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Seyed Amir Reza Nejat, Mahmoud Bigler, Seyedeh Bahareh Kashian,
Volume 16, Issue 1 (3-2022)
Volume 16, Issue 1 (3-2022)
Abstract
Background and Aim: Intellectual capital, with its basic knowledge nature, is an intangible, strategic, unique and competitive advantage resource. The purpose of this study is to investigate the current state of intellectual capital maturity in the field of management and planning of Tehran university of medical sciences.
Materials and Methods: This research was applied in terms of purpose and with a quantitative approach in 1400 and a questionnaire was used to collect information. The statistical population is the middle and basic managers of the Vice Chancellor for Resource Management Development and Planning. Using Morgan table, 57 people were randomly selected and analyzed by t-test and non-parametric statistical tests using SPSS software. Has been. The content validity of the questionnaire was obtained by examining the research background and obtaining the opinions of experts, and the Cronbach’s alpha coefficient was used to assess the reliability, the value of which was 0.874.
Results: Statistical tests show that the five levels of intellectual capital management maturity follow a nonlinear pattern and the level of realization of the initial level characteristics, ie lack of intellectual capital structure, is higher than acceptable, but the statistical test of other levels of maturity Included; Managed, defined, quantified and optimal management is not significant at the significance level of 0.05.
Conclusion: The current situation of intellectual capital in the study population indicates that management is unaware of the importance of intellectual capital and no action has been taken to implement the knowledge capital management process. Although there is a lot of necessary infrastructure in the Vice Chancellor, however, insufficient understanding of the capabilities of intellectual capital management as a strategic resource is evident in this research. To reach the defined level and the next levels, the organization needs to identify, activate and direct the intangible source and then quantify, standardize and manage quantitatively and analyze the strengths and weaknesses and finally the continuous improvement of processes and Focus on innovation.
Materials and Methods: This research was applied in terms of purpose and with a quantitative approach in 1400 and a questionnaire was used to collect information. The statistical population is the middle and basic managers of the Vice Chancellor for Resource Management Development and Planning. Using Morgan table, 57 people were randomly selected and analyzed by t-test and non-parametric statistical tests using SPSS software. Has been. The content validity of the questionnaire was obtained by examining the research background and obtaining the opinions of experts, and the Cronbach’s alpha coefficient was used to assess the reliability, the value of which was 0.874.
Results: Statistical tests show that the five levels of intellectual capital management maturity follow a nonlinear pattern and the level of realization of the initial level characteristics, ie lack of intellectual capital structure, is higher than acceptable, but the statistical test of other levels of maturity Included; Managed, defined, quantified and optimal management is not significant at the significance level of 0.05.
Conclusion: The current situation of intellectual capital in the study population indicates that management is unaware of the importance of intellectual capital and no action has been taken to implement the knowledge capital management process. Although there is a lot of necessary infrastructure in the Vice Chancellor, however, insufficient understanding of the capabilities of intellectual capital management as a strategic resource is evident in this research. To reach the defined level and the next levels, the organization needs to identify, activate and direct the intangible source and then quantify, standardize and manage quantitatively and analyze the strengths and weaknesses and finally the continuous improvement of processes and Focus on innovation.
Sakineh Motayerzadeh, Rahim Tahmasebi, Behrooz Kavehie, Azita Noroozi,
Volume 16, Issue 3 (8-2022)
Volume 16, Issue 3 (8-2022)
Abstract
Background and Aim: Vaccination is one of the most effective preventive measures to control of infectious diseases. To create effective interventions for the acceptance of the COVID-19 vaccine, it is important to identify the factors that affect the vaccine acceptance. The aim of this study was to determine the predictive power of the Extended Parallel Process Model (EPPM) for acceptance of Covid-19 vaccine.
Materials and Methods: In this cross-sectional study, 1455 people over 18 years old covered in health centers living in Bushehr province in cities of Bushehr, Genaveh, Tangestan, and Asaluyeh in 2021 were selected by convenience method. Data collection was online by using questionnaire included three sections comprised of demographic factors, questionnaire related to model constructs, and self-administered questionnaire related to acceptance of Covid-19 vaccine. Data were analyzed using chi-square, two independent sample T-test and logistic regression; in SPSS software.
Results: Out of 1455 participants, 1067 persons (73.3%) had been vaccinated. The results showed that men (P=0.006), people with higher education (P=0.001), government employees (P=0.001), single people (P=0.01), people with history of specific disease (P=0.05), individuals with a history of Covid-19 positive test (P=0.001) and their family (P=0.03) were more than other vaccine recipients. Perceived severity, response efficacy and perceived self-efficacy were predictors of vaccine acceptance. Predictive variables and constructs explained 43.8% of changes in vaccine acceptance. Among the participants in the study, 1366 (93.9%) were in the fear control process, in which the highest defense response has been avoided.
Conclusion: In order to increase the acceptance of the vaccine, the efficacy and effectiveness of the vaccine and the severity of the complications of the disease should be emphasized. Therefore, public health campaigns aimed at increasing vaccine acceptance should provide a high level of transparency about the safety and effectiveness of vaccines to the community.
Materials and Methods: In this cross-sectional study, 1455 people over 18 years old covered in health centers living in Bushehr province in cities of Bushehr, Genaveh, Tangestan, and Asaluyeh in 2021 were selected by convenience method. Data collection was online by using questionnaire included three sections comprised of demographic factors, questionnaire related to model constructs, and self-administered questionnaire related to acceptance of Covid-19 vaccine. Data were analyzed using chi-square, two independent sample T-test and logistic regression; in SPSS software.
Results: Out of 1455 participants, 1067 persons (73.3%) had been vaccinated. The results showed that men (P=0.006), people with higher education (P=0.001), government employees (P=0.001), single people (P=0.01), people with history of specific disease (P=0.05), individuals with a history of Covid-19 positive test (P=0.001) and their family (P=0.03) were more than other vaccine recipients. Perceived severity, response efficacy and perceived self-efficacy were predictors of vaccine acceptance. Predictive variables and constructs explained 43.8% of changes in vaccine acceptance. Among the participants in the study, 1366 (93.9%) were in the fear control process, in which the highest defense response has been avoided.
Conclusion: In order to increase the acceptance of the vaccine, the efficacy and effectiveness of the vaccine and the severity of the complications of the disease should be emphasized. Therefore, public health campaigns aimed at increasing vaccine acceptance should provide a high level of transparency about the safety and effectiveness of vaccines to the community.
Mohammad Hossein Sadeghian, Seyed Amirhossein Mahdavi, Farhad Habibi, Masoud Shafiei,
Volume 16, Issue 3 (8-2022)
Volume 16, Issue 3 (8-2022)
Abstract
Background and Aim: The American Psychiatric Association identifies suicide as the third leading cause of death among people aged 15 to 24. This study was conducted with the aim of investigating factors affecting of the occurrence of suicides leading to death in corpses referred to the Forensic Medicine Organization of Tehran Province from 2010 to 2019.
Materials and Methods: This research was a descriptive and analytical cross-sectional study in 2019 year. The statistical population includes all bodies referred to forensic medicine. The information related to all corpses referred to forensic medicine which was analyzed between 2010 and 2019 were 5471 cases. Descriptive and analytical statistical methods were used to analyze the data. P-value less than 0.05% was considered valid.
Results: The results showed that 50% of suicide deaths were under 32 years old. Sixty-nine point two percent of suicides leading to death are male and the rest are female. The highest frequency in terms of method was related to the hanging method, 39.3%, and in the youth age group, in terms of the level of education in men, high school diploma and diploma in women. The highest frequency of suicide related to singles was 47.1% and 27.4% in the summer season. The most common method of suicide was hanging, with more than 39%, followed by poisoning with poison, with more than 25% of cases. The least used method was drowning.
