A comparative study: Accreditation of universities' disaster risk management for health promotion

BACKGROUND

Risk management processes accreditation in emergencies and disasters can determine the effectiveness and efficiency of these processes. Universities, as the highest level of education, should provide a safe environment for educational services and activities of these people.

AIMS

The present study aimed to review and compare different accreditation models for emergencies and disaster risk management in selected countries. Reaching other accreditation models together and identifying their similarities and differences, along with considering the implementation of each model, can significantly help the countries which aim to design and develop a risk management accreditation model or upgrade their models.

MATERIALS AND METHODS

In this qualitative comparative study, the US, UK, Canada, Australia, Japan, and South Africa were selected based on research criteria. A literature review compared university emergency and disaster risk management accreditation models. The obtained data were collected in a researcher-made matrix, and a content analysis method was used for data analysis. Differences and similarities of selected countries in the fields of accreditation program(s), accreditation institute, start year, obligation, accredited organizations, number of criteria, criteria titles, accreditation focus, accreditation stages, number of stages, scoring method, and ranking method were compared.

RESULT

Designing a local model for the accreditation of disaster risk management in universities based on the crisis management system in each country can lead to improving the level of responsiveness and quality of services in emergency situations and health promotion.

Developing a conceptual model of post-disaster damage and loss assessment program in the Iranian health sector: a qualitative study protocol

INTRODUCTION

Annual natural and man-made disasters in Iran eventually lead to casualties and considerable financial loss. The success of a reconstruction programme depends on accurate postdisaster damage and loss assessment. Based on these assessments, the goals, priorities and approaches required for reconstruction are prepared and formulated. To effectively implement a reconstruction and rehabilitation programme in the country's health sector, it is necessary to prepare and compile a postdisaster damage and loss assessment programme.

METHODS AND ANALYSIS

This qualitative study will be conducted to develop a conceptual model of a postdisaster damage and loss assessment programme in Iran's health sector. First, a scoping review method will be conducted to identify the entities and components of the postdisaster damage and loss assessment programme. Then, using semistructured interviews, the opinions of university professors and disaster damage and loss assessors in the health sector will be obtained. Next, by conducting a focus group discussion, the initial programme of disaster damage and loss assessment in the Iranian health sector will be developed and then, the modified Delphi method will be used to validate it.

ETHICS AND DISSEMINATION

Ethical approval for this study was obtained from the research ethics committee of Isfahan University of Medical Sciences (IR.MUI.NUREMA.REC.1400.171). The study results will be disseminated to stakeholders, published in peer-reviewed journals and presented at conferences.

Integrated operations for natural disaster management: A systematic Review

Background: This study aimed to conduct a systematic review of models describing the integrated logistics operations performed as a response to natural disasters, with the hope to identify the challenges and limitations of healthcare systems in natural disaster management. Methods: A systematic literature search was carried out in PubMed/Medline, Scopus, Google Scholar, and bibliographies of retrieved articles using MeSH headings and keywords such as natural disaster, logistics, model. A total of 98 publications were identified through the search process. Seven potentially relevant articles met the inclusion criteria. The key demographic, clinical, and pathological information of all qualified studies were extracted from the full-text articles. Results: Among the seven included studies, six had either model data or considerations on distribution methods. Storage, human resources, infrastructures, primary priority items, coordination of organizations, and information and communication with the media were also the focus of studies. The articles were mainly from Iran (n=2), the United States (n=2), and Indonesia (n=2). The models presented in the studies has mainly focused on a specific aspect of disaster management, such as smart government development, use of military services, people with logistic training and/or medical team model. Conclusion: This study systematically highlighted the crucial points that should be considered in managing natural disasters including human resources, infrastructure, storage, priority items, distribution, access system, coordination of organizations, information, and communication with the media. In this regard, we prepared a comprehensive comparison of possible models and logistics.

Explore of the reasons of irrational prescribing in Iran: A qualitative study

Background

Irrational prescribing is highly prevalent in Iran, and it is under the impact of different factors.

Objective

This research aims to recognize the reasons for Irrational prescribing in Iran.

Methods

A qualitative approach and a conventional content analysis were employed to perform this research. The research community includes some experts and key specialists in medication prescribing. Semi-structured interviews were used for data collection. The intentional sampling method was applied, and theoretical saturation was reached by conducting 40 interviews with experts. The data analysis process was done following the steps suggested by Graneheim and Lundman.

Results

Four main categories and 12 subcategories appeared after analyzing the data. The main categories are organizational and management factors, legal factors, cultural factors, and economic factors.

Conclusion

Irrational prescribing can be prevented by reforming the referral system, overseeing pharmacies and physicians, raising public awareness and correcting their misconceptions about the medications, and creating an appropriate mechanism for pricing and selling medicines.

Hospital management model for biological hazards: A qualitative content analysis study

BACKGROUND

Biological hazards such as epidemic, pandemic, and bioterrorism are the most probable types of emergencies and disasters, which cause a high rate of mortality and morbidity. Hospitals have an important role in reducing the consequences of biological hazards. Given this, we set out the present study to design a model for managing biological hazards in hospitals.

METHODS

A qualitative content analysis study was performed using in-depth semistructured interviews with 40 experts. We selected participants through purposeful sampling; also, we interviewed experienced experts, policy makers, and managers in the field of hospital management regarding biological hazards. The study setting was Iran Ministry of Health and hospitals as well as other relevant organizations responsible for hospital management in biological hazards. We analyzed the data concurrently using the method recommended by Graneheim and Lundman.

RESULTS

After collecting and analyzing the data obtained from the interviews, we extracted the dimensions of our model in the form of four themes, including mitigation, preparedness, response, and recovery.

CONCLUSION

Based on the results of the present study, we believe that a comprehensive and practical model for hospital preparedness regarding management of biological hazards is essential. The model of hospital preparedness in biological hazards leads to an effective response and reduces the physical, psychological, social, and economic consequences of biological hazards.

Disaster and Multiple Sclerosis: A Systematic Review

Background

Multiple Sclerosis (MS) patients experience a variety of disease caused disabilities that makes them more vulnerable to the effects of disasters. This study aimed to review all existed studies about disasters and related disaster management planning about MS patients.

Methods

The PubMed, Google Scholar, Scopus, and Web of Science, ProQuest, science direct , and grey literature databases were searched up to the mid of 2021. All obtained titles were assessed by the inclusion criteria. Abstracts of the relevant titles were reviewed and eligible articles/documents were included for full text review and data abstraction.

Results

From 24616 Articles/documents, finally 15 documents (13 articles, and 2 books) were selected. In 8 articles (53%) specifically, focused on MS patients and, in the rest focused on them as a member of people with disabilities. Most studies (10, 71.4%), emphasized on the disaster induced stress effect on MS patients. In two books/book sections, the disaster preparedness plan for all types of disabilities was presented in general, and MS patients were mentioned as a member of the group of patients with disabilities.

