Balancing Overuse and Underuse in the Iranian Healthcare System: A Force Field Theory Analysis

BACKGROUND: Overuse and underuse of healthcare services occure within population, organizations and even patients around the world. Producing a balance between these two can increase efficiency, service quality and patient satisfaction. It also decrease extra costs. The aim of this study was to identify forces for change and forces against change for generating balance between overuse and underuse to achieve right care.METHODS: This study was conducted in five steps: 1) describe our plan or proposal for change; 2) identify forces for change; 3) identify forces against change; 4) assign forces; and 5) analyze and apply. We used purposive sampling strategy. The number of participants in the expert panel were eight. Each participant signed informed consent form before starting the study (Ethical code: IR.TBZMED.REC.1396.908).RESULTS: The driving factors for balancing overuse and underuse were education, preparing clinical guideline and standard protocols, resource allocation, using evidence-based medicine, evidence-based management and evidence-informed policy making approaches and social prescribing. The restraining factors for balancing overuse and underuse were conflict of interest issues, payment systems, paternalism and medicalization, patients and physicians’ side problems and culture of consumerism in the community. The total scores for and against change were 14 and 17, respectively.CONCLUSION: It seems that the emphasis on education and training in this field is essential for physicians, patients and all people in the community. Also, making reforms in payment systems and changing the rules and regulations in this area could be major drivers

Vitamin D deficiency prevention policies in Iran: a retrospective policy analysis

AimIran has a higher prevalence of vitamin D deficiency (VDD) than the global level. This study aimed to assess VDD prevention policies in Iran through a policy analysis of agenda setting using the multiple streams framework (MSF).MethodsUsing Kingdon's MSF model, this qualitative analytical study performed a policy analysis on vitamin D-related policies in Iran. The policy documents were reviewed, and in-depth interviews were conducted with stakeholders (n = 27) using the framework analysis method. To categorize data and extract the related themes, MAXQDA version 10 was used.ResultsAccording to Kingdon's MSF theory, the problem stream included the high prevalence of VDD among Iranian infants (23.3%), adolescents (76%), and adults (59.1%). The policy stream was identified to focus on preventing programs for non-communicable diseases in the health sector. The political stream indicated that national and international support could provide a political climate for this issue.ConclusionAccording to our results, a window of opportunity for policymaking on VDD prevention has opened. However, there are some challenges related to the implementation of these policies. These include the dominance of a treatment-based view rather than a prevention-based approach in the health sector, economic problems, and restricted access to health services due to the outbreak of coronavirus disease 2019 (COVID-19). To strengthen and implement VDD prevention policies, the stakeholders need support from high-level policymakers

The Relationship between Organizational Entrepreneurship and Communications Network in Health Deputy of Ahvaz University of Medical Sciences

Background & Objectives: Effective communication can be considered as the foundation of modern organizations and effective organizational communication can provide an appropriate context for organizational entrepreneurship. This study investigated the relationship between organizational communications network and organizational entrepreneurship in Vice-Chancellor for Health Affairs in Ahvaz University of Medical Sciences. Methods: This descriptive-analytical and cross-sectional study was conducted in 2015. Statistical population of the research was all staff of Vice-Chancellor for Health Affairs in Ahvaz University of Medical Sciences (n=106), of whom, 90 ones returned their questionnaires. Data gathering was done using the questionnaire of organizational communication network including 14 questions and the questionnaire for organizational entrepreneurship including 31 questions. Scoring was done using 5-item Likert scale. Data analysis was performed through SPSS16 and using t-test, ANOVA and correlation coefficient. Results: Mean score of communication network was 3.28 and mean score of organizational entrepreneurship was 3.13. The results showed a significant direct relationship between organizational communications network and entrepreneurship (P <0.001). Conclusion: According to the results of the present study, having an efficient communications network in organization makes the organization potentially entrepreneur. Therefore, organizations should try to create friendly and collaborative relationships among all staff through holding educational programs. Key¬words: Organization, Communications network, Organizational entrepreneurship, Health Vice-chancellor ¬Citation: Khodayari-Zarnaq R, Ravaghi H, Fadayi Dehcheshme N, Sanadgol A, Mobasseri K. The Relationship between Organizational Entrepreneurship and Communications Network in Health Deputy of Ahvaz University of Medical Sciences. Journal of Health Based Research 2017; 3(1): 39-49