Conclusion: Based on the results of this study, it seems that factors such as age, sex, level of education, and even geographic and social factors are among the factors that affect suicide, which can help policymakers, managers, psychologists, psychiatrists, and related organizations. Paying attention to educational literacy, employment status and income level of people, special attention of families to adolescent and young boys and girls and especially their marital status can be effective measures to prevent suicide.
Materials and Methods: This research was a descriptive and analytical cross-sectional study in 2019 year. The statistical population includes all bodies referred to forensic medicine. The information related to all corpses referred to forensic medicine which was analyzed between 2010 and 2019 were 5471 cases. Descriptive and analytical statistical methods were used to analyze the data. P-value less than 0.05% was considered valid.
Results: The results showed that 50% of suicide deaths were under 32 years old. Sixty-nine point two percent of suicides leading to death are male and the rest are female. The highest frequency in terms of method was related to the hanging method, 39.3%, and in the youth age group, in terms of the level of education in men, high school diploma and diploma in women. The highest frequency of suicide related to singles was 47.1% and 27.4% in the summer season. The most common method of suicide was hanging, with more than 39%, followed by poisoning with poison, with more than 25% of cases. The least used method was drowning.
Conclusion: Based on the results of this study, it seems that factors such as age, sex, level of education, and even geographic and social factors are among the factors that affect suicide, which can help policymakers, managers, psychologists, psychiatrists, and related organizations. Paying attention to educational literacy, employment status and income level of people, special attention of families to adolescent and young boys and girls and especially their marital status can be effective measures to prevent suicide.
Hamzeh Amin-Tahmasbi, Kimia Malekzadeh Shafaroudi,
Volume 16, Issue 4 (10-2022)
Volume 16, Issue 4 (10-2022)
Abstract
Background and Aim: Today, treatment is one of the important goals of tourism. Tourism in health and healthcare is growing rapidly in the world. Despite the fact that Guilan province, as one of the most important and touristic provinces of the country, has an annual population of 500,000 foreign tourists and can be the center of health tourism in Iran. Unfortunately, this province has not been able to have a proper share of the revenues of this field and attract foreign patients in parallel with its treatment capacities.
Materials and Method: The aim of this study was to identify the factors affecting the development of health tourism. In this regard, first, literature review was used and opinions of experts in this field, who were employees in five hospitals in Rasht, including Velayat, PourSina, Aria, Pars and Qaem hospitals, were selected using the Snowball sampling method. Twenty-five effective factors were identified and using Delphi method, 14 factors were selected as the final factor. Then by used of the Best and Worst Method (BWM), the importance of each factor was determined. Finally, using DEMATEL method, the effect of this factor on each other was determined.
Results: After conducting two rounds of Delphi, 11 factors that had an average lower than the average of the total opinions of the experts and there was more disagreement about them were eliminated. Then, by implementing the best-worst method, the quality of medical services was determined as the most important factor, and the ease of booking an appointment in advance for admission and the status of the banking system were determined as the least important factors among the final factors. Also, based on the results of the DEMATEL method, the quality of medical services has the greatest effect and the ease of booking an appointment in advance for admission has the least effect on other factors. Finally, the quality of medical services is the most effective and appropriate advertising about health tourism in domestic and foreign chambers of commerce has the least effectiveness.
Conclusion: Health tourism in Iran despite the relative quality and cheap price, has not yet found its place in the market due to the lack of proper advertising is still taking the first steps. Considering the environmental conditions and the existence of tourism aspects of Rasht, carrying out measures such as improving the quality of medical services, appropriate marketing, and improving infrastructures will lead to the development and improvement of health tourism, and as a result, increasing satisfaction and attracting more customers.
Materials and Method: The aim of this study was to identify the factors affecting the development of health tourism. In this regard, first, literature review was used and opinions of experts in this field, who were employees in five hospitals in Rasht, including Velayat, PourSina, Aria, Pars and Qaem hospitals, were selected using the Snowball sampling method. Twenty-five effective factors were identified and using Delphi method, 14 factors were selected as the final factor. Then by used of the Best and Worst Method (BWM), the importance of each factor was determined. Finally, using DEMATEL method, the effect of this factor on each other was determined.
Results: After conducting two rounds of Delphi, 11 factors that had an average lower than the average of the total opinions of the experts and there was more disagreement about them were eliminated. Then, by implementing the best-worst method, the quality of medical services was determined as the most important factor, and the ease of booking an appointment in advance for admission and the status of the banking system were determined as the least important factors among the final factors. Also, based on the results of the DEMATEL method, the quality of medical services has the greatest effect and the ease of booking an appointment in advance for admission has the least effect on other factors. Finally, the quality of medical services is the most effective and appropriate advertising about health tourism in domestic and foreign chambers of commerce has the least effectiveness.
Conclusion: Health tourism in Iran despite the relative quality and cheap price, has not yet found its place in the market due to the lack of proper advertising is still taking the first steps. Considering the environmental conditions and the existence of tourism aspects of Rasht, carrying out measures such as improving the quality of medical services, appropriate marketing, and improving infrastructures will lead to the development and improvement of health tourism, and as a result, increasing satisfaction and attracting more customers.
Ehsan Zarei, Kheyrollah Chavosh Sani, Mohammad Saadati, Soheila Khodakarim,
Volume 16, Issue 4 (10-2022)
Volume 16, Issue 4 (10-2022)
Abstract
Background and Aim: In recent years, public trust in health system has been considered one of the performance evaluation indicators of health systems. However, most of the research on public trust in health system is related to developed countries, and research in this regard is limited in Iran. A better understanding of trust in health system and some influential factors helps to develop targeted interventions to increase trust. The present study was conducted to investigate the level of public trust in health system in Rasht County.
Materials and Methods: In this cross-sectional study, 680 households (510 urban and 170 rural) were included. The data collection tool was a questionnaire to measure public trust in health system with 30 items and six dimensions, whose validity and reliability were confirmed. Mann-Whitney and Kruskal-Wallis tests were used to compare and analyze the difference in public trust in health system between groups.
Results: The overall score of trust in health system was 66.7 out of 112. The highest score for the quality-of-care dimension was 16.38 out of 28, and the lowest for the cooperation quality of providers dimension was 7.47 out of 12. Among service providers, the highest trust was in nurses and specialist doctors, and the least was in traditional medicine service providers. Women, government employees, people without health insurance, people with excellent and good health status, those who had used hospital services, and those who were satisfied with the last service received had a high level of trust in the health system (P<0.05).
Conclusion: The results showed that despite people’s trust in the expertise and knowledge of physicians and other providers, public trust in health system was relatively moderate, indicating deficiencies in the health system’s performance. Focusing on physician-patient communication and improving communication skills, establishing electronic records and sharing patient information between health service providers, and respecting patient rights can build greater trust in the health system.
Materials and Methods: In this cross-sectional study, 680 households (510 urban and 170 rural) were included. The data collection tool was a questionnaire to measure public trust in health system with 30 items and six dimensions, whose validity and reliability were confirmed. Mann-Whitney and Kruskal-Wallis tests were used to compare and analyze the difference in public trust in health system between groups.
Results: The overall score of trust in health system was 66.7 out of 112. The highest score for the quality-of-care dimension was 16.38 out of 28, and the lowest for the cooperation quality of providers dimension was 7.47 out of 12. Among service providers, the highest trust was in nurses and specialist doctors, and the least was in traditional medicine service providers. Women, government employees, people without health insurance, people with excellent and good health status, those who had used hospital services, and those who were satisfied with the last service received had a high level of trust in the health system (P<0.05).
