HAKIM RESEARCH JOURNAL
Year:2011 | Volume:14 | Issue:2|Papers Count:10

Introduction: Education is a key element for the success of health services delivery. Pamphlet is a distance learning method of education. Regarding the critical role of correct and reasonable prescriptions by physicians, we aimed to investigate the effect of sending an educational pamphlet to general practitioners on their prescribing skills.Methods: This study is a randomized controlled trial. We randomly assessed 600 prescriptions of general practitioners to identify their errors. Based on the most common content errors and literature review, we developed an educational pamphlet under supervision of clinical pharmacology professors. A total of 200 general practitioners (100 individuals in each intervention and control groups) were randomly selected from the general practitioners in contract with the Social Security Organization of Tehran; and their prescriptions were assessed in a one-month period. The pamphlets were sent to the intervention group. The prescriptions of both groups were assessed after three months.Results: A significant decrease was evidenced in the number of prescribing medicines (p=0.014) (from 3.61±0.87 before the intervention to 3.50±0.95 after the intervention) in the intervention group. Decreases in prescription of injections (p=0.024), Corticosteroids (p=0.036), the 3rd generation of Cephalosporin (p=0.017) and Non steroidal inflammatory drugs (p=0.005) were also observed in the prescriptions of the intervention group after the intervention.Conclusion: As general practitioners are often unwilling to participate in face to face teaching programs, the results of this study showed that a suitable educational pamphlet has significant effects on GPs’prescribing skill. Pamphlets should be used as a means of continuous medical education.

Introduction: Globalization is an important issue in political, business, and cultural domains worldwide.It also affects health market. There are more attentions on drugs and their effects on sustainable development nowadays. Because of the strategic effects of medications on health and national security, the politicians pay more attention on drugs issues.Methods: We aimed to assess business effects of Iran’s membership in the WTO on drug industries through four hypotheses. We recruited all 50 business experts, and managers of drug companies in Tehran.The participants had the responsibility of 80% of drug production and sales. Data was gathered using a validated questionnaire and analyzed using statistical t test.Results: The results showed that the effect of WTO membership on drugs export before and after membership was 30.24 (7.64) and 48.28 (5.35), respectively. The effect on drugs import was also 20.4 (3.1) and 22.96 (3.81), respectively. For assessing the impact of WTO membership on quality of drugs, we included three variables; the mean score was 7.76 (2.34) and 12.68 (2.07), respectively. Regarding the survival of Iran’s drugs industry before and after WTO membership, the mean score was 3.96 (8.5) and 50.16 (6.64), respectively.Conclusion: The results showed that membership in WTO may have positive effects on the country’s drug export and import. It may also have positive effects on quality of the country’s drug production and the survival of the country’s drug industries.

Introduction: Urban deprived area can be considered as a symbol of inequity. It can be appeared as result of wrong politics, socioeconomic structures, and inefficient urban management. Lack of practical and suitable system for equity measurement and indentifying and selecting the interventions in order to elimination of inequity has encountered Urban developing with problem, policy makers with uncertainty about the appropriate choices and stakeholders with obstacles. The aim of this study was to assess the systematic accountability to citizens in Tehran "Urban HEART" study.Methods: In this descriptive study, we used Urban HEART method in order to measure equity in Tehran.We used second data to assess systematic responsibility, active participation in municipal activities, rate of standard activities and citizens' satisfaction in the 22 regions of Tehran. We gathered data from municipals, its affiliated organizations, and research institutions. In order to assess the rate of standard processes, we conducted a survey.Results: The average value of citizens' satisfaction (57%) was laid in low middle range. Participation in improvement of municipal services was 87/1%. Reporting to citizens was 3/37 out of 10 and finally, standard processes were not fully appropriate.Conclusion: The assessment of equity in governance indicated that the total performance of the municipal in all areas of governance such as responsibility, citizen satisfaction, participation in improvement of municipal services, and standard performing (55.32%) was laid in average range.

Introduction: The real and reasonable valuation of health care services is one of the most important factors affecting several components of health system, especially economic and treatment issues. This study aimed to define the effective different factors on relative value units (RVU) of GP’s visit in private offices in Tehran.Methods: This is an analytical study. The views of three groups including 668 general practitioners, 583 patients referred to general practitioners, and 22 national experts regarding the factors that affect the relative value unit of general practitioners visit in their private offices in Tehran were gathered using a self-structured questionnaire. Data were analyzed using descriptive statistical methods and Pearson correlation coefficient.Results: Regarding factors influencing relative value unit of GPs' visits, physicians' skills, severity of illness, duration of visits, medical errors, risk for physicians, and physicians' visits were most influential.There was no significant relationship between the duration of visits and the physicians' skills from the physicians point of view (r=-0.01, p=0.72). There was also no significant relationship between physicians' skills and medical errors (r=0.01, p=0.78).Conclusion: The findings can help determining the relative value units applied to other medical services and management levels. The Ministry of Health, Management and Planning Organizations and other relevant organizations can use the results of this study to determine the real costs.

