Evaluation of responsiveness to non-clinical demands of patients in Iran: a quantitative study on the university hospitals in Bushehr

  Background: Responsiveness along with health promotion and financial risk protection plays a pivotal role in health systems. The present study aimed to examine responsiveness in hospitals affiliated to Bushehr University of Medical Sciences, in the south-west of Iran.  Methods: In a cross-sectional study, the statistical population consisted of the patients referring to two university hospitals in Bushehr, namely Persian Gulf Hospital and Bushehr Heart Center. In total, 402 patients were selected using the stratified random sampling method. Data was collected using a demographic questionnaire and the validated Persian version of the standard World Health Organization questionnaire on health system responsiveness to assess responsiveness level during 2015.    Results: Responsiveness level was statistically different between the two hospitals (2.3±0.58 and 2.7±0.50, respectively). In general, “access to social support” (3±0.93) and “choice of health provider” (1.7±0.93) obtained the highest and lowest scores. Apart from “confidentiality” and “access to social support,” a statistically significant difference was observed in other domains (dignity”, “autonomy”, “communication”, “quality of basic amenities”, “choice of health care provider”, and “prompt attention” (between the two hospitals.  Conclusion: University hospitals studied had an average performance regarding responsiveness. It seems necessary to pay more attention to two domains of responsiveness including choice of health provider and autonomy in the hospitals

Avoidable Mortality Differences between Rural and Urban Residents During 2004–2011: A Case Study in Iran

Background: Avoidable mortality as an indicator for assessing the health system performance has caught the attention of researchers for a long time. In this study we aimed to compare the health system performance using this indicator in rural and urban areas of one of Iran’s southern provinces. Methods: All deaths (29916) which happened during 2004–2011 in Bushehr province were assessed. Nolte and McKee’s avoidable deaths model was used to distinguish avoidable and unavoidable conditions. Accordingly, all deaths were classified into four categories including three avoidable death categories and one unavoidable death category. STATA software was used to conduct Poisson Regression Test and age-standardized death rate. Results: Findings showed that avoidable mortality rates declined in both urban and rural areas at 3.33% per year, but decline rates were influenced by Ischemic Heart Disease (IHD) and preventable death categories to treatable death category. Annual decline rate for IHD category in rural and urban areas was nearly the same as 8%, but in preventable death category, rural areas experienced more decreases than urban ones (7% vs 5% respectively). However, decline rate in treatable mortality neither in urban and nor in rural areas was statistically significant. Conclusion: Despite the annual decline in the rate of avoidable deaths, policy making initiatives especially screening and inter-sectoral measures targeting cause of deaths such as colon and breast cancers, hypertension, lung cancer and traffic accidents, can still further decrease avoidable deaths in both areas

Psychometric evaluation of the health-seeking behavior scale based on Kroeger’s model for elective cardiac interventions

Background: Coronary artery bypass graft surgery (CABG) is one of the two most commonly used interventions for Myocardial Reperfusion. Studies suggest that the existence and direction of the effect of the factors affecting health-seeking behavior depend on the context of each society. Thus, this study aimed to introduce and validate a tool for investigating the factors affecting the health-seeking behavior of patients requiring a cardiovascular intervention as a prerequisite for planning and policymaking.   Methods: By reviewing the literature and questionnaires previously used in the field of health-seeking behavior and the patient's decision-making process, a set of related questions was collected based on Kroeger’s model variables. Ten content experts were requested to evaluate each item and then content validity ratio (CVR) and content validity index (CVI) were calculated and used for instrument modification. Participants were included through a convenience sampling procedure. Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) was used to assess construct validity. Cronbach's alpha coefficient was used to measure instrument reliability.   Results: Of the 142 participants, 79 (55.5%) were male. Through the validation process, a hierarchical model with four factors and 20 items with three error covariance (accounting for 63.06 present of outcome variable variation) was confirmed. Also, an examination of the four constructs obtained with Cronbach's alpha coefficient was more than 0.8 indicating acceptable reliability.   Conclusion: Findings suggest that the designed scale of health-seeking behavior based on Kroeger’s model is a reliable and valid scale among the Iranian population

Avoidable Mortality Differences between Rural and Urban Residents During 2004–2011: A Case Study in Iran

Background: Avoidable mortality as an indicator for assessing the health system performance has caught the attention of researchers for a long time. In this study we aimed to compare the health system performance using this indicator in rural and urban areas of one of Iran’s southern provinces. Methods: All deaths (29916) which happened during 2004–2011 in Bushehr province were assessed. Nolte and McKee’s avoidable deaths model was used to distinguish avoidable and unavoidable conditions. Accordingly, all deaths were classified into four categories including three avoidable death categories and one unavoidable death category. STATA software was used to conduct Poisson Regression Test and age- standardized death rate. Results: Findings showed that avoidable mortality rates declined in both urban and rural areas at 3.33% per year, but decline rates were influenced by Ischemic Heart Disease (IHD) and preventable death categories to treatable death category. Annual decline rate for IHD category in rural and urban areas was nearly the same as 8%, but in preventable death category, rural areas experienced more decreases than urban ones (7% vs 5% respectively). However, decline rate in treatable mortality neither in urban and nor in rural areas was statistically significant. Conclusion: Despite the annual decline in the rate of avoidable deaths, policy making initiatives especially screening and inter-sectoral measures targeting cause of deaths such as colon and breast cancers, hypertension, lung cancer and traffic accidents, can still further decrease avoidable deaths in both area