Conclusion: The results showed that despite people’s trust in the expertise and knowledge of physicians and other providers, public trust in health system was relatively moderate, indicating deficiencies in the health system’s performance. Focusing on physician-patient communication and improving communication skills, establishing electronic records and sharing patient information between health service providers, and respecting patient rights can build greater trust in the health system.
Fatemeh Mohabati, Maryam Tajvar, Bahram Mohaghegh, Seyedpouria Hedayati, Mohammad Arab,
Volume 16, Issue 4 (10-2022)
Volume 16, Issue 4 (10-2022)
Abstract
Background and Aim: Reforming the structure of medical universities and its continuous adaptation to the mission of the organization and new functions is an undeniable necessity. The purpose of this article was to explain how to implement this policy.
Materials and Methods: The current qualitative study was conducted in 2020 retrospectively based on Kingdon’s multiple streams model. Data collection was done using two methods: individual interviews and document review. Sampling of the managers and experts of the administrative development and transformation centers of the Ministry of Health and 12 universities of Medical Sciences as well as vice-chancellors of the universities was done in a purposeful and snowball method until data saturation was reached by conducting 19 individual interviews. Data analysis were done with framework and content analysis methods, and using MAXQDA 2020 software.
Results: The low of structural problems included quantitative and qualitative changes in new tasks in the environmental units of universities, interference and parallel work in the tasks of university units, and bargainings for restructuring by universities. The policy low included the obligation to make structural changes in the upstream laws and documents, including the Fifth Development Plan, and the cooperation of all stakeholders. The political process included the implementation of the Health Transformation and the Family Physician Plan, and the support of relevant policymakers and the approval of the law of becoming a university trustee in the law of the fifth plan of economic development and also gaining the all-round support of the stakeholders.
Conclusion: The medical sciences universities, as the headquarters arm of the Ministry of Health at the provincial level, need to have flexible structure in line with the needs of their surrounding units. In luential context factors in policy-making the reform of the structure of the headquarters of universities/colleges, in addition to the stream of structural problems, the main of which was the change in the duties of the units, along with the political determination created in the Ministry of Health, led to the simultaneous occurrence of three streams of problems, Politics and politics and finally opening the window of opportunity and changing the structure and organization of the headquarters of medical sciences universities.
Materials and Methods: The current qualitative study was conducted in 2020 retrospectively based on Kingdon’s multiple streams model. Data collection was done using two methods: individual interviews and document review. Sampling of the managers and experts of the administrative development and transformation centers of the Ministry of Health and 12 universities of Medical Sciences as well as vice-chancellors of the universities was done in a purposeful and snowball method until data saturation was reached by conducting 19 individual interviews. Data analysis were done with framework and content analysis methods, and using MAXQDA 2020 software.
Results: The low of structural problems included quantitative and qualitative changes in new tasks in the environmental units of universities, interference and parallel work in the tasks of university units, and bargainings for restructuring by universities. The policy low included the obligation to make structural changes in the upstream laws and documents, including the Fifth Development Plan, and the cooperation of all stakeholders. The political process included the implementation of the Health Transformation and the Family Physician Plan, and the support of relevant policymakers and the approval of the law of becoming a university trustee in the law of the fifth plan of economic development and also gaining the all-round support of the stakeholders.
Conclusion: The medical sciences universities, as the headquarters arm of the Ministry of Health at the provincial level, need to have flexible structure in line with the needs of their surrounding units. In luential context factors in policy-making the reform of the structure of the headquarters of universities/colleges, in addition to the stream of structural problems, the main of which was the change in the duties of the units, along with the political determination created in the Ministry of Health, led to the simultaneous occurrence of three streams of problems, Politics and politics and finally opening the window of opportunity and changing the structure and organization of the headquarters of medical sciences universities.
Fahimeh Hasanzadeh, Ali Aghajanloo, Dr Mohammadreza Dinmohammadi,
Volume 16, Issue 4 (10-2022)
Volume 16, Issue 4 (10-2022)
Abstract
Background and Aim: The most recent threat to the global community is the ongoing outbreak of the disease known as Coronavirus Disease 2019 (COVID-19). Taking personal protection measures (PPM) is crucial to prevent the spread of COVID-19. This study aimed to determine the factors affecting the acceptance of PPM among patients before having COVID-19 admitted to hospitals in northwestern of Iran.
Materials and Methods: In this cross-sectional study, 560 eligible patients with a diagnosis of COVID-19 were selected by convenience sampling. Data were collected from January 6 to May 21, 2021, through a researcher-made questionnaire and were analyzed with descriptive statistics (number, percentage, mean, standard deviation), independent t-test, and multiple linear regression by SPSS. A significance level of 5% was selected.
Results: The average age of the participants was 60.1 (16.01) years with an age range of 21 to 95 years. Most of the participants were male (53.9%) and married (91.8%). The mean score of PPM acceptance among patients was 16.55 (2.59) out of 20 points. Multiple linear regression analysis determined employment status (β=0.29, P<0.001), residency (β=-0.19, P<0.001), education level (β=0.11, P=0.048), smoking (β=-0.10, P=0.03) and income level (β=0.13, P=0.01), as predictors of acceptance of PPM. Other personal and occupational variables, including age, gender, marriage, living status, having children, and history of influenza vaccination, were not found to be effective in predicting the acceptance of personal protection measures among participating patients.
Conclusion: The acceptance of personal protection measures among patients was relatively high. Acceptance of the unemployed, rural residents, illiterate, smokers, and those with low-income level was low. This study emphasizes the need to pay attention to the changes in the individual, social and economic characteristics of the community and their effects on preventive health behaviors, especially in vulnerable groups.
Materials and Methods: In this cross-sectional study, 560 eligible patients with a diagnosis of COVID-19 were selected by convenience sampling. Data were collected from January 6 to May 21, 2021, through a researcher-made questionnaire and were analyzed with descriptive statistics (number, percentage, mean, standard deviation), independent t-test, and multiple linear regression by SPSS. A significance level of 5% was selected.
Results: The average age of the participants was 60.1 (16.01) years with an age range of 21 to 95 years. Most of the participants were male (53.9%) and married (91.8%). The mean score of PPM acceptance among patients was 16.55 (2.59) out of 20 points. Multiple linear regression analysis determined employment status (β=0.29, P<0.001), residency (β=-0.19, P<0.001), education level (β=0.11, P=0.048), smoking (β=-0.10, P=0.03) and income level (β=0.13, P=0.01), as predictors of acceptance of PPM. Other personal and occupational variables, including age, gender, marriage, living status, having children, and history of influenza vaccination, were not found to be effective in predicting the acceptance of personal protection measures among participating patients.
Conclusion: The acceptance of personal protection measures among patients was relatively high. Acceptance of the unemployed, rural residents, illiterate, smokers, and those with low-income level was low. This study emphasizes the need to pay attention to the changes in the individual, social and economic characteristics of the community and their effects on preventive health behaviors, especially in vulnerable groups.
Seyyed Morteza Mojtabaeian, Fatemeh Monfared,
Volume 16, Issue 5 (12-2022)
Volume 16, Issue 5 (12-2022)
Abstract
Background and Aim: The participation of doctors and clinical leadership in organizational strategies to improve quality performance is a necessary precondition for providing safe and high-quality care, and since improving the quality of health care services and increasing the participation of doctors in accreditation is very necessary, the present study was conducted with the aim of explaining the obstacles of doctors' participation in the accreditation programs of Iranian hospitals with a qualitative approach.
Materials and Methods: In this study, using the snowball sampling method, interviews were conducted with 11 managers, 9 doctors and 8 officials and experts in the field of quality management (a total of 28 people) in the field of hospital accreditation. Interviewees were selected through purposive snowball sampling. To collect data, unstructured and semi-structured in-depth interviews were conducted. The obtained data were analyzed using the conceptual framework method in ATLAS.ti.
