Quality of Services in the Hospitals of Iran: A Systematic Review and Meta-Analysis

Background: Quality of hospital services leads to increased patient satisfaction and ultimately improves hospital performance. This study aimed to review the quality of services in the hospitals of Iran. Methods: This systematic review and meta-analysis was carried out in 2018. Articles related to assessing quality of services in hospitals were searched in seven electronic databases, until September 2018 and appraised. Finally, 15 articles were selected and analyzed using the Comprehensive Meta-Analysis software. Results: According to the random effect model, the overall average score of patients' perception and expectation of the quality of hospital care in Iran were 7.19 (95% CI: 6.63-7.75) and 9.53 (95% CI: 8.99-10.07), respectively. The overall average score of patients' expectation of the quality of hospital care was higher in central provinces and educational hospitals. The average perception and expectation of the quality of services score decrease with increased time (P=0.0001) and increased with increase in sample size (P=0.0001). Conclusion: Overall, the quality of hospital services was lower than patients' expectations. Therefore, health managers and policy-makers should take serious steps for identifying patients' expectation and their dissatisfaction and enhance the quality of hospital services using managerial strategies. Keywords: services quality, hospital, SERVQUAL, Systematic Review, Meta-Analysis, Ira

The Effective Factors in Improving Hospital Performance Indicators from the Viewpoint of Zabol Hospital, Iran, Managers

Background: Efficiency is related to doing things right in the organization; this means making decisions to reduce costs, increase production, and to improve the quality of products. Since efficiency plays an important role in an organization’s effectiveness and outcomes, identifying the effective factors is important. The present study aims to determine the effective factors in improving hospital performance indicators and prioritizing them. Methods: The present descriptive –analytical study was carried out as a cross sectional study. The study population consisted of top, middle and operational managers of Zabol hospitals, Iran, including hospital managers, nursing managers, supervisors, and all in charge of the therapeutic, administrative, and financial units, who all participated in the study on a census bases. Data analysis was done using descriptive statistics and mean weight. Results: Bed occupancy rate (mean = 31.32), average length of stay (mean = 23.89), bed day cost (mean = 23.16) and bed turnover rate (mean = 23.14), were respectively the most important and influential factors on efficiency. Conclusion: Most mangers emphasized the necessity of more attention being paid to human resources (i.e. employing skillful and committed human resources and recruiting experienced managers) and organizational resources (accessibility and proper use of facilities) as indispensable factors in improving hospitals efficiency. Keywords: Efficiency, Hospital, Manage

Reasons for Induced Demand in the Health System: A Scoping Review

Background and Aim: Induced demand is the provision of healthcare services to patients by the influence of healthcare providers. Induced demand causes excessive use of health services, increases the waiting time for receiving health services, increases the price of health services, increases the costs and reduces the efficiency of the health system. Policymakers and health managers should take measures to reduce induced demand. Hence, they should understand the reasons for induced demand in the health system. Therefore, this research aimed to identify the reasons for induced demand in the health system. Materials and Methods: This research was carried out using the scoping review method. All published articles and documents about the reasons for induced demand in the health system until June 21, 2023 were searched in nine databases and Google Scholar search engine. Finally, 38 articles were selected and reviewed. The data were analyzed by thematic analysis method and using MAXQDA10 software. Results: Thirty-eight studies about the reasons of induced demand in the health system were published between 1974 and 2021. The number of researches in this area has been growing since 2011. Overall, 32 reasons for induced demand in the health system were identified and grouped into three categories: macro (health system), meso (health care organization) and micro (provider and receiver of health services). The most frequent reasons for healthcare induced demand in the literature include inappropriate policies, insufficient monitoring, inappropriate payment system, large number of physicians, lack of attention to clinical guidelines, financial motivation of healthcare providers, patient insurance coverage, unreasonable patients’ expectations, inappropriate price of health services, the complexity of the health service and patients’ inadequate medical knowledge. Conclusion: Induced demand has negative effects on the health system and will lead to an increase in health costs, waste of health resources, a decrease in the efficiency of the health system, and finally, a decrease in people’s access to essential health services. Several factors at different levels of the health system lead to induced demand for health services. Therefore, interventions should be systematically applied at three levels of the health system, healthcare organizations, and providers and recipients of health services to prevent and reduce healthcare induced demand