Conclusion

Despite the importance of planning in response to disasters to address specific problems of MS patients, there is a lack of proper planning. This is very important and there is an urgent need to develop appropriate planning protocols for addressing the special conditions of MS patients in response to disasters.

Hospital Management in Infectious Disease Outbreak: Lessons Learned From COVID-19 Epidemic

Background: Biological events, including epidemics, pandemics, and emerging and reemerging infectious diseases, have significant adverse consequences on human health. Hospitals have a major role in the management of outbreaks and mitigation of their consequences. During pandemics, health systems, especially hospitals, are affected. The current study aims to collect and analyze hospital lessons learned during the COVID-19 epidemic in Iran. Materials and Methods: The study data were collected through document analysis, direct observation, and taking the opinions of an expert panel (including hospital chiefs, hospital managers, disaster committee managers, matrons, and other hospital staff) at hospitals involved with coronavirus patients. Results: The practical measures performed in Iran hospitals included the development of the hospital incident command system, screening and triage, establishing a call center, patient and family management, personnel management, volunteers management, education, planning, safety, environmental health, dead patients management, sampling, food hygiene of staff and patients, coordination and cooperation, sharing information, home treatment and care, infection prevention, and control and isolation. Conclusion: COVID-19 pandemic has significant adverse consequences on human health, hospital, and medical staff. During COVID-19, hospitals will face a high surge in suspected and confirmed patients. Therefore, hospitals should perform the proper measures to manage an emergency.

New financial management system for Iran public health sector: A qualitative study

BACKGROUND

Financial management system acts as a driving force and the first important principle of health sector reform. This study aimed to prepare a framework for new financial management system in Iran health sector.

MATERIALS AND METHODS

This qualitative study was conducted by content analysis approach and 15 key informant participants selected through purposive sampling consisted of three minsters of Ministry of Health and Medical Education (MOHME), three vice-chancellors in the Center of Resource Development and Management, Two members of the Health Assembly of the Islamic Consultative, four Medical Sciences university's presidents, and three managers in Budgeting and performance Monitoring Center of MOHME in 2017. Data were collected through semi-structured interviews and they were analyzed using Atlas T₆ software.

RESULTS

Six main themes were emerged as follow: "legal reform," "removing barriers to set up accrual accounting," "cost price calculation," "operational planning and budgeting," "human resources' organization, recruitment, and moderation," and "financial system output utilization (management accounting techniques) as the base for evidence-based policymaking and decision-making practices."

CONCLUSION

Any efforts for improving the current situation and reducing of mentioned limitations could be useful in providing required space for future phases of reforms and calculation of unit cost, operational budgeting, and management of cost and productivity. This can be achieved through an integrated system of recording and producing standard and accrual financial information. Furthermore, changing the accounting process and the financial system that complies with one single encoding in the country is a key issue.

Prevalence Rate of Diabetes and Hypertension in Disaster-Exposed Populations: A Systematic Review and Meta-Analysis

Background

Non-communicable diseases (NCD) such as hypertension (HTN) and diabetes mellitus (DM) have been one of the major health problems in the world. The aim of this study was to evaluate the prevalence rate of DM and HTN following natural and man-made disasters that impose significant economic and psychological burdens on human communities.

Methods

In this systematic and meta-analysis review, all cross-sectional studies that at least one of their objectives was to measure the prevalence of HTN or DM in individuals affected by natural and man-made disasters were included. Literature review was done in international databases including PubMed, Scopus and Web of Science, from database inception to February 17, 2019. The extracted data included the bibliographic characteristics of the article, the age of the participants, number of participants, gender, sample size, outcome, duration of the follow-up, and prevalence of DM and HTN. Data were analyzed by STATA software (version 11) and random effect method and the I2 index were used to investigate heterogeneity between the articles.

Results

A total of 16 articles met the inclusion criteria. Based on the quality assessment, 11 papers were categorized as moderate and 5 paper were categorized as high quality. The prevalence of HTN and DM in disaster-exposed populations were 47.35 (CI 95%: 38.53–56.17) and 13.56 (CI 95%: 10.12–17.01), respectively.

Conclusion

The results of this study show a high prevalence of HTN and DM in survivors of major disasters, which is higher in comparison to the general population

Earthquake and the Educational Needs of People With Physical Disabilities and Associated Groups: A Qualitative Study

Objective People with disabilities are highly vulnerable during disasters and their mortality is higher than normal population. The causes of this vulnerability, in addition to the physical problems and movement limitations, can be lack of their knowledge in facing with disasters. Such deficiencies can adversely affect their preparedness surviving in the disastrous situations and cause adverse consequences. Hence, this study aimed to identify the educational needs of people with physical disabilities and related groups in earthquakes, through understanding their views. Materials & Methods The study was done in a qualitative method. Participants were selected from people with physical disability who had an experience of earthquake, literate, and in the age range of 18-60 years, through purposive sampling in two methods of maximum variation and snowballing. Semi-structured interviews were used for data collection and data saturation was reached with the entry of 18 eligible individuals. Thematic analysis was applied for data analysis assisted by MAXQDA software V. 10. Results According to the participants, education was an essential factor for improving their preparedness for earthquake. The educational needs were categorized as two main themes. The first main theme included two subthemes: 1. Basic educational needs such as saving life and prevention of secondary disabilities, keeping calm, stress management, and decision making; and 2. Empowerment educational needs such as coping with disabilities in critical situations, providing relief to other people in case of having enough ability, and educating other people with disabilities. The second theme included two subthemes: 1. General educational needs related to families and public, such as rescue of people with disabilities, saving self-life and prevention of disabilities, proper relief to public for prevention of disabilities, accompanying and psychological support of people with disabilities; and 2. The specialized educational needs for relief workers and disaster managers, including relief to people with disabilities, prevention of disability and injury while rescuing public, familiarity with different groups of people with disabilities and their needs, and considering the needs of people with disabilities in the response measures.. Conclusion Based on the findings, the educational needs of people with physical disabilities and related groups, emerged in the form of preserving life, health and disability prevention, empowerment and improving the quality of services in the earthquake. Fulfilling the educational needs can increase the preparedness of these people in facing with earthquakes, although it requires the development of standard and practical educational programs by obtaining their opinions and implementing it in the situations before the disasters. On the other hand, considering that no serious and principled action has been taken so far in the field of education of people with disabilities, it is necessary for the planners and policymakers to formulate specialized policies in accordance with the country's conditions. This measures can be effective in reducing mortality and improving the health of these people in disaster situations.

Developing a hospital preparedness checklist to assess the ability to respond to the COVID-19 pandemic

Background

During epidemics and pandemics, health systems, and especially hospitals, face many challenges in the management of patients and staff. Hospital preparedness measures are critical for hospitals to respond effectively to the admission and management of COVID-19 patients. Ministry of health policy for pandemics must cover the ability of hospitals to respond to COVID-19.