Results: The results of this research extracted 3 main issues including cultural, organizational and behavioral factors. Also, this research found 12 sub-themes and 57 items. Subtopics in the cultural area were motivation, patient demand, mutual trust, and evaluation system. The organizational field included seven sub-topics, including high workload, understanding the role of the quality management unit, unrealistic accreditation, the nature of accreditation, empowering doctors in the field of quality, effective communication, and limited resources. Subthemes in the behavioural dimension were role ambiguity and uncertainty about how to participate in the accreditation program. The most repeated challenges in the interviews were expressed in the field of effective communication and the least in the field of role ambiguity.
Conclusion: Physicians' participation in accreditation programs can be increased through culture building and proper training in accreditation activities in the medical community. By revising the categories of activities performed in the hospital by doctors and including a specific time to perform activities to improve quality and accreditation and create a balance between the quantity and quality of services provided in the hospital, it is possible to increase the participation of doctors in the accreditation program.
Materials and Methods: In this study, using the snowball sampling method, interviews were conducted with 11 managers, 9 doctors and 8 officials and experts in the field of quality management (a total of 28 people) in the field of hospital accreditation. Interviewees were selected through purposive snowball sampling. To collect data, unstructured and semi-structured in-depth interviews were conducted. The obtained data were analyzed using the conceptual framework method in ATLAS.ti.
Results: The results of this research extracted 3 main issues including cultural, organizational and behavioral factors. Also, this research found 12 sub-themes and 57 items. Subtopics in the cultural area were motivation, patient demand, mutual trust, and evaluation system. The organizational field included seven sub-topics, including high workload, understanding the role of the quality management unit, unrealistic accreditation, the nature of accreditation, empowering doctors in the field of quality, effective communication, and limited resources. Subthemes in the behavioural dimension were role ambiguity and uncertainty about how to participate in the accreditation program. The most repeated challenges in the interviews were expressed in the field of effective communication and the least in the field of role ambiguity.
Conclusion: Physicians' participation in accreditation programs can be increased through culture building and proper training in accreditation activities in the medical community. By revising the categories of activities performed in the hospital by doctors and including a specific time to perform activities to improve quality and accreditation and create a balance between the quantity and quality of services provided in the hospital, it is possible to increase the participation of doctors in the accreditation program.
Mohammad Jalali, Ehsan Zarei, Ali Maher, Soheila Khodakarim,
Volume 16, Issue 5 (12-2022)
Volume 16, Issue 5 (12-2022)
Abstract
Background and Aim: With the outbreak of the COVID-19 pandemic, the performance of hospitals were affected, and changes were made in the utilization of hospital services. Analyzing hospital performance data during the COVID-19 pandemic can provide insights into service utilization patterns and care outcomes for managers and policymakers. This study was conducted to investigate the impact of COVID-19 on selected outcome indicators in the hospitals of Shahid Beheshti University of Medical Sciences, Tehran.
Materials and Methods: This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method.
Results: The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05).
Conclusion: Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic.
Materials and Methods: This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method.
Results: The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05).
Conclusion: Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic.
Roghayeh Gandomkar, Azim Mirzazadeh, Amin Hoseini Shavoun,
Volume 16, Issue 5 (12-2022)
Volume 16, Issue 5 (12-2022)
Abstract
Background and Aim: Evaluation of hospital environments with reliable and valid tools is considered to be one of the essential prerequisites for continuous improvement of the hospital learning environment. The present study aimed to translate and evaluate psychometric properties of the short version of the PHEEM questionnaire among the residents of Tehran University of Medical Sciences residents.
Materials and Methods: This was a psychometric evaluation study. After translation and back translation, the questionnaire was provided to 18 experts. The content validity was qualitatively checked using the coefficients of content validity ratio (CVR), content validity index (CVI), and face validity. Then, the revised questionnaire was distributed among 20 residents. Face validity was evaluated by qualitative method and cognitive interview to check the questionnaire items in terms of difficulty level, appropriateness, and ambiguity. The test-retest method checked initial reliability by redistributing the questionnaire to the same residents with an interval of two weeks. In order to determine construct validity, the modified questionnaire was distributed among 548 medical residents from 24 specialized fields. The sample was selected using the convenience sampling method. Then the data were analyzed using exploratory and confirmatory factor analysis. Internal consistency was calculated using Cronbach’s alpha.
Results: The questionnaire’s content validity ratio (CVR) and content validity index (CVI) were 0.93 and 0.88, respectively. Based on the results of face validity, some minor changes were made to the vocabulary of most items, and item 12 was wholly changed. The ICC coefficient was more than 0.90 in all dimensions. In the exploratory factor analysis using the principal component method (PCA), the Kaiser-Meyer-Elkin value was 0.83. Bartlett’s test of sphericity was statistically significant (P<0.001), which confirms the functionality of the correlation matrix. The Cronbach’s alpha coefficient of the questionnaire was 0.83, which indicates the internal consistency of the questionnaire items.
Conclusions: According to the results, the PHEEM short-version questionnaire has good reliability and validity (face, content, and structure) among medical residents. Therefore, this measure can be used to evaluate residents’ perceptions regarding the quality of the educational environment of hospitals.
Materials and Methods: This was a psychometric evaluation study. After translation and back translation, the questionnaire was provided to 18 experts. The content validity was qualitatively checked using the coefficients of content validity ratio (CVR), content validity index (CVI), and face validity. Then, the revised questionnaire was distributed among 20 residents. Face validity was evaluated by qualitative method and cognitive interview to check the questionnaire items in terms of difficulty level, appropriateness, and ambiguity. The test-retest method checked initial reliability by redistributing the questionnaire to the same residents with an interval of two weeks. In order to determine construct validity, the modified questionnaire was distributed among 548 medical residents from 24 specialized fields. The sample was selected using the convenience sampling method. Then the data were analyzed using exploratory and confirmatory factor analysis. Internal consistency was calculated using Cronbach’s alpha.
Results: The questionnaire’s content validity ratio (CVR) and content validity index (CVI) were 0.93 and 0.88, respectively. Based on the results of face validity, some minor changes were made to the vocabulary of most items, and item 12 was wholly changed. The ICC coefficient was more than 0.90 in all dimensions. In the exploratory factor analysis using the principal component method (PCA), the Kaiser-Meyer-Elkin value was 0.83. Bartlett’s test of sphericity was statistically significant (P<0.001), which confirms the functionality of the correlation matrix. The Cronbach’s alpha coefficient of the questionnaire was 0.83, which indicates the internal consistency of the questionnaire items.
Conclusions: According to the results, the PHEEM short-version questionnaire has good reliability and validity (face, content, and structure) among medical residents. Therefore, this measure can be used to evaluate residents’ perceptions regarding the quality of the educational environment of hospitals.
Mohamad Hoseini Kasnavieh, Mahsa Mahmoudinejad, Mohammad Veisy, Pouya Hedayati Shahidani, Ali Tahmasebi,
Volume 16, Issue 5 (12-2022)
Volume 16, Issue 5 (12-2022)
Abstract
Background and Aim: this study aims investigating the effect of the physician's presence on the error of recording surgical codes by surgical assistants and the resulting financial effects in Rasoul Akram hospital.
Materials and Methods: The present study was a descriptive-analytical and prospective study that was performed by collecting data in the hospital and reviewing the documents from Jun to March 2022. Therefore, in order to compare the deductions according to the presence or absence of the doctor, an expert was stationed in the operating room to enter the information in special forms, and thus the types of deductions for each of the mentioned situations were identified. T-test was used for analysis between the two groups (presence and absence of physician) and data were analyzed using Excel and SPSS software.
