Hakim Journal
Year:2020 | Volume:23 | Issue:3 (90)|Papers Count:11

The Covid-19 epidemic is a great threat to human health. Countries have taken several measures to control the disease, as well as dealing with infodemics. In a situation where the infodemics makes it difficult to distinguish correct and scientific information from incorrect ones, the preparation of evidence-based content has been an effective measure, recommended by World Health Organization. In this regard, the school of Public Health at Tehran University of Medical Sciences, in collaboration with the Iran National Institute of Health Research formed a specialized committee for public education to provide evidencebased answers to public questions. The achievements of this collective efforts were providing useful and practical educational content based on the most credible evidence. In this editorial, we will look at the actions taken and the achievements of this experience.

The purpose of public health activities is to provide conditions in which people can be healthy that requires the participation of other sectors and the community. But in our country, the training of public health personnel has been mainly focused on some diseases and maternal and child health care. Services provided by public health graduates are focused on individuals, while public health services, according to its definition and examples in developed countries, should be population-based. According to the real needs of the community and health staff, it is necessary, in the context of the education transformation plan and in line with responsive and community-based education, to revise the curriculum of this field, by emphasizing training individual care and public health services in order to train two separate groups of health professionals. Keywords: Public Health, Educational Curriculum, Health Workforce.

Introduction: Hospitals are faced different conditions for effective management of crises and disasters. The current study aimed to identify the strengths, weaknesses, opportunities, and threats from the viewpoints of the members of the disaster management committee (DMC) of Iran’ s public hospitals. Methods: This cross-sectional study was conducted in 2018. The study population was Iranian public hospitals, of which 20 were randomly selected based on spatial planning. We interviewed members of DMC of 87 public hospitals. Data were collected using a 17-item researcher-made questionnaire that included two sections of individual variables, and strengths, weaknesses, opportunities, and threats. The questionnaire contained both open and closed-ended questions. Data were analyzed by SPSS version 23. Results: A total of 347 members were interviewed. In total, 3 524 items were extracted, which 784 (22. 2%) were strength, 717 (20. 3%) weakness, 344 (9. 8%) opportunity, 649 (18. 4%) threat, and 1030 (29. 2%) solutions. There was a significant association between the city of work, years of experience as a committee member, the number of active beds, area of study, gender, age, occupation, type of hospital, and the total number of strengths, weaknesses, opportunities, threats, and related solutions (P<0. 05). Conclusion: This study demonstrated that, concerning crisis and disaster management, Iranian public hospitals, while having strengths and opportunities, are faced several challenges and threats. Hence, there is a need to design and implement appropriate intervention programs.

Introduction: Law is an important tool for the realization of health policies and health legislations must be in accordance with “ good legislative” procedures. Based on the legislative formalities in Iran, the Cabinet develops the bills and the parliament is the legislative body. The current study aimed to investigate the laws passed in the field of health from the perspective of legislative initiative. Methodology: In this comparative study, ten terms of the Islamic Parliament of Iran are investigated. Laws and bills submitted in each term were identified and reviewed. Results: From the first to the tenth legislature a total of 60, 53, 46, 48, 46, 39, 40, 44, 39, and 37 health-related bills have been presented, of which 36, 31, 27, 31, 28, 22, 25, 29, 8, and 14 laws are passed, which most of them have been bills. In various legislatures, the ratio of bills to plans has been different. As we approach the present, the number of passed health-related laws decreases. Conclusion: The higher number of bills, compared to plans, is in line with good legislative principles. Due to the existence of powerful associations, which based on the constitution can provide legal comment, the higher number of bills is not unexpected.