Aims

The aim of this study was to develop a checklist for evaluating the preparedness of hospitals to respond to the COVID-19 pandemic.

Methods

We searched for and reviewed available evidence, including the literature and guidelines presented by related organizations. Due to the COVID-19 outbreak, face-to-face interview was not possible so we used telephone and video connections, mobile applications and email for unstructured interviews. Checklist development was carried out by a multidisciplinary panel of experts.

Results

After applying the opinions of the experts, the final checklist had 2 main domains: measures at national and measures at hospital level. Preparedness at national level was categorized into 3 aspects that are implemented by the health ministry. Preparedness at hospital level was categorized in 24 subgroups.

Conclusion

Hospital preparedness for admission and management of COVID-19 patients is essential. A checklist for the assessment of hospital preparedness for COVID-19 patient management and hospital management was designed and developed. Our preparedness assessment checklist is an expanded tool that provides clear and practical guidance that can be adapted for any hospital admitting COVID-19 patients.

Health effects of air pollution in the aftermath of earthquake

Natural disasters are always among the main problems and challenges facing societies. Earthquakes had many adverse effects on human life, causing mortality, morbidity, and economical, psychological, and environmental damages. Tehran is one of the most vulnerable regions for disasters, especially earthquake due. In recent decades, ambient air pollution represents one of the most environmental risks to health in Tehran. One of the main factors increasing the concentration of air pollutants is vehicles. After the earthquake, people left their homes and stayed into their cars until morning. Therefore, due to the pollution caused by leaving the cars on, the concentration of pollutants increased and the caused a greater number of deaths attributed to air pollution.

The main factors of supplier-induced demand in health care: A qualitative study

BACKGROUND

Induced demand is a major challenge for financing health promotion, whereby providers exploit patients' information gap to manipulate their demand for health care. The purpose of this study was to identify the factors associated with induced demand for health-care services in hospitals affiliated with Iran University of Medical Sciences (IUMS) in 2018.

MATERIALS AND METHODS

In this qualitative study, semi-structured interviews were conducted with 20 participants from IUMS hospitals, including faculty members, physicians, public hospital managers, patients, and researchers with academic and practical experience. Inductive content analysis was used to analyze the data.

RESULTS

Overall, 24 subthemes or factors were identified and classified into the health system, the insurer, health-care provider, and health-care recipient themes. Poor monitoring and control, the fee-for-service payment system, limited role of insurance companies, insufficient monitoring of insurance companies, the educational nature of our health centers, health-care providers' interests, and patients' information gap were some important factors in induced demand for health-care services.

CONCLUSION

Our results showed that there are many factors that contribute to induced demand for health care. Given the four levels of factors identified in this study, health policymakers and managers must develop strategies at each level to reduce induced demand for health care.

A model of reopening businesses to decrease the heath and economic impacts of the COVID-19 pandemic: Lessons from Iran

Background: OVID-19 is a major cause of morbidity and mortality worldwide. The closure of governmental and nongovernmental centers as well as social, cultural, and economic activities are other major negative impacts of the virus. The present paper aimed to develop a model of economic and health-related factors which affect the reopening of businesses and the proper management of the effect of virus on different aspects, particularly on people’s health and economy.

Methods: In order to facilitate decision-making and model risk analysis of guilds and occupations, an expert panel, including eight 8 experts, was convened by the Ministry of Health in Iran to prepare a strategic framework for the national taskforce of COVID-19 management. The panel spent many hours to prepare a simple model of reopening businesses and prioritize them from low to high risks.

Results: The experts identified and weighed seven health and three economic-related factors. The businesses and jobs were classified into 69 categories based on their similarities; they were also graded according to a predefined five- point Likert scale and categorized into three levels of low, medium, and high risk. The policymakers recommended to reopen businesses stratified by risk levels at least two weeks’ intervals.

Conclusion: The relaunch strategy in Iran put health and safety first while gradually reopening businesses, resuming activities, and getting people back to work. At the same time, attempts were made to slow the spread of the virus through following public health measures, social distancing, good hygiene, and continued acting responsibly. As many countries may have to deal with the same issue, this model can help them adopt appropriate policies and strategies for disease containment.

Study of Households’ Preparedness for Disasters and Emergencies in West Regions of Tehran Province, Iran

Background: Disasters and emergencies are always among the major challenges and problems facing societies. By proper education and preparedness promotion for households, the effects of disasters and emergencies can be reduced. This study was performed to provide disaster assessment and education guidelines in western regions of Tehran Province in 2018. Materials and Methods: This was a cross-sectional study. For data collection, the “Disaster Assessment and Education Guidelines” provided by the Ministry of Health was used. The forms and checklists were compiled by experts of urban and rural health centers. Then, the level of household preparedness for disaster was evaluated. Results: Based on the present study in 314 centers covered, 1726803 households were evaluated. In the northwest and west Tehran health centers, Shahryar, Malard, Qods, Robat Karim, and Baharestan and all of the regions, the levels of preparedness were estimated 34.9, 24.7, 31.3, 36.2, 21.9, 24.6, 12.3, and 26.9, respectively. Conclusion: The city of Tehran is located on important faults and areas prone to floods. So Tehran is highly vulnerable to natural disasters. Because of the important role of the people and the community-based management of disasters, household readiness must be improved to reduce the burden of death, injuries, and other disastrous consequences.

Health, safety, and education measures for fire in schools: A review article

Fire buildings is considered as one of the most common and the most devastating disasters and emergencies. Saving school buildings against incidents such as fire is very important since students are so vulnerable to incidents especially fire. The most school classes were devoid of safety conditions and oil-burning heaters were used. Such a condition has increased the risk of disaster and is considered as a serious menace for students' lives. The present study conducted with aim of review the Health, Safety and Education Measures for Fire in Schools. To this purpose, we selected suitable keywords some articles published in Scientific Information Database of PubMed, Web of Science, Scopus, and ProQuest were searched. The search was limited to reviewed articles in English and Persian language published between 1970 and 2019, based on inclusion and exclusion criteria. Furthermore, the selected articles were reviewed for relevant citations. The reviewing of articles was conducted by two member of research team independently. The primary search found 194 relevant studies. After eliminating the duplicates and articles which were not related to the review of the abstract, 51 references were identified for inclusion. Finally, 13 articles were selected after screening and evaluated by two authors to final review main factors and dimensions of schools' health, safety and education include the rules and laws, allocating sufficient budgets, education the teachers, students and their families, exercise, risk analysis, intersectional relations, fire extinguishing equipment, early warning system, and also optimization and reformation of heating system. Applying these new approaches prevents disasters and increases the level of preparedness in case of fire occurrence.

