مجله تحقیقات نظام سلامت حکیم
سال بیستم شماره 1 (پیاپی 76، بهار 1396)

In the past 2 decades, following the failure of health systems to fulfill new needs and expectations of the community, a strong international motion to health system reform is formed. According to the new plan for this reform, the current study aimed at evaluating the challenges ahead of the health system evolution plan in Guilan University of Medical Sciences, Rasht, Iran.
The current study was conducted based on a content analysis approach. A total of 43 managers of health care systems and hospitals directors completed a researcher-designed open-ended questions questionnaire. The qualitative data were analyzed using the content analysis method.
Based on the obtained results, a total of 672 initial codes were extracted. After the analysis of initial codes, they were categorized into 4 main classes: “the health system: a need for the country”, “prerequisites”, “sustained monitoring” and “challenges”. The health system: a need for the country focused on regional necessities, health-oriented goals of the government, achieving health; a human priority; prerequisites focused on planning, culture-making, and infrastructures; sustained monitoring focused on polls and continuous supervision, and challenges focused on current and future challenges.
The health system evolution plan was implemented emphasizing the accessibility of health care services to everybody. Based on the viewpoint of manager, the plan was aimed to reduce the health care costs for the people, which is of great importance in Guilan province with regard to the problem of tourism industry. Of course, given the prerequisites and sustained monitoring of plan to carry out it better, it can play an effective role.

In the current study, the referral system in family medicine program was assessed based on the criterion of comprehensive health care services on data from 17 health centers in Gorgan city, Iran.
First, the indices of referral system failure and family medicine characteristics for comprehensive care were introduced. Then, the regression correlation between referral failure and explanatory variables of comprehensive care in a panel data model with error-correction framework was considered, using monthly records of the Gorgan health centers from 2011 to 2012. Based on the employed model, the difference between coefficients in a monthly (long-run) and less than a month (short-run) trends was detectable.
In the monthly trend, 10% increase in the number of family physicians reduced referral failure by 4.3%. On the contrary, the effect of 10% increase in the number of nurses and midwives, and similarly medical laboratory services on the failure of the program was negligible, 0.2%, and 1.5%, respectively. The weight coefficient of physicians in monthly trend was more than other factors, 51%.
The difference between family medicine program and health network development program can be described in the comprehensive care prompted by family physicians and the associated team services. This difference indicated the priority of family medicine program over the health network services. The lower effects of physicians’ assistants, compared with family physician services, on the improvement of referral system could be considered as the difficulties of health system development in Iran.

Drug consumption in Iran is higher than the global standards due to irrational prescriptionand self-medication practices. On one hand, it losses the national capital directly and indirectly and, on the other hand, threatens community health; therefore, it is essential to employ all the capacities to modify the current pattern.
In the current study, factors influencing drug use were extracted by reviewing literature, interviewing experts, and analyzing the data by the analytic hierarchy process (AHP) technique. Then, by analyzing the strengths and weaknesses, opportunities and threats, the strategies for modifying drug consumption patterns were developed in consensus sessions between experts and authors. The statistical population of the study included all physicians, pharmacists, pharmaceutical manufacturers and suppliers, and a sample of 30 individuals was selected by the snowball sampling method.
The analyses showed that lack of monitoring on the diagnosis and prescribing system, lack of a comprehensive referral system, lack of monitoring on medication distribution, physician visit cost, advice from others, buy without a prescription from pharmacies, irrational prescriptions, an experience of a disease and its diagnosis, the cultural context of patients and their insistence on taking more drugs, financial relationship between the doctor and the patient, lack of knowledge about side effects of drugs, distribution of drugs in stores other than pharmacies, and safety and low price of medicines could be considered as the main causes of irrational drug use.
To modify the drug consumption pattern, it is necessary to modify culture, set up a referral system, expand insurance, educate medical staff continuously, and monitor medicine supply chain and prescription patterns.

Health systems attempt to fulfill health goals through evidence-based and value-oriented approaches, but decision-making in this sector is under the influence of some unknown and unexpected factors. The current study aimed at examining the role of lobbying and conflict of interests on the Iranian health system decision-making.
The literature review and interview with key experts were used in the current qualitative study to collect data. Thirty semi-structured interviews were carried out at micro, meso, and macro levels. Data were analyzed and interpreted through a mixed (inductive/deductive) thematic framework.
Two themes and 6 subthemes were categorized based on the analyses; the theme of “the effects of conflict of interests on health system” with subthemes of effect on plans implementation, effect on intersector relations of national bodies, effect on public decisions, and also the theme of “effects of lobbying on health system” including subthemes of effect on attaining more budget or obtaining extra resources, effect on health technologies buying, and effect on implementation or non-implementation of special plans.
Conflict of interest indicates insufficient monitor of health system authorities, but lobbying can protect patients’ rights, if it is principally and ethically aligned with utilitarianism.

Factors affecting blood donation play an important role in attracting safe and continuous blood donors. The current study aimed at determining the factors affecting blood donation through comparing 2 groups of continuous and non-continuous blood donors, using the theory of planned behavior.
The current descriptive, analytical study was carried out in 2015 in Ilam, Iran. The population contained 234 blood donors recruited by the quota sampling method. The data were collected by the theory of planned behavior questionnaire (TPB questionnaire) developed by Hasanzade et al., which its validity and reliability were evaluated and confirmed in previous studies. Data were analyzed with SPSS version 16, using the Spearman correlation and the Mann-Whitney U tests.
Among continuous and non-continuous blood donors, 54.4% and 50.8% had higher education, 35.1% and 45.8% had job, 99.3% and 88.3% were male, 80.7% and 75.8% were married, and 66.8% and 61.7% were in the age range of 30 - 50 years, respectively. Results also indicated that attitudes (score = 0.28), facilitating factors (score = 0.28), and self-efficacy (score = 0.27) were the most important factors affecting blood donation in the continuous donors group, while attitudes (score = 0.27) and facilitating factors (score = 0.20) were the most important ones in the non-continuous blood donors.
In the current study, attitudes and facilitating factors were the predictive factors of donation behavior. It is proposed to design intervention programs and launch educational campaigns to attract long-term donors in order to improve the attitudes toward blood donation and encourage and attract donors to increase and retain both the continuous and non-continuous donors.