Journal of

Background and Aim: Cutaneous leishmaniasis (CL) is prevalent in most tropical and subtropical countries of the world and leads to adverse economic consequences. This study was performed to estimate the cost of healthcare services delivered to CL patients in Qom Province.

Materials and Methods: Based on the data from 638 CL patients, this cross-sectional study was performed in Qom during 2009-2011. First, using researcher-made forms and based on the accounting documents, the direct and overhead costs of health services in the studied areas were calculated. Then, the out-of-pocket costs per patient were obtained. Finally, the gathered data were calculated using the excel software.

Results: In total, more than 1,600 million rials was spent on providing health services to 638 patients with cutaneous leishmaniasis in endemic foci of Qom. The direct healthcare cost was estimated to be about a thousand million and the overhead cost about 600 million rials. Besides, the state cost per patient was estimated to be over 2,520 thousand and the out-of-pocket cost per patient about 240 thousand rials. Moreover, the average total cost per patient was calculated to be 2,760,772 in the studied period.

Conclusion : Based on results, considerable costs are spent for CL diagnosis and treatment in Qom. Therefore, health planners should give priority to the prevention of this disease in their programs.

Background and Aim: Despite all inherent advantages of information technology in health sector, its implementation still faces many problems. One of the most important barriers is people’s resistance. This study was carried out to survey the factors affecting the acceptance of information technology by Health Information Management (HIM) staff of Tehran University of Medical Sciences (TUMS) hospitals based on Technology Acceptance Model (TAM) in 2011.

Materials and Methods: It is a descriptive-analytical survey. The population of the study consisted of the HIM staff (363 members) of TUMS hospitals. As the sample, 123 employees were selected. The data gathering tool was a questionnaire the validity and reliability of which were confirmed. The data were collected and analyzed by SPSS software, descriptive statistical methods and Spearman Test.

Results: The results showed that there was a positive direct relationship between perceived ease of use (PEOU) on the one hand and the staff’s attitude and their application of IT on the other hand (R=0.14, P= 0.05 R=0.36, P=0.05). Also, perceived usefulness (PU) had a significant direct effect on the staff’s attitude and their application of IT (R=0.22, P= 0.05 R=0.37, P=0.05).

Conclusion : Perceived ease of use (PEOU) and perceived usefulness (PU) are the factors affecting the acceptance of information technology by the HIM staff of TUMS hospitals. Therefore, it is suggested that the above two principles be considered when designing and implementing the IT systems.

Background and Aim: Stewardship and delivery of health services are considered as the most important areas in the healthcare system of the Islamic Republic of Iran in 1404. This study was conducted to investigate the main challenges in medical education stewardship because of its importance in the management and leadership of education from the viewpoint of education process providers.

Materials and Methods: This qualitative research was conducted using thematic and framework analyses to obtain the collective view of faculty members of Medical Sciences Universities in Iran. The data were collected applying deep semi-structured interviews. To increase the acceptability of the study, four criteria of Lincoln and Gupta were used. Codes, categories and themes were extracted by expert researchers of qualitative studies who had no conflict of interests with the topic.

Results: Of the 24 faculty members interviewed, 7 were females and 17 were males. They comprised 5 full professors, 8 associate professors, 9 assistant professors and 2 lecturers. The findings of the interviews were categorized in three main lines of stewardship in health system in the form of main and sub themes so that there were 2, 2 and 5 main themes in each line, respectively.

Conclusion : Since many of the challenges extracted from the present interviews are considered as essential interventions for achieving the stewardship functions of health system -- and, as a result, medical education -- , it is important to pay more attention to these challenges and at the same time conduct more complete studies to get more practicable solutions to these problems.

Background and Aim: Development of information and communication technology has led to enormous changes in different areas. Electronic medical records system is valuable to access patient data in hospitals. This study aimed to investigate and compare the educational hospitals of Uemia University of Medical Sciences in case of technical, organizational and legal to establish the system.

Materials and Methods: The study was a descriptive cross-sectional study. The study population consisted of 98 senior and central managers. In this study population census was used and the entire population were considered as the sample. A questionnaire was used for data collection, which included two sections in order to determine the level of research community awareness and to analyze the standards related requirements for the implementation of the system. Validity and reliability were assessed and the data was analyzed by SPSS.

Results: Sample awareness in 5 hospitals of this study was moderate. In terms of requirements, there was a significant difference between the means of Electronic Medical Records in terms of three variables between hospitals "D" and the rest of the hospitals. And no significant difference was seen among other hospitals.

Conclusion : Three hospitals, "a", "c" and "b", among five studied hospitals are in preparation for the deployment of electronic medical records. Other two hospitals were not prepared. However, the implementation of electronic medical records, increases health care quality, patient safety and patient care and also decreases health costs. So it is suggested that hospitals do necessary efforts to establish EMR.

Background and Aim: Today, healthcare system is exposed to inappropriate human resources distribution challenges in all over the world. So far there is not an appropriate policy for human resources distribution in Iran. This deficiency may cause several problems for providing healthcare services. This research was aimed to determine the situation of human resources distribution among Tehran University Of Medical Sciences (TUMS) Hospitals.

Materials and Methods: This is a cross-sectional definitive study induced in four general and special TUMS hospitals. The research tool was a checklist that determine the number of nurses, paraclinic and supportive employees and finally the decrease and increased of the human resources among the departments of the hospitals regarding Iranian Ministry of Health (MOH) issues. The data was collected and analyzed by SPSS software and determined the differences between current situation in accordance to MOH issues.

Results: We observed the deficiency of human resources among all studied hospitals. Also the distribution of human resources among most of the hospitals departments was not coordinated with MOH issues.

Conclusion : It seems the distribution of human resources among Iranian healthcare system is not followed by a special model. Therefore, we suggest the model of health human resources planning should be determined and related by information, providers, services, education and policy as healthcare system factors and overlapping of these factors.

 Background and Aim: Aging is a natural experience which is usually accompanied by a variety of diseases. Hence, this research was conducted to study the elderly people’s disease rate and the number of times they refer to medical centers in Tehran.

 Materials and Methods: This descriptive analytical study was conducted on the old people referring to the Elderly Centers in Tehran in 2012. For data collection purposes, valid and reliable self-report demographic and disease questionnaires were used. The data were analyzed by SPSS software together with T-test and one-way ANOVA.

 Results: Four hundred old people participated in this study. Of the participants, 300 (75%) were female and 100 (25%) male with a mean age of 67.65 (±6.38) years. Besides, 160 (40%) people had heart diseases, 137 (34.3%) muscoskeletal diseases, and 83 (20.8%) endocrine diseases. Moreover, 381 (95.2%) participants had referred to doctors and therapeutic centers at least once during the last year. Furthermore, 177 subjects (44.2%) were hospitalized at least once last year.

 Conclusion: The prevalence of diseases in elderly people is more than expected. Most old people refer to doctors and therapeutic centers, which is indicative of the fact that they suffer from diseases and need varied health services.

 Background and Aim: Learning styles are among efficient factors in the teaching-learning process. The aim of the present study was to assess healthcare management students’ learning styles at Tehran University of Medical Sciences (TUMS).

 Materials and Methods: This descriptive cross-sectional study was conducted on healthcare management students selected randomly through stratified sampling (response rate = 85%). The data collection tool used in this study was Kolb learning style questionnaire (Cronbach Alpha was 0.7-0.9). The data were analyzed through descriptive and analytical tests (χ² and t-test).

 Results: Most postgraduate students preferred the Accommodate Style (55.6% of PhD students and 64% of MCs students). The majority of undergraduate students, however, preferred the Convergent Style (45.67%).

 Conclusion: As to these students’ dominant learning styles, the results of the study emphasized the use of “teaching methods based on Role Playing and Simulation” among postgraduate students and “Problem-Based Learning” among undergraduate students.

 Background and Aim: One of the most important factors to present successful managers is general health. If managers have not highly general health, then they will encounter many problems. Therefore, this research is aimed to induce the general health among Tehran University of Medical Sciences hospitals’ administrators. 

 Materials and Methods: A cross-sectional, deceptive and analytical study was conducted among 25 Tehran University of Medical Sciences hospitals administrators in Tehran, Iran. The research tool was general health questionnaire developed by Goldberg and Hillier to assess the administrators general health and its demographic details. Data was analyzed by SPSS software and using analytic statistical methods.

 Results: The results of this study showed that the hospitals administrators had normal range of general health. Also, there was significant correlation between anxiety with physical dysfunctions, and depression with physical dysfunctions, and anxiety with social functions.

 Conclusion: The rate of general health among TUMS hospitals administrators is higher than the other mangers compared with similar studies in Iran and out of Iran. Therefore, we suggest periodic medical examination, general health training, and consultant services to develop or maintain the general health among healthcare managers.

 Background and Aim: The applicability of any technology to enter a certain field is determined by defining the advantages and disadvantages of the system in that field. The aim of this study is to show the advantages and limitations of using speech recognition systems in health care and providing practical solutions to improve the acceptability of the system in that field.

 Materials and Methods: This is a descriptive research with a review method that employs library resources and online databases such as Proquest, Pubmed, Science Direct, Ovid and Scientific Information databases using key words like speech recognition software, health care, benefits, barriers, and solutions.

 Results: Speech recognition system has many advantages like increased accuracy of medical documentation, and reduced documentation time. It is a tool for data entry into electronic health records. However, there are several limitations in applying the system in Iran, such as the lack of definition of database system and the high cost of hardware and software.

 Conclusion: Considering the study results in relation to the benefits and limitations of systems in healthcare area, solutions such as production of a national integrated database for the exchange of health information, improving database to increase the accuracy of word recognition, and training the users of the system can reduce the limitations of the system to some extent. Also, in the country’s movement towards the implementation of electronic health records and the users’ need to enter data into the computer, the software is a good alternative to keyboard and mouse input.

 Background and Aim: : Technical knowledge of managers of health care industry regarding budgeting have an essential function on increased efficiency of organizations working in this sector, since every single right decision, rely on appropriate knowledge and analysis. Therefore, the purpose of this study was assessment of technical knowledge of managers of health care system regarding budgeting.

 Materials and Methods: This was a descriptive  -analytic, cross- sectional study. From 80 managers of Tabriz Medical Sciences University 63 participated in the study and a questionnaire was employed to collect data. Data was analyzed by Spss 16 software, Pearson correlation test, T test and ANOVA.

 Results: Mean of total scores was 16.9±4.6 of 30. There was no significant difference between total scores in different courses (P=0.276) and positions (P=0.431). Mean of total scores between women and men (P=0.782) were the same.

 There weren't significant relation between technical knowledge of managers with age (p=0.392, r=0.1), job background (p=0.299, r=0.1) and management background (p=0.121, r=0.2).

 Conclusion: With respect to low level of manager's awareness about budgeting,improving of technical knowledge is essential. Lack of significant relation between technical knowledge of managers and their length of management practices, with unstable situation, may harm seriously organizational achievements. Reviewing and promotion of educational programs and continuous training of managers with respect to budgeting seems to be an essential need for improving manager's performance.

 Background and Aim: Information literacy is a set of skills required to identify rightful information resources and access to them. These skills are empowering goal oriented use of information resources. This study aimed to determine the ability rate of information literacy among health services administration students in Jundishapur University of Medical Sciences based on SCONUL seven pillars model.  

 Materials and Methods: This cross-sectional descriptive-analytic study was conducted using a questionnaire developed based on SCONUL information literacy seven pillars model. Validity of the questionnaire was confirmed through content analysis and coefficient of Chronbach’s alpha was 0.93. The study population included students of health services administration in Ahvaz Jundishapur University of Medical Sciences in 2013. The sample size included 40 cases collected randomly. Data analyzed through SPSS descriptive statistics and non-parametric statistical tests.

 Results: The mean score for the studied components of information literacy abilities among the study population was 0.5±0.43. Information Literacy score among freshmen was significantly different from other students (P<0.03). Students who passed Computer Basics and Research Methodology educational courses showed significant differences from other students in the information management (P<0.01).

 Conclusion: Given the increasing development in information technology, the need to develop information literacy skills is considerable especially among those who are going to be engaged in the health sector. Although studied students’ information literacy estimated relatively well, it seems necessary to take measures to improve their information literacy in all components.

 Background and Aim: In order to better design an electronic health record system in the country, determining standardized data elements for creating an integrated information system is important. In this study, the minimum data set of radiology reporting system is determined.

 Materials and Methods: In this descriptive cross-sectional study, 13 radiologists, 3 anesthesiologists, 3 general practitioners and 3 insurance experts working in the Imaging Center of Imam Khomeini hospital in Tehran were chosen. The research tool was a questionnaire having 11 parts. Content validity and test-retest method were used to measure the validity and reliability of the questionnaire, respectively. Data analysis was performed using the SPSS software.

 Results: The highest means reported were radiologists' written explanations and suggestions (9.6), image interpretation (9.5), the name of contrast material (9.4), the name of imaging procedure (9.3) type and date of previous measures (9.1), and the final diagnosis (9) and the lowest averages belonged to referring physician's address (4.8), relationship between patients and the primary individual insured (4.3), and religion (2.2).