The Role of Health Centers Services for Response to COVID-19 in Iran

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus. Iran is one of the countries affected by the disease. Health center services have a critical role in response to the COVID-19 outbreak. This study with the aim of providing the functions and services of primary health care was performed by a health center in Iran during the COVID-19 outbreak. Based on the results, of the functions and services of the primary health care included purposive inter-organizational interaction and cooperation, risk analysis, planning, education and consultation, exercise, risk communication, environmental health, occupational health, and development of health infrastructures. Iran established and developed specific approaches for case identification, screening, and resource allocation to protect public health by primary health care services. Health center services are effective for a proper response to COVID-19 and a reduction in mortality by screening, rapid identification, and public education.

New insight into the informal patients' payments on the evidence of literature: a systematic review study

BACKGROUND

Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments.

METHODS

In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software.

RESULTS

Themes related to informal payments in external context of health system were demographic features of health service consumers, patient's personality features and social & cultural backgrounds of the community. Health system challenges' themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources' organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs.

CONCLUSION

It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems' goals and policies should be investigated due to the consideration.

The Role of Academic Partnership in Disaster Risk Management: A Systematic Review

OBJECTIVE

The aim of this systematic review is to investigate the community-based academic partnership roles in disaster risk management.

METHODS

The assessment of the documents was conducted by reviewing abstracts and full papers of the available studies, which provided considerable background and promoted knowledge in academic interventional roles in disaster risk management. The articles were searched with a wide range of key words related to the research topic. The studies included the research available between 2000 and September 2017 in the English language. The selection of articles was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

RESULTS

Of 997 articles, we selected 12 full-text articles that met the criteria for the final review based on the study objective. The results show that, although universities can play multidirectional roles in disaster risk management phases, the development of the academic partnership potential and collaboration for disaster risk management and disaster risk reduction for stakeholders is necessary.

CONCLUSION

The universities' potential in providing sufficient disaster health literacy is not currently considered important enough in communities.Therefore, the proper context-bound models of development based on a community's skills and universities' potential should receive more attention.

Perceptual errors in Iranian society: A qualitative study

Background:

General risk perception is defined as the collective wisdom of comprehension of risk, exposure and hazard in a society which decisions made during accidents and disasters are driven by the risk perceived by the influenced society. Always, the path of reaches to general perception is not smooth, one of the reasons of low impact risk reduction programs are perceptual errors that threat personal safety.

Methods:

This qualitative study was done considering the grounded theory. Thirty individuals participated in this study who were divided into two groups of expertise and ordinary people with maximum diversity. The data were collected through semi-structured interviews.

Results:

The finding of the study were extracted from 1357 primary codes. The risk perception structure in Iranian society was threatened with five diminishing factors called perceptual errors, negative experiences, negative beliefs, disapprovals and institutional factors. A perceptual error was due to an error in the estimation power of risk and error in its ability. The errors are less or excessive than the realistic estimated of the actual hazard. The individual's ability referred to coping power, therefore mistakenly estimates can cause personal injury. Some people consider denial or low-risk approach to their power to be sufficiently coped or dispersed. Negative experience occurs due to normalization of risk, and failure to predict incidence.

Risk perception is deliberately and voluntarily done. Non-acceptance is due to disclaimer of self-disclosure, conflict of interest. Institutional agents mean institutions that consist of governmental and non-governmental organizations that manage risk reduction. Some of institution agent are lack of commitment, trust, practical obligation and Instrumental use of people.

Conclusions:

The finding of this study can be identify perception errors that may play important role in actual understanding and create reasonable concern to providing precaution and safety. Actual risk perception formation need to educational, cultural and institutional strategies to promote risk perception. In order to paving up the safety upgrade path, policy makers, cultural, political and social managers can monitor and control this perception errors.

Keywords:

Risk perception, Risk reduction, Safety upgrade, Perception error, Iranian society

Disaster risk governance in Iran: Document analysis

BACKGROUND

Disaster risk is a product of a combination of hazard, exposure, and vulnerability. Governance in the health system is a multifaceted sphere, with political, economic, and legal dimensions. Disaster risk governance is an analytical framework employed for assessing the capacity of institutional governance. This study has been conducted to investigate the current status of national strategy documents concerned with disaster risk governance in Iran through document analysis.

MATERIALS AND METHODS

The investigated documents were collected through requests from the secretariat and the archives. 102 documents were analyzed. Twelve documents in the domain of accountability, 7 in participation, 9 in state and nonstate actor, 14 in knowledge sharing, 21 in sustainable developments, and 19 documents in integrated risk management were analyzed. The process of analysis included selecting documents and evaluating and analyzing them by content analysis method.

RESULTS

Documents coded according to the main areas of policymaking in disaster risk governance were analyzed, and sub-component and related topics were deduced in each domain. The acquired themes include unity of command, trustee, commitment, capacity prosperity, align strategy, information synergy, knowledge enhancement, sustainable security, justice clarity, land use planning, climate change adaptation, environment reform, wisdom, environment, diplomacy, capacity and coherence.

CONCLUSIONS

Disaster good governance is strengthened by the trustee, commitment, capacity prosperity, align strategy, and organize. Information synergy and knowledge enhancement are effective in the culture of prevention. Collective wisdom, diplomacy, and capacity coherence raise the alignment of public organizations and the government in the risk management process.

Communicable diseases management in disasters: an analysis of improvement measures since 2005, Islamic Republic of Iran

Background

Due to the importance of managing communicable diseases in disaster situations, the Centre for Communicable Diseases Management (CCDM) within the Iranian Ministry of Health and Medical Education has taken measures to improve routine communicable diseases management systems in normal and emergency situations.

Aims

This study aimed to explore the improvement measures since 2005.

Methods

A qualitative document analysis method was used to analyse all documents related to communicable diseases management from March 2003 to the end of 2014 in the CCDM and on official websites of related organizations.

Results

Seventy-two documents addressing communicable diseases management in disasters were included in the final analysis. The findings were summarized in 4 phases of the disaster management cycle corresponding to 5 core and support functions of the surveillance system.

Conclusions

The findings highlighted improvements in communicable diseases management in disasters, including interorganizational collaboration, information flow and use of new technologies such as web-based or mobile phone-based systems.

Conceptual model of managing health care volunteers in disasters: a mixed method study

Background

Shortage of specialized healthcare volunteers is a major challenge during disasters and one solution could be pre-identified healthcare volunteers. This study aimed to develop a conceptual model of managing Iranian healthcare volunteers in disasters.

Methods

This mixed method study was designed in two phases. A qualitative study using semi-structured interviews was conducted with 22 health professionals and key informant. The interviews were analyzed by framework analysis. In the second phase, concepts derived from the first step were evaluated in a two round Delphi study by an expert panel comprised of 42 experts.

