Socio-economic inequalities in health services utilization: a cross-sectional study.

Purpose Developing country workers mainly face important challenges when examining equality in health services utilization among the population and identifying influential factors. The purpose of this paper us to: understand health service use among households with different socio-economic status in Isfahan province; and to investigate probable inequality determinants in service utilization. Design/methodology/approach Almost 1,040 households living in Isfahan province participated in this cross-sectional study in 2013. Data were collected by a questionnaire with three sections: demographic characteristics; socio-economic status; and health services utilization. The concentration index was applied to measure inequality. Analysts used STATA 11. Findings Economic status, educational level, insurance coverage and household gender were the most influential factors on health services utilization. Those with a high socio-economic level were more likely to demand and use such services; although self-medication patterns showed an opposite trend. Practical implications Female-headed families face with more difficulties in access to basic human needs including health. Supportive policies are needed to meet their demands. Originality/value The authors used principle component analysis to assess households' economic situation, which reduced the variables into a single index.

Cost-effectiveness of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in two hospitals of Tehran city in 2014.

Background: Bariatric surgery with the improvement of obesity-related diseases, increases longevity and quality of life and is more cost-effective when compared to non-surgical Procedures. Objective: The aim of this study is to compare the cost-effectiveness of Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). METHOD: This study was performed in two stages. Initially, a cross-sectional study was carried out for costing LSG and LRYGB in Rasoul Akram and Bahman hospitals in Tehran in the year 2014. Direct costs for each surgical procedure were calculated according to the average time of surgery in both the private and public sectors. In the second stage, using Outcome (ΔBMI) collected by means of a systematic review study and cost data; cost effectiveness of two surgical procedures was examined by ICER analysis and compared with threshold limit. The Perspective of this analysis was health system. Results: The direct cost of services for LRYGB was $ 2991.5 (98121659 Rials) in the public sector and $4221.9 in the private sector. In LSG, it was $ 1952.9 (64055468 R) in the public sector and $ 3177.2 in the private sector. ICER for LSG was 720.48(23631855 R) and $716.27 (23493924 R) in private and public sector respectively. Conclusion: In this study, LSG procedure when compared to LRYGB was cost effective. The ICER obtained indicated that LSG surgery in comparison to LRYGB was $716.27 (23493924 R) and $720.48(23631855 R) in the public and private sector respectively. Moreover, per unit change in BMI was less than the threshold.

Role of Organizational Climate in Organizational Commitment: The Case of Teaching Hospitals.

OBJECTIVE: The commitment of employees is affected by several factors, including factors related to the organizational climate. The aim of this study was to investigate the relationship between organizational commitment of nurses and the organizational climate in hospital settings. METHODS: A cross-sectional study was conducted in 2014 at two teaching hospitals in Yazd, Iran. A total of 90 nurses in these hospitals participated. We used stratified random sampling of the nursing population. The required data were gathered using two valid questionnaires: Allen and Meyer's organizational commitment standard questionnaire and Halpin and Croft's Organizational Climate Description Questionnaire. Data analysis was done through SPSS 20 statistical software (IBM Corp., Armonk, NY, USA). We used descriptive statistics and Pearson's correlation coefficient for the data analysis. RESULTS: The findings indicated a positive and significant correlation between organizational commitment and organizational climate (r = 0.269, p = 0.01). There is also a significant positive relationship between avoidance of organizational climate and affective commitment (r = 0.208, p = 0.049) and between focus on production and normative and continuance commitment (r = 0.308, p = 0.003). CONCLUSION: Improving the organizational climate could be a valuable strategy for improving organizational commitment.

Is Scores Derived from the Most Internationally Applied Patient Safety Culture Assessment Tool Correct?

BACKGROUND: Hospital Survey on Patient Safety Culture, known as HSOPS, is an internationally well known and widely used tool for measuring patient safety culture in hospitals. It includes 12 dimensions with positive and negative wording questions. The distribution of these questions in different dimensions is uneven and provides the risk of acquiescence bias. The aim of this study was to assess the questionnaire against this bias. METHODS: Three hundred nurses were assigned into study and control groups randomly. Short form of HSOPS was distributed in the control group and totally reversed form of it was given to the study group. Percent positive scores and t-test were applied for data analysis. Statistical analyses were conducted using SPSS Version 16. RESULTS: Finally a total of 272 nurses completed the questionnaire. All dimensions with positive wording items in both groups had higher scores compared with their negative worded format. The first dimension "organizational learning and continued improvement" which had the only statistically significant difference, got 16.2% less score in the study group comparing the other group. In addition six out of 18 differences in questions were statistically significant. CONCLUSION: The popular and widely used HSOPS is subject to acquiescence bias. The bias might lead to exaggerate the status of some patient safety culture composites. Balancing the number of positive and negative worded items in each composite could mitigate the mentioned bias and provide a more valid estimation of different elements of patient safety culture.

Nurses' emotional intelligence impact on the quality of hospital services.

BACKGROUND: Emotional intelligence is the potential to feel, use, communicate, recognize, remember, describe, identify, learn from, manage, understand and explain emotions. Service quality also can be defined as the post-consumption assessment of the services by consumers that are determined by many variables. OBJECTIVES: This study was aimed to determine the nurses' emotional intelligence impact on the delivered services quality. MATERIALS AND METHODS: This descriptive - applied study was carried out through a cross-sectional method in 2010. The research had 2 populations comprising of patients admitted to three academic hospitals of Yazd and the hospital nurses. Sample size was calculated by sample size formula for unlimited (patients) and limited (nursing staff) populations and obtained with stratified- random method. The data was collected by 4 valid questionnaires. RESULTS: The results of study indicated that nurses' emotional intelligence has a direct effect on the hospital services quality. The study also revealed that nurse's job satisfaction and communication skills have an intermediate role in the emotional intelligence and service quality relation. CONCLUSIONS: This paper reports a new determinant of hospital services quality.