Investigation of administrative obstacles to family physician program in urban areas of Iran

Health is regarded as one of the basic rights of each person in society; so governments are obligated to provide it equally for everyone. The best way to achieve this goal is the establishment of health insurance with the orientation of family physician and the strategic referral system. Yet, such programs will not be successful without encouraging people to participate and changing social behaviors. The aim of the present study was to investigate the administrative obstacles and problems to family physician program in urban areas of Iran. This study was a qualitative research conducted. A purposive sampling method was employed and the data were gathered via semi-structured interview with open-ended questions and document examination. All the interviews were recorded digitally and immediately transcribed verbatim. They were finally analyzed based on framework analysis. The participants' detailed descriptions showed that systemic, environmental, and human related factors were the main obstacles to the implementation of family physician plan. Since the success and performance of each program effectively cannot be obtained without people’s acceptance and collaboration, the necessity of training and giving information rapidly and timely to the residents in urban areas is felt more than ever. Also, making authorities aware of the obstacles expressed by people can be helpful in harmonizing the program with people’s requests; and can result in overcoming the challenges and obstacles facing the program

The Impact of Public and Private Health Expenditures on Poverty in developing countries

Background & Objectives: Changes in twenty-first century and incidence of development gap among countries has caused particular attention of all economic schools to the problem of poverty and the factors affecting it, as a consequence of underdevelopment. Health and health expenditures are considered as a tool for governments to get out from poverty. Methods: This study is one type of econometric studies with using panel data for Iran and 30 developing countries during 2005 to 2012. To determine the effect of health expenditures on poverty headcount ratio, Hassman and Chow tests were used in order to select the type of random or fixed effect regression model. Data analysis was done through Eviews 6 software. Results: Among factors affecting poverty, health expenditure had more significant impact on poverty. So that, one unit increase in public and private health expenditures caused respectively -2.93 decrease and 1.19 unit increase in headcount poverty ratio. In comparison to health expenditure, access to health facilities and primary school enrollment rate with respectively coefficients of -0.81 and 0.34 had less impact on poverty headcount ratio. Conclusion: Governments should pay more attention to policies of financing health sector and more expansion of governmental functions in financial support of health sector rather than private sector. Key­words: Public Health Expenditure, Private Health Expenditure, Poverty Headcount Ratio Citation: Harati J, Harati Khalilabad T, Rezapour A. The Impact of Public and Private Health Expenditures on Poverty in developing countries: 2005– 2012. Journal of Health Based Research 2017; 2(4): 345-354

Identification determinant factors on willingness to pay for health services in Iran

Abstract Background A common method used to examine the relationship between internal preferences and caring externalities is willingness to pay (WTP) approach. We aimed to estimate WTP for health status with different severity level and identify determinant factors on WTP. Methods For determining main factors in WTP, a cross-sectional study was conducted in Shiraz in the southeast of Iran, in March to April 2015. The open-ended method was used to estimate monthly WTP in private and altruistic section. Multivariate regression analyses using ordinary least squares were applied to examine the effect of Scio–demographic factors on WTP using SPSS software 21. Results Participants were willing to pay an average amount of $295 in health status 1 and an average amount of$ 596 in health status 6 (worst status) for internal preferences. Altruistic WTP for health status 1 was $294 and participants were willing to pay an average amount of$ 416 in health status 6. Multiple regression analysis identified monthly income as the key determinant of WTP for internal preferences and caring externalities (P < 0.01). With an increase of 1% in income, private WTP increase 1.38% in health status 1. Conclusions The finding indicates that the mean of WTP increases at severe health status; therefore, health policy maker should allocate resources toward severe health status

Occurrence and types of medication error and its associated factors in a reference teaching hospital in northeastern Iran: a retrospective study of medical records

