Financial and Economic Criteria for Evaluating the Performance of Pharmacies

Improving the economic performance of pharmacies need to economic and financial indicators. Despite this necessity, economic and financial performance indicators have not been identified comprehensively in the pharmacy setting. Thus the aim of this study is to determine the economic and financial performance assessment criteria of the pharmacies by specialist’s point of view. This study is a qualitative study in which experts and professional’s point of view were gathered by focus group discussion. 15 health system experts were selected by purposive sampling approach. Data from focus group discussions (FGD) were analyzed by thematic analysis method. Twelve main themes in two scopes were obtained to assess the economic and financial performance of the pharmacy by review of specialists view. These themes are waste rate, profitability, cost control, financial management, economic and political issues, pharmacist, doctor, medical insurance, management system, pharmaceutical companies, cultural issues and public or private administration system of pharmacy.Based on the results of this study, the most important criteria to evaluate the financial and economic performance of pharmacies were identified. These results can be used for to economic and financial performance evaluation of pharmacies

Health care seeking behaviors in type 2 diabetic patients in East Azerbaijan

Background. Timely and effective use of health care services is essential to delay or prevent complications and reduce the burden of diabetes. Positive health care seeking behaviors can improve diabetes control and, as a result, reduce the incidence of the complications. So, this study aimed to investigate the status of health care seeking behaviors and affecting factors in type 2 diabetic patients. Materials and methods. This was a cross-sectional study. There were 1139 patients with type 2 diabetes aged > 18 years selected who referred to educational hospitals, Endocrinologist office, primary health care centers, and Clinics. Data collected using a researchermade questionnaire and analyzed using SPSS software version 22. Results. 36.3% of diabetic patients initially referred to a physician in the event of illness symptoms, and 70.7% of patients referred to a physician in case of exacerbating of disease symptoms. 58.4% of patients preferred to consult a specialist directly. 78.85 of patients reported that they had referred to a physician on a regular basis and 59.9% of patients followed up their treatment process on a regular basis. The physician was the main source of information for the majority of patients. Income, education and health insurance status, disease severity, chronicity of DM, the history of hospitalization due to DM were the affecting factors on health care seeking behaviors (p < 0.05). Conclusion. Most of the diabetics often did not follow the official structure of health care providing to manage their illness, and despite the referral system and family practitioner program more than half of the patients went directly to the specialist physician’s office. Factors related to the patient (an income and education status), disease characteristics (disease severity, chronicity of DM and the history of hospitalization due to DM) and health care system factors (type of the basic insurance and supplementary insurance status) affect the health care seeking behaviors

Cost-savings of community water fluoridation program; Kerman, Iran, 2016

BACKGROUND AND AIM: Oral diseases are very important because they impose economic and social burden on societies. Given the resource scarcity, it is necessary to devise cost-effective and scientific strategies to prevent and control oral diseases. This study aimed to estimate the potential cost-savings for dental caries treatment associated with Community Water Fluoridation Program (CWFP) in Kerman, Iran. METHODS: An economic model to compare the costs of CWFP with treatment savings achieved through averted tooth decay was developed. Direct cost of prevented caries was taken equal to treatment savings. Implementation cost and the associated savings was estimated for Kerman in 2016. We obtained required data and parameters for costs and savings estimation through published documents and other sources. RESULTS: Annual cost-savings associated with implementing the water fluoridation in Kerman was estimated about $11160415.5 to$44350544.11. About $34.9 to$136 could be achieved per each dollar spent. Annual cost and benefit per capita was $0.66 and$23.4-$91.09 respectively. Net benefit per capita was$22.7 to $90.4. CONCLUSION: This study indicates significant annual savings from CWFP; additional savings could be achieved if this program is implemented in other regions. We could also receive even more if this program is integrated with other public oral health programs such as screening school children, community dentistry and oral health education. KEYWORDS: Water Fluoridation; Dental Caries; Cost Savings; Cost-Benefit; Oral Healt

Effectiveness of nutrition education and counseling on metabolic control parameters of diabetes mellitus type 2 patients in primary health care centers