Investigating the Effects of Educational Intervention Based on the Health Belief Model in Adopting Healthy Behaviors by Type 2 Diabetic Patients in 2021

Background: The essential strategies to avoid diabetes complications are lifelong health education and self-care. This study determines the impacts of an educational intervention based on a health belief model. Methods: This quasi-experimental study was conducted on patients with type 2 diabetes using convenience sampling. They were randomly assigned to experimental (n=55) and control groups (n=55). A standard questionnaire was used to collect the data. The healthy behaviors were measured again after 3 and 6 months, and the data analysis was performed using the SPSS software, version 20. Results: The mean value of perceived susceptibility boosted in the intervention group from 18.94 before the training to 22.90 and 22.3 after 3 and 6 months of the intervention, respectively. The mean score perceived severity increased in the intervention group to 31.30 and 31.42 after 3 and 6 months of the intervention, respectively. Meanwhile, the mean score of perceived benefits increased in the intervention group from 10.06 before the training to 11.61 and 13.32 after 3 and 6 months of the intervention, respectively. The mean score of perceived barriers decreased in the intervention group from 19.50 before the training to 13.35 and 12.21 after 3 and 6 months of the intervention, respectively. The mean score of perceived self-efficacy boosted in the intervention group from 24.16 before the training to 29.44 and 29.48 after 3 and 6 months of the intervention, respectively. The mean value of cues to action boosted in the intervention group from 20.15 before the training to 22.2 and 23.2 after 3 and 6 months of the intervention, respectively. Conclusion: The results demonstrated the importance of designing educational programs based on the health belief model constructs over 3 and 6 months in adopting healthy behaviors by subjects with type 2 diabetes

Prevalence of Severe Depression in Iranian Women with Breast Cancer: A Meta-Analysis

Background. Breast cancer is one of the most common cancers in women and has mental and emotional effects, which lead to a decline in their quality of life. This study is aimed at determining the prevalence of severe depression in Iranian women with breast cancer. Methods. This meta-analysis study was conducted at Zabol University of Medical Sciences in 2019. Seven electronic databases were searched and evaluated for original research papers published on the prevalence of severe depression in Iranian women with breast cancer. Finally, 13 articles were selected and analyzed via Comprehensive Meta-Analysis software. Results. Overall, the prevalence of severe depression in Iranian women with breast cancer was 11% (95% CI (7.2, 16.5)). The highest prevalence was 44% in Tehran City in 2015 (95% CI (31, 57.9)), and the lowest prevalence was 0.8% in Qom City in 2017 (95% CI (0.01, 6.2)). A significant statistical correlation was observed between the prevalence of severe depression and sample size (p<0.05). Conclusion. According to the results of this study, the prevalence of severe depression affects more than one-tenth of women with breast cancer

