فهرست مطالب

  • Volume:4 Issue: 2, 2020
  • تاریخ انتشار: 1399/03/12
  • تعداد عناوین: 8
|
  • Leila Doshmangir, Parinaz Doshmangir, Rahim Khodayari Zarnaq, Leila R.Kalankesh* Pages 74-75

    Almost two weeks after the first official announcement of deaths from COVID-19 on Feb 19, 2020(1), Iran used all its public healthcare facilities as well as its entire military, security, economic, and social capabilities to fight the pandemic. Considering the economic challenges (2) and lack of consensus among national authorities in Iran, cities with large infection clusters were not isolated. However, the National Committee for Fighting COVID-19 (NCFC) was established. Under the recommendations of this committee, some interventions were conducted as follows: nationwide closing of kindergartens, schools, universities, and dormitories; temporarily freeing some prisoners; suspending the activity of public transportation services and shopping malls; shutting down sports and scientific events; canceling congregational prayers; and closing holy shrines for the first time in Iran’s history. National universities were also asked to provide critical advices on strategies for tackling COVID-19. To communicate the risk of the virus to the general public and inform and persuade them to stay home, the country has turned to reliable channels such as Short Message Service (SMS) as well as mass media like the state TV and radio stations, while providing dedicated websites and portals. Some data analytics tools have also been provided to announce regions and urban areas with the highest risk of virus. At entry points of cities, passengers were scanned with a thermal scanner (3,4).These restrictive measures appeared to flatten the curve of cases to some extent. In response to COVID 19, Iran’s Ministry of Health and Medical Education(MoHME) also conducted special activities, including running over 10,000 hotlines and helplines, launching 1000 selected comprehensive health centers functioning 16 and 24 hours each day, 7 days every week, screening households by phone, self-assessment, and self-report through answering the questions in the website “salamat.gov.ir", and providing free health services for COVID patients in hospitals or in their homes .At the first stage, about 75 million people were screened through self-assessment(5). By May 7, 2020 more than 25 million people were screened in the second phase (6). On April 20, the government set to ease the lockdown restrictions gradually.The government defined and introduced specific health protocols and procedures for different businesses and professions. It should be noted that defining the protocols does not mean they will be utilized properly. Implementation of some protocols needs some infrastructure changes. However in the case of some other protocols, the control mechanisms should be in place to make protocols work. In addition to the above-mentioned measures, the authorities are recommended to design an interconnected chain of corona control packages from prevention to diagnosis, treatment, medication, and rehabilitation. Moreover, closer attention must be paid to residents of the suburbs due to their high population density and low financial capacity. Moreover, patients with non-communicable diseases such as diabetes, hypertension, and cancers should be monitored and trained more specifically. In Iran, the community engagement in complying with home quarantine and following the recommendation provided by the NCFC have not been completely successful, which could be attributed to the authorities' unwillingness to follow the forced strategies. The economic problems due to the sanction hasalready put Iranians in hardship and home quarantine worsened it. Under the quarantine, some people may have financial problems. Therefore, the recommendation for home quarantine does not work at the first place for the whole population. The following measures can also be taken to deal with this crisis more effectively: organizing political support, creating a strong alliance among the government agencies, using the guidelines provided by MoHME in the private sector,using people's representatives to lead the crisis properly, invoking and reinforcing people's social responsibility, utilizing the past and current national and international experiences, and organizing the service delivery system based on the active care system using the capacity of Iran's national health network.

    Keywords: COVID-19, Crisis, Pandemic, Response, Iran
  • Agus Joko Susanto*, Amos Neolaka, Hafid Abbas, Evi Nopiyanti Pages 76-81

    Public health servicesneed serious attention in Indonesia. In fact, the number of health workers is sufficient enough and even excessive in certain areas. This situation is caused by lack of observing principles of the local and national cultural values in carrying out the public health services. We reviewed the published literature over the current satisfactory level of people with regard to thehealth services. Furthermore, we compared the results between residents of the suburb and urban areas regarding the national health services. This critical perspective offerred a concept of health services based on the cultural values with the belief that these values can influence the perceptions, attitudes, and behaviour of individuals, including health workers in rendering health services through health consultations. The purpose was to design a situated cultural learning, through which they can learn to respect and apply cultural values in implementing health services. To implement such cultural values, the concept of industrial revolution 4.0 and 5.0 is also needed, where individuals utilize and work together with machine learning technology or artificial intelligence.

