نشریه سازمان نظام پزشکی مشهد (سیمرغ سپید)
سال هجدهم شماره 3 (پیاپی 67، زمستان 1393)

Mashhad is the second largest metropolitan in Iran which its medical capacities, established medical academic background and three specialized general hospitals are some of the infrastructures of health tourism in this city. This study aimed to evaluate the features and capabilities of health tourism in the city of Mashhad, with regards to the effective variables on satisfaction and selection of health tourists. In this cross-sectional study, a 4-part questionnaire consisting of (1) demographic characteristics, (2) tourists’ past history and purpose of travel (3) satisfaction with medical services and facilities (4) satisfaction towards environmental factors of travel, was given to non-Iranian health tourists visiting the main hospitals in Mashhad. In this study, 100 tourists were surveyed which the majority of them were from Iraq (93%). Most respondents (87%) were men. The majority of respondents (93%) traveled to Mashhad by public and private medtourism companies. The purpose of the travel for most respondents (64%) was use of medical care (surgery, infertility treatment and dental care). The majority of respondents (74%) stated reasonable costs as the main factor in choosing Iran (Mashhad) for the destination of health tourism. Reverence and well treatment provided by medical staff was evaluated as "average" in most cases (80%). The competence and proficiency of medical staff was assessed "high" in 95% of cases and "very high" in the remaining 5%. The quality of medical equipment in medical tourism provider centers was found to be "high" by the majority of respondents (76%). The majority of participants (85%) expressed the quality of hotels and accommodation services as "high". Quality of transport facilities in the city of Mashhad was assessed as "average" by most of the respondents (61%). In order to attract more health tourists and promote this industry, health tourism in-charges in Mashhad, in addition to trying to maintain and improve the quality of medical services, should move towards the improvement of reverence and well treatment to patients, increase the quality of touristic services and environmental factors as well as offering competitive prices lower than the region.

Considering the importance of midwifery for the health of the community, this study was performed to identify some of the career problems of midwives in private and public institutions. In this descriptive analytical study which was conducted as a survey in 2014, a questionnaire containing demographic information of respondents and questions related to educational problems, lack of resources or personnel, cultural issues, problems with dealing with patients and problems related to management and policy of treatment centers, was given randomly to midwives working in private and public institutions in the city of Mashhad, Iran.From 90 questionnaires sent, 52 individuals responded (response rate: 57.7%) to the survey questions. The mean age of participants in the survey was 34.6 ± 5.4 years and their mean of work experience was 8.4 ± 4.4 years. The most emphasized educational problems were "lack of scientific workshops and CME courses" (44.2%) and "lack of practical skills training courses" (44.2%). Considering personnel number and facilities, "lack of adequate number of personnel in the center" (78.8%) was the most common problem posed by the respondents. About cultural issues and problems with dealing with patients, the majority of participants (55.8%) complained of "excessive and unreasonable expectations from the medical staff". The most common problems related to management and policy of treatment centers included "low income" (53.8%), followed by "high number of shifts and irrational working hours" (40.4%). Effective measures to resolve issues posed by the midwives in this study may improve the satisfaction of this class of the medical community and can consequently increase job efficiency and improve the public health.

Smartphones as tools having special features such as medical software, connection to the internet and computing capabilities, are valuable assistants to healthcare providers. The objective of this study was to evaluate the purpose and rate of use of smartphones by medical interns and residents during training and clinical practice. This was a survey conducted in 2014 on a number of interns (47 person) and residents (50 Persons) studying in Mashhad University of Medical Sciences. Participants were asked to answer to a nameless questionnaire consisting of questions on the rate of use of smartphone apps, rate of work-related phone calls via smartphones, and the most commonly used medical and non-medical apps. The mean age of responders was 27.9 ± 4.0 years. According to Likert scale, the most popular use of smartphone for both interns and residents participating in this survey included making or receiving calls (4.3 ± 1.9), sending or receiving text messages (3.9 ± 1.9) and use of medical and pharmaceutical software. Comparing the use of smartphones between the two groups; the use of web chat and social network software (P=0.021), taking photo from non-medical subjects (P=0.022) and playing games (P=0.003) was significantly higher among interns than residents. Conversely, taking photo of patients and medical subjects was significantly more common in residents compared to interns (P=0.038). The number of work-related phone calls was higher by residents compared to interns, and the difference was close to the level of significance (P=0.059). The most frequently used app among residents and interns was “UpToDate” (73%). Residents and Interns use their smartphones on a daily basis during clinical practice for making contacts, taking photos and accessing to medical software and websites. Necessary guidance on the proper use of these devices pertinent to safe preservation of patient's information, and restrictions on the use of these devices in certain clinical settings should be provided. In addition, advice is needed on the validity and reliability of medical apps and websites.

