مجله تحقیقات نظام سلامت حکیم
سال هفدهم شماره 4 (پیاپی 67، زمستان 1393)

Population health promotion، determined by socio-economic factors، needs inter-sectoral collaboration. The Provincial Health and Food Security Workgroups (PHFSWs) have been established as an authority for policy making، planning and coordinating the inter-sectoral health interventions at local levels. This study aimed to assess the performance of these workgroups in Iran. This cross-sectional study examined the viewpoints of experts working in the deputies of health at the universities who had experiences with the PHFSWs at local levels. The structure and function and agenda (October 2011 to September 2012) of the workgroups were assessed using a self-reported questionnaire consisting of open and closed questions. The quantitative data were analyzed in the Excel using the descriptive statistics. The qualitative data were extracted using simple content analysis. The Provincial Planning and Development Council Bylaw was considered as the baseline for performance judgment. The f requency and discipline of the meetings، participation and involvement of members، management of the meetings، communication of workgroups، and addressing to the health equity and social determinants of health approach in decision making were not appropriate. About half of the universities showed a low performance in this regard. Furthermore، content assessment showed that only a limited part of issues were approached by the social determinant of health based interventions. The PHFSWs are considered as a potential capacity for inter-sectoral collaboration at local levels. Hence، it is expected that national and local policy makers and authorities apply proper interventions for performance standardization of these workgroups as emphasized on empowerment، establishing the common language and understanding، applying proper mechanisms for decision making and enforcement and addressing the health equity and the social determinants of health approach.

Knee pain is a common complaint among patients; and Magnetic Resonance Imaging (MRI) is repeatedly used to diagnose the problem. There are insufficient scientific evidences to make appropriate decisions in clinical diagnosis in Iran. This study aimed to evaluate medical costs resulting from inappropriate prescriptions of the MRIs for knee joint، using RAND Method in Ghaem Hospital- 2013. First، we conducted a qualitative study to develop the knee MRI indications and scenarios using the RAM (RAND Appropriated Method). Then، data were gathered through a cross-sectional study. To determine the appropriateness of the prescriptions، the histories of 115 patients with knee pain were assessed. Sixty three scenarios for knee MRI (in 26 indications) were extracted from the selected clinical guidelines. Among scenarios، 50. 79% were considered as appropriate، 19. 04% were uncertain، and 30. 17% were inappropriate. From 115 cases of knee MRI prescriptions، 63 cases (54. 8%) were considered as inappropriate، 17 cases (14. 8%) were uncertain، and 35 cases (30. 4%) were appropriate. The economic burden of inappropriate prescriptions was 38159100 Rials. Developing، customizing، and performing clinical guidelines are necessary and may improve quality of care and prevent unnecessary costs.

Despite the pivotal role of clinical governance in enhancing quality of services provided by hospitals، there is no scientific framework with specific criteria in order to evaluating hospitals in Iran. This study was conducted to identify the challenges involved in evaluating systems of clinical governance in Iran. In this qualitative study، 15 semi-structured interviews with experts in the field were conducted in 2011. Data were analyzed using the framework analysis method. Five major challenges were emerged in evaluating clinical governance including: 1) managing human resources; 2) improving clinical quality; 3) managing development; 4) organizing clinical governance; and 5) providing patient-oriented healthcare system. This study provided a transparent framework to identify challenges of clinical governance implementation in hospitals in Iran.

Although hypochondriasis is classified as a form of Somatoform Disorders، cognitive - behavioral theories consider it as the extreme form of health anxiety. This study aimed to translate and evaluate the reliability and validity of the Short Form Health Anxiety Inventory. In this cross-sectional study، 363 students (140 males and 223 females) studying at Malayer University were selected through convenience sampling method. Students filled out the Short Form Health Anxiety Inventory، depression، anxiety، stress، general health questionnaire and the acceptance and action questionnaire II. The test-retest reliability and Cronbach''s alpha coefficient were used to assess the reliability and the convergent validity method and confirmatory factor analysis were used to assess the validity The Cronbach''s alphas were 0. 76 for the risk of disease، 0. 63 for the negative effect of disease، and 0. 79 for the total questionnaire. Concurrent validity of the short form health anxiety questionnaire was correlated with the public health (0. 42)، experiential avoidance (0. 31)، anxiety (0. 47)، stress (0. 32)، and depression (0. 34) items. The confirmatory factor analysis showed that the two-factor and three-factor structure of this questionnaire were both acceptably fit. The results of this study showed that The Short Health Anxiety Inventory is a reliable and valid questionnaire for research on hypochondriasis disorder and health anxiety.

Family satisfaction is an important measurable outcome of quality of care in intensive care units. The spiritual support of family members in the process of decision making about patients plays an important role in family satisfaction. It seems family-centered care is an approach with the capability of achieving this goal. There is little evidence supporting this issue in our country. The present study was conducted to determine the effectiveness of family-centered care on family satisfaction in adult intensive care units. This randomized controlled trial was conducted in two neurology and neurosurgery intensive care units of Shahid Rahnemoon Hospital in Yazd، Iran، in 2013. Seventy four family members were enrolled in the study using random sampling method. The data were collected via a questionnaire in the third and seventh day of hospitalization. Patients in the intervention group received family-centered care. The control group experienced usual care. Data obtained before and after the intervention were analyzed in the SPSS-18. A t baseline، the mean ± SD satisfaction score was 56. 86±11. 88 and 54. 80±13. 12 in the intervention and control groups، respectively (p=0. 480). After the intervention implementation، mean satisfaction score was significantly increased in the intervention group (66±10. 61) (p<0. 0001). According to the findings، f amily -centered care could increase the family satisfaction in intensive care units. The family-centered care should be applied in intensive care units. Professional nursing policymakers should find ways to overcome barriers of family-centered care.

Informal payments are paid to individuals and organizations offering health services، either in cash or non-cash via informal channels. The aim of this study was to estimate the amount of informal payments in Urmia hospitals and to assess the related factors. This cross-sectional study was conducted in February 2013. Data were collected using a questionnaire that was completed via telephone calling to the patients. Data were analyzed using the OLS model in the SPSS-21 and EVIEWS7. The mean formal and informal payments to the hospitals were 3270000 and 600000 Rials، respectively. The mean (SD) informal payment to the doctors was 5030000 (5520000). The mean (SD) informal payments to the nurses and other staff were 200000 (130000) and 160000 (160000) Rials، respectively. Type of hospital، place of settlement، treatment procedure and income were recognized as the related factors with the amount of informal payments. Given the results of this study that indicated high amounts of informal payments، and considering the serious negative effects of informal payments on appropriate governance، policymakers should pay attention on the issue in order to restrict the informal payments.

The way in which national health care is financed influence the distribution of household income. Progressive (regressive) system reduces (increases) income inequality. In order to assessequity in health payments، studying the progressivity alonewill be misleading. Health financing system should be decomposed to its components including progressivity، horizontal inequity and rerankingto assess equity in health payments. First، we assessed the progressivity in health payments. We applied the Aronson et al method and the ADePT software to decompose the redistributive effect of Iran’s health care financing system to health insurance prepayment and out of pocket payments using Iranian household income expenditure micro data during 2005-2010. The health insurance prepayment and out of pocket payment were regressive and progressive during the study period. They were improved up to 53% and 35%، respectively. Progressivity of the total health care payments was increased by 19% and resulted in reducing income inequality. There was a strong horizontal inequity in out of pocket payments. In Iran، h ealth payments have been progressive and have reduced income inequality during the study period. Results of income redistribution effect indicated that only studying the progressivity for equity assessment was not enough. Despite existence of progressivity and vertical equity، there was horizontal inequity within each income groups. Since most of health care payments in Iran are through out of pocket payments، better-off not only pay more، they also get more health services.

Charity donors’ participation in health and medical care fileds can help to enhance the public health resources. The purpose of this study was to assess the charity-related evidence in health care system in Iran and to present a perspective in this area. This was a narrative review. We searched four Iranian scientific databases using the following key words: donor OR charity، NGOs، health care. Twenty reports were retrieved in the area. Most of the reports were published in the scientific journals (65%). Most of the reports have focused on the government (35%). Most of the studies were derived from studies on the health care system (75%) versus the hospital (25%). The amount o f the studies shows that there were little scientific focus on the issue and the trend of the scientific works in the issue are gradually increasing. We recommend planning joint projects between the policy makers، health charity organizations، and the researchers to widen the scientific perspectives on charity issues.

Vaccination is a cost-effective intervention in order to protect children against vaccine preventable diseases. Once children are vaccinated successfully، they become immunized to fight against those diseases. The purpose of this study was to determine vaccination coverage among nomad children. In this cross-sectional study، 214 nomads’ under 6 years children living in Kermanshah province were selected. Data were collected using a checklist consisting of the children''s vaccination cards information. Data were analyzed using the Chi-squared test in the SPSS-13. The results of the study showed the following rates of the vaccination coverage: BCG: 99. 1%; Hep 1:98. 6%; Hep 2:98. 6%; Hep 3:95. 4%; Poli 0:98. 6%; Poli 1:98. 6%; Poli2:96. 1%; Poli3:95. 4%; DTP 1:98. 1%; DTP 2:96. 1%; DTP 3:95. 4%; MMR 1:92. 8%; and MMR 2:84. 7%. Most of the children (80%) had a vaccination card. The overall vaccination coverage among nomads’ children was 85%. Among children، 1. 4 to 15. 4% did not receive any vaccines. About 5 to 30% of the children did not receive vaccination on time. There were no significant relationships between the parents’ job، children’s’ gender، and the number of children with vaccination (p>0. 05). There is a necessity to plan promoting programs to increase vaccination coverage among nomads’ population.

The health sciences studies can be beneficent to the community health when the results can appropriately be disseminated among stakeholders. The aim of this study was to assess the knowledge transfer and exchange (KTE) state among approved research projects at Ilam University of Medical Sciences (IUMS) in 2008-2012. This study was a cross-sectional study in which 135 research projects of Ilam University of Medical Sciences were studied during 2008 to 2012. Data were gathered via a checklist. Data of 100 projects could be retrieved and analyzed using the descriptive statistics and ANOVA test in the SPSS. Among the studied projects، 74 projects (74%) were applied research، 24 projects were basic research and two projects were applied-basic projects. Most of the projects (n=63; 63%) had a cross-sectional design; and 13 projects (13%) were intervention studies. Only 2 (2%) projects were related to other projects of the researchers. Only 3% of the projects had been collaborated with other research organizations which shared only 0. 12% of the proposal budgets. Active KTE score of the IUMS researchers was 6±2. 4 out of 28; and score of the passive KTE including publishing and presentation of the results in national and international scientific seminars was 9±2. 6 out of 28. According to the results، it seems that the format of the IUMS proposals should be revised in order to add project audiences in proposals and research messages in final reports. Policies for faculty promotion should be revised and funds should be attracted from other research organizations to improve KTE at the IUMS.