فهرست مطالب

Evidence Based Health Policy, Management and Economics - Volume:1 Issue: 2, 2017
  • Volume:1 Issue: 2, 2017
  • تاریخ انتشار: 1396/04/22
  • تعداد عناوین: 9
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  • Omolbanin Atashbahar, Mohammad Ranjbar *, Fateme Ataaollahi Pages 62-64
  • Mohammad Ranjbar, Aboghasem Pourreza, Iraj Harirchi, Mohammad Bazyar * Pages 65-73
    Background
    The Cancer Institute of Iran, located in Tehran (Iran’s capital city), is a national specialized center for cancer. Cancer patients from all over the country refer to it. This study compared the out-of-pocket expenditures of patients from Tehran and patients from other parts of Iran who were hospitalized in this center.
    Methods
    This cross-sectional study included all patients over 18 years of age with head and neck or digestive system cancer who were actively undergoing primary treatment in the Cancer Institute of Iran located in Tehran (the capital city). Data was collected through a structured interview with the patients themselves and/or their companions and then analyzed using SPSS16 Software.
    Results
    Direct medical costs of patients from Tehran were much higher than those of patients from other provinces. In contrast, the average direct non-medical costs including transportation, accommodation, food, etc. of patients from other provinces were significantly higher than those of patients from Tehran, and 53% of patients borrowed money for their treatments.
    Conclusion
    It seems necessary to develop new supportive policies to alleviate financial costs for cancer patients and help them manage their cancers effectively. Patients from the provinces faced additional costs for travel, food, and accommodations which complicated their access to special services. Establishing and improving specialized cancer centers in other cities can reduce the burden of out-of-pocket expenditures for patients from remote areas.
    Keywords: Out-of-Pocket Expenditures, Direct Medical Costs, Cancer Patients
  • Hedayat Salari, Mohammad Reza Ravanbod, Ali Akbari Sari, Atefeh Esfandiari * Pages 74-79
    Background
    Osteoarthritis is the most common joint disease in humans, which is the greatest cause of physical disability among the elderly in developed countries. Homeopathy is a specific therapy that treats patients based on precise stimulation of the immune and vital systems by certain homeopathy medications. Given the widespread use of this technology, in this article, we compared homeopathy Health Technology with non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis.
    Methods
    In this study, Health Technology Assessment (HTA) was employed to compare homeopathy treatment with non-steroidal anti-inflammatory drugs (NSAIDs), by reviewing clinical trials. The study population included patients with knee osteoarthritis; the intervention group included homeopathy, and the control group comprised routine medical treatment (NSAID) and outcomes measured included efficacy, safety, and cost effectiveness. The most important electronic medical databases were searched for relevant articles published from 2000 to 2016, including The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL); Center for Reviews and Dissemination, University of York (CRD; NHS EED), Trip; PubMed; EMBASE and Google Scholar.
    Results
    Effectiveness was measured by indicators of pain and motor function. Total changes in VAS index revealed about 34 units decrease in the intervention group, while there was 12 units reduction in the control group. Reducing the consequences of pain and knee function problems were 10 points more in the intervention group in comparison to the control group. Safety outcomes were measured via skin reactions (and sensitivity) which were lower in the intervention group. In terms of cost-effectiveness, the results revealed that for each unit of pain relief, more cost was spent in homeopathy method.
    Conclusion
    Given that the overall costs of both treatments were low, even with the higher effectiveness and safety of homeopathy treatment, compared with NSAIDs, homeopathy is preferable.
    Keywords: Health Technology Assessment, Homeopathy, Knee Osteoarthritis
  • Fahimeh Rabbanikhah, Robabeh Mousa Gholizadeh, Samira Alirezaei * Pages 80-86
    Background
    The educational system of any organization is actively and potentially one of the most important aspects of that organization in human resource development. It is necessary for any system to benefit pathology in order to function properly. The goal of this study is to investigate and identify the weaknesses of staff education systems of the country's medical universities based on 7 S McKinsey model.
    Methods
    This cross-sectional study was conducted in two phases. In the first phase through key criteria, seven elements of the model were extracted using expert ' opinions and selection criteria was converted to measures and distributed in the form of a questionnaire among 113 officials and experts from Medical Sciences universities. Cronbach's alpha questionnaire was 0.931. Data were analyzed by using descriptive statistics for the frequencies of demographic data and means and standard deviation and analysis statistics such as t-test.