Results: Three hundred and one records were reviewed during the presence of the physician and 300 cases during the absence of the physician based on Cochran sampling formula. The percent difference between hidden deductions in the presence and absence of the physician was not significant (P-value=0.078). However, the difference between the obvious deductions in the presence and absence of the physicians was significant (P-value=0.024). The difference in obvious deduction costs was significant in the presence or absence of a physician (P-value<0.001). But, the difference in hidden fraction costs in the presence or absence of physicians, was not significant (P-value=0.435).
Conclusion: The presence or absence of a surgeon has an effect on the amount of errors in the registration of surgical codes by the surgeon’s assistant and, as a result, this matter affects the percentage and costs of surgical deductions, especially in the obvious deductions. Therefore, planning for the presence of the surgeon in cases where the error of registering the codes by the surgeon’s assistant leads to obvious deductions, can help to more accurate documentation and, as a result, fewer deductions are accrued.
Materials and Methods: The present study was a descriptive-analytical and prospective study that was performed by collecting data in the hospital and reviewing the documents from Jun to March 2022. Therefore, in order to compare the deductions according to the presence or absence of the doctor, an expert was stationed in the operating room to enter the information in special forms, and thus the types of deductions for each of the mentioned situations were identified. T-test was used for analysis between the two groups (presence and absence of physician) and data were analyzed using Excel and SPSS software.
Results: Three hundred and one records were reviewed during the presence of the physician and 300 cases during the absence of the physician based on Cochran sampling formula. The percent difference between hidden deductions in the presence and absence of the physician was not significant (P-value=0.078). However, the difference between the obvious deductions in the presence and absence of the physicians was significant (P-value=0.024). The difference in obvious deduction costs was significant in the presence or absence of a physician (P-value<0.001). But, the difference in hidden fraction costs in the presence or absence of physicians, was not significant (P-value=0.435).
Conclusion: The presence or absence of a surgeon has an effect on the amount of errors in the registration of surgical codes by the surgeon’s assistant and, as a result, this matter affects the percentage and costs of surgical deductions, especially in the obvious deductions. Therefore, planning for the presence of the surgeon in cases where the error of registering the codes by the surgeon’s assistant leads to obvious deductions, can help to more accurate documentation and, as a result, fewer deductions are accrued.
Saeed Nateghi, Ali Ganjali Khan Hakemi, Soheila Damiri, Samira Raoofi, Elham Haghshenas, Sara Akhavan Rezayat, Shamsi Ekhtiyar, , Maryam Radin Manesh,
Volume 16, Issue 5 (12-2022)
Volume 16, Issue 5 (12-2022)
Abstract
Background and Aim: Effective monitoring and evaluation of human resources in countries require an agreed set of indicators and measurement tools. Due to the existence of different payment mechanisms, this study aimed to identify performance evaluation indicators in hospitals affiliated with the Tehran University of Medical Sciences.
Materials and Methods: A qualitative phenomenological study was conducted in 2022. Data were collected using semi-structured interviews, purposive sampling, and participation of 23 members of the Senior executives and financial team of hospitals affiliated to Tehran University of Medical Sciences and analyzed by content analysis method using MAXQDA-10 software.
Results: Twenty-three experts participated in this research, 78.2% were men and 21.7% were women, and a total of 526 final codes were identified and according to the balanced scorecard management tool in 4 main themes of finance, customers, internal processes, and growth and Development. Also 8 sub-themes of resource efficiency with 86%, medical tourism with 52%, professional ethics with 65%, satisfaction with 78%, accreditation with 48%, diagnosis and treatment with 78%, education with 56% and The research was categorized with 78%.
Conclusion: The provision of optimal medical services requires managers to be aware of the performance of subordinate personnel, which makes it possible to choose the appropriate criteria, develop performance evaluation systems and conduct correct evaluation, informing Doctors regarding the indicators considered for more accurate evaluation are among the suggestions that can be a solution to the existing problems. Another important point considering the limited available resources is the role of doctors in the field of health tourism to which attention will lead to an increase in financial resources.
Materials and Methods: A qualitative phenomenological study was conducted in 2022. Data were collected using semi-structured interviews, purposive sampling, and participation of 23 members of the Senior executives and financial team of hospitals affiliated to Tehran University of Medical Sciences and analyzed by content analysis method using MAXQDA-10 software.
Results: Twenty-three experts participated in this research, 78.2% were men and 21.7% were women, and a total of 526 final codes were identified and according to the balanced scorecard management tool in 4 main themes of finance, customers, internal processes, and growth and Development. Also 8 sub-themes of resource efficiency with 86%, medical tourism with 52%, professional ethics with 65%, satisfaction with 78%, accreditation with 48%, diagnosis and treatment with 78%, education with 56% and The research was categorized with 78%.
Conclusion: The provision of optimal medical services requires managers to be aware of the performance of subordinate personnel, which makes it possible to choose the appropriate criteria, develop performance evaluation systems and conduct correct evaluation, informing Doctors regarding the indicators considered for more accurate evaluation are among the suggestions that can be a solution to the existing problems. Another important point considering the limited available resources is the role of doctors in the field of health tourism to which attention will lead to an increase in financial resources.
Rajabali Daroudi, Mahmoud Zamandi,
Volume 16, Issue 6 (1-2023)
Volume 16, Issue 6 (1-2023)
Abstract
Background and Aim: The role of accurate information in decision-making and programs implementation has highlighted the need to design an appropriate costing system. The present study aimed to estimate the cost of student Training in the Department of Health Management and Economics at the School of Public Health, Tehran University of Medical Sciences using activity-based costing.
Materials and Methods: This research was an applied, descriptive, and cross-sectional study. In this study, all information was collected through interviews with seven officials, financial and administrative staff, and also by using available documents in the faculty. To analyze the costs, the administrative and educational sections were classified into three levels including overhead, middle, and final activity centers, and, using appropriate bases and Microsoft Excel 2013 software, costs of overhead, middle, and final activity centers, and finally, the total cost of each student was calculated.
Results: In this study, the total cost of education for each Ph.D. and master’s student in the department of health management and economics was estimated as 1.95 billion and 376 million IR Rials, respectively. So that the cost of each year of Ph.D. and master’s student education was 433 and 150 million IR Rials, respectively. Out of the total costs of the Department of Health Management and Economics, only 22% of the costs were related to overhead and middle activity centers, and 78% of the costs were exclusive to the final activity center, and the majority of these costs (97%) were related to the personnel, especially the faculty members.
Conclusion: The cost of training Ph.D. students due to the high coefficient of the degree and thus increasing the importance (cost share) of the field, receiving a scholarship from the Ministry of Health and a longer period of study, was estimated to be about 5 times that of a master’s degree. The Ministry of Health and universities can design and implement targeted research programs with the help of faculty members and graduate students, especially Ph.D. students, to solve problems and improve the health of the community, thus improving resource efficiency and productivity.
Materials and Methods: This research was an applied, descriptive, and cross-sectional study. In this study, all information was collected through interviews with seven officials, financial and administrative staff, and also by using available documents in the faculty. To analyze the costs, the administrative and educational sections were classified into three levels including overhead, middle, and final activity centers, and, using appropriate bases and Microsoft Excel 2013 software, costs of overhead, middle, and final activity centers, and finally, the total cost of each student was calculated.
Results: In this study, the total cost of education for each Ph.D. and master’s student in the department of health management and economics was estimated as 1.95 billion and 376 million IR Rials, respectively. So that the cost of each year of Ph.D. and master’s student education was 433 and 150 million IR Rials, respectively. Out of the total costs of the Department of Health Management and Economics, only 22% of the costs were related to overhead and middle activity centers, and 78% of the costs were exclusive to the final activity center, and the majority of these costs (97%) were related to the personnel, especially the faculty members.
