Showing 352 results for Type of Study: Original Article
Ahmad Arabkhani, Hossein Dargahi, Raheb Ghorbani, Israfil Rushdi,
Volume 22, Issue 1 (5-2023)
Abstract
Background: The development of the health system increases the health level of the society. The present study was carried out with the aim of development of "Health System Development Scale".
Methods: The study was qualitative-quantitative. For qualitative part, a semi-structured interview with 11 experts was conducted in a targeted manner with maximum diversity and the results were analyzed by open, central and selective coding method. For quantitative part, first the validity of the questionnaire was carried out through interviews with 10 experts. Finally, the construct validity was conducted according to the opinion of 220 experts by exploratory factor analysis (with the Kaiser-Meyer-Elkin scale) and confirmatory factor analysis (in the form of divergent, convergent validity and fit indices) using SPSS and Lisrel software. Reliability was also measured by calculating Cronbach's alpha coefficient and composite reliability.
Results: The scale was designed with 40 statements obtained from the findings of the qualitative study. In the quantitative part, the appearance and content validity ratio of the dimensions of the questionnaire was qualitatively confirmed (for all statements between 0.80 and 0.1). Construct validity was done by exploratory and confirmatory factor analysis and convergent validity was between 0.53 and 0.75 and divergent validity was between 0.54 and 1. The internal consistency of the tool was approved with Cronbach's alpha coefficient between 0.75 and 0.86 and composite reliability coefficient was between 0.72 and 0.80.
Conclusion: The validity and reliability of the scale was confirmed. It is suggested to use it to measure the level of development in the health system by experts in this field.
Rohollh Hosseini, Anis Javanmard,
Volume 22, Issue 1 (5-2023)
Abstract
Background: Achieving goals and developing hospital services depends on competence and optimal management. There will be competent managers who can be successful in performing managerial roles. Playing the roles supports the management in the direction of efficiency, administration and optimal management of the hospital. The purpose of this study is to evaluate and prioritize the roles of management in the hospital from the experts' point of view.
Materials and Methods: This research has a practical purpose and a descriptive and analytical approach. The statistical sample of the research included 65 experts from Imam Khomeini (RA) Al-Shatar Hospital, who were identified based on the snowball and selective sampling method. In this study, a self-made matrix questionnaire whose validity has been confirmed by experts was used to collect data. TOPSIS technique was used to analyze the data. In this study, five criteria and three main roles, which include 10 secondary roles, were identified
Results: The data analysis showed that the promotion of organizational commitment with the percentage of importance (23.2%) with the most important criterion, followed by organizational improvement criteria (20.9%), coordination and coherence (19.4%), promotion of employees' job motivation (7%) 18.00) and improvement of performance efficiency (18.4%) are ranked as effective indicators respectively. Also, the sub-role of analyst supervisor (0.926) was introduced as the most important role among the sub-roles of management in the hospital.
Conclusion: Considering that the role of decision-making was introduced as the most important role, as well as the consequences of decisions on the present and future of the hospital, it is necessary for the hospital management to pay more attention and importance to the role of decision-making in order to make optimal decisions.
Hossein Rahimi Klour, Seyed Ali Naghavi,
Volume 22, Issue 1 (5-2023)
Abstract
Background and objective: As a critical factor for hospital effectiveness, agility uncovers the way such organizations react to internal and external changes. From this perspective, the present study was to design an agent-based model to simulate organizational agility development in the hospitals of Ardabil Province, Iran, in view of the effective factors.
Materials & Methods: Utilizing an exploratory, mixed-methods research design, this study was performed in accordance with inductive-deductive reasoning. For this purpose, the samples included 10 theoretical and experimental experts, selected by purposive sampling of the non-probability type. As well, the data collection tools were interviews and questionnaires. During the qualitative phase, the main factors affecting organizational agility were initially isolated using thematic analysis. Afterward, the given factors were prioritized with the fuzzy Delphi method in the quantitative phase. Ultimately, the model for organizational agility development was simulated through the agent-based approach.
Results: With reference to the study results, 50 primary codes, 15 sub-themes, and 5 main themes were identified, and then “influence in management” was acknowledged as the most significant one shaping organizational agility. Besides, the simulation outputs demonstrated that the proposed model could provide the right estimate of the future of organizational agility development in the hospitals of Ardabil Province, Iran.