Background. Diet compliance is an essential part of the treatment and control of diabetes. The present study aimed to determine the effectiveness of education and face to face diet counseling on metabolic control parameters of patients with type 2 diabetes in primary health care centers. Methods. This quasi-experimental study was conducted on 90 T2DM patients who referred to Andimeshk community health centers in 2018. Patients were randomly divided into two intervention (n = 45) and control (n = 45) groups. Data were analyzed by independent t-test, paired t-test and Chi-square using SPSS-18 software. Results. Sixteen weeks after the implementation of the nutrition education and counseling program, there was a significant decrease in the clinical, anthropometric, and biochemical parameters of the intervention group (P < 0.001). However, none of the parameters were significantly decreased in the control group (P > 0.05). Conclusion. The research findings show that the implementation of group education program, along with individual nutrition counseling, is very effective and can lead to weight loss, improved blood pressure and better control of blood glucose and lipids in T2DM patients. Therefore, the combination of education and counseling as two complementary methods in the treatment and control of diseases such as diabetes seems essential and effective

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Financial protection and equity in the healthcare financing system in Iran: a cross-sectional study among slum dwellers with type 2 diabetes

Objectives This study was conducted to assess financial protection and equity in the healthcare financing system among slum dwellers with type 2 diabetes (T2D) in Iran in 2022.Design Cross-sectional study.Setting Primary care centres in Iran were selected from slums.Participants Our study included 400 participants with T2D using a systematic random sampling method. Patients were included if they lived in slums for at least five consecutive years, were over 18 years old and did not have intellectual disabilities.Primary and secondary measures A self-report questionnaire was used to assess cost-coping strategies vis-à-vis T2D expenditures and factors influencing them, as well as forgone care among slum dwellers.Results Of the 400 patients who participated, 53.8% were female. Among the participants, 27.8% were illiterate, but 30.3% could read and write. 75.8% had income below 40 million Rial. There was an association between age, education, income, basic insurance, supplemental insurance and cost-coping strategies (p<0.001). 88.2% of those with first university degree used health insurance and 34% of illiterate people used personal savings. 79.8% of people with income over 4 million Rial reported using insurance to cope with healthcare costs while 55% of those with income under 4 million Rial reported using personal savings and a combination of health insurance and personal savings to cope with healthcare costs. As a result of binary logistic regression, illiterate people (adjusted OR=16, 95% CI 3.65 to 70.17), individuals with low income (OR 5.024, 95% CI 2.42 to 10.41) and people without supplemental insurance (OR 1.885, 95% CI 0.03 to 0.37) are more likely to use other forms of cost-coping strategies than health insurance.Conclusions As a result of insufficient use of insurance, cost-coping strategies used by slum dwellers vis-à-vis T2D expenditures do not protect them from financial risks. Expanding universal health coverage and providing supplemental insurance for those with T2D living in slums are recommended. Iran Health Insurance should adequately cover the costs of T2D care for slum dwellers so that they do not need to use alternative strategies

Performance analysis of hospitals before and during the COVID-19 in Iran: A cross-sectional study

Background and objective The COVID-19 pandemic placed considerable pressure on the health care systems and caused many disruptions to the care hospital system around the globe. This study aimed to analyze the performance of hospitals affiliated with the University of Medical Sciences and Health Services of South Khorasan Province before and during COVID-19. Method This cross-sectional study tracked the financial performance (FP) and service performance (SP) of 12 hospitals affiliated with South Khorasan University of Medical Sciences and Health Services using the Farabar system and Hospital Information System (HIS). Our study covered two time periods: from February 2018 to February 2020 (pre-COVID-19) and from February 2020 to February 2021 (during COVID-19). SP analysis of hospitals was performed by examining the trend of monthly changes before and during the COVID-19 pandemic and analyzed using SPSS software version 22 and Paired Sample T-Test. FP of hospitals was analyzed through relevant ratios and analyzed using Microsoft Office Excel. Results Most SP indicators decreased considerably in all hospitals during COVID-19. FP ratios (e.g., activity and leverage ratios) increased during either or both pre-COVID or COVID periods. Compared to before COVID-19, the operating margin ratio and operating expenses coverage from operating income increased from -0.50 and 66.55 to -1.42 and 41.32, respectively, during COVID-19. Moreover, the net profit margin ratio and Return On Assets (ROA) ratio were increased during COVID-19. Conclusion COVID-19 has decreased the FP and SP of hospitals due to limitations in providing services to patients since the beginning of COVID-19. Measures such as providing various financing resources and improving the financial resilience of hospitals are essential. Funds should be disbursed to offset hospitals’ losses due to reduced elective and outpatient revenue. Policymakers should come up with holistic policies to tackle the adverse impact of such crises in the future, support hospitals financially, and consider allocating additional funding to them during emergencies

Barriers to health care utilization among patients with type 2 diabetes living in slums: a qualitative study from providers' perspective