Conclusion: The cost of training Ph.D. students due to the high coefficient of the degree and thus increasing the importance (cost share) of the field, receiving a scholarship from the Ministry of Health and a longer period of study, was estimated to be about 5 times that of a master’s degree. The Ministry of Health and universities can design and implement targeted research programs with the help of faculty members and graduate students, especially Ph.D. students, to solve problems and improve the health of the community, thus improving resource efficiency and productivity.
Mohammad Javad Kabir, Alireza Heidari, Nahid Jafari, Honarvar Mohammad Reza, Sajad Moeini, Zahra Khatirnamani,
Volume 16, Issue 6 (1-2023)
Volume 16, Issue 6 (1-2023)
Abstract
Background and Aim: Many health policies are not implemented or incompletely implemented after approval. This issue significantly reduces the popularity and responsiveness of the top managers of the health system and leads to service disruption in the target community. Therefore, this study was conducted to explain the existing challenges in the implementation of health policies.
Materials and Methods: A qualitative study was conducted in 2021. The participants in the study were 20 scientific and executive experts. The data was collected using an interview guide and the in-depth individual interview method and was analyzed using the content analysis method using thematic analysis with Graneheim and Lundman's approach.
Results: The challenges include the policies formulation (lack of evidence-informed decision-making, lack of attention to the details of the implementation, the change of the initial text of the policy, conflict of interests, unclarity the executives, the lack of proper integration between the political and technical components of the policies, the weak participation of the main stakeholders, the lack of the same understanding of policies concept between policy makers and executives and lack of budget forecasting), challenges of policies implementation (uncertainty about roles of executive organizations, lack of executive attachment, conflict of interest, lack of project management, change of formulated policies with change of executives, little belief among executives, lack of executive guarantee, lack of operational plan) and challenges of policies evaluation (Inadequate supervision and the absence of an informational and supervisory dashboard).
Conclusion: Using effective solutions to solve the challenges extracted in the stages of formulation, implementation and evaluation of health policies can lead to achieving the goals of the formulated policies and improving the health of the society.
Materials and Methods: A qualitative study was conducted in 2021. The participants in the study were 20 scientific and executive experts. The data was collected using an interview guide and the in-depth individual interview method and was analyzed using the content analysis method using thematic analysis with Graneheim and Lundman's approach.
Results: The challenges include the policies formulation (lack of evidence-informed decision-making, lack of attention to the details of the implementation, the change of the initial text of the policy, conflict of interests, unclarity the executives, the lack of proper integration between the political and technical components of the policies, the weak participation of the main stakeholders, the lack of the same understanding of policies concept between policy makers and executives and lack of budget forecasting), challenges of policies implementation (uncertainty about roles of executive organizations, lack of executive attachment, conflict of interest, lack of project management, change of formulated policies with change of executives, little belief among executives, lack of executive guarantee, lack of operational plan) and challenges of policies evaluation (Inadequate supervision and the absence of an informational and supervisory dashboard).
Conclusion: Using effective solutions to solve the challenges extracted in the stages of formulation, implementation and evaluation of health policies can lead to achieving the goals of the formulated policies and improving the health of the society.
Rahil Nahari, Saeed Hashemzadeh, Ehsan Zarei,
Volume 16, Issue 6 (1-2023)
Volume 16, Issue 6 (1-2023)
Abstract
Background and Aim: Medical tourism refers to travel for receiving health services abroad. The COVID-19 crisis affected a wide range of tourism-related businesses, including medical tourism, and caused a decrease in the supply and demand of health services in this market. This study aimed to investigate the impact of the COVID-19 pandemic on Medical Tourism in Iran.
Materials and Methods: This cross-sectional study was conducted in Iran in 2021. The data used in this study were extracted from the information system of the Ministry of Health from 2018 to 2021, which includes the number, origin, and destination of medical tourists, per capita revenue, and monthly revenue two years before and one and a half years after the COVID-19 pandemic. For data analysis, t-tests of independent groups and interrupted time series regression were used in SPSS and EViews 10 software.
Results: The COVID-19 pandemic has caused a 42% decrease in the average monthly number of medical tourists, a 45% decrease in the monthly revenue, and a 10% decrease in the per capita income per tourist (P<0.05). The arrival of medical tourists from the Republic of Azerbaijan, Bahrain, Iraq, and Oman has decreased by more than 80%, and the largest decrease in the number of tourists has been related to Ahvaz, Urmia, Tabriz, and Shiraz. In all diagnostic groups except obstetrics and gynecology, there has been a decrease between 50 to 70% The declining trend of medical tourism indicators was stopped in the second year of the COVID-19 pandemic and has continued as a constant trend.
Conclusion: The COVID-19 crisis has hurt the number of international patients and their revenue in Iran. Relative success in controlling COVID-19 can return to a pre-pandemic situation that requires appropriate policies and administrative measures by government and industry players, such as policies to facilitate patient entry, marketing measures, branding and creating a positive image of the country to potential clients, use of telemedicine facilities for consultations and follow-up, etc.
Materials and Methods: This cross-sectional study was conducted in Iran in 2021. The data used in this study were extracted from the information system of the Ministry of Health from 2018 to 2021, which includes the number, origin, and destination of medical tourists, per capita revenue, and monthly revenue two years before and one and a half years after the COVID-19 pandemic. For data analysis, t-tests of independent groups and interrupted time series regression were used in SPSS and EViews 10 software.
Results: The COVID-19 pandemic has caused a 42% decrease in the average monthly number of medical tourists, a 45% decrease in the monthly revenue, and a 10% decrease in the per capita income per tourist (P<0.05). The arrival of medical tourists from the Republic of Azerbaijan, Bahrain, Iraq, and Oman has decreased by more than 80%, and the largest decrease in the number of tourists has been related to Ahvaz, Urmia, Tabriz, and Shiraz. In all diagnostic groups except obstetrics and gynecology, there has been a decrease between 50 to 70% The declining trend of medical tourism indicators was stopped in the second year of the COVID-19 pandemic and has continued as a constant trend.
Conclusion: The COVID-19 crisis has hurt the number of international patients and their revenue in Iran. Relative success in controlling COVID-19 can return to a pre-pandemic situation that requires appropriate policies and administrative measures by government and industry players, such as policies to facilitate patient entry, marketing measures, branding and creating a positive image of the country to potential clients, use of telemedicine facilities for consultations and follow-up, etc.
Miss Maryam Eslami, Javad Jahangirzadeh,
Volume 16, Issue 6 (1-2023)
Volume 16, Issue 6 (1-2023)
Abstract
Background and Aim: The curriculum as the heart of the educational system is one of the effective factors in achieving the goals and mission of the university and its evaluation is of particular importance. Since medical education deals with human life and clerkships also play an essential role in shaping the professional abilities of medical students, this research was conducted with the aim of determining the desirability of clerkship programs from the point of view of medical students of Tehran University of Medical Sciences during the Covid-19 pandemic based on the nine elements of Francis Klein.
Materials and Methods: In this study, a descriptive-survey method was used. The statistical population was 487 medical students of Tehran University of Medical Sciences, who were undergoing the clerkship stage at the time of the research, and the questionnaire was provided to them in the form of a census. The number of samples was determined based on Morgan’s table of 215 people. The research tool was a standard questionnaire, the validity of which was confirmed by professors in the field of educational sciences, and its reliability was calculated using the Cronbach’s alpha method of 0.794. Descriptive statistics (including statistical tables, graphs, central and dispersion indices) and inferential statistics (including one-sample t-tests and independent two-sample t-tests) were used for data analysis.
