HAKIM RESEARCH JOURNAL
Year:2013 | Volume:16 | Issue:3|Papers Count:14

Introduction: For proper implementation of the Health System Reform Plan, the implementation process should be monitored using proper indicators. This study was conducted to determine the macro indicators for monitoring the Iranian Health System Reform Plan.Methods: In this cross-sectional study, we invited 34 experts to the study using the purposeful sampling. We provided a questionnaire using the important indicators for evaluation of the health system. The questionnaires were sent to the participants via e-mail. Data were analyzed in the SPSS-16.Results: The most important monitoring indicators of Health System Reform Plan were Life expectancy at birth (mean=4.3±0.3), Infant mortality rate (4.2±0.3), Maternity mortality rate (4.2±0.2), Life expectancy standard deviation in different cities (3.8±0.3), Out of pocket rate (4±0.4), Total expenditure of government in health sector (4.1±0.3), and Health insurance coverage (4.4±0.2), respectively.Conclusion: In order to monitor the Health System Reform Plan, the seven above-mentioned indicators should be considered. It is also suggested to provide proper strategies to measure theses indicators.

Introduction: One of the major goals of health systems is to establish a fair financial contribution to support the households in affording the expenses of health and treatment and to minimize the exposure of households to catastrophic expenditures. Unfair financial contribution and out of pocket payments that are not in line with capacity to pay, not only lead to more households exposed to catastrophic health expenditures but also result in impoverishment. This study aimed to assess the fair financial contribution index and influencing factors in the rate of households for rural and urban areas in nine regions in Iran.Methods: We used the household income-expenditure data of the Iran Statistical Center from 1984 to 2010. Data were analyzed using the STATA 11-SE package.Results: The fair financial contribution index had mild fluctuations from 1984 to 2010. There were no significant differences between the nine urban and rural areas regarding the index. The percentage of households exposed to catastrophic expenditures was increased during the study years.Conclusion: The applied strategies were not effective and financial contributions in health expenditures were not properly categorized during the selected years. In fact, the health system had not been successful in proper appliance of the health insurance system.

Introduction: Road traffic crashes (RTC) are common accidents and lead to a large drain on the healthcare resources in Iran. The aim of this study was to estimate the annual costs of road traffic crashes for Iranian Healthcare system.Methods: In this study, we estimated the pre-hospital, hospital and rehabilitation costs of road traffic crashes in Iran in 2009. The data on the number of injuries and deaths resulting from the RTCs were obtained from Iran's Ministry of Health and Medical Education and from Iran Forensic Medicine Organization. We also reviewed 400 medical records in two large trauma centers to estimate the average costs of patients that were hospitalized after the RTC.Results: In 2009, approximately 2297 individuals died and a further 806922 individuals were injured due to the RTCs. The total healthcare costs of the RTCs were 2952 IR billion Rials (around 295 million USD using an exchange rate of 10.000 IR Rials for each USD). Most of the total costs (87%) were spent for the hospital costs followed by 12% of the total costs for pre-hospital costs and 1% for rehabilitation costs.Conclusion: RTCs result in an extensive number of deaths and injuries and a large drain on Iran Healthcare resources.

Introduction: Partnership with private sector is an option for public hospitals to improve efficiency, quality and effectiveness of services and to share the risks and responsibilities of administration. This study aimed to introduce public-private partnership options in public hospitals around the world.Methods: In this systematic review, several databases including the Wiley Inter Science, PubMed, Cochran, Springer Link, Elsevier, Proquest, Scopus, Emerald, and the Google Scholar search engine were searched. The applied keywords included the Public-Private Partnership, PPP, PFI, Public Hospital, Partnership Models and their Persian equivalents. We found 723 articles and refined them step by step according to the aim of the study by reviewing the titles, abstracts and full papers. Finally, 20 articles were selected for further study.Results: In this study, public-private partnership options were divided into seven models including service contract, outsourcing contract, management contract, leases contract, private finance initiative contract, concession contract, and divestiture contract.Conclusion: Each model of public-private partnership varied in the degrees of risk and responsibility when transferred to the private sector. The risks and responsibilities transferred to the private sector were at the lowest level in service contracts. The risks increased with moving toward divestiture contracts.

Introduction: Foundry workers are at risk of the silicosis; a disease caused by inhalation of dust containing free silica. The amount of silica in dust is important in developing the disease. In order to determine the occupational exposure limits (OEL), it is important to measure the respirable dusts containing free silica. The aim of this study was to assess the exposure to respirable dust and the percent of free silica in small foundries in Pakdasht.Methods: In this study, we measured the amount of indoor free silica and respirable dust concentration during the casting activities. The respirable dust was gathered using the sampler pump and the cyclone. We used the gravimetry test to quantify the amount of respirable dust; and the colorimetric spectrophotometer method (Method 7601, National Institute of Occupational Safety and Health (NIOSH)) to measure the concentration of free silica.Results: According to the NIOSH and ACGIH limits (0.025 mg/m3), fifty percent of workers were exposed to high concentrations of crystalline silica. The mean free silica exposure was 0.04±0.02 mg/m3. According to the PEL presented by the OSHA, the mean respirable dust concentration was high in all four processes in the foundries.Conclusion: The findings showed that fifty percent of workers were exposed to high amounts of the crystalline silica dust. It is necessary to control silica dust through various technical and management measures.