Abstract Background Due to slum dwellers' deprivation, they are more likely to develop Type 2 Diabetes (T2D) and its complications. Type 2 Diabetes is a long-life disease that requires continuous health care utilization. One of the negative outcomes of slum-dwelling is health care underutilization. Therefore, this study aimed to understand barriers to health care utilization among those with T2D living in Tabriz slums, Iran, from the perspective of healthcare providers, in 2022. Methods A phenomenological approach was used in this study. Purposive sampling for conducting in-depth interviews was used to select 23 providers consisting of general practitioners, midwives, nutritionists, and public health experts. We conducted a content analysis using the 7 stages recommended by Colaizzi. We used four criteria recommended by Lincoln and Guba for ensuring the research’s trustworthiness. Results Three main themes and 8 categories were developed. Three main themes are 1) health care provision system barriers, including four categories: lack of motivation, non-availability of facilities and doctors, poor relationship between patients and providers, and disruption in the process 2) coverage problems, including two categories: insurance inefficiency, and limited access, and 3) contextual barriers, including two categories: environmental problems, and socioeconomic barriers. Conclusions Recommendations are presented in three levels to improve implementation. The health care system needs to modify the payment methods, Patients-providers relationship improvement, and increase the number of providers. Insurance organizations should consider sufficient coverage of costs for slum-dwellers with T2D and expand the benefits package for them. Government should consider infrastructure upgrading in slums to eliminate barriers related to slum-dwelling. Overall, health care utilization promotion needs intersection cooperation

Development of diploid pollinator for resistance to powdery mildew disease in sugar beet

For development of pollinator parent resistant to powdery mildew disease of sugar beet, relatively resistant 14442 population was used. Based on resistance index, 50 resisitant plants were selected to produce half sib family(H.S.F). After random pollination between these 50 plants, seed of H.S.F was harvesed. From these 50 plants, only 39 plants had produced enough seed. Next year these H.S.F were planted in one raw plots with six replications and evaluated for disease resistance. After evaluation, 3 H.S.Fs (H.S.F13, H.S.F24 and H.S.F35) with high level of resistance were selected. From those 3 families, 150 roots were selected to produce new half sib families (N.H.S.F). Between these 150 families only 88 roots produced enough seed. In the next cycle, 88 N.H.S.F were evaluated for disease resistance and 3 N.H.S.F (H.S.F5, H.S.F17 and H.S.F22) with high level of resistance were selected. From each N.H.S.F, 35 roots were selected to produces. In the cage, from 105 roots only  13 plants produced enough seed. In the next year 13, S1 again evaluated again for disease resistance. Low level of infection (12.9 %) was observed in the S1 lines. Therefore, selection in the 14442 population for powdery mildew resistance was very effective, and plants selected in this method showed 72.6 % selection progress. Because of the good resisitance of the S1 lines, they could be used to develop powdery mildew resistance varieties

Smoking Prevention Programs Based on Schools Health Profile in the Viewpoint of School Administrators and Health Educators of Tabriz

Background: Smoking is a global issue, Iran as one of the youngest contemporary societies, is involved in this dilemma. Therefore, this study was conducted with the aim of studying the implementation of programs and policies on preventing and controlling smoking in schools in Tabriz in 2017 using school health profiles from the viewpoint of school administrators and health educators. Methods: This is a cross-sectional study. The statistical population included all school administrators and health educators in Tabriz in 2017. In the first stage, stratified proportional sampling and in the second stage systematic randomized sampling was applied. The data collection tool was schools health profiles. Relevant questionnaires were filled out by school administrators and health instructors. The data were analyzed by SPSS version 22 using descriptive statistics (frequency and percentage). Results: 34.4% of schools had an approved policy on tobacco prohibition and 65.6% had no approved or coherent policies or programs on prohibition of smoking. The average and standard deviation of schools based on the use of teaching materials related to smoking prevention and control was 36.14 ± 40.57 out of 100. Most activities were related to the training of short-term and long-term health effects of smoking (50%) and the least activities were related to the provision of health services for preventing and quitting smoking (23.3%). Conclusion: Most schools in Tabriz do not apply any smoking policy. Most schools also do nothing about preventing and controlling smoking outside the schools. Educational materials do not have necessary information in this regard to be taught by teachers. As a result, health managers and policy makers, in collaboration with school administrators and health educators, need to plan and take steps to develop appropriate programs, policies and materials for preventing and controlling smoking