A Scoping Review of Components of Physician-induced Demand for Designing a Conceptual Framework / 예방의학회지

OBJECTIVES: The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions. METHODS: This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework. RESULTS: The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage. CONCLUSIONS: A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.

A Scoping Review of Components of Physician-induced Demand for Designing a Conceptual Framework / 예방의학회지

OBJECTIVES@#The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions.@*METHODS@#This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework.@*RESULTS@#The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage.@*CONCLUSIONS@#A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.

Factors associated with delay in thrombolytic therapy in patients with ST-elevation myocardial infarction

Treatment delay in the management of ST-elevation myocardial infarction conversely correlates with prognosis and survival of the patients. This study aimed to investigate factors associated with delay in the thrombolytic therapy of these patients in Tehran. Between 2007 and 2010, the interval between the self-reported time of the onset of symptoms and initiation of the thrombolytic agent in 513 patients with a diagnosis of acute ST-elevation myocardial infarction was recorded. Medical history and socio-demographic characteristics of the patients treated within two hours after the onset of symptoms and patients treated after two hours from the onset of symptoms were compared, and the odds ratios were calculated using logistic regression. The mean age of the patients was 61.2 [SD = 11.1] years, and 76% of the patients were male. The median time between the onset of symptoms and treatment was 158 [SD = 30.4] minutes. Mean for decision time was 61 [SD = 19], which was responsible for 83% of the entire treatment delay. The mean transportation time was 34 [SD = 12] minutes, and the median door-to-needle time was 44 minutes. Odds ratio for history of diabetes mellitus was 1.90 [95% CI: 1.26-2.87], for hypertension was 1.55 [95% CI: 1.08-2.23], and for prior coronary heart disease was 1.47 [95% CI: 1.17-1.84]. The most important factor associated with delay in treatment was decision time. Improving emergency medical services dispatch time, obtaining pre-hospital electrocardiograms for early diagnosis, and pre-hospital initiation of thrombolytic therapy may reduce the delay time

[ motives of medical students in Tehran university for choosing medicine field and their for their profession: qualitative versus quantitative approach]

It seems that in our country choosing medicine as the field of study in university is mostly due to family and society pressures rather than the applicant's real interest in this field. To determine medical students' motives for choosing medicine and their outlooks for this profession by using two qualitative and quantitative approaches. The qualitative part includes two focus group discussions with interns, and one focus group discussion with fresh students. In the quantitative part, complementary to the qualitative section, the causes of choosing medicine field and the rate of students' and applicants' awareness toward the future statue of their profession were studied. For this purpose, 33 fresh students, 107 interns, and 88 applicants of medicine field after taking the entrance examination were selected through convenient and consecutive sampling and were asked to complete the designated questionnaire. In the qualitative part, everybody agreed that the applicants' own preference is not determining, and almost all of the students mentioned the social prestige of a physician and medical field as the main cause of choosing this field. In the quantitative part, interest in the scientific content of this field [in 42%], the role of physician in health improvement [in 21%], financial income [in 14.3%], the social prestige of physician [in 13%] and the pressure of family and society [in 1%] were mentioned as the main causes of choosing medicine field. On the other hand, participants in the qualitative part of the study didn't have a good outlook for the professional status of general practitioners and some of them believed that continuing studies in medicine field is more difficult than other fields. In the quantitative part of study, as the age of participants increased they more asserted that in medical field the possibility of continuing studies, finding job in good area, and with good income is less compared with other fields. The results of this study revealed that many students have not adequate awareness toward the medicine field and in choosing this field they are mostly under the influence of factors such as the pressure of family and the social prestige of the physicians. Although these aspects were not obvious in the quantitative part of the study, they were confirmed by all of the participants in the qualitative section of the study. This fact denotes the importance of qualitative approaches or the combination of qualitative and quantitative designs. On the other hand, since with increase in the age of students their awareness toward the future statue of their field improves, it is suggested that admission is not confined to academic criteria and appropriate meta-cognitive characteristics of applicants are also considered in admitting the students