collection performed using a researcher-made questionnaire. This questionnaire consisted of 34 items in four dimensions (physical, verbal and mental, sexual) and violence experienced by the husband. Data were analyzed using SPSS version 16 with descriptive statistics and analytic statistics such as Kolmogorov–Smirnov, ANOVA, independent t test, and Pearson correlation coefficient and multivariate regression.
 
Results: Study results revealed that verbal and mental (55.33%), physical (36.16%), and sexual (6.66%) violence were the most common type of violence against women, respectively. There was a significant statistically association between age gap, forced marriage, husband’s addiction, income and precedent violence Experience and violence against women.
 
Conclusion: This study presented prevalence and related factors of demotic violence among women. Therefore, it is imperative that health authorities, especially hospital managers, pay attention to this phenomenon assessing further investigation of factors related to violence against women in order to take the necessary steps to mitigate and reduce related factors using life skills workshop, training and counseling for couples.

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Background: Patient complaints from the healthcare system can be helpful to respond patients’ needs using identifying the weaknesses. In this study, the complaints trend of patients has been investigated before and after healthcare system reform progress in a public hospital.
 
Materials and Methods: This descriptive-analytic study was carried out to assess trend of patient's complaints in two period of time in a northeast governmental hospital before and after healthcare system reform implementation (2012-2016). In order to collect data, the checklist designed by the ministry of Health was used. Data entered to SPSS version 21 and analyzed using descriptive statistics and analytical tests such as Chi-square.
 
Results: The study results revealed that the number of complaints were 29 and 198 before and after implementation of healthcare system reform, respectively. Most complaints were related to the emergency sector (31%) and about 40% of the complaints were from physicians. Most of the registered complaints were related to the quality of provided services (33.5%) and personnel exposure (30%), respectively. Accordance to study results, there was a significant difference between the number of complaints before and after implementation of the health system reform with the type of complainant (P <0.05).
 
Conclusion: Implementation of healthcare reform plan has led to systematic registration and special attention to complaints in assessed hospital. Most of registered complaints were related to the emergency department which requires managers and hospital officials to pay special attention to this sector and take effective steps to improve quality of services.

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Background: Considering the increasing growth in health care costs along with the resources finitude; therefore, improving the efficiency and efficient use of resources is considered as one of the main priorities of the health system. The aim of this study was to determine the efficiency of direct medical services affiliated with Iranian Social Security Organization using Stochastic Frontier Analysis (SFA) Method in 2008-2015.
 
Materials & Methods: In this descriptive- analytical study, performance of 30 units of direct medical services affiliated with Iranian Social Security Organization was analyzed using Stochastic Frontier Analysis (SFA) Method. The number of active beds, physicians, nurses and staff were used as inputs and combined variables obtained from factor analysis were selected as output. Frontier version 4.1 was used to determine the efficiency and Stata version 14 was used to study the effective factors on efficiency.
 
Results: The average technical efficiency of studied units was 0.816. Based on the value of index of likelihood ratio test ( LR = 100.45 ), Cobb-Douglas production function was selected as the best model.
 
Conclusion: Based on the findings of this study, adjusting surplus manpower, congenital planning for increasing efficiency and resource management should be the priority of the managers so that they can increase the level of efficiency of studied units and reduce the costs to the least possible.
 

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Background and Aim: Hospital is organization which its performance improvement is very important. In order to do this, we must evaluate the allocated resources and performance of hospitals. Calculating hospitals efficiency is one of the possible ways to evaluate the performance of them. In this study, the efficiency of allocated financial and human resources of public hospitals by provinces is examined.
Materials and Methods: This study was conducted in 2017-2018. Data were collected from 31 provinces of Iran. Input (including: number of physicians, number of nurses and number of active beds per ten thousand population) and output (number of hospitalizations and number of outpatients per ten thousand people). Data were collected from studies. The efficiency analyzing of the provincial treatment department was performed with DEAP software.
Results: The input population (nurse, doctor, bed) is related to hospitals and health centers in Semnan, Yazd and Mazandaran provinces And the least amount of input was related to Sistan and Baluchestan, Khuzestan, North Khorasan provinces. The highest output (inpatient and outpatient) belongs to East Azarbaijan province and the lowest output belonged to Hamedan province. Efficiency score, variable return to scale and constant return to scale for all hospitals in the country are 0.565, 0.813 and 0.47, respectively.
Conclusion: proper and correct distribution of resources between provinces may increase efficiency of resource distribution.

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Background and purpose:
As people age, physical dysfunction often increases, leading to various challenges and a heightened need for urgent medical services. Elderly individuals are among the primary users of healthcare and pre-hospital emergency services. Their subjective experiences during emergencies are influenced by their need for timely and relevant information regarding emergency procedures and their clinical condition—a need that is also shared by their caregivers. This study aims to elucidate the experiences of elderly individuals who have used pre-hospital emergency services in Shiraz.
Methods:
This qualitative study was conducted in two phases. In Phase 1, semi-structured interviews were conducted with 21 elderly participants using purposeful and snowball sampling until data saturation was achieved. The interview transcripts were analyzed using Colaizzi’s method to extract key themes. In Phase 2, a panel of experts was convened to further discuss the findings and provide recommendations.
Results:
Analysis of the interviews revealed several themes related to the elderly’s experiences with pre-hospital emergency services. These themes were categorized into sub-themes including ambulance condition, performance of technicians, timeliness of emergency response, and issues related to emergency rules and regulations. In Phase 2, the expert panel offered practical solutions to address the identified challenges.
Conclusion:
The findings indicate that elderly patients face significant challenges when accessing pre-hospital emergency services, such as poor ambulance conditions, suboptimal technician performance, delayed emergency response times, and restrictive emergency protocols. The recommendations provided by the expert panel could inform policy development and lead to improvements in the quality of pre-hospital care for the elderly.