Unbalanced distribution of medical student admission, inequities in the distribution of manpower and employment problems are among the difficulties of each health system. The aim of this study was to evaluate the number of admissions of Iranian medical schools in 2014 according to the country divisions, as well as macro-zoning for medical education. This descriptive analytical study was performed by using the information of field selection booklet of university entrance exam in Iran in 2014. The information was separated by Azad or Public Universities or private campus admissions for each province and city. The population of each province was extracted from the national census of 2011. The number of admissions in each city and province was extracted and the admission per capita of each province and each medical education macro-zone was calculated. Iranian medical schools are established in 49 cities of 31 provinces to train medical students. The overall capacity of medical student admission in 2014 was 4589 individuals, which with regards to the country population of 75,130,000 people represents admission per capita of medicine (admission per thousand population) to be 0.061. Considering the population of each province, the highest admission per capita of medicine was in Semnan (0.246), Southern Khorasan (0.156) and Yazd (0.126) provinces and the lowest was in Alborz (0.013), Northern Khorasan (0.023) and Qazvin (0.033) provinces. Based on the ten macro-zones for medical education, the highest admission per capita was in the macro-zone 1 (0.079) and the lowest was in macro-zone 4 (0.041). Given that infrastructures of medical schools are currently established in all 31 provinces of Iran, and moreover, more physicians are needed to reach the world average of physician workforce, it appears necessary that while the admission capacity of the zones with higher admission per capita is maintained, the admission of medical schools in the provinces and macro-zones with admission per capita of lower than the national average should be increased.

Effective delivery of medicines and supplies is one of the most important determinants of quality of healthcare provided in hospitals. This study was designed: (1) to delineate the problems of management in provision, procurement, storage and distribution of supplies in hospitals after implementation of the health system reform project in Iran, (2) to explore the pitfalls in this process and (3) to provide scientific and practical solutions. In this qualitative - descriptive study, in order to identify the effective factors on irregular provision of supplies in hospitals, five brainstorming sessions attended by 20-25 head nurses (supervisors) of operating rooms of 6 university hospitals in Mashhad and relevant experts was held. At the end of 160 person-working hours during the meetings, the problems and the effective factors on them were discussed by the participants, and in addition, solutions to resolve the problems were raised. For providing suitable supplies for patients in the hospitals, the following process was proposed: 1. Visiting the patient by treating physician and requesting the necessary supplies by the physician, 2. Setting up and confirming the request for the required supplies by the department supervisor, 3. Sending the request to the technical in-charge for hospital supplies, 4. Coordinating between technical in-charge for hospital supplies and the supplier of the hospital, 5. Provision and delivery of supplies by the supplier of the hospital to the supplies warehouse together with matching the entry products with requested product by the technical in-charge for hospital supplies, 6. Charging the product to the account of the department supervisor, 7. Charging the supplies from the account of the supervisor to the account of the patient 8. Confirming the invoices of the supplies by the treating physician, the supervisor, and circular and scrub nurses, 9. Disbursement of the approved invoices, 10. Sending back the surplus supplies Preventing the wastage of financial resources and facilities as well as providing medical supplies with the best price are of the most important factors effective on the appropriate provision of supplies in hospitals. To this end, in addition to regular monitoring by hospital administrators, an optimized process which helps to systematize the provision and recharging of supplies and equipment is needed.

Adjutant rural health insurance centers (ARHIC) are established with the aim of guiding and serving the rural insured persons in the cities of Iran. The aim of this study was to investigate the reasons for visiting ARHIC of Razavi Khorasan province by rural patients during 2009 and 2010. In this descriptive study, demographic features and reasons of villagers who visited Razavi Khorazan province ARHIC in the years 2009 and 2010 were extracted from admission software and were analyzed. During the 2 years, 69,580 individuals visited the Razavi Khorasan ARHIC which over half of them (54%) were women. The majority of individuals (30826, 44.3%) were those who despite compliance to the referral system and having referral stamp were not admitted by 2nd level of medical care providers and so they had to come for having a second stamp in their insurance booklets. In the next rank, there were individuals (20971, 30.1%) who, against referral system codes, came for receiving referral stamp to be able to be visited by specialists. For 5020 patients (7.2%) admission to hospital became necessary while travelling to the city and so they needed the referral stamp on their insurance booklets. 902 patients (0.3%) come to receive the referral stamp as they thought they needed to be admitted to hospitals, while after further evaluation they were guided to 1st or 2nd level of medical care without needing to be hospitalized. 226 patients (0.3%) primarily needed to only 1st level of medical care. In order to reduce cases which against referral system codes, are not admitted by 2nd level of medical care providers; raising awareness, educational programs and intra and extra-sectorial cooperation are necessary. To reduce unnecessary visits of villagers to specialists, education and building awareness on how the referral system works and how health insurance booklets should be used is necessary for the insured persons in rural areas.