مجله تحقیقات نظام سلامت حکیم
سال بیست و سوم شماره 1 (پیاپی 88، بهار 1399)

Research evaluation based on peer review is done to assess the quality of research. In this article, the peer review evaluation results of selected Iranian research centers are presented.

A qualitative study was conducted through peer review with 106 and 15 Iranian professors from inside and outside the country, respectively. The evaluation was implemented in four areas of leadership, structure, research products, and impact. In this study, research centers with independent research budget lines and 12 top research centers during 2015-2018 were evaluated.

The most weaknesses in these research centers were in leadership (scattered work, island and parallel activities) and impact (inefficiency of knowledge utilization in transfer chains) areas, and the greatest strengths were related to knowledge production (quantitative and qualitative development in the number of published articles and citations). In the structural part, the lack of attention to technological activities, the lack of applicability of research, and inadequate physical space were the most important weaknesses.

In the peer review method, the assessment of leadership, structure, and in particular, impact areas has a very important role in research quality promotion due to appropriate interactions with specialists and peers.
 

Changing the tendency of medical students in specialty choice has been an alarm for policymakers in health services. In recent years, the demand has been very high for radiology and very low for internal medicine. This study aimed to identify the factors influencing radiology and internal medicine residents to choose their future specialty.

In a cross-sectional study, the reasons for choosing the radiology and internal medicine specialties were investigated in Ahvaz Jundishapur University of Medical Sciences in 2018. Data were collected using a questionnaire consisting of 16 questions. The validity and reliability of the questionnaire were evaluated and confirmed. Descriptive statistics and the Mann-Whitney test were used to analyze the data.

Overall, the most important factors influencing the specialty choice were as follows: “Raising the knowledge and improving the treatment”, “personal interest”, and “good job position in the future” with average scores of 4.23, 3.90, and 3.74, respectively. The comparison of residents’ opinions showed that the convenience and lack of emergency (with a mean of 3.90 vs. 2.36, p = 0.0001), social prestige (3.71 vs. 2.98, p = 0.0001), and high income (3.76 vs. 2.97, p = 0.0001) were more significantly important factors in choosing the radiology specialty. The discipline comprehensiveness factor and the possibility of continuing education (4.01 vs. 3.43, p = 0.003) were more significantly important factors in the selection of the internal medicine specialty.

Many factors appeared to inspire physicians to choose a future specialty. By identifying these factors and justifying medical students in the selection of specialty, administrators can steer medical students toward certain specialties to meet the workforce demand.

In recent years, one of the most important policies for reducing cesarean sections has been the promotion of natural childbirth, which is one of the seven health system reform plans. Since this policy is somewhat different in terms of both content and scope than other policies in this area, it needs further analysis.

This study was based on the conceptual framework of Walt and Gillson’s policy triangle. The model covers four general sections, including content, context, stakeholders, and the policy process. The required data were collected through interviews with midwifery experts, officials of the Ministry of Health, and trustees of the health transformation plan, focus group discussions with different groups, and review of ministry documents and hospital records.

The findings of this study were categorized according to the policy context, policy content, policy-making process, and stakeholders who played a significant role in designing and implementing this policy.

The policy of promoting natural childbirth is a policy supported by most of the political and health authorities in the country and has had acceptable performance in reducing the rate of cesarean sections. In line with the population policies and prevention of cesarean section complications, supporting and continuing this policy can have good effects on maternal and neonatal health, as well as the achievement of population policy goals.
 

The policy of the Ministry of Health is to save currency and support the domestic health and pharmaceutical industry by restricting and even prohibiting the import of medicines that are similar to domestic products. However, some pharmaceutical companies, doctors, and patients demand imported medicines. The purpose of this study was to investigate the efficiency and impact of the import restriction policy on Iran’s pharmaceutical industry. This study tried to determine whether the policy could have affected the sales for domestic pharmaceuticals.