    Keywords: Cultural values, Cultural health services, Situated cultural learning, Critical perspective, Industry revolution
  • Hedayat Salari, Habib Omranikhoo, Azam Amini, Mosayeb Amiri, Saeed Bayyenat, Mohammad Azmal, Atefeh Esfandiari* Pages 82-88
    Background

    Many prevalent disorders were observed in and around the knee joint. Magnetic resonance imaging (MRI) was a modern and costly diagnostic technology that was progressively applied worldwide. This study was conducted in the Bushehr educational hospitals in 2018 with the purpose of determining the necessity of knee MRI prescriptions.

    Methods

    This paper was a kind of cross-sectional descriptive-analytical study. The statistical population of the study was all patients who were prescribed knee MRI due to the appearance of knee problems and referred to the MRI Center of Bushehr University of Medical Sciences in 2018. The sampling method was convenient sampling. The sample in this study included 274 patients. The indications and data collection form of Vojdani et al.'s study were used to specify the necessity of the mentioned prescriptions. In this study, SPSS 22 software was applied to analyze data. Also, the Chi-Square test was used to for analyzing the data.

    Results

    Among the total studied population in this study, MRI prescription was evaluated inappropriately for approximately 24 % of patients. In this study, the appropriateness of the prescriptions had a significant relationship with age, job, education level, physician prescribing, and requesting MRI (P-value < 0.05).

    Conclusion

    It could be deduced that about a quarter of MRI was not appropriate to clinical prescription. Regarding the high cost of hospital and the necessity of their reduction, induced demand would be prevented by using valid indications. Therefore, reducing unnecessary prescriptions yielded to fewer costs of the health system and patients.

    Keywords: Clinical Appropriateness, Knee Disorder, Clinical Practice Guidelines, Overuse
  • Mohsen Barouni, Leila Ahmadian, Hossein Saberi Anari, Elham Mohsenbeigi* Pages 89-101
    Background

    The implementation of different reimbursement methods has various positive and negative effects on the health system of different countries. Identifying the challenges of these methods is essential to improve these reimbursement methods and modify them if required. This article aimed to qualitatively assess the challenges of current hospitals' payment systems in the Iranian health system and determine the required solutions for modifying these payment systems.

    Methods

    This qualitative study was conducted in 2019. Semi-structured interviews were conducted recruiting 20 experts including operational, middle and top managers working in three different levels of health systems. Data collection was continued until it reached a saturation point. MAXQDA 10 was used for data analysis. The data content analysis method was used to analyze the data and the themes and categories were determined.

    Results

    The challenges of the payment systems were categorized into four main themes regarding policy, cost, regulatory and functional challenges, and 15 sub-themes. The findings related to the proposed strategies were presented in six main themes consisting of legal solutions, structural reform, cost, quality improvement, service provider and client, and monitoring and evaluation; and 12 sub-themes.

    Conclusion

    This study showed that the health systems in Iran face various structural and procedural challenges in terms of reimbursement mechanisms. Therefore, it is recommended that policymakers pay attention to these challenges before making any changes. Using hybrid payment systems can be one of the proper solutions.

    Keywords: Challenges, Provider payment mechanisms, Provider payment methods, Reimbursement system, Qualitative study, Iran
  • Parisa Rahmani, Rafat Mohebbifar, Sima Rafiei* Pages 102-111
    Background

    The process of the patient discharge from the hospital is one of the most important processes that has been taken into consideration by managers in recent years. An efficient health system can only accomplish its duty to provide the health of the community by providing the right services and this system can be evaluated through its services. Therefore, the necessity of performing this research is to improve the quality of hospital services for patients and increasing patient satisfaction. This study has been aimed to identify the factors affecting the process of patient discharge.

    Methods

    This was a cross-sectional study conducted in a general hospital located in Takestan, Qazvin in 2019. The study population in the qualitative section of the study included those who were aware of the discharge process and had managerial positions in the hospital. The sampling process was continued until achieving data saturation. The required information was gathered through reviewing relevant literature, observing the discharge process, and conducting semi-structured interviews with managerial members and study experts.

    Results

    In the present study, the most important factors affecting the discharge process were lack of timely physician visit and issuance of the discharge order, delay in the approval of medication used by pharmacy officer, sending discharge files to hospital discharge unit, the patients' needs, diagnostic services (discharging with doctor's opinion), delays in registering nursing records, and undue secretarial performance in reviewing and recording reports in the hospital information system.

    Conclusion

    The results of the present study, in line with other researches, have shown that the importance of the discharge process on hospital performance is undeniable and this process needs continuous investigation, monitoring, and intervention.

    Keywords: Hospital discharge, Patient discharge, Hospital, Affecting factors
  • MohammadHossein Mehrolhassani, AliAkbar Haghdoost, Reza Dehnavieh, Maryam Esmaeili, Vahid Yazdi Feyzabadi* Pages 112-126
    Background

    Reproductive health (RH) in adolescents and youth, as one of the critical components of population health policies, plays a pivotal role in preventing risky behaviors and achieving a healthy and productive generation for the future society. Thus, this study aimed to explore the challenges of RH in adolescents and youth in Iran.