    Results
    The results showed that the state of education in the country's universities is undesirable respectively in dimensions of the structure (P-value = 0.401), management practice (P-value = 0.69) and strategy (P-value = 0.473). However, the average of overall pathology (141.07) was higher than the interested average (138) and showed that there is generally no serious damage in the country's medical universities training.
    Conclusion
    Manager's support, clarification of educational rules and regulations, determining specific hierarchy in training unit, goal setting and training strategies in a targeted form and by stakeholder's engagement are proper strategies to remove injuries in staff training systems.
    Keywords: Pathology, McKinsey Model, Organizational Training
  • Sima Marzban, Jaber Hekmatyar *, Keyvan Nasrollahzade, Habib Rahimkarimi Pages 87-93
    Background
    Time management skills are a determining factor in a manager's success. These skills comprise a wide range of activities including planning, scoping, analyzing spent time, monitoring, organizing, scheduling, and prioritizing. This study investigated the relationship between the personal and organizational time management skills of managers at Zabol Medical Sciences University.
    Methods
    This descriptive-analytical study was conducted in 2015. The study’s statistical population included all managers of hospitals and centers covered by Zabol Medical Sciences University. A total of 75 managers were selected for participation using the simple random sampling method, and the response rate was 93%. Data was gathered using a two-part questionnaire composed by the researcher. The first part of the questionnaire measured personal time management skills, and the second part measured the organizational skill of time management and six dimensions of it.
    Results
    The findings showed that even though the relationship between interpersonal skills and organizational skills of time management is a positive one with a 0.45 correlation coefficient, the mean interpersonal and organizational skills of time management scores of managers, both male and female, undergraduate and high school level, had no significant statistical differences.
    Conclusion
    Time management is one principle of management; it requires special organizational and individual skills and plays an important role in improving leadership and organizational productivity. Thus, it is essential that all centers and organizations of a country, especially educational and health centers, put considerable focus on this issue.
    Keywords: time management, personal skill, organizational skill
  • Mohammad Ebrahim Eghbali Zarch, Razieh Montazeralfaraj, Farimah Shamsi, Mohsen Pakdaman, Ghasem Taheri, Mohammad Aghily, Mohammad Amin Bahrami * Pages 94-102
    Background
    Health care organizations are faced with a new technology called telemedicine which provides a platform for remote cooperation, training, and consulting. Telemedicine is the use of information technology for clinical care of patients. This study aimed to establish the feasibility of telemedicine in two educational hospitals of Yazd.
    Methods
    This cross - sectional study was conducted in 2014. Census and random sampling were applied to recruit 200 out of 722 clinical and administrative staffs of both hospitals. Data were then collected through a standardized three-part questionnaire entitled "telemedicine measurement tools". The first two parts of the instrument were in the form of checklist that evaluated the infrastructure, administrative culture, and education dimensions. Questionnaires were distributed among hospital's managers and IT staffs. The third part of the questionnaire was in a five-item Likert questionnaire format that evaluated staff preparation and also any obstacles to the deployment of telemedicine from the employee's perspectives. Data were analyzed through SPSS18 software and by using descriptive statistics, frequency, and percentage.
    Results
    Providing raining and providing care were selected as the best applications in telemedicine by respectively 82.4% and 76.2% of respondents. Additionally, lack of technical staff and insufficient bandwidth in telemedicine were reported by respectively 85.4% and 77.8% of participants as the biggest barriers for use of telemedicine. Distance learning and remote monitoring were experienced by 14.5% and 10% of employees, respectively. There was no strategic plan and support for the use of telemedicine in the two hospitals. Employees had the necessary knowledge on the benefits of telemedicine, as well as barriers to its deployment. Technical infrastructure required for the deployment of telemedicine at the two hospitals was not available.
    Conclusion
    For the deployment of telemedicine, the two hospitals should invest in technical infrastructure and administrative culture. Also, the preparation of the two hospital's staffs is the reliable implementation of this plan.
    Keywords: Feasibility, Telemedicine, Educational Hospitals
  • Rohollah Kalhor, Mohammad Azmal, Omid Khosravizadeh, Saeideh Moosavi, Maryam Sadat Asgari, Fatemeh Gharaghieh * Pages 103-111
    Background
    Providing healthcare services of the highest quality and quantity, based on the results of scientific research, is one of the main tasks of nurses. The aim of this study is to evaluate nurses’ perception of evidence-based knowledge, attitude and practice in selected hospitals of Iran.