Results

Two themes and eight subthemes were identified based on the results of the first phase. The theme of background requirements included three sub-themes of laws and regulations, NGOs and socio-cultural factors. The second theme was called operational requirements which included six subthemes of preparedness, response, retention, relocation, terminating and follow-up. According to the results of the Delphi study, all of the concepts were confirmed.

Conclusion

In addition to the need for supportive legal framework and building the culture of volunteering, it seems it is crucial to identify and prepare the health care volunteers in the preparedness phase and assign them appropriately in the response phase. Furthermore, the necessary measures should be prioritized to enhance volunteers’ retention rate and motivation. Plans should also be implemented for volunteers’ termination and volunteers’ physical and mental health follow up after their mission.

Intervention strategies for improvement of disasters risk perception: Family-centered approach

INTRODUCTION

Today, the role of people in crisis management plans is of particular importance due to the prepared community approach. It is difficult or impossible to attract public involvement due to the low level of public perception of risk. Therefore, it is necessary to discover the status of risk perception and its affecting factors. This study was conducted to investigate factors affecting the strategies of disaster risk perception improvement.

MATERIALS AND METHODS

This systematic review study was conducted in 2017 using extensive electronic and library literature searches in the Web of Science, Scopus, and PubMed electronic databases. The preliminary findings included 1030 studies. Out of 941 retrieved references, 925 references were excluded because they did not meet the objectives of this review or did not focus directly on general population. Finally, 16 articles were selected for further investigation.

RESULTS

The extracted variables were divided into four general domains: personal, psychological, socioeconomic, and cultural factors. Personal characteristics included sex, age, marriage, level of education, personal knowledge, and disaster personal experience. Psychological factors comprised emotions (fear and insecurity), mental images (beliefs, attitudes), and internal and external control. Cultural factors such as, belief, values, norms, faith, religious, and protective spirit were effective in general perception of disasters risk. Socioeconomic factors such as, income, livelihood, insurance coverage, trust, and fair access to land and resources were also influential. The strategies to improve public disaster risk perception were educational, participatory, incentive, confidence building, supportive, managerial and cultural ones. A family-centered approach is recommended for the better implementation of strategies.

CONCLUSION

The improvement of risk perception requires government planning in different fields such as education, research, health, and culture, with an emphasis on social groups especially family.

Features and Results of Conducted Studies Using a Lean Management Approach in Emergency Department in Hospital: A Systematic Review

Objective:

To perform a systematic review of the properties and results of the studies that their approaches are lean management in emergency departments and the factors which influence on their performance.

Method:

The necessary information in the first stage was collected by searching these keywords: "Lean principles" “Lean Six Sigma", "Lean Process", “Lean thinking”, “Lean Methodology”, “Toyota Production System lean processing”, "lean techniques", "emergency department”, “emergency medicine”, “emergency room” and “emergency care ” . And in the next stage the keywords such as “lean management” and “emergency” was collected from SID, Medlib, IranDoc, Google Scholar, MagIran, IranMedex data bases. For extracting the data data-extracting forms was prepared. The information we got from the forms was organized in information-extracting forms and was analyzed manually. The diagrams were drawn in Excel: 2010.

Results:

Finally, 26 essays have been included. Most of the studies were accomplished in Canada and U.S.A. only in one of the cases, the authors used the control group. Each of these terms, “lean techniques” and “lean principals”, with five times repetitions had the highest frequency. The most important team of implementation of lean management included: hospital management team or the manager of Emergency department, physicians, nurses, staffs and external counselors. Generally, 51 indicators were studied which among them the length of stay and the timing had the most frequency. After implementation of lean management, almost all studied indicators have significantly improved. 14 barriers, 14 facilitators and 10 effective factors were recognized in implementing the lean management.

Conclusion:

According to the studies, responsibility of organization’s senior management and his/her supports; increasing the knowledge of the characteristics and dimension of lean among the providers of health service; and decreasing the resistance and consulting with external counselors can have great effect on the success of lean management.

Roles, responsibilities, and strategies for enhancing disaster risk perception: A quantitative study

INTRODUCTION

Perception the risk of disasters, is mainly of universal and theoretical nature and is a means of achieving risk understanding/knowledge. In Sendai Framework, the focus is on increasing risk understanding plans in order to achieve community resilience. Therefore, to achieve greater public participation in planning for disaster risk reduction (DRR), this study was conducted primarily to clarify people's expectations from disaster risk management authorities in order to approach managers' and experts' views to people's views.

MATERIALS AND METHODS

This qualitative study was conducted through semi-structured interviews with 22 participants, who were selected using a purposive sampling technique, in three provinces of Iran. Data analysis was performed by qualitative content analysis using open coding, classifying, and abstracting.

RESULTS

By constant, comparison of data, classes, and subcategories were defined. Knowledge, beliefs, practical obligation, respect for human beings, endeavoring for systemic actions in terms of planning, implementation, and evaluation classes. In three more abstract categories, personal, interpersonal, and social commitments were defined.

CONCLUSION

At the preparatory stage, disaster managers need the maximum participation of people in DRR programs. They, in addition to understanding the importance of their managerial positions at individual levels and social interactions, are committed to reducing risk.

History and Structure of the Fourth Leading Emergency Medical Service in the World; a Review Article

Over forty-three years have passed since the foundation of pre-hospital emergency care system in Iran. Considering the changes that have taken place in recent years in pre-hospital emergency and limited studies in this area, the present review aimed to describe the history, organizational structure, combination of workforce, dispatch system, medical direction and innovations in the pre-hospital system of Iran. The present paper also discusses the strengths and weaknesses of the current system.

Disaster Health Literacy of Middle-aged Women

As disasters have been increasing in recent years, disaster health literacy is gaining more important for a population such as middle-age women. This is because they face developmental crises (menopause) and situational crisis (disaster). Due to the growing elderly population, it is imperative to seriously consider the issue of aging women's healthcare, and their educational needs relative to emergencies and disasters. The purpose of study was to clarify the importance of disaster health literacy for middle-age women. This study is a review of the literature using PubMed, ScienceDirect, Web of Science, Google Scholar, SCOPUS, OVID, ProQuest, Springer, and Wiley. Data was collected with keywords related to the research topic (“Women's health” OR “Geriatric health”) AND (“Health literacy” OR “Disaster health literacy” OR “Disaster prevention literacy” OR “Risk knowledge” OR “Knowledge management”) AND (“Disasters” OR “Risk” OR “Crises”) in combination with the Boolean-operators OR and AND. We reviewed full text English-language articles published November 2011 November 2017. Additional references were identified from reference lists in targeted publications, review articles and books. This review demonstrated that disaster health literacy is critical for elderly women, because they may suffer from physical and psychological problems triggered by developmental crises such as menopause and situational crises such as disasters. Disaster literacy could enable them to improve resiliency and reduce disaster risk. Education has vital role in health promotion of middle-age women. Policymakers and health managers should be aware of the challenges of elderly women as a vulnerable group in disasters and develop plans to incorporate disaster health literacy for preparedness and prevention in educating this group.

