نشریه راهبردهای مدیریت در نظام سلامت
سال سوم شماره 4 (پیاپی 10، زمستان 1397)

Given the importance of assessment to ensure the quality of rendered services in health care centers, this study was carried out. The aim of this study is to assess performance of health care centers within the health networks in south of Tehran. This cross-sectional research was conducted among 360 individuals who referred to the health care centers related to South Tehran Health network. Of the 31 health centers, 15 centers were selected by proportional allocation sampling. The data collection tool was a primary care assessment questionnaire, which included 2 sections of demographic questions and indicators of health centers' assessment. The data was analyzed by SPSS 22 using independent-samples t-test and one-way ANOVA for analytical results. The total mean performance of health care centers was 1.56. The highest score was related to care continuity (2.64); whereas, the least score was related to the care comprehensiveness (0.81). Moreover, age, educational degrees, number of visits, and cause of reference had a significant correlation with several assessment indicators of the health centers. All health care centers are required to improve their performance by reviewing and modifying the measures, goals, policies, and managers' performance.

Aging population is one of the most important demographic phenomena associated with increasing costs and demand for health services. Hence, planning and utilizing health services is a very important concern for the elderly as well as the politicians. The purpose of this study was to determine the status of utilization of outpatient health services among the elderlies of Yazd in 2018. This cross-sectional study was conducted on 300 elderly people in Yazd. The participants were selected using stratified sampling method. Data were collected using a structured questionnaire with 37 questions, which included three sections of demographic information, household characteristics, and health care utilization status. To analyze the data, SPSS 20, chi-square test tests, and logistic regression at a significant level of 0.05 were applied. The frequently visited places by patients to receive the outpatient services were specialist physicians' offices (34.0 %) and the most common cause to receive the outpatient services was cardiovascular diseases (34.0 %). Women (59.9 %) more than men and housewives (61.4 %) more than other people benefited from outpatient services. The average cost paid for the outpatient services was 500,000 Rials and 53.2 % of the elderly spent less than this amount. Factors affecting utilization of outpatient services included marriage, complementary insurance, education, specific illness, and household size. Cardiovascular disease is the most common cause of utilizing the outpatient services, which leads to an increase in the demand for outpatient health services. The utilization of these services is also affected by factors such as marital status, complementary insurance, education, specific illness, and household size. Therefore, proper planning is essential in this regard.

Assessing the effectiveness and efficiency is one of the main issues in hospitals. Utilization of a hospital bed is important in determining the hospital's efficiency. The purpose of this study was to investigate the effect of Health Evolution plan on the performance indicators of hospitals affiliated to Mashhad University of Medical Sciences. This cross-sectional descriptive study was conducted in 22 hospitals of Mashhad University of Medical Sciences in 2013 and 2017 to investigate the effect of Health Evolution Plan. The study population included all hospitals (N = 28) affiliated to Mashhad University of Medical Sciences. The study samples consisted of 22 hospitals, which were active at the time of study.  The data were collected by referring to the statistical unit of the studied hospitals and extracting the functional indicators. Data analysis was performed using the Pabon Lasso chart in Excel software and SPSS 16. Furthermore, paired t-test was used to determine the relationship. In 2013 and 2017, the highest bed occupancy rates were 86.55 and 94.27 %, respectively; whereas, the lowest rates were 48.20 and 54.21 %, respectively. The maximum numbers of bed turnover were 144.28 and 184.97 before and after the health evolution, respectively. However, the lowest rates were 7.45 and 8.85 before and after the health evolution, respectively. Moreover, the average daily hospital admission rates before the program were 40.10 and 6.33days in the studied years, respectively. After the plan, admission rates were 38.41 and 8.00 days in 2013 and 2017, respectively. The lowest admission rates before and after the plan were 1.51 and 1.41 days, respectively. A significant difference was observed between before and after implementation of plan regarding the percentage of bed occupancy, the average hospitalization period in days, and bed turnover (p < 0.05). After implementation of the Health Promotion Plan, favorable changes happened in the hospital status on the Pabon Lasso chart. Continuation of this program and its regular monitoring can improve the performance indicators of the hospitals.

Out-of-pocket is one of the most important payment methods in Iran's health system, which has negative impacts on equity and pushes the vulnerable groups into poverty. Considering the importance of this method, as one of the key issues in health policy, the present study was conducted to identify the factors that affect the household direct payments. This cross-sectional descriptive-analytic study was carried out based on the information obtained from Mazandaran University of Medical Sciences in four one-year periods (2013-2016). The study population included all governmental hospitals in Mazandaran province. Data collection tools included some of the hospital performance indicators. After data collection, the relevant information was entered into Eviews 6 software and the least squared (OLS) method was used to analyze the data. Based on the research findings, 73 percent of the variations in out-of-pocket payments were explained by the independent variables. The number of specialist physicians, the total bed days, and the length of patients' stay in the hospital had a significant relationship with out-of-pocket (p>  0.05), but the relationship of active beds, bed occupancy, and bed occupancy rate with out-of-pocket payments was not significant (p > 0.05). Out-of-pocket is complex and multifactorial. So, different factors should be investigated thoroughly in order to identify and control the determinants of these payments and to determine appropriate strategies.

The main part of drug industry marketing activities focuses on physicians as drug prescribers, which is usually conducted by Pharmaceutical Sales Representatives (PSR) who visit the physicians. The aim of this study was development and validation of a tool for Direct-to-Physician (DTP) pharmaceutical marketing survey.

In the first phase of this study, the first version of a questionnaire was developed by reviewing the related literature. Then, face and content validities of the designed questionnaire were confirmed by a panel of experts. In the next step, Convenience Sampling method was applied and the questionnaire was distributed between 297 General Practitioners and Specialists. The Cronbach’s Alpha was conducted to confirm the validity of the questionnaire and the exploratory factor analysis for derive components of physicians' attitude toward pharmaceutical sales representatives. Data analysis was performed using SPSS 22.

The questionnaire had 2 parts; the demographic information and Direct-to-Physician pharmaceutical marketing survey, which included 11 dimensions. The first dimension studied the frequency of PSRs' visits with physicians. The second dimension dealt with the prevalence of each recommended gifts and benefits offered by PSRs. The third dimension reviewed the strategies used by PSRs. The fourth and fifth dimensions investigated the acceptance of gifts by physicians and their colleagues. The sixth and seventh dimensions surveyed the physicians’ viewpoints about the effect of PSRs' visits and their gifts on prescribing behavior. The eighth dimension was about the effective factors on the efficiency of PSRs' visits. The last three dimensions considered the ethical viewpoints of physicians about gifts and benefits recommended by PSRs. The physicians' attitudes toward PSRs were also studied in this section. Moreover, the physicians' awareness about the domestic guidelines with regard to DTP pharmaceutical marketing was surveyed. As a result of the content validation process, 7 items were removed from the attitude section. The Cronbach’s Alpha score for the attitude and awareness sections were 0.72 and 0.83, respectively. In the attitude dimension, 5 components were determined using the exploratory factor analysis.

The developed questionnaire is a valid tool to investigate DTP pharmaceutical marketing and can be used by other researchers.

Considering the prevalence of cardiovascular diseases in Iran and the high rate of death caused by these diseases, correct prediction of patients' situation is important. So, it is necessary to use the prediction models with minimum error and maximum reliability. Artificial neural network (ANN) was used to evaluate the patients who had myocardial infarction or congestive heart failure. In this study, data of 497 patients were extracted from medical records who they were hospitalized in Ayatollah Golpayegani Hospital in Qom in 2018. In this regard, 19 important features of these profiles were extracted and a particular type of ANN called the Multi-Layer Perceptron (MLP) with Back propagation algorithm was used to evaluate the status of patients with heart failure. The sigmoid transfer function and tangent sigmoid transfer function were selected and trained using 19 neurons in the input layer, 6 neurons in the middle layer, and 75 % of the existing data. Neural network training was done using Matlab software. The mean square error was 0.35 prior to data normalization, which reduced to 0.04 after data standardizing using the minimum and maximum method. The accuracy of the predictive model reached 89.50 % on the validation dataset. Considering the high sensitivity and specificity of the predictive model, it seems to have a good predictive power to classify patients accurately. This study, a neural network model was developed, which could predict heart failures accurately. The prediction is based on the use of a series of individual and clinical variables such as age, gender, shortness of breath, changes in blood pressure, and some blood tests. In this study, we tried to use important and low-cost factors for predicting heart disease, so that all people can be aware of their diseases with a lowest cost.

Personal and organizational characteristics play an important role in nurses' performance quality. The purpose of this study was to determine the structural equation modeling in the relationship of self-acceptance, role overload, and organizational justice with burnout among woman nurses. This correlational study was conducted over all nurses working in Ahvaz hospitals. The sample consisted of 300 people selected by multi-stage sampling method. Expression measurements included the Burnout Questionnaire, Unconditional Self-Acceptance Questionnaire, Overload Role Scale, and Organizational Justice Scale. Data analysis was performed using structural equation model with Amos 21. Descriptive information of burnout (62.77 ± 9.83), self-esteem (74.20 ± 8.46), overload role (10.52 ± 2.34), distributive justice (13.50 ± 2.00), procedural justice (19.37 ± 3.30), and interactive justice (25.87 ± 4.04) variables were invetiated. Analysis showed that self-esteem had a negative and significant relationship with emotional exhaustion, personality deprivation, lack of individual success, and overall burnout score (p > 0.01). Distributive,  procedural, and interactive justice had a negative and significant relationship with personality depersonalization, lack of personal success, and job burnout total score (p < 0.01). Furthermore, the role overload had a positive and significant relationship with excitement exhaustion, depersonalization and lack of individual success, and overall burnout total score (p <  0/01). Regarding the direct effect of personality (Self-Acceptance) and organizational (organizational justice and overload role) factors on nurses' burnout, the Ministry of Health and Medical Sciences should promote effective personality traits and take basic steps to improve the nurses' work environment.

Considering the role of general practitioners in the family physician plan, policymakers and planners are required to be aware of the factors influencing the practitioners' decision to enter this plan. The aim of this study was to identify the effective factors on the decision of general practitioners to participate in the family physician plan. Furthermore, the interaction among these factors and the demographic characteristics of physicians working in Yazd University of Medical Sciences were identified. This descriptive study was conducted on 137 general practitioners, who were selected using the census method and discrete choice test in 2018. Data were collected using a questionnaire designed by orthogonal method and analyzed by SPSS 24. Data analysis was conducted using the Logit regression model in Stata 13 software. The findings showed that the "higher salary" construct was more favorable among the male married general practitioners who had higher incomes. Furthermore, married physicians were significantly more willing to provide out-of-pack services and use facilities of housing and transportations. On the other hand, these physicians have little desire to continue their education and use their quota for admission in the specialization course. Moreover, a reverse and significant relationship was observed between the place of service and the marital status. The family physician plan should be designed by taking into account the demographic characteristics of general practitioners. Therefore, more general practitioners would participate in and cooperate with the plan. The upstream laws of Iran emphasize the necessity of implementing family physician program and general practitioners have an important role in the formation and successful implementation of this program. Consequently, policy making in this area should take into account the demographic variables of physicians, so that more physicians are attracted to it.