Determining the frequency of defensive medicine among general practitioners in Southeast Iran

Abstract Background: Defensive medicine prompts physicians not to admit high-risk patients who need intensive care. This phenomenon not only decreases the quality of healthcare services, but also wastes scarce health resources. Defensive medicine occurs in negative and positive forms. Hence, the present study aimed to determine frequency of positive and negative defensive medicine behaviors and their underlying factors among general practitioners in Southeast Iran. Methods: The present cross-sectional study was performed among general practitioners in Southeast Iran. 423 subjects participated in the study on a census basis and a questionnaire was used for data collection. Data analysis was carried out using descriptive and analytical statistics through SPSS 20. Results: The majority of participants were male (58.2%). The mean age of physicians was 40 ± 8.5. The frequency of positive and negative defensive medicine among general practitioners in Southeast Iran was 99.8% and 79.2% respectively. A significant relationship was observed between working experience, being informed of law suits against their colleagues, and committing defensive medicine behavior (P< 0.001). Conclusion: The present study indicated high frequency of defensive medicine behavior in the Southeast Iran. So, it calls policy-makers special attention to improve the status quo

Determining the Frequency of Defensive Medicine Among General Practitioners in Southeast Iran

Background: Defensive medicine prompts physicians not to admit high-risk patients who need intensive care. This phenomenon not only decreases the quality of healthcare services, but also wastes scarce health resources. Defensive medicine occurs in negative and positive forms. Hence, the present study aimed to determine frequency of positive and negative defensive medicine behaviors and their underlying factors among general practitioners in Southeast Iran. Methods: The present cross-sectional study was performed among general practitioners in Southeast Iran. 423 subjects participated in the study on a census basis and a questionnaire was used for data collection. Data analysis was carried out using descriptive and analytical statistics through SPSS 20. Results: The majority of participants were male (58.2%). The mean age of physicians was 40 ± 8.5. The frequency of positive and negative defensive medicine among general practitioners in Southeast Iran was 99.8% and 79.2% respectively. A significant relationship was observed between working experience, being informed of law suits against their colleagues, and committing defensive medicine behavior (P< 0.001). Conclusion: The present study indicated high frequency of defensive medicine behavior in the Southeast Iran. So, it calls policy-makers special attention to improve the status quo

The Effect of Lodge on Performance Indicators of Rural Family Physicians in Health Care Centers of Jiroft and Kerman Universities of Medical Sciences

Background: Access to family physicians plays an important role in individuals&amp;#039; health and health indicators. This study aimed to determine the effect of family physicians lodge on performance indicators of rural family physicians working in health centers of Jiroft and Kerman Universities of Medical Sciences. Methods: In this cross - sectional study conducted in 2013, 26 lodge physicians (as the case group) and 26 non lodge physicians (as the control group) were selected by systematic sampling from health centers of Jiroft and Kerman Universities of Medical Sciences. Demographic information of physicians and data related to health centers and indicators were collected. Average times visiting a physician, village visit and forming health files indicators were calculated. Data were analyzed using ANOVA, t-test, chi-square and Pearson coefficient of correlations and through SPSS 16 software package. Results: There was no significant difference between the two groups in regard to demographic variables. According to t-test, there was statistically significant differences between the two groups in percentage of forming health files (P=0.05) and percentage of village visits (P=0.001); and the mean of these indicators in lodge physicians was more than that in the non- lodge physicians and there was no significant difference between the two groups in average times visiting a physician (P=0.35). Conclusion: Some strategies such as increasing the number of lodge health centers, providing transportation facilities, suitable physical spaces and equipment seem necessary in order to improve indicators

The Competitive Analysis of the Private Hospital Industry Using Porter's Competitive Diamond Model: A Case Study in Kerman 2014