Stakeholder analysis of Iran's health insurance system

INTRODUCTION

This study was designed and implemented with the purpose of identify and analyze the stakeholders in Iran's Health Insurance System (HInS).

MATERIALS AND METHODS

This study was a mixed method study. The study setting was in the field and consists of all organizations in the HInS. The study steps designed according to the Kammi Schmeer stakeholder analysis model. The information was collected through semi-structured and structured interviews with 16 stakeholder representatives. The data collection tool was checklist and matrixes that determined the characteristics of the stakeholders. Analysis of data was done by Maxqda10 and Mactor software.

RESULTS

A total of 34 stakeholders were identified that were involved in nine main activities of HInS. Major stakeholders have governmental nature. The Government, the Planning and Budget Organization, the Ministry of Health, the Welfare Ministry, the Higher Health Insurance Council, and the Medical Council were stakeholders who have high financial, decision-making, and political power simultaneously. The Parliament and the Health Commission, the Government, the Planning and Budget Organization, and the Ministry of Health were stakeholders that had the most influence on other stakeholders. Most of stakeholders have same position to the objectives of the HInS. The insurer organizations had opposed position with the objective of integrity of the funds.

CONCLUSIONS

Stakeholders of Iran's HInS are multiple and involved in various activities that sometimes they are overlapping and parallel. Regarding the same position of the majority of stakeholders to the objectives, reforms are possible, provided that influential stakeholders participate in policies making.

Health Economic Evaluation of Home and Hospital-Based Care in T2D Patients on Insulin Therapy

Background

Type 2 Diabetes is a main concern of public health in contemporary world with remarkable mortality, delayed complications and health costs. Governments are obliged to improve the quality of health care and consider appropriate strategies to reduce the costs. An alternative strategy for hospital services is care at home. Therefore, this study was aimed to evaluate the cost-effectiveness of home-based and hospital-based diabetes care.

Methods

A quasi-experimental, pre-test and post-test design was conducted in Northwest Iran. Sixty subjects who were eligible insulin-treatment type 2 diabetes mellitus were randomly assigned into two equal groups to receive home-based or conventional hospital-based care. Data on glycosylated hemoglobin (HbA1c), hypoglycemia episodes, time needed to achieve glycemic control level, diabetes treatment satisfaction, diabetes knowledge and costs during three months were collected.

Results

The cost of home-based care in insulin therapy diabetes was 61% less compared with the hospital-based methods. The former strategy was cost-effective in terms of reduction in HbA1C and the time needed to achieve glycemic control. The patients in home care group were more satisfied and knowledgeable.

Conclusions

The care at home approach for type 2 diabetic patients can be introduced and supported as a cost-effective care method in the country.

Prevalence of depression in cardiovascular patients in Iran: A systematic review and meta-analysis from 2000 to 2017

BACKGROUND

In both developed and developing countries, cardiovascular disease is on the rise, representing nowadays one of the main challenges for the health systems worldwide. This increase generates relevant costs. The aim of this study was to conduct a systematic and meta-analytical review of the prevalence of depression in cardiovascular patients in Iran.

METHODS

Articles written in English and Persian were searched from January 2000 to July 2017 in different scholarly databases.

RESULTS

12 studies were retained and included in the current meta-analysis. Selected studies were published between 2008 and 2016. The number of patients participating in these studies was 9292. Based on the random-effects model, the prevalence of depression in cardiovascular patients in Iran was 47% [95% confidence interval or CI 38-56], I²=98.2% with P = 0.000. The relative risk (RR) of depression in cardiovascular patients yielded a value of 1.30 [95%CI 1.05-1.62] with P < 0.001. Women are more at risk for depression than men.

CONCLUSION

The current meta-analysis estimated the prevalence of depression among cardiovascular patients in Iran. The prevalence found computed by the present study is higher than the figures found in developed countries. Depression with cardiovascular disease causes many problems for these patients, and early diagnosis and treatment significantly helps in improving quality of life, as well as saving costs and resources.

Strategies for disaster risk reduction education: A systematic review

INTRODUCTION

For many years, numerous researches and risk reduction activists have emphasized the importance of public awareness and education for disaster risk reduction (DRR). These needs, due to human natural manipulation, have increased. The present study was aimed to assess and determine the evidence on the strategies for education of DRR.

MATERIALS AND METHODS

This study was a systematic review of publications and gray literatures regarding to strategies for education of DRR conducted in December 2016. Fifteen articles and dissertations published during January 1, 2000 to December 31, 2016 were extracted through PubMed, Scopus, ProQuest, Web of Science, ScienceDirect, Ovid, Google Scholar, Scientific Information Database, Magiran, and Irandoc with the inclusion criteria of English and Persian language. Thematic analysis technique was used to analyze the articles.

RESULTS

The thematic analyses revealed eight major categories of DRR educational strategies such as raising knowledge, educational needs assessment, educational planning, educational approaches, educational content, educational tools, involved organizations, and educational learning barriers and challenges.

CONCLUSIONS

Most countries have launched DRR education activities, but these actions are not enough, and there are some gaps between what is it and what should be. More effective and efficient teaching and learning strategies are needed to increase the effectiveness of preparedness and DRR activities at all levels of community.

Validity and reliability of the Evidence Utilisation in Policymaking Measurement Tool (EUPMT)

Background

As a well-known theory in studying the effective factors on behaviour, the theory of planned behaviour (TPB) is frequently used in evaluating the health behaviour of people and healthcare providers, but rarely applied in studying the behaviour of health policymakers. The aim of the present study is to design and validate a TPB-based measurement tool for evidence utilisation in health policymaking (the EUPMT) through a mixed approach using confirmatory factor analysis.

Methods

The study population consisted of all the specialised units and their employees in the five deputies of Iran’s Ministry of Health and Medical Education in 2013. All those eligible were invited to participate in the study, which comprised 373 persons. The reliability of the EUPMT was determined through test-retest and internal consistency. Additionally, its validity was determined by face, content, convergent, discriminant and construct validities. SPSS-20 and LISREL-8.8 were employed to analyse the data. To assess the fitness of the measurement models, three groups of indices were used, i.e. absolute, relative and parsimonious.

Results

The content and face validities of the tool were 83% and 67%, respectively. Cronbach’s alpha of different constructs ranged from 0.7 to 0.9. In the test-retest method, the intra-class correlations were between 0.75 and 0.87. Confirmatory factor analysis showed that the penta-factorial structure of the experimental data had acceptable fitness with the TPB (GFI = 0.86, NFI = 0.94, RSMEA = 0.075).