This applied, descriptive survey was conducted in two quantitative and qualitative phases. In the quantitative phase, the sales for imported medicines and domestic products before and after implementing the policy were determined between 2012 and 2018. In the qualitative phase, the views of six experts and policy-makers of the Food and Drug Administration and six managers of pharmaceutical companies were assessed and analyzed through semi-structured interviews.

Based on the quantitative and qualitative data and the analysis of medicines with import restrictions in each drug group, it was shown that the sales for domestic pharmaceutical products increased due to the policy. However, in products such as thalassemia medicines, due to the support by the Special Diseases Association, we did not observe this increased sale.

Increasing restrictions on medicine import and even prohibition cannot be considered a good policy in practice and would lead to the spread of domestic economic imbalances, monopolies, smuggling, and economic corruption.

Identifying the challenges and barriers to the successful deployment and implementation of an integrated health care system from the perspective of the field and residential user staff can provide valuable information for administrative staff and policymakers at the provincial and national levels.

The present study was qualitative research. Data were obtained through semi-structured interviews, which continued until data saturation. Purposeful sampling was performed in 2018 among service providers, experts, and managerial staff from the South Tehran Health Center and Tehran University of Medical Sciences. Data were analyzed using standard qualitative content analysis with MAXQDA software.

The analysis of the interview data resulted in the emergence of 504 initial codes and eight themes. The themes included 1) System definition, 2) Comments on the system, 3) Project benefits, 4) Project disadvantages, 5) National implementation, 6) Challenges of successful implementation of the project, 7) Project implementation conditions, and 8) Suggestions to resolve the existing problems.

The integrated electronic health record system is essential for upgrading the country’s health system. But there are problems in setting up, running, and programming the system, which requires coordination and collaboration at different levels of management. The participants considered the experience of Tehran University of Medical Sciences to apply to the whole country for resolving the problems and defects.
 

Today, evaluation is almost the center of gravity of all educational quality policies and strategies. The present study aimed to evaluate the pre-marriage education program of the State Welfare Organization and its distance from the optimum level, according to the perspectives of provincial and headquarter decision-makers.

This is an applied, descriptive-survey, quantitative study. The statistical population consisted of four groups, including headquarter managers, headquarter experts, provincial prevention deputies, and provincial experts, with a total number of 70 people. Four researcher-made instruments were designed and used according to the groups. The instruments were rated based on a four-point Likert scale. The items were about context, input, process, product, short-term effects, mid-term effects, and long-term effects. The instruments, after being assessed for the psychometric properties, were distributed to the four groups to evaluate the pre-marriage education program. Data were analyzed based on the Gap analysis using standard score of correction.

According to the standard score of correction, the context subscale (indices of design background, briefing actions, and organizational strategy), the input subscale ( indices of instruction, content, and budget), and the product subscale (index of long-term impact) had relatively low utility and most needed to be reformed. On the other hand, the process subscale was relatively more favorable.

Given the priority of reform from the perspectives of the four sample groups, the most important action of decision-makers and managers in reviewing the program is to focus on redesigning and strengthening the infrastructure and re-targeting and determining organizational strategies for the program. A working group needs to be established consisting of scientific and executive agents from provincial and headquarter managers to use the experiences of national programs and the results of educational need assessments.
 

Drug addiction is a multifactorial problem in which various political, economic, social, and cultural factors are involved. The controlled supply chain of narcotics has been introduced as one of the effective harm reduction solutions. This study aimed to evaluate the supply-oriented intervention for opium harm reduction in Iran with a focus on the historical experience of controlled distribution of opium at drug stores before the 1979 revolution.

In this study, we used a case study method with the Critical Incidence Technique (CIT) in which, we held 15 semi-structured face-to-face interviews with experts practicing in many related fields of policy-making, regulatory, research, and delivery of substances. The available documents were reviewed and all data were coded and categorized by thematic analysis.

After categorizing the codes, the data were divided into two groups :(1) The pre-revolutionary harm reduction state, which includes the opium situation from the stage of cultivation to primary and secondary distribution at drug stores, its strengths and weaknesses; and 2) The post-revolutionary harm reduction state, which includes examining the existing challenges, the actions taken by the government so far (including NGOs for harm reduction of opium, addiction treatment clinics, and regulations designed to reduce harm), its strengths and weaknesses, and proposed strategies.

According to the results, the re-distribution of opium at drug stores like what used to be is not a good remedy to reduce the harm. Desirable results may be obtained by performing some corrections in the current system.
 

Knowledge translation in health policy and management is the process of utilizing evidence-based research in policy-making and managerial decision-making. This study aimed to identify the barriers to knowledge translation in health policy and management.

This study was conducted using the scoping review method at Tehran University of Medical Sciences in Spring 2020. All published articles on the barriers to knowledge translation in health policy and management from January 1, 1995, to December 31, 2019, in nine databases were searched. Finally, 58 documents were reviewed and analyzed using MAXQDA software.

Overall, 76 barriers to knowledge translation in health policy and management were identified and grouped into seven categories, including barriers related to the characteristics of the healthcare system, healthcare organization, health policy and management knowledge, the knowledge producer, the knowledge user, knowledge transfer technology, and the communication between the knowledge producer and the user. A lack of access to knowledge and databases, time and resource constraints, inadequate policymakers’ support, lack of motivation to exchange knowledge, insufficient education and training, lack of knowledge translation awareness, and lack of knowledge applicability were the most often reported barriers to knowledge translation in health policy and management.

The gap between theory and practice is high and there are many barriers to knowledge transfer in health policy and management. Therefore, policymakers and managers should take serious measures to make the optimal use of knowledge for enhancing healthcare organizations’ performance.
 

Smoking is considered a gateway to drug use and other risky behaviors. This study aimed to investigate the effect of images (neutralized and warning) on tobacco product packaging on brain wave patterns of smokers.

A semi-experimental study was designed. The statistical population included all male students of Tabriz University in 2017-18. The alpha-peak, theta, alpha, SMR, and beta frequency bands of these individuals were quantitatively recorded. Data were then analyzed by repeated-measures analysis using SPSS version 21 software.

The results showed that the main effect of recording position (P <0.001), the main effect of the frequency band (P <0.001), and the interactive effect of recording position and frequency band (P <0.001) were significant. Warning images were more effective than neutral images. The mean beta was 10.21 for warning images, 8.03 for neutral images, and 7.25 for resting.

Designers should revise the structure of alert messages on cigarette packs such as the plot, size, and type of images, reform items such as repeating the message image and neutralizing the image, and pay low attention to the attractiveness of the brand.
 

Health care systems are constantly looking for the best functions. Integrated health care systems have effective solutions for enhancing service quality and reducing health system costs. Mental health integration services aim to identify and treat women who are at high risk of mental disorders. This issue is of high importance for reproductive health and mental health professionals .

A community-oriented interventional study was designed to evaluate an integrated model of mental health during gestation. The study was conducted on 206 pregnant women (105 in the intervention group and 101 in the control group) referring to Kashan Health and Treatment Centers. The data were collected using the Golomberg questionnaire, GHQ-28 questionnaire, and interviews with mothers and their first-degree family members about their mental health signs and the history of their emotional health. Mothers in the intervention group received psychological interventions. The data were analyzed using SPSS-22 software by the Pierson correlation coefficient and t-test.

Pregnant mothers were classified into high-risk, at-risk, and low-risk groups based on the data collection tools. The necessary actions were provided for each group of mothers based on the models. After psychological interventions in the intervention group, the complaining subscale of somatization significantly reduced compared to the control group. The health of mothers improved after implementing the reproductive health primary care and only 5% of women needed professional levels of intervention.

The integration of mental health services into primary health care measures during gestation for recognizing mental health disorders of pregnant mothers at the primary level of pregnancy care services can help health care system managers, policymakers, and decision-makers. This method can enhance the health level, reduce the cost of the health care system, and help achieve sustainable development goals.

Maintaining and enhancing the capacity of health resources are key factors in reducing health crises and making sustainable growth and development. Given the important role of health resources and their unequal distribution on health status, this study aimed to investigate the effect of health resources on health status in Iran.

This study is a descriptive-analytical, applied, and correlational study that used a vector error correction model for Iran at the national level. The annual time series data were extracted from the World Bank database and statistical yearbooks of the Iranian Statistical Center for the years 1990–2017. The estimates of the research model and required tests were performed in Eviews 10 software.

The results showed that if the physician supply increased by one percent in the previous year, life expectancy would increase by 0.11 percent. Also, with each one percent increase in the gross national income, health expenditures, and average years of schooling, life expectancy increases by 0.0005, 0.001, and 0.04 percent, respectively.

Physician supply, gross national income, health spending, and mean years of education had positive impacts on life expectancy in Iran. Thus, adopting policies to optimize physician supply if does not lead to induced demand, as well as enacting and enforcing laws to prevent induced demand, can improve the health status in Iran.
 

Grossman’s study on health demand extends the function of household production for health and assumes that households combine medical care and time to produce health. In this study, education as an environmental variable increases the efficiency in health production.

The association between households’ education and family spendings on health care such as outpatient visits, prescription drug, dental care, and mental care in urban families was examined by using the data of the 1393 to 1396 Iranian survey on household incomes and expenses and ‌Bayesian Model Averaging.

The results showed that the effect of education on outpatient and dental costs is stronger than on pharmaceutical costs. The effect of education on mental costs is significant only for masters’ and Ph.D. groups. In most of these cases, the wives’ education was more important than the husbands’ education. The income variable affected dental costs more than out-patient costs and prescription drug costs but its impact on mental costs was negligible due to little Posterior inclusion probability and small coefficient. Therefore, high educational and social status has more effects than households’ income on patients’ visits to psychiatrists. Insurance status did not affect dental and psychiatric costs but reduced outpatient spendings and increased prescription drug expenditures. Thus, the most important moral hazard risk of insurance was related to pharmaceutical costs.

Higher education leads to increased health care costs. Therefore, by improving the educational conditions for low-income and low-educated households, community health develops and households become healthier. Please cite this article as follows: Mehrara M, Farshchi M. Effect of education level on urban households’ medical treatment spending using bayesian model averaging (BMA). Hakim Health Sys Res. 2020; 23(1): 130-143.   *Corresponding Author: Department of Economics, University of Tehran, Tehran, Iran. Tel: (+98)2188004486, E-mail: mmehrara@ut.ac.ir

Capabilities such as the possibility of providing health services with the appropriate cost at any time and place, within the framework of e-health have led to the development of a new concept called mobile health. This study was conducted with a quantitative-qualitative approach to identify and prioritize the barriers to the provision of mobile health services and provide solutions to reduce these barriers in Kerman University of Medical Sciences in 2018.

An applied research project was carried out in an analytical exploratory manner. First, data were gathered through library studies and deep interviews with experts in the field of electronic health. Then, a paired comparison questionnaire was calibrated and completed by 24 experts in mobile health and prioritized by AHP and Expert Choice software.

In this study, 27 barriers to effective health service delivery were identified. They were categorized into five groups by the PESTEL model. The results showed that the structural-managerial barriers (0.296), human barriers (0.223), economic barriers (0.184), technological barriers (0.154), and legal-legal barriers (0.143), in sequence, were more important barriers than each other.

The research showed that the lack of support from senior managers of health programs is the most important obstacle to the realization of m-health. Hence, we should attract the support of high-level managers from m-health to overcome the obstacles concerning their priority.