Abstract Background Medication errors are categorized among the most common medical errors that may lead to irreparable damages to patients and impose huge costs on the health system. A correct understanding of the prevalence of medication errors and the factors affecting their occurrence is indispensable to prevent such errors. The purpose of this study was to investigate the prevalence and types of medication errors among nurses in a hospital in northeastern Iran. Methods The present descriptive-analytical research was conducted on 147 medical records of patients admitted to the Department of Internal Medicine at a hospital in northeastern Iran in 2019, selected by systematic sampling. The data were collected through a researcher-made checklist containing the demographic profiles of the nurses, the number of doctor's orders, the number of medication errors and the type of medication error, and were finally analyzed using STATA version 11 software at a significance level of 0.05. Results Based on the findings of this study, the mean prevalence of medication error per each medical case was 2.42. Giving non-prescription medicine (47.8%) was the highest and using the wrong form of the drug (3.9%) was the lowest medication error. In addition, there was no statistically significant relationship between medication error and the age, gender and marital status of nurses (p > 0.05), while the prevalence of medication error in corporate nurses was 1.76 times higher than that of nurses with permanent employment status (IRR = 1.76, p = 0.009). The prevalence of medication error in the morning shift (IRR = 0.65, p = 0.001) and evening shift (IRR = 0.69, p = 0.011) was significantly lower than that in the night shift. Conclusion Estimating the prevalence and types of medication errors and identified risk factors allows for more targeted interventions. According to the findings of the study, training nurses, adopting an evidence-based care approach and creating interaction and coordination between nurses and pharmacists in the hospital can play an effective role in reducing the medication error of nurses. However, further research is needed to evaluate the effectiveness of interventions to reduce the prevalence of medication errors

The cost-effectiveness of neoadjuvant chemotherapy in women with locally advanced breast cancer: Adriamycin and cyclophosphamide in comparison with paclitaxel and gemcitabine

Background: A decision analysis model was developed to assess the cost-effectiveness of adriamycin and cyclophosphamide (AC) in comparison with paclitaxel and gemcitabine (PG) in women with advanced breast cancer in Iran. Materials and Methods: This is a cost-effectiveness analysis performed as a cross-sectional study in Namazi Hospital in Shiraz, Iran. Patients were divided into two groups by random numbers, 32 women in the AC group and 32 women in the PG group. The costs were measured using the societal perspective and effectiveness of 2 regimens were assessed using tumor response. By a decision tree, the incremental cost-effectiveness ratio was calculated. In addition, the robustness of results was examined by sensitivity analysis. Results: The estimated total cost of AC and PG per patient was 1565.23 ± 765.31 and 2099.08 ± 926.99, respectively. Response to treatment in AC and PG arm were 84% versus 75% respectively. The incremental cost-effectiveness ratio results showed AC is a dominate alternative. Conclusion: Overall, AC was a simple dominate strategy. In other words, AC was estimated to have a lower cost and greater effectiveness than PG

The cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancers

Abstract Purpose Intensity-modulated radiotherapy is developed as a replacement for 3-dimensional conformal radiation therapy. Considering the difference in costs and effectiveness of these interventions, the aim of this study was to compare the cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancer in east of Iran. Methods A Markov model including six states based on xerostomia and dysphagia was developed to estimate the incremental cost effectiveness ratio from the perspective of societal. Cost and quality of life data were collected from 97 respondents via a checklist and EuroQol-5Dimension questionnaire. The robustness of results was examined by deterministic and probabilistic sensitivity analysis. All analysis were conducted with Treeage software. Results The results of this study showed that the cost and quality adjusted life years for 3-dimensional conformal radiation therapy were 9209.76 and 3.63 respectively. However, the cost and quality adjusted life years for intensity-modulated radiotherapy were 12562.90 and 3.17 respectively. Therefore, 3-dimensional conformal radiation therapy produced 0.45 more quality adjusted life years than intensity-modulated radiotherapy and saved $3353. According to the incremental cost effectiveness ratio, 3-dimensional conformal radiation therapy as compared to intensity-modulated radiotherapy saved$7367.27 per quality adjusted life years. These results confirmed by sensitivity analysis. Conclusion This study concluded that in the treatment of head and neck cancer, the 3-dimensional conformal radiation therapy method appears to be cost-effective when compared with intensity-modulated radiotherapy

The global economic burden of COVID-19 disease: a comprehensive systematic review and meta-analysis

