مجله تحقیقات نظام سلامت حکیم
سال بیست و سوم شماره 2 (پیاپی 89، تابستان 1399)

Interdisciplinary interaction can lead to the convergence and synergy of disciplines and prepares the country to enter new scientific fields. Some believe that the integration of medical science education into the health system has limited opportunities for interdisciplinary interactions. This article briefly discusses the strategies for the development of interdisciplinary interactions within the Ministry of Health of Iran in three areas: structure, faculty members, and students. Although, for many people, restructuring is the first step to improvement, making cultural changes in society and alterations in the key actors’ opinions is even more important. If society does not move towards scientific convergence, the appropriate structure will not be formed or will be inefficient until the demands of the students and then the faculty members and even the general public are directed towards scientific convergence.
 

This study aimed to determine the perceived need, seeking, and utilization of health services among eight-year-old or younger children with disabilities in Iran.

This descriptive cross-sectional study was conducted on a sample of 2,000 children with disabilities aged eight years or lower selected through multistage sampling from five provinces of Iran. Data were collected using a researcher-made electronic questionnaire. Descriptive statistical methods were used to analyze the data by Stata 13.

The highest percentages of perceived needs for outpatient services in the last three months belonged to specialist physician visits (65.80%), medication (66.05%), speech therapy (57.58%), and occupational therapy (54.89%). The lowest percentages of seeking for perceived needs belonged to dental services (45.80%), psychiatry services (51.30%), and physiotherapy services (60.69%). The lowest percentages of utilization after seeking for perceived needs belonged to dental services (61.00%), physiotherapy services (82.38%), and outpatient surgery services (86.40%). The percentages of perceived need, seeking, and utilization of inpatient services over the past 12 months were reported to be 22.08%, 88.73%, and 87.89%, respectively.

There was a significant difference between perceived need, seeking, and utilization of health services in children with disabilities in Iran. Health system policymakers should consider the factors affecting the seeking and utilization of health services by children with disabilities in designing appropriate interventions.
 

Clinical knowledge and skills, good communication skills, and a sound understanding of ethics constitute the foundation of professionalism as a core competency of physicians. However, it is hard to measure this concept in medical practice. Thus, in this study, the professional behavior of clinical professors was assessed from their clinical students’ viewpoints. 

A cross-sectional study was conducted at the Tehran University of Medical Sciences in 2013. Data were collected through classified random sampling via a standard questioner, namely the Professionalism Assessment Tool in clinical training (Beaton method). This questionnaire consists of four dimensions: Clinical professor-patient communication, clinical professor-student communication, professional communication dimension, and clinical professor communication with himself/herself. The results were compared using descriptive-inferential statistical methods and the reliability was measured by Cronbach’s alpha test (≥0.88). The Pearson correlation coefficient test was used to assess the validity and the Chi-square statistical test was performed separately in four communication domains. 

Generally, the teachers’ score was 60.35% ± 28.84, which was considered as a moderate score in professional behaviors.

It seems that the residents and fellowships were not completely satisfied with their clinical teachers’ professional behavior and there are hidden concerns in this field. Therefore, it is essential to develop comprehensive professionalism and implement regulations to ensure successful professionalism. Also, the precise evaluation of professionals can encourage the maintenance of professional behaviors, potentially decrease negative role-modeling, and influence the hidden curricula. Operational approaches to formulate appropriate regulations and measures for establishing professional ethics are of great importance.
 




Please cite this article as follows: Garshasbi S, Saffarinia M, Emami Razavi SH. Effect of clinical professors’ professionalism on trust formation in resident and fellow students at Tehran University of Medical Sciences. Hakim Health Sys Res. 2020; 23(2): 170-178.




  
*Corresponding Author: Department of Psychology, Central Organization of Payam Noor University, Nakhl St, Artesh Boulevard, Tehran, Iran. Tel: (+98)2188992766, Fax: (+98)2188992762.  Email: sima_garshasbi@yahoo.com

Iran is a country with characteristics such as social inequality and complex epidemiological evolution, in which a group of its population does not have adequate health services. Health insurance is a promising tool to achieve universal health coverage. This study aimed to explain the factors affecting the improvement and effectiveness of basic health insurance.

In this qualitative study, 15 senior managers of the Ministry of Health and the Health Insurance Organization were selected by purposive sampling. The data were collected using interview guidelines and semi-structured in-depth interviews. All interviews were transcribed. Data were analyzed using the content analysis method with in-situ analysis.

By analyzing the data, seven categories (managerial, executive, political, technological, organizational, economic, and cultural factors) and 25 sub-categories were identified.

It is necessary to consider facilitators and inhibiting factors extracted from the study and select appropriate strategies to improve the current situation. It can lead to the quantity and quality improvement of basic health insurance.
 

In the present study, structural challenges in the governance system of the Ministry of Health, Treatment, and Medical Education of Iran were analyzed based on the network structure model.

The present qualitative study was conducted using a meta-combined approach. The study used the findings of 19 qualitative studies, conducted between 2001 and 2018, and semi-structured interviews with 14 non-randomly selected experts of the Iranian health system. The Kapa-Cohen index was used to calculate the reliability, which was 80%. Also, the Waltz-Basel method was used to assess the content validity of the extracted indices, which was calculated to be 85%. Through the content analysis of the articles and interviews with experts, the structural challenges of the governance system were classified into seven dimensions, including policy-making and decision-making challenges, legal challenges, organizational challenges, managerial challenges, communication challenges, financial challenges, and regulatory challenges.

The findings showed that important challenges in the current governance structure of the Ministry of Health, Treatment, and Medical Education of Iran include the instability of managers, inconsistent speed of policy-making and changes in society, the separated activity of the Health Deputy and Treatment Deputy of the Ministry, lack of defined inter-sectoral cooperation, lack of transparency, lacked knowledge of the requirements of collective decision-making in health policy-makers, the lacked use of evidence-based policy-making, inadequate budget system, and lack of control over the private sector.

According to the challenges and their importance, health policy-makers and planners must provide practical and applicable solutions to address the challenges of the current governance structure.

Health reform plan in dentistry has been implemented systematically in Iran since 2014 in villages and cities with a population lower than 20,000 inhabitants. This study aimed to evaluate the impact of this plan on the utilization of dental services in Isfahan province.

Ten health centers with dentists contracted with the health reform plan were recruited. The frequency of dental services (examination, preventive care, restorative care, and extraction) was assessed. Four centers not in contract with this plan were considered as the control centers. To compare the frequency of provided services, the non-parametric tests of Mann-Whitney and Wilcoxon (α=0.05) were used (SPSS 22).

In the control centers, the cumulative frequency of provided care demonstrated no significant difference between 2014 and 2017. In the centers subject to the reform plan, there were increases in examination (p=0.02), amalgam (p=0.04), and composite restoration (p=0.04) in the age group of 6 years, and examination, extraction, amalgam, and composite restoration (p=0.007) in the age group of 6-12 years. In pregnant women, extraction (p=0.017), composite restoration (p=0.04), and scaling (p=0.012) increased significantly. In the six-year-old group, the means difference of extraction (p=0.036) and amalgam restoration services (p=0.024) and in the age group of 6-12 years, the means of extraction (p=0.014) and amalgam restoration (p=0.008) were significantly increased in the centers subject to the reform plan than in the control group.

After the implementation of the reform plan in health centers, dentists were more willing to provide preventive and restorative care that could be partially due to financial incentives.
 

Due to the limited resources in the health system, it is necessary to measure the efficiency of health organizations. The purpose of this study was to evaluate the efficiency of pre-hospital emergency centers in medical sciences universities of Iran.

In this study, the efficiency of pre-hospital emergency care in medical sciences universities of Iran was evaluated by using the data analysis technique from 2015 to 2018. The inputs included the number of road stations, urban stations, ambulances, and manpower. The outputs included the mean bedside time, the number of dispatches to the hospital, and the travel number for traffic accident and non-accident patients. Data were collected through the accident and non-accident registry system in Khuzestan and Lorestan provinces (fourth planning region) and then analyzed using DEAP 2.1 software.

The mean scores of technical, managerial, and scale efficiency for the whole region were 0.889 ±0.025, 0.994 ±0.008, and 0.889 ±0.024, respectively. Therefore, there is a potential for upgrading technical and scale efficiency by 10%. The results showed that manpower was the main slack of production factors which reduced relative efficiency.

Overall, the efficiency of pre-hospital emergency centers was appropriate in Khuzestan and Lorestan Medical Sciences Universities (in the fourth planning region).

The advance in technology has improved the quality and timely access to laboratory services, besides increased costs. Approximately, 70% of clinical decisions are made based on laboratory results. For cost management in the health system, the role of the number of requested tests is unclear in health quality. Therefore, this study aimed to investigate the number of laboratory tests in medical prescriptions in the Alborz province of Iran.

In a descriptive-analytic study, the number of requested laboratory tests was extracted from medical prescriptions issued to the Social Security Organisation and the Iranian Health Insurance in the province of Alborz between 2011 and 2016. The data were analyzed by Excel.