Introduction: The Internet using has become an important part of individuals, especially youth's daily life activity in recent years. Regarding changes due to using this technology, the question comes to mind is which effects internet using has on life style of its users. The aim of this study was to evaluate student’s life styles and its relationship with using the Internet.Methods: The students of Tehran University of Medical Sciences were recruited to this cross-sectional research using multistage sampling. Data were collected using a self-structured questionnaire developed based on a pilot study. Data were analyzed using Fisher's exact test, Man Whitney, and kruskalwalis tests.Results: The results showed that more than half of the participants had unhealthy life style. Only 4.4% of the students had appropriate knowledge on the Internet's effect on their health. Most of the students (70%) believed that using internet had decreased their physical activity. About half of the students (47%) did not believe that smoking would be affected by using the Internet.Conclusion: Regarding the increasing pattern of the Internet using among youth and knowledge insufficiencies among them about the effect of the Internet on health, proper educational programs should be designed and implemented among youth. Moreover, effectiveness Internet-based intervention should be applied to increase knowledge students.

Introduction: Health care managers and planners should be able to use resources with the most effective and efficient ways. The purpose of this study was to investigate the factors affecting in patients' preferences for choosing a hospital based on the mix marketing components in Isfahan in 2010.Methods: In this cross-sectional study, 350 patients were selected from Isfahan's hospitals based on random sampling. Data were collected using a questionnaire including the mix marketing components. The validity and reliability of the questionnaire was confirmed. We analyzed the data in the SPSS.Results: The highest score in choosing a hospital belonged to "staff" (doctors and paramedical personnel) (72.2 ± 18.4) and the lowest score belonged to the "location" (hospital environment) (44.5±19.1). The "cost of services" was the most important factor in choosing a hospital in public hospitals; however, in private hospitals, the "personnel" (doctors and paramedical personnel) was the most important factor.Conclusion: Recent advances in health care have created needs for innovative marketing techniques.Because health care consumers differ from other domains consumers; and the nature of services provided makes different kinds of relationships, it is necessary to notice to marketing principles, especially the mix marketing components in providing services.

Introduction: There are increasing international interests in the use of performance measurement and their public release in order to improve the quality of care. However, few studies have assessed stakeholders’awareness and use of performance data. Iranian hospitals have been graded annually since 1998 and hospital hotel charges vary by grades; however, system has never been evaluated.Methods: We conducted a cross-sectional survey of 104 outpatients at eight Teheran hospitals, and 103 general practitioners (GPs) to assess the awareness of and attitudes towards hospital grading system.Results: Only 5.8% of patients (95% CI: 1.3–10.3%) and 11.7% of GPs (95% CI: 5.5–17.9%) were aware of grading results. Patients’ awareness was positively associated with their education level (P-value=0.016).No patient used the grading results for choosing a hospital; and only one GP (1%, 95% CI: 0–2%) reported using hospital grade to decide on referrals. Patients were more influenced by hospitals’ public reputation and that of their specialists. GPs believed that the grading system did not reflect the quality of care in hospitals.Conclusion: The hospital grading system had nearly no effect on choosing hospital among patients and GPs. When developing performance measurement systems, public release of data should be accompanied by evaluation of its impact on awareness and health-care choices.

Introduction: One of the most important duties of a family physician is to provide primary health care.This is completely considered in the family physician program for a target population. This study aimed to assess quality of implementation of the national family physician program in Shahroud in 2010.Methods: In this cross-sectional study, all health care centers (n=19) in where the family physician program was implemented were studied. A checklist and a 164-item questionnaire were filled out for each center. The data were analyzed using SPSS 16.Results: Most of the physicians were female (60.7%). More than half (53.6%) were married. The duration of employment as a family physician was 22.05±18.91 months. In 84.2% of the centers, a board of trustees was formed. About half of the physicians (47.4%), had fully registered the referred patients’ characteristics and the results of the follow-ups in the recording system. No significant relationships were observed between the quality of the data registration with age, gender, marital status, and duration of working as family physician and general practitioner. There was a significant relationship between the welfare facilities of heath care centers and the distance of the centers from city.Conclusion: Many components of the family physician program such as supplies, office, medical equipments, patient referral and follow-up, filling out health files of the target population, forming boards of trustees, providing reference feedbacks from level two, and issuing death certificates were lower than the expected level. Thus, revising and improving the family physician program will greatly help to a better implementation of the program.