Introduction: Tele-education is an effective strategy due to elimination of time and space limitation and establishment of an effective relationship with client. This study was carried out to determine the impact of a tele-education strategy via telephone and short message service on promoting self-care in patients with type 2 diabetes.Methods: This experimental study was carried out on patients with type 2 diabetes registered to the Urmia Diabetes Association. Sixty six patients were selected and randomly allocated into two intervention and control groups. Data were gathered using the Summary of Diabetes Self- Care Activities questionnaire. The education and telephone follow ups had given to the intervention group during 12 weeks. Data were analyzed using the Chi-squared test, paired t-test and independent t-test.Results: Findings of the study showed that self-care activity was increased in the intervention group after the education and telephone follow ups. After the intervention, the mean score of the self-care activities were 53.33±16.97 and 103.67±7.46 in the control and intervention groups, respectively (P<0.001). There were significant differences in the mean scores of the self-care behaviors in the areas of adherence to diet, physical activity, blood sugar self-monitoring, adherence to medication regimens, foot care and overall self-care in the intervention and the control groups (P<0.001).Conclusion: Telephone follows ups and tele-education by nurses had important effects on promoting self-care activities among patients with type 2 diabetes.

Introduction: Although information technology has developed in healthcare and arrived in Iran about two decades ago, there are no systematic reviews to depict the related studies in Iran. This study was carried out to systematically review the studies conducted on the HIS in Iran.Methods: In this systematic review, we used the HIS related key words and searched the related databases from 1968 to July 2011. After removal of non-related articles and repetitive studies, a total of 61 articles were retrieved. Finally, 25 articles were selected for the review. A standard form with special data elements was used to summarize the articles. Data obtained from this form were analyzed using the descriptive statistics.Results: Most of the articles (48%) had a descriptive, cross-sectional design. In most cases (28%), the HIS was the population of studies. The results showed that 36 and 24 percent of the papers had focused on HIS situation, and outcomes-capabilities, respectively. Other studies had considered other aspects of the HIS.Conclusion: According to the results of this study, quantity of the conducted studies on HIS in Iran is not satisfactory; and most of the published articles are descriptive studies. Studying different aspects of the HIS including technical, ethical and legal aspects are recommended.

Introduction: Readmission indicates partial treatment of patients except for follow-up treatments. This study aimed to determine the causes of patients’ readmissions in teaching hospitals at Zahedan University of Medical Sciences in 2010.Methods: In this cross-sectional study, 864 out of 2798 medical records of patients readmitted to the hospitals were randomly selected. Data were collected using a checklist included 16 items in five sections. Validity and reliability of the checklist were assessed. Data were analyzed using the descriptive statistics, Fisher exact test, and Chi-squared test.Results: From all readmitted patients, 52.3% were females. Follow-up treatment was mentioned as the main cause of patients’ readmissions (46.5%). Recurrence of disease (20.3%), disease complications (14.5%), other diseases (10.4%), partial treatment (7.1%), postoperative complications (1%), and medical procedure complications (0.2%) were other causes of readmissions.Conclusion: This study showed that 56.9% of the causes of patients' readmissions were inevitable; and 43.1% of them were evitable. Some proper measurements to decrease patients' readmissions are equipping hospitals with adequate facilities for outpatient surgeries, performing non-invasive surgeries, improving outpatient clinics and quality of clinical services, visiting patients at home, and educating patients at the time of discharge.

Introduction: Patient safety is the most important part of medical care, and also a major pillar of the "Clinical Governance". The first stage of the "patient safety improvement step by step plan" is to know safety culture and to strive towards improving it. Regarding the importance of clinical governance in the health system, and hospitals movements towards creating "Patient Friendly Hospitals", this study aimed to measure the current status of patient safety culture in general hospitals affiliated to the biggest medical university in Iran.Methods: This cross-sectional study was carried out in a period of six month in 2009. We used stratification to allocate 420 staff proportionally in each stratum. The HSOPS questionnaire was used to gather data. Total positive scores, ANOVA and T-test were used to analyze data.Results: A total of 343 out of 420 individuals sent back the questionnaires (response rate: 81.6%). In almost all dimensions, positive scores in our study were lower in comparison with the benchmark hospitals (hospitals participated in the AHRQ's survey in 2009). The highest positive score was calculated for the "teamwork within units" (69%); while the lowest score was calculated for the "non punitive response to error" (18%).Conclusion: The results showed relatively high difference between the statuses of patient safety culture in the studied hospitals with hospitals in other countries. Policy makers, authorities and managers should pave the way towards a balanced improvement in safety culture and patient safety.

Introduction: Nursing documentation and data entry is foremost requisite step for high quality patient care. Recently, modern information technologies caused documentation to be changed. Health settings were applied transition from paper-based recording to electronic documentation systems which is one of the most important alterations in this regard. This study aimed to assess nursing needs about methods of documentation in Electronic Health Records (EHR).Methods: This analytic study was conducted on 132 nurses in 2012. The study tool was a self-developed questionnaire that its validity was confirmed using experts' opinions and the reliability was measured using the Cronbach's alpha. The data was analyzed using descriptive statistics in the SPSS. Results: Using voice recognition and predefined templates were considered very important for documentation. For nurses, easy to use manners for data entry in the electronic system (81.9%), user training on electronic documentation (75%), and using bedside terminals (51.6%) were considered to be the highest priorities, respectively from the nurses' point of views.Conclusion: Electronic documentation methods, voice recognition and predefined templates were the most important priorities for nurses. Focusing on nurses' priorities and their abilities can lead to lower burden of electronic documentation and understand the benefits of Electronic Health Records.