Introduction: Diagnosis-related group payment system is highly valuable for developing countries and governments that are seeking to appropriately control health costs and expanding public health coverage due to its impact on managing costs and increasing efficiency of hospitals. The present study aimed to investigate the implementation of this payment sysvem. Methods: This cross-sectional descriptive-analytical study was performed on 34 hospital managers, Iranian health insurance managers, and clinical and financial experts of Hamadan province. In the first part, a researcherdeveloped questionnaire was used to assess the level of knowledge and attitude. In the second part, a checklist was used to assess how to record patients’ clinical-financial information in five public hospitals in the Hamadan province. Data were analyzed using descriptive statistics by Stata version 11. Results: Various factors were identified, including pros and cons, barriers and prerequisites of implementation, increasing the efficiency and quality of provided services after implementation, synchronization with insurance organizations, the use of this payment system for outpatients were mentioned. All public hospitals in the Hamadan province recorded financial and clinical information completely and appropriately using the International Classification of Diseases, versions 9 and 10. Conclusion: Considering the limitation of resources and diversity of health staff, changing the payment system is difficult in all countries. However, preparing the executive staff and managerial support pave the way for changes in the payment system and help to address the resulting problems. According to the findings, it seems that the DRG payment system can be implemented after establishing necessary measures and providing appropriate infrastructure.

Introduction: The current study aimed to evaluate the experiences obtained from the 4030 telephone system from the perspective of managers and consultant operators. Methodology: In this qualitative content analysis, we examined the views of operator consultants (n=21) and executive managers (n=5). The interviews were conducted by telephone one month after the launch of the 4030 system in two weeks. Interviews were audio-recorded after receiving the approval of interviewees. Data were analyzed in OpenCode version 4. 2 using the CFIR framework. Results: A total of 220 semantic codes were extracted and then categorized into five themes of program characteristics, inner setting, outer setting, characteristics of individuals involved in the program, and implementation process. Conclusion: Initial planning, recruitment process, initial evaluation and training, and in-service training are of particular importance, which were not performed properly due to the hasty launch of the program. Internal interaction (between individuals, managers, and system administrators) and interactions with other target organizations were identified as weak. From the perspective of executives, participation (i. e. at all levels of planning, implementation, evaluation, and decision-making) has not been achieved properly, which has created a major obstacle for several mid-level management and executive processes and actions. It seems that with the onset of the Covid-19 pandemic in China and the possibility of its expansion to other countries, the precision of initial planning, expanding infrastructure, human resources, and other processes has increased.

Introduction: Health equity means having fair access to needed healthcare services, paying healthcare costs according to payment capacity, and enjoying the highest achievable standard of health. Equitable distribution of hospital beds increases people’ s access to health services, which in turn improves their health status. This study aimed to examine the equity in the distribution of hospital beds in Semnan Province, Iran. Methods: Data for this descriptive and cross-sectional study were obtained from the Ministry of Health and the Iranian Statistics Center. The study population consisted of all Semnan Province hospitals in 2016. The equity in the distribution of hospital beds was evaluated using the Lorenz curve and the Gini coefficient. Excel software was used for data analysis. Results: The population of Semnan province was 702, 360 in 2016. There were 11 hospitals with 1, 485 beds in this province in 2016. There were 1. 6 hospitals per 100, 000 population and 2. 1 hospital beds per 1000 population in the Province. Shahroud, Semnan, and Damghan cities have had the highest hospital beds per 1000 population. About 36% of hospitals and 51% of hospital beds were in the city of Shahroud. The Gini coefficient for hospital bed distribution in the Semnan province was 0. 28. Conclusion: The distribution of hospital beds in Semnan Province was fair. Equitable allocation of hospital beds, particularly in less developed cities, is necessary for achieving fairness in population health. Health policymakers and managers should take measures to improve equity in access to hospital beds.

Introduction: Suicide is a major health and psychosocial problem in the contemporary world. The current study aimed to investigate the social factors affecting the tendency towards suicide among female high school students in the city of Boyer-Ahmad. Methods: In this quantitative study data were collected following a survey technique and using a questionnaire. The study population was all female high school students in Boyer-Ahmad city. The sample size was estimated at 373, based on the Lin table, with a 95% confidence interval and 5% sampling error. Sampling was performed using a two-stage cluster sampling technique. Results: There was a negative association between suicidal ideation and all five dimensions of religiosity. There was a positive significant association between the rate of change in socioeconomic status and the rate of suicidal ideation, as well as a negative association between the rate of social support and the rate of suicidal ideation. Academic failure, parental divorce experience, and sexual abuse experience could also influence suicidal ideation. Overall, these factors could explain 1. 44% of the changes in the dependent variable (i. e. suicidal tendency). Besides, 9. 55% of the remaining variance was explained by factors other than the variables included in this study. Conclusion: The social context has a key and effective role in the present time, and the necessary conditions for its improvement should be provided.