    Methods
    This study was a descriptive cross-sectional analysis that was conducted to investigate nurses’ perception of evidence-based practice (EBP). Two hundred-and-sixty nurses were selected randomly from six hospitals in Qazvin city in Iran to participate in the study. An evidence-based practice questionnaire was used to assess the dimensions of EBP. Descriptive and inferential statistics using frequency tables, t-student statistics, Pearson correlation coefficient and ANOVA were used for data analysis.
    Results
    According to this study, nurses’ perception of EBP was generally above average (3.91 out of 7) and average of Practice, attitude and knowledge/skills were 4.14, 3.78 and 3.74 respectively. There was no statistically significant relationship among EBP dimensions and gender, age and job tenure (p > 0.05). There was a statistically significant relation between attitude of nurses and type of employment (p
    Conclusion
    In this study, the mean of evidence-based practice among nurses was at a level higher than the average. The attitude of the nurses who were studied was moderate, but thanks to the low level of their knowledge about EBP, training programs based on needs assessments resulting from the findings of this study were suggested that could improve nurses’ knowledge of EBP.
    Keywords: Evidence-Based Practice, Nurse's Knowledge, Skills, Nurse's Attitudes, Teaching Hospital
  • Seyed Masood Mousavi, Fateme Pourshariati, Ghasem Rajabi, Mojgan Letafatnejad * Pages 112-119
    Background
    The clinic in a hospital is usually the first place to which patients are referred. A long queue, which results in dissatisfaction among patients, is economically costly for managers; medical institutions can, therefore, determine the level of required resources for optimum investment through management tools like queue theory and waiting time caused by it. The current study was conducted to evaluate waiting time at various clinics of Amir Alam Hospital in Tehran.
    Methods
    The analytical study was conducted in the period from April to August in 2015 on 150 patients who were referred to five clinics of Amir Alam Hospital. The samples were selected through stratified random proportion to sample size and data was collected in a designed frame through SPSS21 and descriptive tests of mean, standard deviation and regression analysis.
    Results
    The longest waiting time for patients was related to the surgery clinic at 61.05 minutes. Also, the longest time to provide service was related to the surgery unit at 26.84 minutes. Results obtained from univariate logistic regression test indicated that all evaluated variables—including time to receive service, capacity of providing service, order of queues and number of doctors—exert a significant effect on waiting time of patients in the hospital (P value
    Conclusion
    Increasing capacities, keeping adequate number of doctors, reforms, removal of unnecessary works and using scientific tools to manage queues can be effective in reducing waiting time for patients. Owing to its importance for patient satisfaction, it is necessary for managers to think of ways to shorten queues in hospitals.
    Keywords: Clinic, Teaching Hospital, Outpatients Waiting Time
  • Mobin Sokhanvar, Reza Moradi, Mohammad Hossein Yarmohammadian, Ali Nemati, Salah Addin Asadi * Pages 120-127
    Background
    Paving the way for having equitable access to medical intervention programs is the most important action that a health system can take in realizing social justice. This study aims at examining proper distribution of specialist physicians as an strategy towards realizing justice and equity in access to and use of health services as well as providing recommendations for policy-makers.
    Methods
    This is a review-narrative and bibliographic research that used databases consisting of Magiran, Irandoc, Iranmedex, SID, PubMed, Scopus, EMBASE, Direct Science with the key words including Specialists, Health, Equity, Accessibility, Health system and Human resources. The data were collected from 1990 to 2015.
    Results
    There are evidences of regions in the world that still are lacking sufficient number of physician workforce and are not only faced with challenges of recruiting, but also with retention of specialist physicians. In fact, migration of human workforce from deprived regions to more organized and prosperous parts has been a factor influencing workforce shortage in these regions; thereby it adds further problem of recruitment and retention of specialist workforce.
    Conclusions
    Human workforce distribution (Specialist or non-specialists) has direct effects on realizing equity and justice in health system; it also influences economy of a given country indirectly. On the other hand, compensation is one of the important incentives that drives workforce behavior and makes them more inclined towards working in deprived regions. Taking the above mentioned ideas, it is recommended for the health system to use more economic incentives and insure proper distribution that fits individual's needs. Using various tax policies in deprived, wealthy, and generally different geographical regions is one of the most important incentives available to leverage this purpose.
    Keywords: Specialist Physicians, Equity, Accessibility, Human resources, Health