Conclusion: Along with the study results, hospital managers are suggested to reflect on the effective factors identified here to better fulfill organizational agility development.
Omid Mazlumi, Mehraban Parsamehr, Akbar Zare-Shahabadi,
Volume 22, Issue 1 (5-2023)
Abstract
Background: Cancer is often stigmatized in many societies and this has unfortunate consequences for sufferers. The aim of this research was to know the factors related to the social stigma of cancer.
Materials and Methods: The research method was correlation-analytical, and the sampling method was multi-stage cluster. Data were collected using CSI and CAM standard questionnaires.The statistical population included three categories of ordinary citizens, medical staff, and companions of patients in Tehran; Using Cochran's formula, the sample size was 384, 201, 384 people, respectively. In order to fit the model and measure the relationships between the variables, the method of structural equation modeling was used in the form of AMOS software.
Findings: Goodness of fit indices (chi-square/df=2.851, Rmsea=0.08, Cfi=0.945) all indicated the appropriate fit of the model. Except for the variable of inequality in treatment, other independent variables had a significant relationship with stigma. The r2 explanatory coefficient showed that the variables of habitus, optimism, cancer awareness, religiosity, social support, and social capital together predicted 48% of stigma changes. Habitus and social support with standard coefficients (beta) of 0.48 and -0.28 had the highest and lowest contribution in explaining stigma, respectively. Based on the mean difference test, the amount of stigma among ordinary people was more than the other two groups.
Conclusion: Awareness of different aspects of cancer disease (such as symptoms, causative factors), removing false stereotypes about cancer (such as cancer means death), constant communication with cancer patients, and receiving the necessary social support from various sources, were the most important tools necessary to reduce the stigma of cancer.
Moslem Sharifi, Jalal Saeidpour, Mohammad Javad Kabir, Abdollah Poursamad, Mehdi Ebrahimi, Bahman Khosravi,
Volume 22, Issue 1 (5-2023)
Abstract
Background and purpose: With the establishment of a comprehensive health information system (SIB system) in the health department of Iran's health system, one of the important programs of this country to improve health care through the integration of health information was keyed. This study analyzed the performance of this program from the point of view of the end users of the system in the health centers of Boyar Ahmad city.
Materials and Methods: This study was a qualitative research that was conducted using semi-structured interviews and focus group meetings with 25 system users, support officials and staff experts at different levels, reviewing relevant documents and also observing users' performance. The snowball sampling method was carried out in a targeted and networked manner. Qualitative content analysis was used to analyze the data. MAXQDA10 software was used to record, organize and manage study data after collection.
Results: The findings of this study showed that the deployment of this system from the users' point of view contains many positive and negative points, which can be categorized in five general axes, data management system, caregivers' performance, care management, quality of care and infrastructure. The most important challenges of the system included technical inefficiencies, operational inefficiencies, the challenge of statistics and reporting, and technical and social infrastructure, and the most important benefits were improving the quality of care, tracking and reporting, facilitating the care process, and improving the performance of caregivers.
Conclusion: From the point of view of users, the Sib system can be considered as a positive experience in improving the quality of health care, but due to the existence of many challenges, it is far from its final goals
Behrooz Rahimi, Seyed Mahdi Jalali, Hamed Nazarpour Kashani,
Volume 22, Issue 2 (9-2023)
Abstract
Introduction: Equitable geographical distribution of healthcare system initiatives, aimed at increasing quality and economic efficiency, is a crucial aspect of ensuring access to healthcare services. This study seeks to elucidate the contextual, procedural, and outcome factors of health marketing in Iran, with a focus on enhancing and improving health services.
Methods: This research was conducted using a qualitative approach. The sampling method employed was purposive, resulting in the participation of 51 experts. The study data were analyzed using content analysis.
Findings: The findings of this study have been categorized into conceptual subgroups, including causal conditions, foundational components, strategies, contextual factors, intervening factors, and consequences of implementation.