    Methods

    Using a purposeful sampling method with maximum variation, semi-structured in-depth interviews were held with eighteen key informants in the field of RH. A Snowball sampling strategy was deployed to identify the participants. The multi-dimensional PRECEDE-PROCEED model of health promotion was used as a guiding framework for the topic guide. The transcribed interviews were coded and analyzed using thematic analysis.   

    Results

    Three main themes of decision-making system, lifestyle, as well as social and epidemiological issues, were emerged from the interviews. We also explored six themes, including the knowledge and expertise about RH, policy-making and management system, environmental factors, individual factors, family and social anomalies, and epidemiological status of RH. Furthermore, twenty-five sub-themes were extracted from the main themes, which represented the challenges. Lack of understanding of the issues and absence of a coherent intellectual system that provides a collaboration of different systems in policy-making were fundamental and dominant challenges of RH for adolescents and youth in Iran.

    Conclusion

    To meet these challenges, we require an integrated and coherent system of policy-making with a reliance on scanning individual, environmental, social, and epidemiological changes that influence RH.

    Keywords: Reproductive health, Sexual health, Adolescents, Youth, Iran
  • Bahman Ahadinezhad, Omid Khosravizadeh*, Najmeh Baghian, Bahareh Mohtashamzadeh, Saeed Shahsavari Pages 127-137
    Background

    In health economics, policymakers need to be aware of the individuals' sensitivity and reaction to change effective factors on the healthcare services demand. This study aimed to estimate the healthcare demand function and extract the price, income, and educational elasticity in Iran.

    Methods

    A panel of macro data was used to estimate the demand function. The data included provincial average of the nominal values of Iranian household healthcare and education expenditure, provincial average of their nominal income, and Consumer Price Index values of the healthcare services from 31 provinces during 7 years (2011 to 2017). This information was obtained from the annual Household Budget Survey Reports and no sampling was performed in this research. The dependent variable was the actual amount of demand for health care services. Robust pre-estimation tests and a robust standard error panel regression were run to estimate the demand function in Stata 15.

    Results

    All variables were stationary at the first-order differential (P-value < 0.01). All four variables were co-integrated (P-value < 0.01). The cross-sectional and fixed effects existed for each province (P-value < 0.01). Income and educational expenditure had a positive association with healthcare demand. Price elasticity of demand was -0.897 (P-value < 0.01), income elasticity was 0.491 (P-value < 0.1), and elasticity of education expenditure was 0.486 (P-value < 0.01). Noteworthy, 1 % increase was observed in the household incomes and their educational expenditure increased the demand for health care services by about 0.49 % and 0.48 %, respectively.

    Conclusion

    Healthcare services have been low elastic to price and education expenditure and have also been the essential commodity in the household budget in Iranian households. Later, the price and income coefficients were consistent with the health investment model, but coefficient of the education expenditure was not matched with predictions of the health investment model.

    Keywords: Healthcare services demand, Robust standard error panel regression, Health investment approach
  • Zahra Mastaneh, Ali Mouseli* Pages 138-149
    Background

    An important feature of novel coronavirus disease 2019 (COVID-19) is its rapid human to human transfer.Technologies can play an important role in controlling this disease. Therefore, this study aims to investigate the technologies that have been applied to solve the COVID-19 crisis. Besides, the approaches used by these technologies are surveyed.

    Methods

    In this narrative review, international databases were searched for papers investigating the role of various technologies in the management of COVID-19 from December 2019 to 20 April 2020. The keywords searchedwere “Technology”, “COVID-19”, “nCOV-19”, Diagnostic Technologies”, “Therapeutic technologies”, “Telemedicine”, “Internet of Things”, “Big data”, “Blockchain”, “Robots”, and “Drones”. Forty-seven articles were found to meet the inclusion criteria after the title, abstract, and full text were reviewed.

    Results

    Two major categories of technology were found to be applied to combat COVID-19. The first category involves technologies that have the potential to support the diagnostic process and case-finding including non-contact thermometers, artificial intelligence, drones, self-assessment applications, and virus genome sequencing. The second category includes technologies with therapeutic and logistic applications searching for medicines or vaccines, and provide support services such as pharmaceutical tech, robots, telemedicine, Geographic Information System (GIS), Internet of Things, and big data and blockchain.

    Conclusion

    It can be concluded that technologies with the ability to reduce human contacts through teleservices as well as those that quickly enable decision-making via in-depth analysis received more attention among the health authorities and organizations.

    Keywords: Technology solutions, COVID-19, Internet of Things, Artificial intelligence, Telemedicine