Introduction: Managers and policymakers are looking for ways to help them make the best decisions and buying the best medical equipment like an electroshock. Given that considering only one criterion for evaluating decision options cannot be realistic, the application of multi-criteria decision-making methods, which employ several criteria (often conflicting) to evaluate decision options, is on the rise. Methods: In this study, SAW, VIKOR, and TOPSIS methods were used to decide on the purchase of an electroshock device. Using literature review and the Delphi method, a series of effective and important criteria were identified for making decisions regarding purchasing an electroshock device and entered in the decision matrix. The other input was the decision matrix of 4 brands of EKG devices, which were selected according to the IMED site and in consultation with the hospital medical equipment manager. The primary decision matrix was developed using expert opinions and was used as the input of TOPSIS, SAW, and VIKOR methods in Excel software. Results: The results obtained from all three decision models of VIKOR, TOSIS, and SAW were similar and confirmed each other and showed that the best brand to buy an electroshock device is brand B. While the most inappropriate option was brand A. Conclusion: The use of multi-criteria decision-making approaches in today’ s competitive and costly world of management is inevitable and effective. Besides, the use of several decision-making methods with different criteria, as well as the similarity of the results, increase the validity of the results.

Introduction: Health system financing is the process of collecting, pooling, and managing financial resources for purchasing healthcare services needed by the society in order to promote, restore, or maintain their health, while financially protecting them against health costs. Financing, as one of the most important functions of the health system, plays an important role in achieving universal health coverage. Therefore, this study aimed to identify indicators for measuring health system financing. Methodology: Following a scoping review approach, we systematically searched six databases to identify relevant documents for the period of January 1, 1975, to May 20, 2020. A total of 79 documents were reviewed and analyzed using MAXQDA software. Results: Overall, 31 health financing indicators were identified, which were categorized into three categories of collecting financial resources, pooling financial resources, and purchasing healthcare services. Out-of-pocket health expenditures, catastrophic health expenditures, total health expenditure as a percentage of gross domestic product, global health spending, general government expenditure on health, medical impoverishment, domestic private health expenditure, and household financial contribution were the most frequently used health financing indicators. Conclusion: Adequacy of financial resources, risk sharing, efficiency, equity, and sustainability are important criteria for evaluating the health financing system. The use of indicators is essential for evaluating the health financing system.

Introduction: The current study aimed to design an educational, research, and support process management system for the School of Management and Medical informatics of Tabriz using business processes management. Methodology: Following an action research design, related processes and activities attributed were identified. Then, by implementing several group discussions and individual interviews, only value-added processes were kept. Then, using a timing study, the observed time was recorded and using Westinghouse criteria, factors of performance and normal and standard time were determined. To address uncertainty, the timing was extracted using fuzzy logic. Afterward, real values were calculated as a mean using de-fuzzing. Bizagi-Modeler software and Excel were used to document the processes and to perform the calculations, respectively. Results: A total of 3729 activities were identified in the form of 384 processes, which all were entered the timing stage. According to Westinghouse, the proposed mean for process centers, performance coefficient, and normal and standard time was 12. 26, 56. 6, and 57. 35 minutes, respectively. According to the meetings of the improvement committees, one of the important reasons for the delayed processes management during the peak operation was changes in the activities. Conclusion: Using the business process model and notation along with strengthening information technology infrastructure can help universities in achieving the goals of medical education by developing performance and cost management. Currently, due to operational processes, schools are highly dependent on headquarters. Nevertheless, they can be more dynamic by delegating more authority.