Conclusion: Adopting an effective health marketing model can create opportunities for service providers to generate sufficient income, thereby motivating them to deliver high-quality services. Attracting ample income, in addition to ensuring service quality for recipients, will also lead to their satisfaction with the healthcare system and contribute to the continuous provision of desirable services.
Hasan Fatahi, Seyyed Mohammad Waziri, Mahyar Souri, Mohammad Hossein Askarian,
Volume 22, Issue 2 (9-2023)
Abstract
Background and purpose: The emergency department of a hospital is akin to its heart, where smooth operations can save many lives. This research aims to reduce patient waiting time in the emergency department using simulation techniques.
Methods: This descriptive-analytical study was conducted cross-sectionally in 2019 at the Qaim Hospital in Mashhad. The study focused on accurately modeling the patient flow process in the emergency department using simulation techniques and Arena software. Key performance indicators such as patient waiting time, number of discharged patients (system output), length of stay, resource efficiency, and improvements in the emergency department were evaluated.
Results: The simulation model's results indicated that the laboratory, specialist doctor examination, and pharmacy departments had the longest waiting times in this department, respectively.
Conclusion: To reduce patient waiting times and improve conditions, the most effective and cost-efficient solution is to add a laboratory technician to the laboratory department during the [15-23] shift at Qaim Hospital in Mashhad, which is projected to decrease patient waiting times by 66 minutes.
Reza Pirayesh, Hamed Rastegarnia, Fatemeh Alilou,
Volume 22, Issue 2 (9-2023)
Abstract
Background and Objective: Employee creativity is a key element for
achieving sustainable competitive advantage in both private and public
organizations. This study aims to explore the influence of leadership styles
and feedback behavior on employee creativity growth, considering the
mediating role of the communication mechanism among employees of
public clinics in Zanjan.
Materials and Methods: This applied study follows a descriptive-survey
approach. Data were collected through field observations, questionnaire
distribution, and library research related to the study variables. The
statistical population included all employees of public clinics in Zanjan. From
209 people, 135 were randomly selected as the sample based on Cochran's
formula. The questionnaires were distributed and completed by these
individuals. Data collected via questionnaires were analyzed using structural
equation modeling with PLS and SPSS software.
Results: Feedback behavior (coefficient = 0.256), leadership styles
(coefficient = 0.543), and the communication mechanism (coefficient =
0.126) significantly influenced employee creativity. Additionally, feedback
behavior (coefficient = 0.267) and leadership styles (coefficient = 0.348)
significantly impacted the communication mechanism. The results also
indicated that the communication mechanism effectively mediated the
relationship between leadership styles (coefficient = 0.044) and feedback
behavior (coefficient = 0.034) on employee creativity growth.
Conclusion: The findings suggest that leadership styles and feedback
behavior significantly influence employee creativity growth through the
mediating role of the communication mechanism. Organizational managers
should leverage these factors to enhance their employees' creativity
Mohammadreza Zahedi, Seyyed Mahdi Hosseini Sarkhosh,
Volume 22, Issue 2 (9-2023)
Abstract
Background and purpose: The Internet of Things (IoT) essentially refers to the connectivity of various objects through the internet to facilitate a more efficient and intelligent experience. However, due to the emerging nature of this technology in Iran, instances of its full deployment in service organizations, including hospitals, are rare or infrequent. Therefore, the aim of this study is to identify the key success factors for the deployment of IoT and assess the readiness for implementing this technology in Milad Hospital, Tehran.
Methods: This research is a descriptive-survey study conducted in two phases. In the first phase, 30 key success factors were identified through a review of previous studies. In the second, survey phase, 93 managers and staff members of Milad Hospital formed the statistical population, and data was collected through a researcher-made questionnaire. The comparison of the current and ideal states of success factors for IoT implementation, and their ranking, were done using the t-test and Friedman test in SPSS software.
Results: Based on this study, factors such as information technology, organizational culture, organizational structure, and human resources were identified as the most crucial for successful IoT deployment in the hospital. Additionally, the results showed that there is a significant gap between the hospital's current state and the desired state for IoT implementation in these identified areas.