Conclusion

TPB is able to explain the behaviour of evidence utilisation in health policymaking. The finalised TPB-based tool has relatively good reliability and validity to assess evidence utilisation in health policymaking. The EUPMT can be applied to determine the status quo of evidence utilisation in health policymaking, whilst designing interventions for its improvement and assessing their outcomes.

A Qualitative Assessment of the Evidence Utilization for Health Policy-Making on the Basis of SUPPORT Tools in a Developing Country

Background: SUPPORT tools consist of 18 articles addressing the health policy-makers so that they can learn how to make evidence-informed health policies. These tools have been particularly recommended for developing countries. The present study tries to explain the process of evidence utilization for developing policy documents in the Iranian Ministry of Health and Medical Education (MoHME) and to compare the findings with those of SUPPORT tools.

Methods: A qualitative research was conducted, using the framework analysis approach. Participants consisted of senior managers and technicians in MoHME. Purposeful sampling was done, with a maximum variety, for the selection of research participants: individuals having at least 5 years of experience in preparing evidence-based policy documents. Face-to-face interviews were conducted for data collection. As a guideline for the interviews, ‘the Utilization of Evidence in Policy-Making Organizations’ procedure was used. The data were analyzed through the analysis of the framework method using MAXQDA 10 software.

Results: The participants acquired the research evidence in a topic-based form, and they were less likely to search on the basis of the evidence pyramid. To assess the quality of evidence, they did not use standard critical tools; to adapt the evidence and interventions with the local setting, they did not use the ideas and experiences of all stakeholders, and in preparing the evidence-based policy documents, they did not take into consideration the window of opportunity, did not refrain from using highly technical terms, did not write user-friendly summaries, and did not present alternative policy options. In order to develop health policies, however, they used the following innovations: attention to the financial burden of policy issues on the agenda, sensitivity analysis of the preferred policy option on the basis of technical, sociopolitical, and economic feasibility, advocacy from other scholars, using the multi-criteria decision-making models for the prioritization of policy options, implementation of policy based on the degree of readiness of policy-implementing units, and the classification of policy documents on the basis of different conditions of policy-making (urgent, short-term, and long-term).

Conclusion: Findings showed that the process of evidence utilization in IR-MoH enjoys some innovations for the support of health policy development. The present study provides IR-MoH with considerable opportunities for the improvement of evidence-informed health policy-making. Moreover, the SUPPORT process and tools are recommended to be used in developing countries.

Development and Psychometric Evaluation of the Pre-hospital Medical Emergencies Early Warning Scale

Introduction:

The number of requests for emergency medical services (EMSs) has increased during the past decade. However, most of the transports are not essential. Therefore, it seems crucial to develop an instrument to help EMS staff accurately identify patients who need pre-hospital care and transportation. The aim of this study was to develop and evaluate the psychometric properties of the Pre-hospital Medical Emergencies Early Warning Scale (Pre-MEWS).

Materials and Methods:

This mixed-method study was conducted in two phases. In the first phase, a qualitative content analysis study was conducted to identify the predictors of medical patients' need for pre-hospital EMS and transportation. In the second phase, the face and the content validity as well as the internal consistency of the scale were evaluated. Finally, the items of the scale were scored and scoring system was presented.

Results:

The final version of the scale contained 22 items and its total score ranged from 0 to 54.

Conclusions:

Pre-MEWS helps EMS staffs properly understand medical patients' conditions in pre-hospital environments and accurately identify their need for EMS and transportation.

Policies on Protecting Vulnerable People During Disasters in Iran: A Document Analysis

CONTEXT

Developing official protection policies for disasters is a main strategy in protecting vulnerable people. The aim of this study was to analyze official documents concerning policies on protecting vulnerable people during disasters.

EVIDENCE ACQUISITION

This study was conducted by the qualitative document analysis method. Documents were gathered by searching websites and referring to the organizations involved in disaster management. The documents were assessed by a researcher-made data collection form. A directed content analysis approach was used to analyze the retrieved documents regarding the protection policies and legislation for vulnerable people.

RESULTS

A total of 22 documents were included in the final analysis. Most of the documents referred to women, children, elderly people, poor, and villagers as vulnerable people. Moreover, the documents did not provide information regarding official measures for protecting vulnerable people during different phases of disaster management.

CONCLUSIONS

A clear and comprehensive definition of "vulnerable people" and formulation of official policies to protect them is needs to be formulated. Given the high prevalence of disasters in Iran, policy makers need to develop effective context-based policies to protect vulnerable people during disasters.

Assessment of Hospital Management and Surge Capacity in Disasters

BACKGROUND

Hospital administrators play a key role in the effective management of surge capacity in disasters, but there is little information available about the characteristics required to manage this.

OBJECTIVES

In this study, we aimed to identify characteristics of hospital administrators that are important in the effective management of surge capacity in disasters.

MATERIALS AND METHODS

This was a qualitative study. Semi-structured purposive interviews were conducted with 28 hospital administrators who had experience working in surge situations in hospitals during disasters. Framework analysis was used to analyze the data.

RESULTS

Three themes and 12 subthemes were identified. The themes were as follows: 1) crisis managerial characteristics, 2) personal characteristics, and 3) specific requirements.

CONCLUSIONS

In this study, some characteristics that had a positive impact on the success of a manager in a hospital surge situation were identified. These characteristics ought to be taken into account when appointing hospital administrators and designing training programs for hospital administrators with the aim of being better prepared to face disasters.

Emergency Nurses' Requirements for Disaster Preparedness

BACKGROUND

Natural and man-made disasters affect people, communities, and health systems. Nurses play a key role in the health system and must be prepared for appropriate response in disasters.

OBJECTIVES

This study was done to assess the current knowledge of nurses in emergency departments for disaster preparedness.

PATIENTS AND METHODS

This cross-sectional study was conducted on 110 emergency nurses working in teaching hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran. A questionnaire was used to collect data and the data were then analyzed using descriptive and inferential statistics with SPSS software version 16.0.

RESULTS

Based on the findings, most of the participants (64.5%) were aged 30 - 39 years old. 84% of the cases were female and 97.3% had a bachelor's degree. The average perceived knowledge of nurses was 2.43 ± 1.01. The nurses had the highest familiarity with triage and lowest knowledge in epidemiology and decision-making.

CONCLUSIONS

Lack knowledge of nurses regarding response to disaster situations indicates inefficiencies in the current system. Therefore, it is recommended to organize more workshops, annual training courses, and maneuvers based on staff needs and formulate continuous education courses for nurses.