Barriers and Facilitators of Branding in Iranian Medical Libraries and Information Centers (MLICs)

Introduction: Library branding is a strategy that creates a positive and long-standing image towards the provided services in the minds of users. The present study aimed to explore the barriers and facilitators of branding in libraries and medical information centers in Iran. Design/materials: This is a qualitative study with the deductive approach conducted using semi-structured interviews with some managers in libraries and medical information centers. Purposeful sampling was employed to gather data. Content analysis was also performed using Maxqada software version 2018 to format the data. Findings: The obtained results revealed that in order to materialize the branding in libraries, four key structures, including librarians, services, physical equipment and infrastructures, and technology, along with their sub-components, must be improved. Conclusion: This study offers insights to help libraries survive in competitive environments and, at least, maintain their users by providing innovative and distinguished services. In this regard, the mentioned four key structures need to undergo significant change

Financial Indicators of Public Autonomous Hospitals: A Case Study in Bushehr Province in 2021

Background: The hospital autonomy plan, the biggest decentralization plan to reform the administration structure of public hospitals, has been implemented for about three decades in Iran. In this study, we aimed to examine the effects of the plan on the financial indicators of autonomous public hospitals. Materials and Methods: This descriptive cross-sectional study used revenue and cost data associated with all public hospitals affiliated to Bushehr University of Medical Sciences in 2021. The relevant data was extracted from two big databases including health information system (HIS) and accounting system, and after the data quality control, specific financial self-sufficiency balance (the ratio of specific income to the specific cost of the same hospital) and total financial balance (the ratio of specific income to the total cost of the same hospital) were calculated using Excel software. Results: Results demonstrated that the specific financial self-sufficiency balance and the total financial balance were 61% and 27%, respectively. The highest and the lowest values of the specific financial self- sufficiency index pertained to the Heart Hospital (the only single specialty heart hospital in the province) and Imam Hossein Hospital (a hospital with 29 active beds in Tangestan county with a population of 82502) as 74% and 45%, respectively. The gap index between the specific cost and revenue of each ac-tive bed showed that on average, the cost of each bed was nearly 215 million Tomans higher than its own income in 2021. Conclusion: The hospital autonomy plan had different effects on the financial indices of public hospitals studied in this research, denoting it is not possible to cover all hospital-specific expenses through its own earned revenues. Accordingly, government subsidies to autonomous hospitals are necessary

Original Article Avoidable Mortality Differences between Rural and Urban Residents During 2004-2011: A Case Study in Iran

Background: Avoidable mortality as an indicator for assessing the health system performance has caught the attention of researchers for a long time. In this study we aimed to compare the health system performance using this indicator in rural and urban areas of one of Iran's southern provinces. Methods: All deaths (29916) which happened during 2004-2011 in Bushehr province were assessed. Nolte and McKee's avoidable deaths model was used to distinguish avoidable and unavoidable conditions. Accordingly, all deaths were classified into four categories including three avoidable death categories and one unavoidable death category. STATA software was used to conduct Poisson Regression Test and agestandardized death rate. Results: Findings showed that avoidable mortality rates declined in both urban and rural areas at 3.33% per year, but decline rates were influenced by Ischemic Heart Disease (IHD) and preventable death categories to treatable death category. Annual decline rate for IHD category in rural and urban areas was nearly the same as 8%, but in preventable death category, rural areas experienced more decreases than urban ones (7% vs 5% respectively). However, decline rate in treatable mortality neither in urban and nor in rural areas was statistically significant. Conclusion: Despite the annual decline in the rate of avoidable deaths, policy making initiatives especially screening and inter-sectoral measures targeting cause of deaths such as colon and breast cancers, hypertension, lung cancer and traffic accidents, can still further decrease avoidable deaths in both areas

Cost of Illness of COVID-19 and Its Consequences on Health and Economic System

The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and$3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and$2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers

The impact of rural health system reform on hospitalization rates in the Islamic Republic of Iran: an interrupted time series

OBJECTIVE: To assess the effects on hospital utilization rates of a major health system reform – a family physician programme and a social protection scheme – undertaken in rural areas of the Islamic Republic of Iran in 2005. METHODS: A “tracer” province that was not a patient referral hub was selected for the collection of monthly hospitalization data over a period of about 10 years, beginning two years before the rural health system reform (the “intervention”) began. An interrupted time series analysis was conducted and segmented regression analysis was used to assess the immediate and gradual effects of the intervention on hospitalization rates in an intervention group composed of rural residents and a comparison group composed of urban residents primarily. FINDINGS: Before the intervention, the hospitalization rate in the rural population was significantly lower than in the comparison group. Although there was no significant increase or decline in hospitalization rates in the intervention or comparison group before the intervention, after the intervention a significant increase in the hospitalization rate – of 4.6 hospitalizations per 100 000 insured persons per month on average – was noted in the intervention group (P < 0.001). The monthly increase in the hospitalization rate continued for over a year and stabilized thereafter. No increase in the hospitalization rate was observed in the comparison group. CONCLUSION: The primary health-care programme instituted as part of the health system reform process has increased access to hospital care in a population that formerly underutilized hospital services. It has not reduced hospitalizations or hospitalization-related expenditure