The results showed that between 2011 and 2016, the number of laboratory tests issued to the two main health insurance schemes of Iran, with the highest population coverage, was increasing. In 2011 and 2016, the average number of tests requested per person was 3.4 and 5.6, respectively.

The requests for laboratory tests or irrational administrations may increase for various reasons, including lack of knowledge, laziness, fear, greed, and induced demand. It is suggested that standard guidelines be developed using the results of this study and similar studies for requesting laboratory tests by doctors.
 

The health system reform is a course of targeted, fundamental, and sustainable changes to increase accessibility, efficiency, quality, equity, resilience, sustainability, accountability, and satisfaction, and to reduce cost. Iran’s Health Transformation Plan (HTP) was implemented in May 2014 to reduce patients’ costs, improve the quality of services, and provide equal access to hospital care. The objective of this study was to evaluate the HTP effect on patient satisfaction.

A retrospective, descriptive-analytical research was conducted using patient satisfaction data from 2012 to 2016 in a specialized hospital in Isfahan, Iran. About 538 and 873 patients were examined before and after the HTP implementation, respectively. A 29-item questionnaire was used to measure patients’ satisfaction with medical, nursing, supportive, and welfare services. Data were analyzed using SPSS-V24.

Patient satisfaction increased from 84% in 2012 to 89.7% in 2016. The HTP implementation increased patient satisfaction by 6.3%, which was statistically significant (p<0.05). Patient satisfaction was increased in all medical, nursing, supportive, and welfare dimensions. The most increase occurred in supportive and welfare services and the least increase happened in nursing services. Patient satisfaction increased by 5.5%, 0.37%, and 0% after one, two, and three years of HTP implementation in the hospital.

Patient satisfaction increased in the hospital following HTP implementation. Evaluating the HTP effects regularly reveals its strengths and weaknesses and policy-makers can apply necessary and on-time changes to sustain its positive results.
 

The purpose of this study was to evaluate the satisfaction of urban and rural populations of Larestan with the family physician plan.

The present study was conducted with a quantitative approach. The data collection tool was a researcher-made questionnaire. The statistical population consisted of all households covered by the plan in Larestan city. A sample of 383 people was selected using the Cochran formula. Data were analyzed by SPSS21 software using Pearson analysis, regression analysis, and T-test. The face validity and Cronbach’s alpha were used to assess the validity and reliability of the research instrument, respectively.

The overall satisfaction with the family physician plan was moderate to high (62.7%). There was no relationship between gender (P=0.074), occupation (P=0.424), and residential homeownership (P=0.338), and satisfaction with the plan. There were significant direct relationships between residence place, marital status, age, education, insurance coverage, income, level of service coverage, medical costs, physician’s clinical expertise, and access to physician, and satisfaction with the plan. The results of multivariate regression analysis showed that service coverage (r=0.925), treatment costs (r=0.928), age (r=0.930), and clinical expertise (P=0.931) explained a total of 86% of changes in the satisfaction with the family physician plan (P<0.001).

The quality of services and satisfaction with the plan can be increased by allocating resources, implementing educational programs for increasing physician skills, holding training courses for villagers to get them acquainted with the goals of the plan, and careful monitoring and surveillance of the program.

Tariff setting in the health sector affects the access, efficiency, and quality of healthcare services. However, the concept of hospital tariffs is vague and complicated. Therefore, this study aimed to explain the concept, attributes, antecedents, consequences, assessment indicators of hospital tariff.

This research was conducted using the conceptual review method from January to March 2020. All published articles related to hospital tariff were searched until December 31, 2019, in eight databases (Web of Science, PubMed, ScienceDirect, Embase, Scopus, Magiran, Iranmedex, and SID). Finally, 41 articles were selected and analyzed.

Hospital tariff is defined as “The price of hospital services set by regulating authorities and purchasers (i.e., the government, health insurer, patients, etc.) that must be paid to the hospital in exchange of services”. The hospital tariff affects health system costs, hospital efficiency, access to health services, and satisfaction of both patients and hospital service providers. The cost of hospital services, the value of services, and the accepted profit are the main elements of hospital tariffs. The cost of hospital services, payment method, competition among hospitals, and the demand for hospital services are the main determinants of hospital tariffs. Cost control, fairness, satisfaction, and transparency are good indicators for evaluating hospital tariffs.

Health policy-makers need to consider the antecedents and consequences of hospital tariffs to satisfy both hospital service providers and customers, improve service quality, increase access to hospital services, and enhance hospital efficiency.