نشریه راهبردهای مدیریت در نظام سلامت
سال ششم شماره 2 (پیاپی 20، تابستان 1400)

Good governance in the last two decades attracted the attention of scientific and international circles around the world. It is a type of governance that is committed to supporting and promoting human health. In order to achieve good governance, components have been identified that knowledge of the weight and importance of each component is undoubtedly necessary to achieve the desired results in the policy-making of the Iranian health system.

This research is descriptive-survey in terms of goal setting and methodology. The multi-stage stratification and availability method was used for sampling and the theoretical saturation rule was used to determine the sample size. In order to define and explain the concept of components of good governance and health policy-making, the library method and review of reference sources were used. 100 survey managers and experts in the Ministry of Health and Golestan, Mazandaran and Neishabour Universities of Medical Sciences were interviewed using a survey method and using a checklist tool (researcher-made (pairwise comparisons)). To analyze the data, Changchr('39')s improved fuzzy AHP method and Expert choice software were used.

Among the components of good governance (for the policy-making process of the Iranian health system), the rule of law included the most important component. After the rule of law, consensus and agreement, transparency, accountability, justice and fairness, effectiveness and efficiency and ethics were in the next ranks.

Good governance is a new narrative of concepts such as democracy, human rights and justice to pursue people-centered human development goals. The rankings obtained from the analyses of this research indicate the need to pay more attention to the rule of law in the health policy-making cycle. It is suggested that in designing the health sector of the seventh economic, social and cultural development plan, executive strategies are paid attention to strengthening the components of good governance, respectively.

HIV patients are exposed to many psychological problems, including psychological inflexibility. It seems that psychological interventions can be effective to improve the psychological state of these patients. Therefore, in this study, we aimed to compare the effectiveness of interventions with 2 methods of Compassion-Focused Therapy (CFT) and Mindfulness-Based Stress Reduction (MBSR) program on psychological flexibility of HIV patients in Imam Khomeini Hospital.

The present study was a descriptive-analytical study that was performed as an intervention in the period from May to January in 2020 on 54 HIV patients referred to Voluntary Counseling and Testing (VCT) center of Imam Khomeini Hospital Complex. The samples of the study mode were selected by available sampling and randomly divided in 3 groups of 18 people based on CFT, MBSR session and the control group. Each treatment was presented to 2 experimental groups for 10 sessions per week and the control group was placed on a waiting lists. Patientschr('39') psychological flexibility was assessed by the Acceptance and Action Questionnaire- II "AAQ-II" in 3 stages: pre-test, post-test and follow-up. SPSS 23 software and analysis of covariance, bonferoni test and one-way analysis of variance were used to analyze the data.

The results showed that CFT and MBSR were effective on increasing psychological flexibility of HIV patients (p < 0.01). Comparison of the effectiveness of the 2 therapies showed that CFT caused a further increase on increasing psychological flexibility (p < 0.01). Changes in follow-up 3 months after treatment also remained stable (p < 0.01).

Findings of the study show that the use of therapies in this study can be effective in planning psychological interventions to promote and improve mental health in HIV patients.

Patientchr('39')s preferences in decision-making procedure are defined as the patientchr('39')s willingness to participate in self-care management and decision-making. The aim of present study was to assess patientschr('39') preferences in decision-making procedure and perceived participation in care and their relationship with demographic in selected educational hospitals of Yazd in 2019.

The study was conducted on 195 inpatients of the gynecology, internal medicine and surgery wards of teaching hospitals in Yazd of Iran. The inpatients were selected through stratified sampling method. The data was collected by 2 questionnaires: Degner and Sloanchr('39')s control preferences scale and patientschr('39') perceived involvement in care scale of Lerman et al. parametric and non-parametric tests used to analyze the data.

In general, 49.20 % of patients preferred a relatively passive role in the decision-making process, and 36.40 % of them had high level of willingness to participate in their medical care decisions. The difference between the types of patients chr('39')decision-making preferences was significant for education level, type of hospital and type of inpatient ward, type of basic insurance (p ≤ 0.05). The mean score of Patientschr('39') perceived participation was 62.08 ± 14.92. The difference observed in the mean score of patientschr('39') perceived participation in care for gender, type of disease, type of hospital, history of hospitalization, type of basic insurance was significant (p < 0.05).

A large percentage of patients in the present study preferred a relatively passive role in decision-making, so it is best for health care providers to provide patients with understandable information about available treatment options and the benefits / risks associated with those choices. Also, the necessary interventions to promote shared decision-making, especially to help female patients and patients with more acute illnesses, as well as to support health care providers to participate in the shared decision-making process with patients, are of particular importance.

The tools to control COVID-19 virus and this epidemic have been tested in all countries and at different levels. At the community level, they include observing hygienic principles, such as observing social distance, wearing masks, washing hands, observing cleanliness, observing personal belongings, and etc. Also at the macro level, governments have taken measures to combat the virus, such as closing cities, purchasing vaccines hygiene training. Given the high costs of closing cities and purchasing vaccines for governments, they may be willing to select and use a combination of them to control the virus. Considering these 2 factors as 2 competitors in the effectiveness of COVID-19 control, this study sought to find an equilibrium point to control the virus.

An infinite 2-player game was defined by considering the number of cities closed per person-day and the number of vaccine purchased per person, both of which have continuous and infinite space. On the other hand, a significant basic criterion for governments can be the cost and number of patients with the disease. Hence, the game was defined based on 2 criteria. A case study was also solved for the sake of clarity.

The government must close offices for at least 12 days and inject 2 doses of the vaccine to about 28 million people in order to achieve its goal of reducing costs and reducing the incidence of the disease.

By solving the proposed model, it was found that for the initial control of the disease, the purchase and injection of vaccines can be more effective, but in order to further reduce and control the disease, it is better to close jobs. Analyses also showed that governments that are less willing to spend money on disease control could close jobs.

The supply of medicines in every country is vital in any country, and access to appropriate medicines ensures the health of that community by preventingthe spread of smuggling. The present study aimed to evaluate the current policies of Iran to supply medicines through importation and examine the application of the ABC-VED (Always, Better, Control-Vital, Essential, Desirable) method in assisting policymakers in making decisions on the medicine importation.

The present research study was conducted in qualitative and quantitative phases. In the qualitative phase, face-to-face interviews were conducted with 13 health experts in the field of production and import of medicine and their "content analysis" was done using MaxQDA 18 software.In the quantitative phase, to determine the nature of imported drug items, the ABC-VED analysis matrix and the information available in the pharmaceutical statistics of 2019 were used. Then, the distribution of drugs in each of the matrix categories was determined.

In the qualitative phase of the study, experts pointed to the impact of restrictive policies on importation of medicines, reducing access to medicines, increasing smuggling, reducing innovation, weakening marketing, and reducing the quality and increasing price of domestically produced medicines. In the quantitative phase, it was found that AV category consists of 36, AE 145, AD 85, BV 31, BE 240, CV 126, CE 970, and CD 672 type of medicines using the ABC-VED matrix. Finally, 21.5 % of medicines were categorized in group I belonging to vital and expensive medicines, 7.2 % in group II that are essential medicnies with moderate prices, and finaly 1 % were categorized in group III which are desirable medicines with lower prices.

According to the opinions of experts in the country pharmaceutical industry, Iranchr('39')s policy on drug importations has always been contractionary. Although it has led to lower prices and increased patientschr('39') access to medicines, it made side effects on the pharmaceutical system. Thses side effects includ sectional medical shortages over time. Policymakers can restrict the import of expensive and small quantities of drugs and allocate more funds to the supply of vital drugs. The analyses used cannot be the criterion for decision alone and can only indicate drug priorities in budget shortages and must make decisions within a multi-criteria decision framework.

Admission and dispatch of patients is considered as part of the patient treatment process. The aim of this study was to investigate the status and income effects of admission and dispatch of patients in need of vascular surgery in hospitals of Iran University of Medical Sciences in 2018-2019.

The present study is a descriptive cross-sectional study in which a checklist was compiled and the required information about admission and dispatch of patients in Iran University of Medical Sciences was extracted from the MCMC (Medical Care Monitoring Center) system. In order to extract the income of services related to vascular surgery service from the average income of each patient file in need of this service, university hospitals were used. The sampling method was census and 14,481 patients admitted and dispatched were examined. The data were analyzed by descriptive statistics using Excel software.

The total number of registrations for dispatch of vascular surgery service was 605, 378 of which were successful. Of these, 145 were from hospitals affiliated to private hospitals and other hospitals affiliated to other medical universities, 233 were related to vascular surgery admissions, and 227 patients were related to failure to dispatch and death. The lost income due to dispatching patients is equal to 4,875,100,680 Rials. Also, the hospitals affiliated to the university have gained income equal to 7,833,782,472 Rials by admitting and not dispatching these patients.

The findings showed that the lost income due to dispatching patients requiring vascular surgery is 4,875,100,680 Rials. Also, the earned income resulting from the existence of medical facilities in the field of the patients’ admission to the hospitals affiliated to the university is 7,833,782,472 Rials.

Curriculum revision based on stakeholderschr('39') needs assessment is one of the essential and continuous functions of educational systems. The aim of this study was to assess the educational needs of bachelor degree of healthcare management from the perspective of students.

This cross-sectional study was conducted in 2019 at Shiraz University of Medical Sciences. 40 undergraduate students of healthcare management were selected by stratified-random sampling. The data were collected using a researcher-made questionnaire. The validity and reliability of the questionnaire were confirmed in a pilot study. Data analysis was done using descriptive statistics and SPSS 21 software.

64.1 % of the participants had chosen their field of study without or with little prior familiarity. More than 60 % of them had chosen the field solely to take advantages of their degree. Only 22.5 % of the participants had high and very high satisfaction with this field of study. However, 65 % of them assessed the entrepreneurial ability of the graduates of this field as moderate and above. The majority of respondents considered field training useful in meeting job needs but believed that the current field training courses need to be improved. The educational content required for bachelorchr('39')s degree of healthcare management was identified and classified into 18 categories.

The findings showed that the current curriculum of the bachelorchr('39')s degree of healthcare management needs to be revised and improved.