Patient Safety in Medical Education: Students' Perceptions, Knowledge and Attitudes

Patient safety is a new and challenging discipline in the Iranian health care industry. Among the challenges for patient safety improvement, education of medical and paramedical students is intimidating. The present study was designed to assess students’ perceptions of patient safety, and their knowledge and attitudes to patient safety education. This cross-sectional analytical study was conducted in 2012 at Urmia University of Medical Sciences, West Azerbaijan province, Iran. 134 students studying medicine, nursing, and midwifery were recruited through census for the study. A questionnaire was used for collecting data, which were then analyzed through SPSS statistical software (version 16.0), using Chi-square test, Spearman correlation coefficient, F and LSD tests. A total of 121 questionnaires were completed, and 50% of the students demonstrated good knowledge about patient safety. The relationships between students’ attitudes to patient safety and years of study, sex and course were significant (0.003, 0.001 and 0.017, respectively). F and LSD tests indicated that regarding the difference between the mean scores of perceptions of patient safety and attitudes to patient safety education, there was a significant difference among medical and nursing/midwifery students. Little knowledge of students regarding patient safety indicates the inefficiency of informal education to fill the gap; therefore, it is recommended to consider patient safety in the curriculums of all medical and paramedical sciences and formulate better policies for patient safety.

Patient education process in teaching hospitals of Tehran University of Medical Sciences

BACKGROUND

Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran.

METHODS

This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling. Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating.

RESULTS

The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to the evaluation of patient education (2.840 ±0.0628).

CONCLUSION

Clarifying patient education steps, developing standardized framework and providing easily understandable tool-kit of the patient education program will improve the ability of nurses in delivering effective patient education in general and specialized hospitals.

Developing of the appropriateness evaluation protocol for public hospitals in iran

Background:

Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems.

Objectives:

This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran.

Patients and Methods:

The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients’ medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses.

Results:

Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92%, while the specific appropriate agreement and specific inappropriate agreement were > 88% and > 83%, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively.

Conclusions:

The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context.

Towards age-friendly hospitals in developing countries: a case study in iran

BACKGROUND

Developing countries such as Iran are experiencing a growth in the elderly population. This is a challenge for healthcare providers and their families. This study investigated the extent in which hospitals at Tehran meet the criteria of age-friendly hospitals.

METHODS

In this descriptive study, using convenience sampling, 26 hospitals were selected in Tehran, the capital city of Iran. The instrument was a checklist included 50 items in the three dimensions of information and training of service providers, management systems in health care centers, physical environment and accessibility of hospitals.

RESULTS

Most hospitals were in a good condition regarding physical environment and access to public transportation, but in a poor condition for special healthcare programs for the elderly, teaching principles of geriatrics and gerontology, interaction of medical staff, physicians and nurses with senior patients and systems of priority for them.

CONCLUSION

Due to the growing elderly population, it is necessary for health policymakers, especially in developing countries, to consider seriously the issue of elderly healthcare and their need for special outpatient and inpatient services.

Fairness of Financial Contribution in Iranian Health System: Trend Analysis of National Household Income and Expenditure, 2003-2010

Background:

Social systems are dealing with the challenge of achieving fairness in the distribution of financial burden and protecting the risk of financial loss. The purpose of this paper is to present a trend analysis for the indicators related to fairness in healthcare’s financial burden in rural and urban population of Iran during the eight years period of 2003 to 2010.

Methods:

We used the information gathered by statistical center of Iran through sampling processes for the household income and expenditures. The indicators of fairness in financial contribution of healthcare were calculated based on the WHO recommended methodology. The indices trend analysis of eight-year period for the rural, urban areas and the country level were computed.

Results:

This study shows that in Iran the fairness of financial contribution index during the eight-year period has been decreased from 0.841 in 2003 to above 0.827 in 2010 and The percentage of people with catastrophic health expenditures has been increased from 2.3% to above 3.1%. The ratio of total treatment costs to the household overall capacity to pay has been increased from 0.055 to 0.068 and from 0.072 to 0.0818 in urban and rural areas respectively.

Conclusion:

There is a decline in fairness of financial contribution index during the study period. While, a trend stability of the proportion of households who suffered catastrophic health expenditures was found.

Financial Management Reforms in the Health Sector: A Comparative Study Between Cash-based and Accrual-based Accounting Systems

Background:

Financial management and accounting reform in the public sectors was started in 2000. Moving from cash-based to accrual-based is considered as the key component of these reforms and adjustments in the public sector. Performing this reform in the health system is a part of a bigger reform under the new public management.

Objectives:

The current study aimed to analyze the movement from cash-based to accrual-based accounting in the health sector in Iran.

Patients and Methods:

This comparative study was conducted in 2013 to compare financial management and movement from cash-based to accrual-based accounting in health sector in the countries such as the United States, Britain, Canada, Australia, New Zealand, and Iran. Library resources and reputable databases such as Medline, Elsevier, Index Copernicus, DOAJ, EBSCO-CINAHL and SID, and Iranmedex were searched. Fish cards were used to collect the data. Data were compared and analyzed using comparative tables.

Results:

Developed countries have implemented accrual-based accounting and utilized the valid, reliable and practical information in accrual-based reporting in different areas such as price and tariffs setting, operational budgeting, public accounting, performance evaluation and comparison and evidence based decision making. In Iran, however, only a few public organizations such as the municipalities and the universities of medical sciences use accrual-based accounting, but despite what is required by law, the other public organizations do not use accrual-based accounting.

Conclusions:

There are advantages in applying accrual-based accounting in the public sector which certainly depends on how this system is implemented in the sector.

Risk Assessment of Drug Management Process in Women Surgery Department of Qaem Educational Hospital (QEH) Using HFMEA Method (2013)

Evaluation and improvement of drug management process are essential for patient safety. The present study was performed whit the aim of assessing risk of drug management process in Women Surgery Department of QEH using HFMEA method in 2013. A mixed method was used to analyze failure modes and their effects with HFMEA. To classify failure modes; nursing errors in clinical management model, for classifying factors affecting error; approved model by the UK National Health System, and for determining solutions for improvement; Theory of Inventive Problem Solving, were used. 48 failure modes were identified for 14 sub-process of five steps drug management process. The frequency of failure modes were as follow :35.3% in supplying step, 20.75% in prescription step, 10.4% in preparing step, 22.9% in distribution step and 10.35% in follow up and monitoring step. Seventeen failure modes (35.14%) were considered as non-acceptable risk (hazard score≥ 8) and were transferred to decision tree. Among 51 Influencing factors, the most common reasons for error were related to environmental factors (21.5%), and the less common reasons for error were related to patient factors (4.3%). HFMEA is a useful tool to evaluating, prioritization and analyzing failure modes in drug management process. Revision drug management process based focus-PDCA, assessing adverse drug reactions (ADR), USE patient identification bracelet, holding periodical pharmaceutical conferences to improve personnel knowledge, patient contribution in drug therapy; are performance solutions which were placed in work order.

Structural and contextual dimensions of Iranian primary health care system at local level

Background:

In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago.

Objectives:

This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level.

Materials and Methods:

A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests.

Results:

Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value < 0.001). Goals and culture dimensions had strongest effects on structural dimensions.

Conclusions:

Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system.