The Effect of Access to Primary Care Physicians on Avoidable Hospitalizations: A Time Series Study in Rural Areas of Tehran Province, Iran / 가정의학회지

Background@#Avoidable hospitalizations (AHs) are defined as hospitalizations that could have been prevented through timely and effective services. AHs are, therefore, an indicator used to evaluate the access and effectiveness of primary health care services. @*Methods@#A retrospective time-series study spanning 8 years (2006–2013) was conducted to determine the relationship between AHs and gender, age, and access to primary health care physicians in rural areas in Tehran province, the capital of Iran. The total number of avoidable hospitalizations was 22,570; logistic regression was estimated for each year separately. @*Results@#Total hospitalizations and AHs increased during the study period, especially during the first 3 years of the study. AHs, as a percentage of total hospitalizations, did not change significantly throughout the study years. This value was 22.3% during the first year of study and varied between 17% and 19.6% from 2007 to 2013. No statistically significant relationship was seen between AH occurrence and access to a physician during the study years. @*Conclusion@#Increasing access to primary health care physicians cannot necessarily result in decreased AHs. Considering the factors influencing AHs while designing and implementing the family physicians program is important to achieve the expected results regarding the effectiveness of primary health care services.

Effects of the health transformation plan on caesarean section rate in the Islamic Republic of Iran: an interrupted time series

Background: in recent decades, the rate of caesarian section [C-section] has increased in the Islamic Republic of Iran. A reform in the Iranian health system - the Health Transformation Plan [HTP] - was launched in 2014 in which one of the objectives of HTP is decreasing the rate of C-section

Aims: this study aimed to assess the effects of the Health Transformation Plan [HTP] on the C-section rate in the Islamic Republic of Iran

Methods: this study was an interrupted time series analysis that used segmented regression analysis to assess the im-mediate and long-term effects of the HTP on C-section rate in two groups of hospitals affiliated and not affiliated to the Ministry of Health and Medical Education [MoHME] in Kurdistan province. Study samples were selected using the data on monthly C-section rate collected over a period of four years

Results: we observed significant decreases in C-section rate immediately after the HTP in both groups of hospitals by 0.0629 and 0.0013, respectively [P < 0.05]. In the long run, we observed no significant decrease in the regression slope of C-section rate in both groups

Conclusions: the implementation of HTP decreased the C-section rate. However, the reduction does not meet expectations

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis / 예방의학회지

OBJECTIVES: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. METHODS: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. RESULTS: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p < 0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p < 0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. CONCLUSIONS: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Analysis of Joint External Evaluations in the WHO Eastern Mediterranean Region

Background: Joint External Evaluation [JEE] was developed as a new model of peer-to-peer expert external evaluations of IHR capacities using standardized approaches.

Aims: This study aimed to consolidate findings of these assessments in the Eastern Mediterranean Region and assess their significance.

Methods: Analysis of the data were conducted for 14 countries completing JEE in the Region. Mean JEE score for each of the 19 technical areas and for the overall technical areas were calculated. Bivariate and multivariate analyses were done to assess correlations with key health, socio-economic and health system indicators.

Results: Mean JEE scores varied substantially across technical areas. The cumulative mean JEE [mean of indicator scores related to that technical area] was 3 [range: 1–4]. Antimicrobial resistance, Biosecurity and Biosafety indicators obtained the lowest scores. Medical countermeasures, personnel deployment and linking public health with security capacities had the highest cumulative mean score of 4 [range: 2–5]. JEE scores correlated with most of the key indicators examined. Countries with better health financing system, health service coverage and health status generally had higher JEE scores. Adolescent fertility rate, neonatal mortality ratio and net primary school enrollment ratio were primary factors within a country's overall JEE score.

Conclusions: An integrated multisectoral approach, including well-planned cross-cutting health financing system and coverage, are critical to address the key gaps identified by JEEs in order to ensure regional and global health security

Payment system of urban family physician programme in the Islamic Republic of Iran: is it appropriate?

Background: The payment system is pivotal in implementing policies in the health sector. Equitable access to healthcare is the main principle of the payment system.

Aims: This study aimed to investigate aspects of the payment system in the urban family physician programme [FPP] in the Islamic Republic of Iran.

Methods: This was a qualitative study. We obtained data from key informants and both formal and grey literature. We used content analysis for data analysis.

Results: A range of concepts was explored related to the payment system of the FPP. By merging similar expressions, we categorized the findings into four main themes including: payment method, payment criteria and incentives, payment process and amount of payment.

Conclusions: FPP is required to follow convenient implementation methods. The mechanisms of payment in the health sector are weak and have no transparency. A blurred combination of criteria makes an unclear process for determining the payment mechanisms. It is recommended that the opinions of key stakeholders be taken into consideration prior to developing payment mechanisms and financial incentives

Systematic review of priority setting studies in health research in the Islamic Republic of Iran

Background: Several research priority-setting studies have been conducted in different countries, including the Islamic Republic of Iran.

Aims: We conducted a systematic review and evaluated the quality of the priority-setting reports about health research in the Islamic Republic of Iran.

Methods: English and Farsi databases were searched from January to July 2016 to extract reports [up to December 2015] about priority setting in health research in the Islamic Republic of Iran. We constructed a checklist to extract data from the identified studies. Articles were studied in detail and content analysis was carried out. Relevant items were scored and analysed using Microsoft Excel.

Results: We identified 36 articles. Eight articles involved all the main stakeholders. About half the articles used valid criteria for ranking. Transparency was fulfilled in 13 articles. Upstream rules and regulations were ignored in 26 articles. An implementation plan was considered in 9 articles and context analysis was demonstrated in only 3.

Conclusions: Developing standard packages for priority setting, training of researchers and improving the capacity of organizations may improve the quality of priority-setting studies in the future.

Psychometric properties of an Arabic safety attitude questionnaire [short form 2006]

Objectives: There is a widespread interest in exploring healthcare providers' attitudes and perceptions about patient safety culture. This study was done to determine the reliability and validity of the Arabic version of Safety Attitude Questionnaire [SAQ] in Palestinian hospitals

Methods: This was a methodological study and the SAQ was translated into Arabic using the forward-backward translation technique. Four Ministry of Health hospitals in the Gaza Strip were randomly selected, and proportionate systematic sampling was followed to select the participants. Questionnaires were distributed to 370 physicians and nurses. Face and content validity were tested, and the content validity index was determined using the average approach. Internal consistency was assessed with Cronbach's alpha, split-half reliability, and intercorrelation between the questionnaire scales. Construct validity was assessed through exploratory and confirmatory factor analysis

Results: A total of 339 questionnaires were received, giving a response rate of 91.6%. Questionnaire acceptability was good and relevant to the study purpose. Cronbach's alpha value was 77.7 [74.7-82.2]. Goodness of fit indices from the confirmatory factor analysis showed a satisfactory model fit: comparative fit of indices [CFI = 0.797], root mean square error of approximation [RMSEA = 0.085], and standardized root square residual [SRMR = 0.074]. Factor analysis with varimax rotation revealed that six factors explained 62.3% of the variance

Conclusions: The Arabic version of SAQ [short form 2006] is valid and reliable, and shows a satisfactory model of fit. This instrument shows promise to be a sound tool to assess the safety culture in Palestinian hospitals

Relationship between the provision of injection services in ambulatory physician offices and prescribing injectable medicines

Overuse of injections is a common problem in many low-income and middle income countries. While cultural factors and attitudes of both physicians and patients are important factors, physicians› financial intensives may play an important role in overprescribing of injections. This study was designed to assess the effects of providing injection services in physicians› ambulatory offices on prescribing injectable medicines. This cross-sectional study was conducted in Tehran in 2012 -2013 and included a random sample of general physicians, pediatricians and infectious disease specialists. We collected data on the provision of injection services in or in proximity of physician offices, and obtained data from physicians› prescriptions in the previous three-month period. We analyzed the data using ANOVA, Student>s t-test and linear regression methods. We obtained complete data from 465 of 600 sampled physicians. Overall 41.9% of prescriptions contained injectable medicines. 75% of physicians offered injection services in their offices. Male physicians and general physicians were more likely to offer the services, and more likely to prescribe injectables. We observed a clear linear relationship between the injection service working hours and the proportion of prescriptions containing injectables [p-value<0.001]. Providing injection service in the office was directly linked with the proportion of prescriptions containing injectables. While provision of injection services may provide a direct financial benefit to physicians, it is unlikely to be able to substantially reduce injectable medicines› prescription without addressing the issue

Development of an eastern mediterranean region search strategy for biomedical citations indexed in PubMed

PubMed, a 'barrier-free' bibliographic database covering biomedical and health disciplines, has been successfully used to identify a multitude of indicators that assist in analyzing global trends for biomedical research productivity. The current study represents an original attempt to develop and optimize an Eastern Mediterranean Region [EMR] search strategy in PubMed to pave the way for subsequent descriptive analyses. The refined EMR search strategy contains elaborate syntaxes which facilitate controlling the search process and maintaining a proper balance between sensitivity and precision of the obtained results. Country-specific citation data were manually scanned for false positive publications. Our results indicate that publication productivity increased nearly five-fold in the EMR from 2004 to 2013. Five countries [Islamic Republic of Iran, Egypt, Saudi Arabia, Tunisia and Pakistan; in order of total publications] contributed to 80% of all EMR publications during this period. Each of the remaining 17 EMR countries contributed less than 4%. We believe that the methodology presented in this study can be used in conjunction with other metrics to extract invaluable indicators to describe EMR health research systems

Assessment of World Health Organization Collaborating Centres in the Eastern Mediterranean Region

Following in-house training, there was a need for assessing perceived performance of World Health Organization [WHO] collaborating centres in the Eastern Mediterranean Region, with special relevance to WHO's programme of work. Thus, a questionnaire was shared with responsible officers covering: selection process, frequency of communication, monitoring mechanisms, key delivered activities, and identified gaps during implementation. These included: tendency to implement regular activities, weak technical capacity and communication, and discrepancies between planned activities and actual implementation. Recommendations for centres included: establishing communication plan/modalities, selecting activities of global/regional nature, and mobilizing resources for work plan implementation. Recommendations for responsible officers included: carefully explaining updated WHO rules and regulations; ensuring that specific terms of reference are set as per WHO's global/regional mandates; setting up regular communication mechanisms; agreeing on regular monitoring and coordination modalities; and ensuring that redesignation planning takes place during the 4th year of prior designation period

Validity and reliability assessment of the Persian version of therapy-related symptom checklist

Therapy-related symptom checklist for children [TRSC-C] was developed as a symptom assessment tool in children receiving chemotherapy. The objective of the present study was to evaluate the validity and reliability of the Persian version of TRSC-C. This cross-sectional study was conducted in 2013-2014 in Tehran, Iran. TRSC-C was translated using backward-forward approach. The content validity, face validity, and comprehensiveness were investigated based on the opinion of experts. The item content validity index [I-CVI] and scale content validity index [S-CVI] were calculated by the mean approach and inter-rater agreement. The scale was revised based on the comments from a team of five experts, after which it was evaluated by an additional group of four experts. To assess the inter-rater reliability, two raters filled the scale with 29 and 30 patients in the outpatient clinic of Hazrat-e Ali Asghar Hospital. The Cronbach's alpha was calculated and factor analysis was performed. The scores of content validity were analyzed in Excel. Other statistical analyses were performed using the SPSS software version 20.0. Based on the initial assessment, the S-CVI with less conservative approach was 60% for clarity, 33% for relevancy, and 60% for simplicity. After revising the scale, the S-CVI reached 100%. The comprehensiveness and face validity of the scale were appropriate. The scale was inter-rater reliable and the Cronbach's alpha was 0.803. Eleven subscales were found in the TRSC-C. It is concluded that the Persian TRSC-C is a valid and reliable tool for measuring children symptoms. Availability of a valid and reliable checklist is a fundamental step in monitoring the symptoms of patients while receiving chemotherapy

Self-reported health-related quality of life (HRQoL) and factors affecting HRQoL among individuals with health insurance in Iran / 한국역학회지

OBJECTIVES: The aim of this study was to measure the health-related quality of life (HRQoL) and to evaluate the factors affecting HRQoL in individuals with health insurance in Tehran, Iran. METHODS: A cross-sectional analytical study was conducted using the 3-level EuroQol 5-dimensions (EQ-5D) questionnaire. In order to estimate the determinants of HRQoL, information about participants’ demographic, socioeconomic, and health status was gathered. The cluster sampling technique was used to collect data from May to June, 2016. The chi-square test and weighted least squares method were employed for data analysis. Data were analyzed using Stata version 11.0. RESULTS: A total of 600 Iranians with insurance completed the study, of whom 327 (54.5%) were male and 273 (45.5%) were female. The mean age of the participants was 41.48 years (standard deviation [SD], 14.60 years). Meanwhile, the mean duration of education was 12.36 years (SD, 4.68 years). The mean EQ-5D score was 0.74 (SD, 0.16). The most common health problems in the participants were anxiety/depression (42.3%), followed by pain/discomfort (39.2%). Sex, age, years of schooling, income, chronic disease, and body mass index had a significant effect on HRQoL (p<0.05). Healthy insured individuals, on average, had a HRQoL score 0.119 higher than that of people with a chronic disease, all else being equal (p<0.001). CONCLUSIONS: Among all determinants of HRQoL, chronic disease was found to be the highest priority for interventions to improve the health status of Iranians with insurance. This finding can help policymakers and health insurance organizations improve their planning to promote the HRQoL of individuals with insurance and society as a whole in Iran.