Introduction: Changes in diseases pattern and increase in demand have necessitated private hospitals’ involvement in the health system. The purpose of this study was to analyze the private hospital industry in order to identify its strengths and weaknesses. Method: This qualitative study was carried out through phenomenological approach. The study participants consisted of 17 experts and chief managers of private hospitals and were selected through purposive and snowball sampling. Data collection was conducted through semi-structured interviews. The data were analyzed using framework analysis method. Results: The challenges of the private hospital industry, in the format of Porter’s diamond model, included 4 main themes and 21 minor themes. The most important challenges of private hospitals were shortage of medical equipment and facilities, old hospital building and physical environment, nursing shortage, lack of job security, and poor of management skills. The strengths of private hospitals were patient satisfaction with welfare services, good relationship between healthcare personnel and patients, and observance of the patient rights charter. Conclusion: Dominance of profit on the private sector's management viewpoint, lack of state financial support, limitations on signing contracts with a variety of supplemental insurances, and poor government monitoring are the major causes of problems in private hospitals. The realization of private-public cooperation in community health improvement can be expected through increased government support and the improvement of the quality and quantity of human, informational, and physical resources. Keywords: Private hospitals, Competition, Porter's diamond model

Identification of Effective Dimensions and Factors on Improving Patient Relationship Management Strategy in Kerman City Hospitals, Iran: A Qualitative Study

Introduction: The patient relationship management is a comprehensive strategy of reception, preservation, and cooperation of customers and gaining information about them as much as possible to create increased value for both the organization and customer. Achieving this goal in hospitals increases patient satisfaction, trust, and commitment. Therefore, this study aimed to determin the dimensions and affecting factors in boosting patient relationship management strategies in Kerman City hospitals, Iran, in 2015. Method: This functional qualitative-correlation study was conducted through phenomenological method in the city of Kerman. The research participants were 15 male and female managers, experts, physitions, assistants, nurses, and scholars in the field of healthcare and treatment, and also patients and their companies in public and private hospitals in Kerman City. Results: The six dimensions of “identifying and attracting the patient”, “patient participation”, “patient confrontation”, “patient empowerment”, “understanding patient’s expectation”, and “patient relationship” were identified as general criteria of patient relationship management in hospitals. Conclusion: Regarding the results, familiarization of hospital managers with the importance of the issue of patient relationship management must be conducted by Kerman University of Medical Sciences. Provision and operationalization of practical and theoretical guidelines for the implementation of patient relationship management strategies in three domains of staffs, equipment, and procedures are suggested. Keywords: Physician-patient relations, Nurse-patient relations, Patient satisfaction, Teaching hospitals, Qualitative researc

Role of Charities in the Health System: A Qualitative Study

Introduction: Donations are one of the resources for financing healthcare. As charities do not always work according to the objectives of health systems, numerous problems develop. This study aimed to identify charities engaged in the health sector of Kerman Province (Iran) and to describe their management, their interactions with other parts of the health system, and their problems and challenges. Method: In the present qualitative study, six charities were identified. We interviewed 15 purposefully selected individuals working in these institutions. The interviews were conducted based on structured interview guide in the form of two in-depth interviews. Data was analyzed through framework analysis. Results: Six themes were recognized regarding charity institutions management. They included institution practice scope, resourcing, type of donations, resource utilization pattern, challenges and interactions with universities and other related institutes. Conclusion: Our findings indicated that primary health issues are not amongst the priorities of the studied charities. On the other hand, as donations are not a sustainable resource, other specific resources are necessary. Donations should be directed toward the objectives of institutions. Legal and administrative obstacles have to be completely eliminated. Medical universities and other organizations should continue their mutual relationship with charities to facilitate the implementation of charities’ plans. Keywords: Charity organization, Health charities, Donatio

Study of patients absconding behavior in a general hospital at southern region of Iran

Background: Patients’ escape from hospital imposes a significant cost to patients as well as the health system. Besides, for these patients, exposure to adverse events (such as suicide, self-harm, violence and harm to hospital reputation) are more likely to occur compared to others. The present study aimed to determine the characteristics of the absconding patients in a general hospital through a case-control design in Shiraz, Iran. Methods: This case-control study was conducted on 413 absconded patients as case and 413 patients as control in a large general hospital in Shiraz, southern Iran. In this study, data on the case and control patients was collected from the medical records using a standard checklist in the period of 2011–3. Then, the data were analyzed using descriptive and analytical statistics, through SPSS 16. Results: The finding showed that 413 patients absconded (0.50%) and mean of age in case group was 40.98 ± 16.31 years. In univariate analysis, variables of gender [Odds Ratio (OR)= 2], ward (OR= 1.22), insurance status (OR= 0.41), job status (OR= 0.34) and residence expenditure were significant. However, in multivariate analysis significant variables were age (OR adj = 0.13), gender (OR adj = 2.15), self-employment/unemployed (OR adj = 0.47), emergency/admission (OR adj = 2.14), internal/admission (OR adj = 3.16), insurance status (OR adj = 4.49) and residence expenditure (OR adj = 1.15). Conclusion: Characteristics such as middle age, male gender, no insurance coverage, inability to afford hospital expenditures and admission in emergency department make patients more likely abscond from the hospital. Therefore, it may be necessary to focus efforts on high-risk groups and increase insurance coverage in the country to prevent absconding from hospital