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 &gt; 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 &lt; 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

Analyzing the Role of Religion and Religious Institutions in Policymaking on AIDS in Iran

For downloading the full-text of this article please click here.Background and Objective: HIV is a social phenomenon whose investigating needs to take culture, traditions, and religious beliefs of the society into account. Given that, the aim of this study is examining the role of religion in policies made to control AIDS in Iran.Method: This qualitative study adopted the content analysis technique with inductive approach in which 30 policymakers, key informants, stakeholders and AIDS patients were given semi-structured interviews and also 21 documents on related policies were analyzed considering factors influencing AIDS policymaking. Then, the data were analyzed using framework method and MAXQDA. In this study, the ethical issues were all considered and the authors declared no conflict of interest.Results: After coding, approximately 300 primary codes were extracted. These codes were checked again and then categorized into three areas: the functions of religion and its preventive and encouraging factors in the related policies; different roles of the clergy as religious authorities, politicians and advisors; and the way religious institutes and organizations play their roles in AIDS policymaking process.Conclusion: Religion and its corresponding ideology have critical encouraging and preventive functions in implementing plans for control and prevention of AIDS. Neglecting religious aspects of the Iranian society in policymaking has led to less effectiveness of policies and failure in controlling AIDS.For downloading the full-text of this article please click here

The Inquiry of International Standards for Medical Tourism: A Case Study into Hospitals of Tehran University of Medical Sciences

Introduction: Medical tourism is a rapidly growing industry that has provided special opportunities to gain competitive advantage over international health organizations. This study aimed to investigate the quality requirements based on Joint Commission International (JCI) for medical tourism in selected hospitals of Tehran University of Medical Sciences. Methods: This is a descriptive and cross-sectional study that was conducted at three educational hospitals operated by Tehran University of Medical Sciences in 2013. The data were collected through the last updated checklists (translation of the standards of JCI, comprising 13 axial) completed by the researcher. Data analysis was done using descriptive and analytical tests including frequency, standard deviation and T- Test by means of SPSS 19.0. Results: Studied hospitals met 76.8% of organization-oriented standards plus 75.4% of patient-oriented standards. There were two patient-oriented standards, namely access to care and its continuity 87.2% alongside anesthesia and surgery care 86.6% which were met at the highest level. On the other side, organization-oriented standard of leadership and guidance 69.2% was the item met at the least. Conclusion: It seems that studied hospitals are ready to attract medical tourists by the advantage of service quality. Moreover, it is necessary to give attention to the strengths and improve the weaknesses concerning quality of services. Criteria on service charges, waited time and etc, should be scientifically analyzed and reviewed as well

HIV outbreak storytelling among residents of an area in Iran: what are the overlooked implications for health policy-makers?

With human immunodeficiency virus (HIV) prevalence of 0.14% in general population of Iran, a preva­lence of at least 5-6% among residents of one village in Lordegan County is considered HIV outbreak. Investigating initial reactions of provincial authorities to this issue indicates a medical view overlooking social nature of HIV/acquired immunodeficiency syndrome (AIDS). Moreover, such an outbreak alarms change in epidemic patterns from localized to generalized in developing countries, such as Iran. In this perspective article, we tried to discuss such events focusing on policy. At this point, we concluded that Iran needs to represent the problem through changing policy image and policy venue in political arena. To strengthen the collaboration among all stakeholders, developing a universal pro-active strategy to facilitate resource mobilization for HIV control is necessary. Integration of social nature of HIV/AIDS, addressing and applying integrated approach to face social and economic harms as well as using a collaborative mechanism to guide various governmental, semi-governmental, and NGO sectors to control HIV/AIDS are all needed. Moreover, focusing more on adopting anti-stigma strategies and disseminating comprehensive public awareness about AIDS, can prevent Iranian society from repeating such situations, and trigger more appropriate responses if they do occur

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