The Prevalence of Depression in Iranian Pregnant Women: A Meta-Analysis

Background & Objectives: Depression is a common problem during pregnancy that can endanger the health of mother and baby. Therefore, the objective of this study was to determine the prevalence of depression in Iranian pregnant women. Methods: This study was performed using a meta-analysis from March 21, 1999 to July 21, 2020. All scientific articles on depression in Iranian pregnant women were searched in six databases as well as Google Scholar search engine and evaluated qualitatively. The heterogeneity of the studies was checked using I2 index, the possibility of publication bias was evaluated by Egger test, and meta-regression model was used to assess variables suspected of heterogeneity at significance level of 0.05. Finally, 33 studies were analysed using CMA. Results: Based on the random model, the prevalence of depression in Iranian pregnant women was 10.9% (95% confidence interval: 8.2% - 14.54%). The highest prevalence was in Bonab in 2015 as 44.8% (95% confidence interval: 36.3%-53.6%) and the lowest prevalence was in Tehran in 2001 as 0.7% (95% confidence interval: 0.4%-1.3%). There was a significant relationship between year, sample size, mean age, and the prevalence of depression in Iranian pregnant women (P <0.05). Conclusion: According to the results of this study, depression affects approximately one-tenth of pregnant women. Therefore, it is necessary to take actions such as exercise and psychotherapy to reduce depression in this group. Key¬words: Depression, Pregnant Women, Prevalence, Iran Citation: Isfahani P, Afshin M, Rasulkhani F, Azizi N. The Prevalence of Depression in Iranian Pregnant Women: A Meta-Analysis. Journal of Health Based Research 2020; 6(1): 51-65. [In Persian

Impact of unemployment on health in Iran: A scoping review of 15 years of research

Background & Objective: One of the social determinants of physical and mental health is unemployment. This has a harmful effect even when the social class, poverty, age, and history of previous illnesses are also controlled. The purpose of this study was to review the evidence of the unemployment on the health of Iranian society. Materials & Methods: This study was conducted using a scoping review to find empirical research papers published on the impact of unemployment on health in Iran from 2003 to 2018. Seven electronic databases and two search engines were searched using appropriate keywords. Bibliography section of the retrieved papers and related journals were also searched for papers that were not yet indexed in the databases. 1063 publications were identified. All retrieved papers were assessed using a valid checklist before analysis. Finally, 56 empirical studies were reviewed using MAXQDA software. Results: About 39.3 percent of articles was published in Persian on impact of unemployment on health, which 70% of them have been written since 2011. Most of the studies were conducted in Tehran, Esfahan and Eastern Azerbaijan provinces. In this study, four main themes were psychological hazards, physical dilemmas, family problems, and socioeconomic risks. Conclusion: Unemployment has the greatest impact on the dependent variable of multidimensional poverty (health). Therefore, attention to professional and occupational policies, the establishment of social welfare systems and taxation can help to expand employment and increasing the share of GDP to implement labor market programs is essential. Efforts to raise employment should be prioritized

Hospital efficiency in the eastern mediterranean region:A systematic review and meta-analysis

Background: Recent rising costs and shortages of healthcare resources make it necessary to address the issue of hospital efficiency. Increasing the efficiency of hospitals can result in the better and more sustainable achievement of their organizational goals. Objective: The purpose of this research is to examine hospital efficiency in the Eastern Mediterranean Region (EMR) using data envelopment analysis (DEA). Methods: This study is a systematic review and meta-analysis of all articles published on hospital efficiency in Eastern Mediterranean countries between January 1999 and September 2020, identified by searching PubMed through MEDLINE, Web of Science, Scopus, Science Direct, and Google Scholar. The reference lists of these articles were checked for additional relevant studies. Finally, 37 articles were selected, and data were analyzed through Comprehensive Meta-Analysis Software (v.2.2.064). Results: Using the random-effects model, the mean hospital efficiency in Eastern Mediterranean hospitals was 0.882 ± 0.01 at 95% CI. Technical efficiency (TE) was higher in some countries such as Iraq (0.976 ± 0.035), Oman (0.926 ± 0.032), and Iran (0.921 ±0.012). A significant statistical correlation was observed between the hospital efficiency and the year of publication and sample size (p &lt; 0.05). Conclusion: Efficiency plays a significant role in hospital growth and development. Therefore, it is important for healthcare managers and policymakers in the EMR to identify the causes of inefficiency, improve TE, and develop cost-effective strategies.</p

Prevalence of hospital-acquired pressure injuries in intensive care units of the Eastern Mediterranean region: a systematic review and meta-analysis

Abstract Background Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region. Methods This study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064). Results A total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05). Conclusion This systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs