Objectives Considering the rapid growth of Iran’ s elderly population with consequent increase in the costs of health services, it is necessary to be aware of the pattern of outpatient health service utilization, in the elderly for resource allocation and health planning. This study aims to determine the pattern of outpatient service utilization for the elderly in Iran and explore determinant factors. Methods & Materials This is a cross-sectional study using secondary analysis method and the data from 2015 National Study of Health Service Utilization. Study population consists of older people aged ≥ 60 years. Of these, 8205 were selected as study samples. The data were collected using personal and household questionnaires collecting information on subjects’ need for, referral to, utilization from, and satisfaction with outpatient services. Logistic regression analysis was used to identify factors related to the need, referral, benefit, and satisfaction with the received outpatient services. Results Out of 8205 participants, 3172 (39%) reported the need for outpatient services, of which 66% referred for services; of these, 98% (N=2060) benefited outpatient services. Females, older subjects, villagers, unmarried and illiterate subjects were more in need of outpatient services, but their referrals to receive the services were not more than those of other groups. Lack of basic insurance, supplementary insurance, and a personal care had a significant impact on reducing the number of subjects referred to receive outpatient services. Inability to pay treatment costs (30%), self-treatment (28%) and lack of proper insurance coverage (13%) were the most important reasons for not referring to receive outpatient services. The highest satisfaction was related to the behavior of physicians and medical staff and the lowest satisfaction was related to the cost of outpatient services. Conclusion Although the use of outpatient health services should be based on the need for these services, the present study showed that the older people with higher socio-economic status had higher utilization from the services in Iran. Therefore, there is an inequality in access to outpatient services in the elderly. The reasons for not using outpatient services and dissatisfaction with these services should be seriously considered by health policy makers.

Background and Objective: We are witnessing a marked increase in demand for outpatient services. Patients experience health-related anxiety, which exerts destructive effects on the treatment. The control and management of this anxiety create confidence in health services. The present study aimed to determine the effect of nursing counseling on health anxiety and its relationship with trust in nursing services in the outpatient department. Materials and Methods: In this quasi-experimental study conducted in 2021, 60 participants were randomly selected from the outpatient department of a clinic and assigned to two groups: intervention and control. Data collection tools were a demographic information questionnaire, Alkovskis and Warwick Health Anxiety, and Trust in Nurses Scale (TNS) (Radwin and Cabral, 2010). The participants answered demographic and health anxiety questionnaires. After the visit, the intervention group received nursing counseling, while the control group only received routine training. One week later, the participants answered the health anxiety questionnaire and trust in nurses scale again. Data were analyzed in SPSS software (version 18) using descriptive and inferential statistical tests. Results: The mean of health anxiety before the consulting was not significantly different between the two groups (P=0. 20),nonetheless, after the consulting, the intervention group obtained a lower mean score compared to the control group (P>0. 001). There was a significant difference between this mean before and after consulting in the intervention group (P>0. 001). There was a significant positive relationship between receiving nursing counseling and confidence in nursing services (P>0. 001) (C. V=-0. 145). Conclusion: As evidenced by the results of this study, the provision of nursing consultation reduces patients' health anxiety and increases confidence in nursing services. It is suggested to pay attention to this role of nurses in outpatient departments.

Purpose: Outpatient services are a significant part of the health care delivery system. Dominance of the non-governmental sector in delivery of these services along with the government stewardship role in health system indicates the importance of monitoring the non-clinical aspects of quality in the outpatient services. The aim of this study was to evaluate the Responsiveness of the health system in the sector of outpatient services for households living in selected areas in Mashhad.Methods: This descriptive-applied study was performed as a cross sectional in 2014. The sample size included 1000 households that selected by multistage sampling from low and high income areas of Mashhad. Data was collected by WHO questionnaire which had three parts and its validity and reliability were assessed and approved. Data were analyzed by Descriptive and inferential statistics in SPSS.Results: The findings generally showed that more than 60 percent of the responders, expressed outpatient services responsiveness as good. The aspects of confidentiality and the quality of the amenities, acquired the highest and lowest level from the respondents view, respectively. The level of responsiveness from the view of residents in the high income area has been reported higher than the low income area.Conclusions: Quality of health services should be a goal that can be achieved with a good stewardship in the health system. Since most institutions that providing outpatient services are outside of the Ministry of Health as a stewardship of health system of Iran, establishing the appropriate mechanisms to monitor of this goal seems necessary.

Introduction: One of the most important measures to ensure achieving Universal Health Coverage (UHC) is expanding health insurance coverage to all population. Accordingly, the present study was conducted with the aim of investigating the effect of having health insurance on the utilization of outpatient services provided by physicians using the data of the utilization of health services survey (2015). Methods: This study is a secondary analysis of the utilization of health services survey data that was conducted in two groups of the insured and uninsured to examine the differences between these two groups in outpatient healthcare utilization provided by physicians. The variables were insurance status as an independent variable and the number of physician visit as a dependent variable. This analysis was disaggregated by place of residence and income. Results: The visit per capita for outpatient services was lower in all uninsured groups. The visit per capita in insured people was almost two times more than that of uninsured individuals, which was 4. 25 and 2. 61 among insured and uninsured individuals, respectively. Therefore, the lack of basic health insurance decreased the utilization of outpatient services by 50 percent. General physician visits per capita for insured people living in urban and rural areas were 11. 2 and 0. 35, respectively. Conclusions: Based on the results of this study, the visit per capita is directly related to the insurance status of the individuals. Therefore, it is necessary to ensure the equity in utilization of outpatient services provided by the physicians among various groups of population.

Background and Aim: Delivering health services to the elderly is one of the most important responsibilities of the health care system of any country. In order to improve the provision of health services to the elderly population under its coverage, the National Social Security Organization conducted this study with the aim of designing, implementing and evaluating a model for providing outpatient health care services to the elderly population under the coverage of its Tehran Province Office. Materials and Methods: This was a sequential-exploratory mixed-method study. The initial model was developed and validated using the integrated review method and the final model using the Delphi technique and group discussions with experts. Then the educational program was developed and implemented for the health team. Assessment of the effectiveness of the program was done using a researcher-made knowledge and attitude questionnaire (pre-and post-test). The model was then implemented in the Khandan-e-Hakim Clinic. The effectiveness of the model implementation was determined based on the qualitative content analysis of the interviews with the elderly and qualitative content analysis of the health team comments. Results: The outpatient care model of the elderly included an organized clinical process consisting of 6 phases. The mean age of the health team members was 45. 7± 15. 11 years. The difference between the health team satisfaction total scores before and after participating in the educational program was statistically significant (P≤ 0. 05). Further analysis of the data showed, based on the interviews with the elderly, the main categories to be "assessment of cognitive function, mood and behavior", "physical assessment", "appreciation of the health and dignity of the elderly" and "satisfaction of the elderly and their companions". Analysis of the comments of the health team revealed their satisfaction with the implementation of the model. Conclusion: The introduced model can make possible rapid identification of health problems and timely intervention in the elderly population. This implementation model will help disease prevention and complications at different levels. The findings of this study can help service providers to provide better care and health services for the elderly.

Objective One of the basic challenges of health care centers is the inflation of the costs of services. Rehabilitation services play a significant role in restoring disabled people's functional ability. Having knowledge of the unit cost of rehabilitation services can be useful in optimal allocation of resources and budget. This study aims to calculate the unit cost of outpatient rehabilitation services provided by the Nezam-Mafi Rehabilitation Center (NMRC) in Tehran, Iran. Materials & Methods This is a descriptive, retrospective study with a cross-sectional design. The time-driven activity-based costing (TDABC) method was used to determine the unit cost for 9 outpatient rehabilitation services related to speech therapy, occupational therapy, physiotherapy and audiology provided by the NMRC in 2019. In the first step, the sequence of each activity was mapped in one code (service). Then, the resources needed to perform each activity were identified and the source of cost for each activity was specified. In the next step, the cost driver for each specific sources and the amount of their use in each activity were determined. Due to the importance of personnel costs, this stage was done with more attention on the time required to provide each activity. In this regard, the cost of each minute of service compensation was calculated by considering the annual attendance time of personnel and their salary expenses. Finally, the costs of each unit of the production factor and the total cost for each code (service) were determined. Results In the NMRC, the costs of renting (47. 9%), consumable materials and supplies (11. 6%), and contracted services (10. 5%) made up the highest percentage of costs. The costs of outpatient rehabilitation services (except for speech therapy) were higher than official tariffs for these services. The cost of specialized personnel for physiotherapy services and the cost of building in occupational therapy, speech therapy, and audiology services had the highest share in their unit costs. The total cost of staff personnel was estimated at 3. 904 Rials per minute (RPM), which was higher than the specialized professional for pediatric occupational therapy (2046 RPM), occupational therapy (1929 RPM), speech therapy (1899 RPM), and audiology (1974 RPM). The high overhead costs of outpatient rehabilitation services (24. 5% of the total cost( were one of the primary reasons for the gap between the average costs and tariffs. Conclusion There is a considerable gap between the cost of some services in the NMRC and the related tariffs. Due to the low capacity of service provision in the NMRC, overhead costs have led to the inflation of the cost of services in this center. Therefore, the consolidation of small institutions and improving the referral system for people with disabilities from medical centers can reduce the unit cost of services. Considering that most rehabilitation services are not covered by the social security insurance and are not affordable for patients, a national-level reform should be prepared in the healthcare system. In addition, using the TDABC method in rehabilitation service centers can be a solution to identify the main sources of costs and control price inflation in the health sectors.