 Conclusion: In an electronic health record system, due to the importance of radiology reports for the diagnosis and future management of a patient's clinical problems, it is necessary to pay attention to the minimum set of data related to these reports such as administrative, insurance, patient identity, and clinical data, and the results of radiological examinations for exchanging with electronic health record system.

 Background and Aim: The quality of health record depends on the quality of its content and proper documentation. Minimum data set makes a standard method for collecting key data elements that make them easy to understand and enable comparison. The aim of this study was to determine the minimum data set for Iranian athletes’ health records.

 Materials and Methods: This study is an applied research of a descriptive - comparative type which was carried out in 2013. By using internal and external forms of documentation, a checklist was created that included data elements of athletes health record and was subjected to debate in Delphi method by experts in the field of sports medicine and health information management.

 Results: From 97 elements which were subjected to discussion, 85 elements by more than 75 percent of the participants (as the main elements) and 12 elements by 50 to 75 percent of the participants (as the proposed elements) were agreed upon. In about 97 elements of the case, there was no significant difference between responses of alumni groups of sport pathology and sports medicine specialists with medical record, medical informatics and information management professionals.

 Conclusion: Minimum data set of Iranian athletes’ health record with four information categories including demographic information, health history, assessment and treatment plan was presented. The proposed model is available for manual and electronic medical records.

 Background and Aim: Due to the role of websites in delivering e-services, this study aims to benchmark rendering healthcare services at medical universities' websites based on Chandler and Emanuel’s four-stage e-government maturity model.

 Materials and Methods: This is a descriptive, cross-sectional study which was conducted using content analysis and benchmarking to evaluate the delivery of healthcare services through medical universities websites towards e-government maturity including Information, Interaction, Transaction and Integration services in 1390.

 Results: The results of the study revealed that type I universities were moderate in giving information, and type II and III universities were poor in this regard. Websites of type I, II and III universities were poor in interaction with scores 1.4±0.73, 1.3±0.75 and 1.2±0.62, respectively. The score of all universities was weak in transaction and integration of healthcare services (mean 1 ±0). 

 Conclusion: Medical universities' websites have lagged behind to render e-services. Due to the challenges of health services and information, realization of e-government in healthcare arena requires special consideration. Adopting e-government in other settings, detecting barriers, and formulating related laws and policies can pave the way to achieve e-government in healthcare arena

 Background and Aim: The hypothesis of supplier induced demand has attracted a lot of attention over the past three decades. Most studies in this field agree that healthcare providers have the ability to influence the demand for their products. The purpose of this study is to evaluate the role of institutions in the phenomenon of induced demand. This study has been done using experts' experiences in Isfahan University of Medical Sciences.

 Materials and Methods: This is a qualitative study in which the semi-structured interview was used for data generation. The participants were those informed in this regard and considered as experts. For data saturation, purposive sampling was done. In this study, 17 people were interviewed, and criteria such as reliability and stability were considered. The anonymity of the interviewees was guaranteed. The data were transcribed and categorized, and then analyzed using thematic analysis.

 Results: In the present study, thematic analysis was conducted and 30 sub-themes and 2 main themes were extracted. The two main themes were healthcare insurance organizations and other health organizations. Each of the themes had its own sub-themes.

 Conclusion: The findings help health policy-makers have a better picture regarding the role of various institutions in the phenomenon of induced demand.

Background and Aim: The Household financial contribution is one of the most important issues in health system. This study aims to determine and present some indices of h ousehold financial contribution in health system in Iran.

Materials and Methods: In this cross sectional- descriptive study, the methods were introduced by World Health Organization. Fair Financing Contribution Index (FFCI), catastrophic health expenditure and impoverishment in Iran were calculated from a national representative data derived from Iranian Statistics Center, Household Budget Survey, and Consumption Expenditures, at 2011. The indicators have been calculated on the basis of the total cost analysis, health and capacity to pay Iranians households.

Results: Household financial contribution in the health system for households living in rural areas is more than urban areas. In this study, more than 3 percent of the households were facing catastrophic health expenditure . Also 1.5 percent of the households have been impoverished. Fair Financing Contribution Index in rural and urban areas was 59 and 65 percent respectively.

Conclusion: Calculation of the indicators related to households financial contribution in Iranian health system need to predict and implement appropriate plans, as well as monitoring and assessment of health system programs in order to increase the equity in the household financial contribution and effectiveness of Utilization of resources.