Informal Payments in Healthcare: A Case Study of Kerman Province in Iran

Background: Informal payments for health care, which are common in many countries, can have negative effects on health care access, equity and health status as they lead people to forgo or delay seeking care, or to sell assets to pay for care. Many countries are putting reforms in place with the aim of reducing informal payments. In order to be successful, such policies should be informed by the underlying causes of such payments. This study attempts to explore why, how, and in what ways informal payments occur. Methods: We conducted face-to-face interviews with a purposeful sample of 45 participants, including patients, healthcare providers and officials, in Kerman province in Iran, in 2010. The research participants were asked about the nature of informal payments, the reasons behind both asking and making those payments. We analysed the data using content analysis. Results: We found that people make informal payments for several reasons, namely cultural, quality- related and legal. Providers ask for informal payments because of tariffs, structural and moral reasons, and to demonstrate their competence. Informal payments were found to be more prevalent for complex procedures and are usually asked for directly. Conclusion: Informal payments are present in Iran’s health system as in other countries. What makes Iran’s condition slightly different from other countries is the peculiarity of reasons behind asking informal payments and the disadvantages associated with these kinds of payments. Iran could overcome this dilemma by precise investigation of the reasons to inform appropriate policy formulation. Some policies such as raising salaries, justifying the tariffs and cost-sharing, defining a benefits package of services, and improving accountability and transparency in the health system could be taken by the government to alleviate the proble

What determines utilization of dental care services? The case of Iran

BACKGROUND AND AIM: Identifying the factors affecting utilization of dental services is one of the best ways to improve the health status. This study aimed to investigate the effective factors on utilization of dental services. METHODS: In this cross-sectional study, 1185 household heads were selected randomly, and using a researcher-made questionnaire based on World Health Organization (WHO) Global Health Survey and Andersen behavioral model, and through multivariate logistic regression, the predictors of visiting a dentist during 1 year ago were investigated in 2017. The households’ income inequality in utilization of dental services was analyzed using concentration indices (CIs) and Pearson chi2 in STATA software. RESULTS: The predictor of dental visit during 1 year ago for men was having decayed teeth [odds ratio (OR) = 1.3, P = 0.030], and the predictors for women were lower ages (OR = 0.8, P = 0.001 for 19-29 years old and so on), having 32 natural teeth (OR = 0.7, P = 0.020), and employment (OR = 1.3, P = 0.048). The common predictors were increase in education level (OR = 1.4, P = 0.001 for men, and OR = 1.7, P = 0.001 for women with university degree), brushing (OR = 1.9; P = 0.001 for women, and OR = 1.3; P = 0.040 for men), and having supplementary insurance (OR = 1.7, P = 0.001 for men, and OR = 1.9, P = 0.001 for women). Being burdensome of dental care costs during 3 years ago (CI: -0.074, P = 0.001), avoiding visiting a dentist during 1 (CI: -0.501, P = 0.001) and 3 (CI: -0.501, P = 0.001) years ago because of its costs, and failure to do all dentistry recommendations during 3 years ago (CI: -0.516, P = 0.001) happen more frequently among the poor. Moreover, the poor used all dental services such as scaling (CI: -0.638, P = 0.001), filling (CI: -0.458, P = 0.001), and root canal (CI: -0.524, P = 0.001) less than the rich. CONCLUSION: Dental health status is negatively affected by population socio-economic situation; therefore, it is necessary to implement policies to improve access to dental services among the undeserved. KEYWORDS: Utilization; Dental Care; Iran Citation: Amiresmaili M, Amini S, Shahrava