Journal of Evidence Based Health Policy, Management and Economics
Volume:7 Issue: 3, Sep 2023

In 2014, the Iranian Ministry of Health and Medical Education (MOHME) has introduced Health Transformation Plan (HTP) to guarantee the provision of high-quality healthcare services. This study aimed to determine the viewpoint of policy-makers, and health system managers affiliated to Kurdistan University of Medical Sciences about the opportunities and challenges of this plan.

In this qualitative case study, a purposive sampling method was used to select study experts in the field of health system. Research data was collected through semi-structured interviews with 18 participants and two focus group discussions associated with health-care reform issues with policy-makers, and health system managers of the province. Data was analyzed using content analysis method and MAXQDA 10.0 software.

As a whole, study findings revealed 8 main themes and 19 sub-themes and 156 codes regarding HTP factors. Three themes were dedicated to opportunities, strengths and opportunities, with seven subthemes and four themes were dedicated to stewardship, Cultural and educational, infrastructural, staffing and service delivery challenges with twelve subthemes.

The HTP should include effective interventions to overcome existing challenges in the provision of healthcare services through establishing new health facilities, offering recruitment and retention incentives for healthcare professionals, expanding primary health care services to urban and peri-urban as well as rural and remote areas.

Identifying effective factors in death caused by the infection of COVID-19 is one of the most worrisome issues in the globe. This study aims to investigate the frequency of risk factors leading to death in patients with COVID-19.

This was a retrospective descriptive study done on 150 confirmed cases of  COVID-19 in Imam Khomeini Hospital in Jiroft in 2019. Patients were included in the study by census method. The required information was extracted and recorded in the researcher's checklist; which included demographic and social characteristics of patients (age, gender, smoking, and opium consumption), underlying disease,test results (leukopenia, leukocytosis, neutropenia, decrease in albumin, increase in creatinine, ALT, AST, LDH and CRP), and the RT-PCR test.,. The researchers analyzed data using independent sample t-test, and chi-square by SPSS-V22.

The mean age of the patients was 72.19 ± 15.97. Most of those who died with COVID-19 were men. There was a statistically significant relationship between the use of drugs and the death of patients with COVID-19(P-value<0.05). The average body mass index (BMI) of the confirmed patients was 31.14 ± 7.08 kg/m2 in the overweight group (P-value<0.001). Moreover, there was a significant relationship between the risk factors CRP, ALB, AST, ALT, Cr, lym, Neut, WBC and inevitable death in patients with COVID-19(P-Value<0.001). Regarding underlying diseases, diabetes, lung, and kidney diseases have been observed in most terminal patients (P-value<0.001).

Old age, male gender, high BMI, blood pressure, increased factors of CRP, AST, ALT, Cr, lym, Neut, WBC, and decreased ALB are among the risk factors leading to death in COVID-19 patients.

The assessment of the performance of medical universities as one of the main organizations providing healthcare services is of utmost significance. In this regard, the indices of treatment domain play a fundamental role in promoting health indices and affect the overall performance of the medical university. The present study evaluated the performance of a selected university of medical sciences in Iran based on treatment driving indices with the AHP-TOPSIS approach.

This research applied a combination of qualitative and quantitative methods. In this study, first the driving indices were identified and weighted, and then the performance was analyzed according to the indices. The statistical population of the research consisted of key experts in the validation and weighting phase and of nine years of information pertaining to one of the medical universities of Iran in the final phase. The instrument used in the study was the Index Collection Form. Prioritization of indices was done by AHP method using Expert Choice and Excel. TOPSIS model were used to evaluate performance.

In the first step, using a review study, 111 indices were identified, and in the validation stage, 10 indices of treatment domain were selected. Then, based on hierarchical analysis and pairwise comparisons in the weighted indices, the highest weight or priority pertained to the index of the ratio of the total nursing staff to the available beds with a weight of 0.161 and the lowest weight or priority related to the index of natural delivery to all deliveries with a weight of 0.049. According to the TOPSIS method, the selected university showed the highest performance (0.228) in 2014 and the lowest performance (0.006) in 2017.

Considering strategic measures in the deputy of treatment simultaneously to improve and manage research indices over time can improve the performance of universities. Thus, it is appropriate to monitor the indices periodically and in the order of priority, so that in addition to maintaining the efficiency, especially in the indices related to human resources, the effectiveness of the measures, including the improvement of the functional indices of the treatment domain, can also be improved.

Since the emergence of COVID-19 disease and its spread, many people have been globally infected. Also, evidence has shown that some specific conditions and underlying diseases result in more severe symptoms in the patients. Therefore, this study aimed to investigate the relationship between demographic characteristics and underlying conditions with symptoms in patients with COVID-19 in one of Iran's major hospitals.

The present cross-sectional and descriptive-analytical study was conducted from February 20th, 2020 to August 20th, 2021. The sampling method was census. The data were collected from the statistics department, medical records, HIS, and they were analysed via SPSS software version 25 using descriptive statistics and statistical tests such as Spearman, Mann-Whitney, and Chi-square.