Conclusion: Successful implementation of IoT requires enhancement in readiness, both in terms of technological and organizational-cultural infrastructures
Javad Pourgholam Sarivi, Fatemeh Rahmaty, Maryam Yaghoubi,
Volume 22, Issue 2 (9-2023)
Abstract
Introduction : The Internet of Things (IoT) enables the connectivity of all devices in our daily lives, and it has had a positive impact on healthcare, specifically in disease diagnosis and prevention, especially during times of crisis. The objective of this research is to identify the factors that influence the use of IoT in combating COVID-19 in hospitals.
Materials and Methods: This qualitative study was conducted in 2023, using semi-structured face-to-face and telephone interviews with ten experts in health information technology and the Internet of Things. Data analysis was conducted using directed content analysis with MAXQDA software, version 2018.
Results: The data analysis resulted in 124 codes, which were then divided into 32 subcategories. These subcategories were further classified into six categories according to the model of the International Telecommunication Union. The categories include Network (five subcategories), Application (ten subcategories), Equipment (four subcategories), Support (three subcategories), Management (six subcategories), and Security (four subcategories). The Application category had the highest frequency, while the Support category had the lowest.
Conclusion: Infrastructure and legal aspects are among the most significant factors in the implementation of the Internet of Things in healthcare, particularly in the fight against COVID-19.
Ahmad Kalateh Sadati, Seyed Reza Javadian, Marzieh Sadeghi Hardangi,
Volume 22, Issue 3 (12-2023)
Abstract
Background and Purpose: Discharge planning, as a process for the safe transfer of patients, has always been challenged by the interventions of medical social workers. Identifying these challenges prevents disruptions in effective planning. This research aims to explore the challenges faced by medical social workers in discharge planning.
Materials and Methods: This is a qualitative study conducted in Iran in 2023. Data were collected through semi-structured face-to-face and telephone interviews with 16 social workers working in hospitals and were manually analyzed using thematic analysis.
Results: The findings of this study revealed that hospital social workers encounter structural and professional challenges during discharge planning. As a result, themes such as professional isolation, erosive environment, back-breaking costs, inefficient structures, and professional pressures were identified, with the main theme being unattended discharge.
Conclusion: The results indicate that social workers in hospitals are faced with poor cooperation and participation, a lack of facilities and equipment, and socio-economic barriers at the community level. They encounter professional challenges in adhering to professional principles and values and in maintaining the quality of social work services in discharge planning. Given the importance of post-discharge interventions, organizational, structural, and professional reforms at both the micro and macro levels are recommended.
Amir Fazel, Behnam Karamshahi, Azin Harandi,
Volume 22, Issue 3 (12-2023)
Abstract
Background and Purpose: Today, the use of strategic management accounting techniques within organizations is expanding rapidly. However, the implementation of these techniques and the examination of variables affecting them in hospitals remain largely unexplored. The aim of this research is to investigate the impact of accountants' networking on the use of strategic management accounting techniques, considering the moderating roles of hospital information systems and organizational culture.
Methods: This descriptive-correlational study utilized a 43-question questionnaire, whose validity and reliability were confirmed. The statistical population consisted of all employees and accountants in the finance and accounting departments of hospitals in Kerman, totaling 141 individuals. The census method was used to complete the questionnaire, with 139 questionnaires returned. Structural equation modeling and Smart PLS 3 software were used to test the research model.
Results: Statistical indices confirmed the model's appropriate fit (GOF=0.738). Networking of accountants, hospital information systems, and results-oriented culture positively influence the use of strategic management accounting techniques, whereas innovative culture has no effect. Additionally, hospital information systems and results-oriented culture positively moderate the relationship between accountants' networking and the implementation of strategic management accounting techniques, while innovative culture does not have any moderating effect.
Conclusion: This research contributes to the expansion of strategic management accounting techniques in hospitals and highlights the importance of influencing factors. Hospitals should apply these techniques while giving due consideration to the factors that affect them.
Masoud Ali Karami, Hadi Hayati,
Volume 22, Issue 3 (12-2023)
Abstract
Background: The rise in healthcare expenditures, particularly drug costs, has posed a significant challenge to the healthcare system. This issue is particularly critical for chronic diseases such as diabetes, as various factors influence patients' access to these medications and their financial ability to pay for them. Thus, this study aimed to investigate the access and purchasing power for anti-diabetic drugs in pharmacies and hospitals in Khorramabad city in 2022.