Abstract Background The COVID-19 pandemic has caused a considerable threat to the economics of patients, health systems, and society. Objectives This meta-analysis aims to quantitatively assess the global economic burden of COVID-19. Methods A comprehensive search was performed in the PubMed, Scopus, and Web of Science databases to identify studies examining the economic impact of COVID-19. The selected studies were classified into two categories based on the cost-of-illness (COI) study approach: top-down and bottom-up studies. The results of top-down COI studies were presented by calculating the average costs as a percentage of gross domestic product (GDP) and health expenditures. Conversely, the findings of bottom-up studies were analyzed through meta-analysis using the standardized mean difference. Results The implemented search strategy yielded 3271 records, of which 27 studies met the inclusion criteria, consisting of 7 top-down and 20 bottom-up studies. The included studies were conducted in various countries, including the USA (5), China (5), Spain (2), Brazil (2), South Korea (2), India (2), and one study each in Italy, South Africa, the Philippines, Greece, Iran, Kenya, Nigeria, and the Kingdom of Saudi Arabia. The results of the top-down studies indicated that indirect costs represent 10.53% of GDP, while the total estimated cost accounts for 85.91% of healthcare expenditures and 9.13% of GDP. In contrast, the bottom-up studies revealed that the average direct medical costs ranged from US $1264 to US$79,315. The meta-analysis demonstrated that the medical costs for COVID-19 patients in the intensive care unit (ICU) were approximately twice as high as those for patients in general wards, with a range from 0.05 to 3.48 times higher. Conclusions Our study indicates that the COVID-19 pandemic has imposed a significant economic burden worldwide, with varying degrees of impact across countries. The findings of our study, along with those of other research, underscore the vital role of economic consequences in the post-COVID-19 era for communities and families. Therefore, policymakers and health administrators should prioritize economic programs and accord them heightened attention

Catastrophic health expenditure of chronic diseases: Evidence from Hamadan, Iran

Background: Chronic noncommunicable diseases (NCDs) could increase the risk of catastrophic health expenditure (CHE). The present study aims to analyze CHE among households with and without chronic NCDs in Hamedan. Methods: In this cross-sectional study, 780 households' patients, who were being discharged from hospitals in Hamedan, were selected using a proportional stratified random sampling method. Required data were collected through interview and observation using World Health Organization standard questionnaire. A household with chronic NCDs is defined as the one with ≥1 chronic disease patient. Both descriptive and analytical statistics, as well as different approaches and thresholds, were used to study CHE among households. Results: The households with chronic disease had higher incidence and intensity of CHE in all approaches and threshold. This result was shown through distributive-sensitive measures. The Regression analysis revealed that lower economic status, lower household size, and high utilization of health care were associated with the CHE incidence and intensity in the households with chronic NCDs in Hamedan. Conclusions: There is a high degree of CHE were caused by chronic NCDs. By thoughtful reconsideration in health-care financing, along with addressing relevant socioeconomic factors, the health system of Iran could cope with financial adversities caused by chronic NCDs

Quality of Life in Breast Cancer Patients using Neoadjuvant AC (Doxorubicin and Cyclophosphamide) in Comparison with PG (Paclitaxel and Gemcitabine) Therapy

Background: Quality of life has become a part of the evaluation criteria for cancer therapy. The aim of this study was to evaluate the quality of life in breast cancer patients under chemotherapy regimens that contained doxorubicin and cyclophosphamide (AC) compared to paclitaxel and gemcitabine (PG). Methods: This cohort study evaluated 100 women with breast cancer treated by doxorubicin and cyclophosphamide or gemcitabine and paclitaxel regimens. We used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Core 30 to assess health related quality of life at the beginning and end of chemotherapy. Data were analyzed by the independent t-test at a significance level of 0.05. Results: Most of the 100 patients were married (68%), aged 41-50 years (36%), non-college educated (76%), and had insurance (97%). The mean quality of life scores at the first session of chemotherapy and prior to the onset of treatment-related adverse events were 71.33 for the doxorubicin and cyclophosphamide groups and 71.15 for the gemcitabine and paclitaxel groups. Analysis of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 at the last chemotherapy session showed that the quality of life in both groups deteriorated as a result of side effects. The mean of quality of life scores at the first session of chemotherapy were 66.49 for the doxorubicin and cyclophosphamide group and 59.99 for the gemcitabine and paclitaxel group. Conclusion: Strategies to improve the emotional and role functions of the patients who undergo treatment should be given priority. Financial difficulties faced by breast cancer patients should be addressed from a policy making level at the initiating health financing system