Among the 7,236 patients with a definite diagnosis of COVID-19, most (53.2%) of the subjects were men and the total death rate was 8%. There was a positive correlation (p-value=0.000) between age and length of stay. About 69% of the patients had symptoms related to the disease in their CT scan and 39.5% had an oxygen level of less than 93%, which roughly 2.6% of them were intubated. There was a significant relationship between patients' age, sex, and length of stay with their discharge status, first symptoms of disease, and patient’s underlying conditions. Also, there was a significant difference in patients' discharge status based on having some early symptoms, gastrointestinal symptoms, and underlying conditions.

The findings of this study emphasize the importance of early detection and management strategies, especially for individuals with specific risk factors. These insights are crucial in guiding healthcare practices and policies to effectively combat the ongoing pandemic. Also, the study outcomes provide valuable insights for healthcare professionals and policymakers, aiding in the development of targeted interventions and patient-centered care protocols.

The World Health Organization recommends that women be continuously supported by a favorite companion during labor. Currently, there is no strong evidence on specific support measures by midwifery in relation to improving the delivery process.

The present retrospective cost analysis study was conducted during 2021-2022. The reports of 243 deliveries were checked in the patients’ files in selected hospitals of Yazd city. Data analysis was done using SPSS26.

According to the study objectives, the desired delivery outcomes included type of delivery, postpartum complications, postpartum bleeding, and length of the active phase of labor, resuscitation of the newborn, hospitalization of the newborn, and Apgar score of the newborn in the first and fifth minutes. There was a statistically significant difference in delivery, postpartum complications, length of the active phase of labor and hospitalization of the newborn in the neonatal unit, resuscitation of the newborn, and the amount of nutrition of the exposed group compared to the non-exposed group. Among the desired performance indicators, patient length of stay and total cost per person between the exposure and non-exposure groups, the mean score of the cost per person had a statistically significant difference between the two groups (P<0.001).

Generally, the presence of a companion midwife next to the mother in the delivery room improves some of the outcomes of the mother and the baby. It is recommended to carry out studies in this field along with checking mothers' satisfaction with companion midwives.

The COVID-19 pandemic has posed many challenges on the health system and hospitals to provide services. This study investigated the difference between factors affecting hospital management which considered in preparing a disaster management plan for hospital in the face of a pandemic based on the experiences of hospital managers.

This qualitative research was conducted on selected hospitals affiliated in Alborz University of Medical Sciences in 2021. Data were gathered with purposive sampling and semi-structured interviews with 16 hospital managers. MAXQDA 10 and framework analysis were used to analyze the data.

The results were categorized in four categories: 1) Mitigation including staffing, bed capacity, enough space for quarantines, protective equipment, diagnosis and treatment equipment, funding, medicines, patient follow-up, management and leadership; 2) Preparedness such as crisis committee, preparedness and response plan, measures, action plan; 3) Response including motivating health workers, cooperation and coordination; 4) Recovery and lessons learned including providing facilities, expediting patient processes, control, economic conditions, and planning better, passive defense, regular crisis committee meetings, human resources, documentation and use of information systems in planning.

In addition to providing the necessary infrastructure, it is important to plan for fair distribution of resources and effective supply chain management. A mechanism should also be developed at the national level to anticipate future health crises and to prevent and control diseases in the most effective way.

Targeting HIV testing services, as the World Health Organization (WHO) recommended in 2015, fast-tracks the identification of individuals with HIV and addresses the persisting HIV testing gap which might delay epidemic control. Following this recommendation, different models of targeted testing have been implemented, exposing varied interpretations by different countries. This study identifies, aggregates, and synthesizes targeted HIV testing models to develop a concise targeted testing package which can increase the identification of people with HIV.

A systematic literature search in PubMed, Scopus and Web of Science databases identified cross-sectional studies of people (18 years and above) from Southern Africa published between 2016 and 2021. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied, and the quality of studies was evaluated using the Joanna Brigs Institute tool (JBI). Data were extracted using a guided matrix to identify the target population, testing models, description, and positivity ratio. Conclusions and methodological suggestions were narratively synthesized.

The authors identified 574 studies; 42 full-text articles were screened which yielded 29 studies of moderate quality (71%) meeting the eligibility criteria. Of these, 25 studies (86.2%) were quantitative. From the included studies, similar models were synthesized, and 12 targeted testing models emerged. Prioritized models were Index testing, described in 3 (10.3%) of the studies, scoring the highest positivity ratio of >30%. Six studies (20.7%) described male-targeted models with yields influenced by age, economic status, and educational level, with a positivity ratio of 10% among first-time testers. In contrast, four (13.8%) described Key and Vulnerable Populations (KVP) focused models (positivity ratio of 37.5%) and recency-informed targeted testing (13.1% positivity ratio).

This review provides a critical overview and insights into the targeted testing models implemented in Southern Africa. Synthesizing comparable models can meet the various needs of unique populations comprehensively and increase positivity ratio. The recommended models can improve the efficiency of programs in targeting HIV testing services.