Materials and Methods: This descriptive-analytical study included patients and visitors to private pharmacies and hospitals in Khorramabad. The required information was collected through patient prescriptions, pharmacy records, interviews, and checklists based on the World Health Organization protocol. Data analysis was performed using t-test, chi-square, ANOVA, and logistic regression, utilizing SPSS version 21 software.
Results: The findings revealed that among the socio-economic factors affecting the financial ability to pay for diabetes medications, income level is identified as a significant factor, particularly in patients with underlying conditions, where their income is adversely impacted. Additionally, the results indicated that, unlike the free market, in the healthcare and pharmaceutical market, no socio-economic factor from the demand side (i.e., patients) influences pharmacies as drug suppliers in terms of the accessibility index.
Conclusion: Despite the good availability of medications in pharmacies, the financial constraints faced by patients in covering medication costs suggest that government intervention through measures such as enhanced insurance coverage and medication subsidies could support economically disadvantaged groups.
Roholah Hosseini, Mohammad Reza Zaman Parvar Barkosrai ,
Volume 22, Issue 3 (12-2023)
Abstract
Background and purpose : Managers, as the most important organizational decision-makers, have a significant and decisive role in the success and development of hospitals. Competency models help hospital managers to apply the knowledge, skills, and experiences needed to fulfill their responsibilities and mission. It helps them to do their jobs more successfully. The purpose of this study is to design a management competency model in order to optimize management systems in Karaj hospitals.
Methods: The current research is based on a quantitative approach, and in terms of its purpose, it is an applied research type, and in terms of data collection, it is a survey type. The statistical population of his research was all employees and medical staff in the hospitals of Karaj city. The sample size is 384 people and stratified random sampling method was used.The data was collected using a researcher-made questionnaire whose validity was confirmed by experts. The software used in this research is SPSS22 and AMOS.
Results: According to the findings The impact of the six main dimensions of the management competency model included Knowledge competence (1.02), personal competence (0.98), interactive competences (0.38), executive competences (0.51), value and moral competences (0.42) and in The maximum job qualifications (0.41) were determined.
Conclusion: Based on the findings The impact of knowledge and personal competence on management competence in hospitals is higher than other dimensions. In other words, management competence in the hospital is highly dependent on the knowledge and personal competence of managers. Also, based on the goodness of fit index, the hospital management competency model was modified and evaluated within the standard. It is suggested to provide the basis and preparations for the implementation of the model for appointing competent managers and improving the competence of the hospital management system.
Mohammadreza Shahraki, Hamidreza Esmaeili,
Volume 22, Issue 4 (1-2024)
Abstract
Background and Purpose: Artificial intelligence (AI) plays a crucial role in the optimal management of hospital waste, particularly in predicting the volume and type of waste generated. This study aims to identify and rank the risks associated with the use of AI systems in hospital waste management by employing a multi-criteria decision-making approach.
Methods: This descriptive, cross-sectional study was conducted in 2023 (1402 in the Iranian calendar) at two hospitals, Ali Ibn Abitaleb and Khatam al-Anbiah, in Zahedan. Ten hospital staff members were selected as expert participants for the Delphi panel. The Shannon entropy method was utilized for risk weighting, and the TOPSIS method was applied to rank the identified risks.
Results: Kendall's coordination coefficient was used to assess the level of consensus among the Delphi panel members, with the coefficient values for the first, second, and third Delphi rounds being 6.3, 7.1, and 7.3, respectively. The indicators were weighted using the Shannon entropy method, based on three criteria: impact intensity (0.3), probability of occurrence (0.4), and detection probability (0.32). The TOPSIS method was then employed to rank the identified risks, with the most significant risks being the need for necessary infrastructure (0.847), the requirement for accurate and complete data (0.751), and budget constraints (0.749).
Conclusion: By applying multi-criteria decision-making methods, healthcare managers can effectively identify and prioritize the risks associated with using AI systems in hospital waste management, enabling them to focus on strengthening waste management practices based on these priorities.
Seyed Masoud Mousavi, Sajjad Bahariniya, Aisa Mardani, Najmeh Baghian,
Volume 22, Issue 4 (1-2024)
Abstract
Background and Purpose: Organizational commitment among nurses, a critical aspect of hospital workforce management, is influenced by various factors, including job attachment. This attachment fosters motivation and commitment, which ultimately enhances the quality of healthcare services. This study investigates the relationship between organizational commitment and job attachment among nurses working in selected teaching hospitals affiliated with Shahid Sadoughi University of Medical Sciences in Yazd in 2022.
Methods: This descriptive-analytical study involved all nurses at Shahid Sadoughi Hospital in Yazd. A sample size of 298 nurses was determined using Cochran's formula. Data collection was conducted using the Job Descriptive Index (JDI) by Edwards and Kilpatrick (1984) and the Organizational Commitment Questionnaire (OCQ) by Allen and Meyer (1990). The data were analyzed using the Chi-square test with SPSS version 21 software and structural equation modeling via LISREL software.
Results: Among the nurses surveyed, 43.17% reported being satisfied with their jobs, while 40.17% exhibited organizational commitment. The findings revealed a significant relationship between job attachment and organizational commitment (P<0.001). The average scores were 3.75 ± 0.76 for the affective dimension, 3.97 ± 0.26 for the continuance dimension, 3.65 ± 0.36 for the normative dimension, and 3.74 ± 0.93 for overall job attachment.
Conclusion: The significant direct relationship between job satisfaction and organizational commitment highlights the importance of managerial focus on enhancing job satisfaction to increase employee responsibility and commitment. Managers should prioritize factors that improve job satisfaction as a means to strengthen organizational commitment.
Ahmad Tahmasebi Ghorrabi, Asgar Aghaei, Efat Jahanbani, Mohammad Kaidkhordeh, Mansour Zahiri, Mahmoud Latifi,
Volume 22, Issue 4 (1-2024)
Abstract
Background and purpose: Assessing job satisfaction within any organization is essential due to its impact on productivity and overall effectiveness. This study aimed to evaluate the validity and reliability of the Persian version of Spector's Job Satisfaction Questionnaire among employees of emergency medical centers.
Methods: This descriptive-analytical study was conducted among 270 employees of emergency medical centers in Ahvaz between February 2021 and June 2021. Data collection was performed using a census method and Spector's Job Satisfaction Questionnaire. Face validity, content validity, and translation accuracy of the questionnaire were reviewed by experts. Convergent and divergent validity and reliability were assessed using factor loadings, average variance extracted (AVE), reciprocal factor loadings, Cronbach's alpha, and composite reliability in SMART-PLS 3 software.
Results: The face validity, content validity, and translation accuracy of the questionnaire were confirmed by experts to suit the Iranian context. All item factor loadings and the AVE index for all constructs exceeded 0.4. The AVE index for the entire questionnaire was 0.523. Examination of reciprocal factor loadings confirmed divergent validity. Cronbach's alpha and composite reliability indices for all constructs were above 0.7. The Cronbach's alpha coefficient and composite reliability for the entire questionnaire were 0.83 and 0.88, respectively.
Conclusion: The validity and reliability of this questionnaire, as adjusted for the Iranian population, were confirmed to be high. Therefore, this questionnaire can be effectively used to evaluate job satisfaction among employees in various organizations, particularly in healthcare organizations and centers.
Asgar Aghaei Hashjin, Ali Nemati, Seyed Mohammad Tabatabaee Jabali, Pouria Farrokhi,
Volume 22, Issue 4 (1-2024)
Abstract
Background and purpose: Iran is ranked among the top ten nations in the world for hosting a large number of migrants and refugees. During the COVID-19 outbreak, refugees and migrants were among the most vulnerable groups. This study aimed to investigate the extent of healthcare service utilization by refugees and migrants during the COVID-19 pandemic in healthcare centers affiliated with Iran University of Medical Sciences
Methods: This quasi-experimental study was conducted in 2021 in Tehran. The research environment included all healthcare networks and general and specialized hospitals. Data were collected through document review and registered information in the Sina system. All provided services were categorized into four groups: primary care, outpatient, emergency, and inpatient services. Data analysis was performed using the Chow test and Interrupted Time Series model with the Wats and Sctest software packages in R version 4.3.0.
Results: The decrease in utilization of outpatient, emergency, and inpatient services by refugees and migrants was significant (P-value < 0.001), whereas the decrease in primary care services was not significant. Additionally, after the onset of COVID-19, only the utilization of inpatient services showed a significant increasing trend (P-value < 0.013).
Conclusion: During the COVID-19 pandemic, the utilization of all healthcare services by refugees and migrants, including primary, outpatient, emergency, and inpatient care, decreased. It is recommended to provide complete insurance coverage for refugees, offer free treatment for impoverished refugees, increase awareness among refugees to encourage greater use of health services, reduce existing social and economic barriers, and facilitate interaction between healthcare providers and refugees.
Mehrak Pourmotahari, Soad Mahfoozpour, Shahram Tofighi, Shaghayegh Vahdat, Irvan Masoudi Asl,
Volume 22, Issue 4 (1-2024)
Abstract
Background and purpose: As health resources face increasing constraints, the use of medical imaging services has risen significantly. On average, diagnostic services account for approximately 10% of total healthcare expenditures, and this figure is steadily increasing. This study aims to identify the causes of irrational utilization of medical imaging services and propose corrective measures.
Methods: This descriptive-survey research was conducted in two phases. In the first phase, a comprehensive literature review was performed using both international and national databases, covering the period from 1990 to November 2021. Relevant studies were identified using specific keywords. In the second phase, a semi-structured questionnaire was developed, and a series of in-depth interviews with experts and professionals were conducted. Data were analyzed using the six-step thematic approach by Braun and Clarke, utilizing MAXQDA software.
Results: A total of 605 studies were initially identified, of which seven met the inclusion criteria after rigorous screening. In the second phase, 12 in-depth interviews were conducted, yielding 65 codes, which were organized into 12 themes. The identified themes included legal issues, conflict of interest, monitoring challenges, poor governance and stewardship, inappropriate policymaking and planning, financial incentives, inadequate service provision infrastructure, health culture, education and continuous training systems, financing and purchasing services, political factors, and inadequate insurance systems. Various strategies for controlling the inappropriate use of diagnostic and therapeutic services were proposed, including policy interventions, monitoring and evaluation, and training.
Conclusion: The irrational use of healthcare services is a significant challenge in many countries. Key contributing factors include incomplete insurance coverage, out-of-pocket payments by patients, defensive medical practices, and gaps in knowledge. Addressing these issues requires targeted interventions and reforms.
Seyed Rahim Safavi Mirmahalleh, Mohammad Rahim Ramazanian, Mahmoud Moradi, Mostafa Ebrahimpour Azbari,
Volume 22, Issue 4 (1-2024)
Abstract
Background and Purpose: Health status is undeniably one of the most critical indicators of social development and progress. Providing healthcare poses a significant challenge for human life, and managing the healthcare supply chain is of strategic importance. The aim of this research is to analyze and compare the results of meta-synthesis with thematic analysis in identifying the risks of the pharmaceutical industry's supply chain.
Methods: This research follows a qualitative approach, utilizing both meta-synthesis and thematic analysis to identify supply chain risks in the pharmaceutical industry. In the first step, a meta-synthesis and systematic review of related studies over the past twenty-three years were conducted, identifying one hundred articles, which were refined to twenty-six key articles for the research. In the next step, risks specific to Iran's pharmaceutical supply chain were identified through thematic analysis and semi-structured interviews with experts, using targeted sampling. Finally, the results from these two approaches were compared and analyzed.
Results: The meta-synthesis approach identified ten general supply chain risks in the global pharmaceutical industry. Similarly, the thematic analysis approach identified ten specific supply chain risks in Iran's pharmaceutical industry. Six risks were common to both approaches: low quality of raw materials, complexity and incompatibility of information systems, supply of foreign currency and financial payments, transportation and insurance issues, increase in the price of raw materials, and unavailability of medicines. These common risks are critical for both the global and Iranian pharmaceutical supply chains.
Conclusion: Stakeholders in Iran's pharmaceutical supply chain (including hospitals) should prioritize managing these six common risks to improve supply chain performance. Additionally, they should focus on the four unique risks identified through thematic analysis specific to Iran's pharmaceutical supply chain, applying appropriate control measures and activities.