Results: The results showed that clerkship programs from the point of view of medical students of Tehran University of Medical Sciences during the covid-19 disease, considering that the t-statistic of all research variables is less than 1.96 (educational objectives t=-4.735, educational content t=0/666, learning activities t=-7.812, teaching strategies t=-4.246, educational materials and resources t=-0.970, grouping of learners t=-5.223, learning space (place) t=-4.029, learning time t=-5.043, and learning evaluation t=-7.348) were not desirable in terms of all elements. It was also found that there is no significant difference in attitudes between male and female students regarding the desirability of these programs except for the element of educational goals.
Conclusion: According to the results of the research, the medical clerkship programs of Tehran University of Medical Sciences are facing challenges during the Covid-19 pandemic. Therefore, it is necessary to provide a program that is compatible with the conditions and can meet the educational needs of the learners.
Materials and Methods: In this study, a descriptive-survey method was used. The statistical population was 487 medical students of Tehran University of Medical Sciences, who were undergoing the clerkship stage at the time of the research, and the questionnaire was provided to them in the form of a census. The number of samples was determined based on Morgan’s table of 215 people. The research tool was a standard questionnaire, the validity of which was confirmed by professors in the field of educational sciences, and its reliability was calculated using the Cronbach’s alpha method of 0.794. Descriptive statistics (including statistical tables, graphs, central and dispersion indices) and inferential statistics (including one-sample t-tests and independent two-sample t-tests) were used for data analysis.
Results: The results showed that clerkship programs from the point of view of medical students of Tehran University of Medical Sciences during the covid-19 disease, considering that the t-statistic of all research variables is less than 1.96 (educational objectives t=-4.735, educational content t=0/666, learning activities t=-7.812, teaching strategies t=-4.246, educational materials and resources t=-0.970, grouping of learners t=-5.223, learning space (place) t=-4.029, learning time t=-5.043, and learning evaluation t=-7.348) were not desirable in terms of all elements. It was also found that there is no significant difference in attitudes between male and female students regarding the desirability of these programs except for the element of educational goals.
Conclusion: According to the results of the research, the medical clerkship programs of Tehran University of Medical Sciences are facing challenges during the Covid-19 pandemic. Therefore, it is necessary to provide a program that is compatible with the conditions and can meet the educational needs of the learners.
- Zeinab Hashemzadeh, Farhad Habibi, Hossein Dargahi, Mohammad Arab,
Volume 17, Issue 1 (3-2023)
Volume 17, Issue 1 (3-2023)
Abstract
Background and Aim: Home care is an alternative method of hospitalization, especially for chronic patients and is an innovative approach to improve care and reduce the costs of hospital readmissions. The present study was conducted with the aim of investigating the benefits and challenges of implementing the home care plan after being discharged from the hospital considering the perspective of health service recipients and providers at Tehran University of Medical Sciences in 2021.
Material and Methods: The present study is an applied research that was conducted qualitatively using structured and semi-structured interviews. The research sample was those responsible for the implementation of this project at the ministry and university level, the implementers of this project in 4 hospitals, 5 institutions providing home care services, and family of patients. Twenty-eight people from the research community were included in the study using the purposeful and snowball sampling method. Content analysis method was used to analyze the interview data. MAXQDA2020 software was used for data classification.
Results: The results were classified into two categories: benefits and challenges of the home care plan after discharge. A total of 61 open codes were extracted from the analysis of research interviews, so that 27 codes led to the identification of 5 themes (Including improving service delivery, reducing costs, achieving health goals, cultural and social benefits, providing the necessary infrastructure) in the benefits and 34 codes led to the identification of 7 themes (including policy-making, legal and ethical, economic, manpower, cultural-social-communication, service provision limitations and time and place limitations) in the challenges.
Conclusion: The result of this research showed that home care services after being discharged from the hospital play an important role in completing the provision of healthcare services. Home care services after being discharged from the hospital improves service delivery, reduces costs, and helps in achieving health goals. It also benefits patients, society and the government in various cultural and social fields. On the other hand, it seems that there are challenges in the political, legal, economic and cultural fields in the way of the optimal implementation of this plan. Therefore, planning to evaluate and solve the problems facing these services is essential.
Material and Methods: The present study is an applied research that was conducted qualitatively using structured and semi-structured interviews. The research sample was those responsible for the implementation of this project at the ministry and university level, the implementers of this project in 4 hospitals, 5 institutions providing home care services, and family of patients. Twenty-eight people from the research community were included in the study using the purposeful and snowball sampling method. Content analysis method was used to analyze the interview data. MAXQDA2020 software was used for data classification.
Results: The results were classified into two categories: benefits and challenges of the home care plan after discharge. A total of 61 open codes were extracted from the analysis of research interviews, so that 27 codes led to the identification of 5 themes (Including improving service delivery, reducing costs, achieving health goals, cultural and social benefits, providing the necessary infrastructure) in the benefits and 34 codes led to the identification of 7 themes (including policy-making, legal and ethical, economic, manpower, cultural-social-communication, service provision limitations and time and place limitations) in the challenges.
Conclusion: The result of this research showed that home care services after being discharged from the hospital play an important role in completing the provision of healthcare services. Home care services after being discharged from the hospital improves service delivery, reduces costs, and helps in achieving health goals. It also benefits patients, society and the government in various cultural and social fields. On the other hand, it seems that there are challenges in the political, legal, economic and cultural fields in the way of the optimal implementation of this plan. Therefore, planning to evaluate and solve the problems facing these services is essential.
Fatemeh Esmaili, Najmeh Ashouri, Seyedeh Mahboobeh Hosseini Zare,
Volume 17, Issue 1 (3-2023)
Volume 17, Issue 1 (3-2023)
Abstract
Background and Aim: Antibiotics are one of the most commonly used drugs that help to heal and treat diseases, but improper administration and excessive use of them can increase length of stay and cost of hospitalization. The purpose of this study was to analyze relationship between experimental use of antibiotics and duration of stay of premature infants admitted to Mahdiyeh hospital in Tehran.
Materials and Methods: This descriptive-analytical and cross-sectional study was carried out in 2019 on 159 premature infants admitted to intensive care ward of Mahdiyeh hospital in Tehran were investigated. The study tool was a questionnaire that validity of questionnaire was measured by content analysis method and reliability of questionnaire was measured by Cronbach’s alpha method. Data analysis was done using SPSS software, with help of descriptive statistics of frequency and percentage and statistical test of one-way analysis of variance and independent t-test.
Results: The results showed that 52.2% of infants were girls and 79.9% of deliveries were performed by cesarean section. The average length of stay of infants was 31.47 days and average birth of infants was 30 weeks. According to results of study, there was a significant relationship between length of hospitalization of infants with duration of antibiotic treatment and number of periods of receiving antibiotics (P<0.05). The duration of hospitalization of infants with a period of receiving less than 14 days of antibiotics was almost half of duration of hospitalization of infants with more than 14 days of receiving antibiotics. Also, there was a significant relationship between number of antibiotic courses and length of hospitalization of patients (P<0.05). With increase in number of antibiotic sessions, duration of hospitalization of infants increased significantly. The results of study showed that there was a significant relationship between birth weight of babies, cost of bed, and total cost of experimental administration of antibiotics (P<0.05).
Conclusion: Considering that rational use of antibiotics reduce length of stay of hospitalized infants, Ministry of Health should develop an updated and transparent antibiotic adminstration protocol for premature infants and awareness physicians to inform particularly prescription of antibiotics and implementation of stewardship antibiotic programs in neonatal intensive care unit. Also the publication of standard treatment guidelines, instructions including importance of prescribing antibiotics with correct dose and clinical education of physicians are necessary.
Materials and Methods: This descriptive-analytical and cross-sectional study was carried out in 2019 on 159 premature infants admitted to intensive care ward of Mahdiyeh hospital in Tehran were investigated. The study tool was a questionnaire that validity of questionnaire was measured by content analysis method and reliability of questionnaire was measured by Cronbach’s alpha method. Data analysis was done using SPSS software, with help of descriptive statistics of frequency and percentage and statistical test of one-way analysis of variance and independent t-test.
Results: The results showed that 52.2% of infants were girls and 79.9% of deliveries were performed by cesarean section. The average length of stay of infants was 31.47 days and average birth of infants was 30 weeks. According to results of study, there was a significant relationship between length of hospitalization of infants with duration of antibiotic treatment and number of periods of receiving antibiotics (P<0.05). The duration of hospitalization of infants with a period of receiving less than 14 days of antibiotics was almost half of duration of hospitalization of infants with more than 14 days of receiving antibiotics. Also, there was a significant relationship between number of antibiotic courses and length of hospitalization of patients (P<0.05). With increase in number of antibiotic sessions, duration of hospitalization of infants increased significantly. The results of study showed that there was a significant relationship between birth weight of babies, cost of bed, and total cost of experimental administration of antibiotics (P<0.05).
Conclusion: Considering that rational use of antibiotics reduce length of stay of hospitalized infants, Ministry of Health should develop an updated and transparent antibiotic adminstration protocol for premature infants and awareness physicians to inform particularly prescription of antibiotics and implementation of stewardship antibiotic programs in neonatal intensive care unit. Also the publication of standard treatment guidelines, instructions including importance of prescribing antibiotics with correct dose and clinical education of physicians are necessary.
Akram Hemmatipour, Ali Hatami, Azam Jahangirimehr, Foruzan Jelodari, Zahra Mehri,
Volume 17, Issue 1 (3-2023)
Volume 17, Issue 1 (3-2023)
Abstract
Background and Aim: There is a correlation between disease and quality of life in patients with chronic disease and physical disorders have a direct effect on all aspects of quality of life. Therefore, this study was conducted to determine the effect of family-centered empowerment model based on multimedia education on the quality of life of children with thalassemia.
Materials and Methods: In this experimental study, 120 patients along with their parents, who had medical records at the thalassemia center of Khatam al-Anbiya Hospital in Shoushtar, were selected according to the inclusion criteria and were divided into two groups of intervention and control (n=60) by random allocation. Subjects were matched in terms of age and gender. The data collection tools included Pediatric Quality of Life Inventory (Ped-SQL) and researcher-made questionnaires of awareness and self-efficacy in the area of thalassemia. The collected data were analyzed using SPSS and Mann-Whitney and Wilcoxon statistical tests and Pearson’s correlation coefficient.
Results: Out of 120 children who were included in the study, 87 were girls (72.5%), the mean age of these children was 9.74±2.25 years and disease duration was 5.35±4.47 years. In this study, in terms of children’s quality of life and its dimensions, after the implementation of the educational model, a significant increase was observed compared to pre-test phase only in the intervention group (P<0.001). After implementing this model, the level of knowledge (P<0.001) and self-efficacy of parents (P=0.003) was faced with a significant increase, and this significance was also observed compared to the control group (P<0.001). The variables of age, gender, disease duration and parents’ education level had no effect on parents’ self-efficacy and knowledge as well as children’s quality of life (P>0.05).
Conclusion: Based on the results of the present study, the implementation of family-centered empowerment programs based on multimedia education among parents of children with thalassemia improved the quality of life of these children by increasing the knowledge and self-efficacy of their parents. It is suggested that this program be implemented on a wider scale with better facilities for parents and the family members.
Materials and Methods: In this experimental study, 120 patients along with their parents, who had medical records at the thalassemia center of Khatam al-Anbiya Hospital in Shoushtar, were selected according to the inclusion criteria and were divided into two groups of intervention and control (n=60) by random allocation. Subjects were matched in terms of age and gender. The data collection tools included Pediatric Quality of Life Inventory (Ped-SQL) and researcher-made questionnaires of awareness and self-efficacy in the area of thalassemia. The collected data were analyzed using SPSS and Mann-Whitney and Wilcoxon statistical tests and Pearson’s correlation coefficient.
Results: Out of 120 children who were included in the study, 87 were girls (72.5%), the mean age of these children was 9.74±2.25 years and disease duration was 5.35±4.47 years. In this study, in terms of children’s quality of life and its dimensions, after the implementation of the educational model, a significant increase was observed compared to pre-test phase only in the intervention group (P<0.001). After implementing this model, the level of knowledge (P<0.001) and self-efficacy of parents (P=0.003) was faced with a significant increase, and this significance was also observed compared to the control group (P<0.001). The variables of age, gender, disease duration and parents’ education level had no effect on parents’ self-efficacy and knowledge as well as children’s quality of life (P>0.05).
Conclusion: Based on the results of the present study, the implementation of family-centered empowerment programs based on multimedia education among parents of children with thalassemia improved the quality of life of these children by increasing the knowledge and self-efficacy of their parents. It is suggested that this program be implemented on a wider scale with better facilities for parents and the family members.
Keyhan Fatehi, Farimah Rahimi, Reza Rezayatmand,
Volume 17, Issue 1 (3-2023)
Volume 17, Issue 1 (3-2023)
Abstract
Background and Aim: Colorectal cancer is one of the most common cancers that its incidence and prevalence and so deaths due to this cancer have increased worldwide recently. This study examines the economic burden of colorectal cancer from different perspectives by conducting a scoping review.
Materials and Methods: In this scoping review, by searching Scopus, PubMed, Embase, Cochrane, and Web of Science, the articles reporting the costs of CRC were reviewed. The search was limited to those published in the past years leading up to 2020. In addition to categorizing different aspects of the reviewed paper, per capita costs were adjusted with the purchasing power parity in order to make some comparisons possible. In this study, the calculated costs of retrieved studies were categorized based on the perspective of each study.
Results: Out of 29 studies, only two have reported indirect costs of CRC, and 4 studies have reported both direct and indirect costs. In other studies, only direct costs of CRC have been reported. Nearly 40% of studies calculated CRC costs from the provider’s perspective. The highest reported annual per-patient cost was $175020(PPP-adjusted) which is related to the average annual costs of patients with CRC at the fourth stage in the United States from a provider perspective. The lowest reported amount was $ 954(PPP-adjusted) which was related to average annual inpatient costs in Brazil from a provider perspective.
Conclusion: Due to variations in study characteristics in terms of perspective, type of costs, type of patient included, etc. any comparison between the economic burden of CRC should be made with caution. However, reviewing various aspects of the economic burden of CRC reported in included studies, will provide researchers and policymakers with a better insight into the CRC burden while designing intervention programs will reduce the budget impact of the those programs.
Materials and Methods: In this scoping review, by searching Scopus, PubMed, Embase, Cochrane, and Web of Science, the articles reporting the costs of CRC were reviewed. The search was limited to those published in the past years leading up to 2020. In addition to categorizing different aspects of the reviewed paper, per capita costs were adjusted with the purchasing power parity in order to make some comparisons possible. In this study, the calculated costs of retrieved studies were categorized based on the perspective of each study.
Results: Out of 29 studies, only two have reported indirect costs of CRC, and 4 studies have reported both direct and indirect costs. In other studies, only direct costs of CRC have been reported. Nearly 40% of studies calculated CRC costs from the provider’s perspective. The highest reported annual per-patient cost was $175020(PPP-adjusted) which is related to the average annual costs of patients with CRC at the fourth stage in the United States from a provider perspective. The lowest reported amount was $ 954(PPP-adjusted) which was related to average annual inpatient costs in Brazil from a provider perspective.
Conclusion: Due to variations in study characteristics in terms of perspective, type of costs, type of patient included, etc. any comparison between the economic burden of CRC should be made with caution. However, reviewing various aspects of the economic burden of CRC reported in included studies, will provide researchers and policymakers with a better insight into the CRC burden while designing intervention programs will reduce the budget impact of the those programs.
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