مجله تحقیقات نظام سلامت حکیم
سال بیست و چهارم شماره 1 (پیاپی 92، بهار 1400)

Futures studies is a field of scientific studies that seeks to better understand changes in humans, society, and the environment by examining the probability of future events at different levels, and one of the reasons for its use is to try to understand topics that we are unaware of because in order to face the future and plan better, sufficient knowledge should be done in the relevant subject. The health system is full of uncertain and complex issues that are risky to address based on findings from past events. It seems that futures research can consider various dimensions and challenges of health system by providing different paradigms and approaches, and while helping to better understand the complexities, provide useful and effective solutions for the development of knowledge and management in the field of health. It is suggested that futures studies knowledge be promoted for health-related planning in order to improve the view of the managers of this system and be given more attention.

Insurance coverage of dental services through reducing costs and increasing the purchasing power of people, leads insured people to use more of these services than people without insurance coverage. One of the requirements of dental services insurance coverage is to determine the tariff of these services. The aim of this study was to explain the tariff-setting process of dental services in Islamic Republic of Iran in 2020.

Various steps were taken to determine the tariff for dental services: identifying the list of services, determining the professional component, the technical component and the consumables and materials component. The required data were collected through ten meetings with the members of the Supreme Council of Health Insurance (Deputy of Treatment, Medical Council of the Iran, and Basic and Complementary Insurance Organizations), two meetings with specialized dental associations, reports of the Statistics Center of Iran and a review of the actual costs of dental clinics across the country.

The professional component was obtained by the cost of living method and by calculating the number of units of relative value that can be provided during a year and then the expected annual income of a general dentist. The technical component was calculated by determining the annual costs of dental clinics and the consumables and materials component by the costing method based on the actual performance of dental clinics across the country. The obtained results for each stage were presented in various meetings in the Secretariat of the Supreme Council of Health Insurance and were confirmed after the final review.

Tariff-setting of dental services has various advantages such as targeting the insurance coverage process of these services, facilitating the process of monitoring tariffs, cost management by provider centers, facilitating the process of updating the tariff of existing services and facilitating the process of tariff-setting of new services.

Some factors have been found to be associated with increased mortality from Covid-19. This study is a systematic review and meta-analysis aimed at finding the factors associated with the increased mortality among Covid-19 patients.

Systematic searches of Medline/PubMed, Scopus, and Google Scholar databases were performed using keywords that correlated mortality, including relative risk (RR), risk ratio, and odds ratio(OR). A total of 20 articles were included in this study. Four factors including age (years) with OR, underlying diabetes with OR, gender (male vs. female) with OR, and gender (male vs. female) with OR which reported by in more than two studies, were meta-analyzed.

A total of 65 factors were identified that are associated with an increase in death from Covid-19. The most important factors were: History of diabetes with an odds ratio of 12.23 (4.13–36.27); Hospitalization in the intensive care unit with a relative risk of 5.79 (4.00-8.38); and requiring which reported by mechanical ventilation with a relative risk of 7.36 (5.06–10.7). These factors can be classified into three categories: 1) individual and genetic factors 2) underlying diseases and conditions, and 3) clinical and laboratory findings.

Having identified these risk faktors, it is necessary to pay more attention on preventive measures and raising awarness among  people with these risk factors. This findings may help health care organizations to prioritize high risk groups for screening and triaging for Covid-19 and for receiving Covid-19 vaccine.

Hospitals are recognized as a 24/7 center in all health systems. Under the health transformation plan, one specific program was envisaged to improve the response to clients during non-business hours and holidays via different specialties being stationed in the hospitals, especially emergency departments, since 2014. It was expected to have a significant impact on emergency performance and patient satisfaction. Therefore, the present study aims to qualitatively evaluate the program of specialists residing in the emergency department, examining its strengths and weaknesses and opportunities for improvement.

In this qualitative study, a semi-structured interview was conducted with 19 specialists, two super-specialists, four general practitioners and two experts, mainly as resident physicians and deputy director of treatment at Tehran University of Medical Sciences. Data analysis was performed using thematic analysis strategy with the help of MAXQDA software.

The strengths included a transparent communication and job descriptions, a reliable access to specialist services at evening and night shifts and speeding up patients’ care and discharge. As such, the lack of monitoring system for physicians’ performance, payment issues and possible damage to student education were the main challenges and weaknesses

The importance of hospitals without the presence of physicians, especially in teaching and public hospitals, will be very small. The instructions of the resident physician’s program were not strictly implemented as opposed to the other programs of the health transformation plan. Numerous causes and factors were identified in this study for this negligence that can to some extent pave the way for health policy makers and managers.

Governance is one of the important functions of health system management. Good governance leads to better performance of the health system and ultimately, achieving better health outcomes for the people. Nevertheless, the concept of health system governance is ambiguous and complex. Therefore, the purpose of this study is to explain the concept of health system governance.

This research was conducted using the conceptual review method. All articles related to the health system governance indexed in Medline, EMBASE, ProQuest, Scopus, Cochrane Library and Science Direct databases and Google and Google Scholar search engines were searched, extracted, and assessed. Finally, 95 articles were selected and analyzed by content analysis.

Health system governance is “a system of structures, processes, values, laws, power and authority for effective management of resources, coordination of stakeholders’ behaviors, planning and stewardship of health programs and evaluation of health system performance to promote, restore, and maintain health”. Health policy-making, strategic planning, organizing, stewardship and controlling are the main components of the health system governance. Environmental factors, information systems, appropriate culture, community participation and cooperation, and resource management influence the governance of the health system. Health system governance affects the goals of the health system (i.e. public health, financial protection, and responsiveness). Finally, a model and a checklist were developed to evaluate the health system governance.

Health system governance is a complex and multidimensional concept that is evolving. Strengthening health policy-making, strategic planning, organizing, stewardship and controlling is essential to achieve good health system governance.

Increase the level of health literacy about communicable and non-communicable diseases using virtual platforms during the Covid-19 epidemic is important. The purpose of this study was to investigate the performance of the deputy of Health of Tehran University of Medical Sciences in using virtual platforms in health education of the covered population during the Covid-19 epidemic.

In this cross-sectional study, recorded data related to educational activities in cyberspace during the months of September to the end of January was used. The variables studied included the number of virtual groups, the number of members participating in the groups, the number of uploaded messages, the sources of content uploaded, and the group manager in different months.

During the under-studied period, about 660 related groups to family health ambassadors, 183 groups of health liaisons, 519 virtual self-help groups, 120 groups related to employees of external organizations, and 132 Virtual groups were created for students and their teachers. The highest number of uploaded messages in all groups was from the deputy of Health, and the group of liaisons and health ambassadors with an average of 0.76 with 0.72 messages per day had the highest average of sending messages per day.

Since the beginning of infrastructural and educational activities in cyberspace, effective measures have been taken by the deputy of the Health of Tehran University of Medical Sciences, which can minimize the negative impact of the Covid-19 epidemic on educational, health, and prevention-related activities.

Nurses job satisfaction is one of the effective factors in improving the quality of nursing care. The aim of this study was to determine the factors affecting job satisfaction of nurses who working in emergency departments in public hospitals, affiliated to Tehran University of Medical Sciences.

This study was a cross-sectional study conducted in the emergency departments of 14 hospitals that affiliated to Tehran University of Medical Sciences. The data collection tool, including a demographic questionnaire and a Herzberg Worksheet Satisfaction Questionnaire. The study sample consisted of 665 nurses working in the emergency department who entered the study by census method. The obtained data were analyzed using descriptive and analytical statistical tests (Mean ±SD and Chi square) and Version 18 SPSS software.

The Mean ±SD of job satisfaction in nurses (141.58±36.831) was moderate to low and the highest level of satisfaction in two dimensions, respectively, communication with colleagues and patients (48.3درصد) and job status (27.7%) and the lowest level of satisfaction were in two dimensions, salary and benefits (62.4درصد) and work situation (49.3%), respectively.

In all organizations, job satisfaction has been identified as an important factor in creating employee motivation, efficiency and responsibility. Job satisfaction in nurses, improve the quality of nursing care and reduce their retirement.

The existence of toxic and flammable chemicals, heavy machineries and the distance of oil facilities from urban communities, make it difficult for Iranian oil company employees to access health services easily. Health service delivery in the Iranian oil company faces some challenges. This study aimed to compare methods of health service delivery to employees of world leading oil companies to propose an appropriate model for Iran’s oil industry.

The scope of the oil company’s activity, the existence of quality healthcare services in the area of its operation, the type of health services required, national and international laws and regulations and social responsibility policis of the oil company affect its choice of a health service delivery model. The Iranian oil company has the highest level of direct involvement in providing health services to its employees. It should be more involved in providing emergency medical and occupational services and less involved in the direct treatment of non-occupational diseases. Non-occupational healthcare services should be purchased from existing healthcare providers or health insurance companies.

 There is no one-size-fits-all solution. Leading oil companies use a suitable model to provide health services to their employees considering several contextual factors. Iran Oil Company should provide non-occupational services through strategic purchasing of health services and contracts with health insurance companies.

The most important guarantee for the success of the health transformation plan is to pay attention to the service providers of that plan. Therefore, the present study was conducted about six years after its implementation.

This descriptive cross-sectional study was performed on 384 staff of hospitals affiliated to Isfahan University of Medical Sciences in 2019. Data collection tools were the Standard Job Satisfaction Questionnaire JDI (Job Descriptive Index), with the first section containing demographic information and the second section containing 30 questions to measure satisfaction. For data analysis, descriptive and analytical statistics were used in SPSS software version 16.

The results of the study showed that the overall score of job satisfaction after the implementation of the health transformation plan was moderate and equal to87.8±10.4. Among the various dimensions of job satisfaction, the highest score was the share of satisfaction with colleagues equal to 21.7±3.0 and the lowest score for the satisfaction of salaries and payments was 10.9±2.7. Only relationship between the age and score the dimension of the nature of the job satisfaction after the implementation transformation plan was significant (p = 0.003).

Despite the measures taken after the implementation of the health system transformation plan to improve the satisfaction of the medical staff, their satisfaction is still not acceptable, especially in terms of promotion and salaries. This can affect the quality of the care team’s work, which seems to need more attention from the authorities.