فهرست مطالب ma. jahani

Pharmaceutical costs account for a major part of health-related costs, and the induced demand for medicine imposes a large financial and economic burden on individuals and the whole society. Therefore, the aim of the present study is to identify the factors effective in creating induced demand for medicine in Iran.

This study is based on grounded theory approach and it was conducted in 2022. The interview questions were semi-structured and asked by experts. The initial selection of the samples was based on targeted sampling from among experts and scholars in the field of medicine and treatment from all over the country. The snowball method was used to increase the sample volume until it reached sufficiency. This research was completed by interviewing 20 experts.

The key factors effective in creating induced demand were identified in the form of 4 themes, 8 categories and 31 subcategories. The extracted themes included social, structural-organizational, economic and beneficiary-related factors. Social factors included the categories of society's culture and pharmaceutical literacy, structural-organizational factors included the categories of regulatory mechanisms and educational and political factors, economic factors included the categories of payment and insurance systems, and finally the beneficiary-related factors included the categories of suppliers and demanders.

Based on the results of this study, several factors play a role in the creation of induced demand for medicine, and following these factors can help policymakers formulate appropriate strategies to reduce unnecessary medicine prescription.

Accidents as the second cause of disability and the main cause of disability and death can lead to physical and mental disorders and even death. The present study was conducted to investigate the mortality caused by accidents and incidents in Babol, Northern Iran, based on the international classification of diseases.

This cross-sectional study was conducted retrospectively on all the deaths recorded during the years 2016-2022 in registration and classification system of causes of death caused by accidents and incidents at the health department of Babol. Deaths caused by accidents and incidents were extracted and analyzed based on ICD-10.

Out of 18265 deaths, 1305 cases (15.7%) were related to accidents and incidents, of which 686 deaths (52.57%) were caused by traffic accidents. The highest frequency of accidents and incidents was 576 cases (44.13%) due to a person being injured in an unknown (traffic) accident and 182 cases (13.95%) being exposed to an unknown factor. The mean age in deaths caused by accidents and incidents in the traffic accident group was 46.05±22.07 and in the non-traffic accident group was 43.35±23.49 years (p=0.033). As the decades of age increased, the death rate increased (p<0.001).

Based on the results of this study, most of the deaths caused by accidents and incidents based on the classification system of the causes of death were due to the injury of a person in an unknown accident, exposure to unknown factors and poisoning.

The mortality in children aged 1-59 months is one of the important indicators in assessing the general health status of a community. The death control system for children aged 1-59 months is used to record and review this indicator in Iran. This study was performed to investigate the mortality rate in children aged 1-59 months in affiliated healthcare centers of Babol University of Medical Sciences based on ICD10.

In this cross-sectional study, all cases of death in children aged 1-59 months registered in affiliated healthcare centers of Babol University of Medical Sciences in 2009-2020 were collected by referring to the reports recorded in the death control system for children aged 1-59 months. Then, information about the cause of death and the trends of mortality during the years 2009-2020 were reviewed.

Out of a total of 303 cases of death in children aged 1-59 months, 179 cases (59.07%) were boys, the mean age of children was 13.08±15.12 months and with 175 cases (57.75%), the highest mortality rate was related to urban areas. The general trend of mortality was declining; from 41 cases in 2009 to 14 cases in 2020 (p≤0.001). Congenital and chromosomal abnormalities in 100 cases (34%), endocrine, nutritional and metabolic diseases in 56 cases (18.48%), nervous system diseases in 23 cases (7.59%) and cancers in 22 cases (7.26%) were respectively the most common causes of death.

The results show a declining trend in the mortality of children aged 1-59 months.

Risk assessment is one of the most important strategies in estimating the risk of cardiovascular disease and controlling the risk factors. In Iran, half of all deaths and 79% of deaths due to non-communicable diseases are attributed to cardiovascular diseases. The aim of this study was to analyze the results of cardiovascular disease risk assessment program in Mazandaran province.

This cross-sectional study was performed in 2019 on 600 patients referred to comprehensive health centers of Noor and Mahmoudabad cities in Mazandaran province. The data collection tool was a checklist containing the risk factors studied in the SIB system. Descriptive statistics such as mean, standard deviation, frequency and percentage as well as analytical statistical tests such as chi-square, regression and analysis of variance were used using SPSS software version 19.

The prevalence of risk factors for cardiovascular disease including history of diabetes, history of hypertension, obesity, high cholesterol, family history of diabetes and heart disease were 36.5%, 45.5%, 42.3%, 34.8%, 23.5% and 10%, respectively. The four variables of age, history of diabetes and hypertension, and blood cholesterol levels were significantly associated with the 10-year risk of cardiovascular disease. With increasing one year of age, the 10-year risk level increased by 15% (p<0.001), and by seven times in people with a history of diabetes (p<0.001) and increased by 83% in people with a history of high blood pressure compared to others individuals (p=0.022).

The results of the study showed that in Mazandaran province, four variables of age, history of diabetes and hypertension and cholesterol levels are the most common factors that are associated with 10-year risk of cardiovascular disease.

In addition to reducing the costs in hospitals, manpower planning can ensure the quality of patient care. Therefore, this study, which is part of a comprehensive study, was conducted with the aim of applying the birth rate method to estimate the number of midwives required in the maternity ward.

In this analytical study, 334 patients who referred to the delivery ward of two hospitals affiliated to the Social Security Organization in Khorasan Razavi province were selected by systematic random sampling. Retrospective data were collected from patients  medical records using the Birthrate Plus (BR+) model questionnaire consisting of 34 items related to maternal and neonatal clinical factors based on scores obtained in five groups (score 6 in group one, score 7-9 in group two, score 10-13 in group three, score 14-18 in group four, and score 19 and above in group five). Then, the data were analyzed.

The results showed that the duration of stay in the maternity wards of the province and district hospitals was 12.07±5.18 and 7.17±4.22 hours, respectively (p<0.001). The mean duration of midwife s care in the two hospitals was significantly different (p<0.001). The results indicated more patients with complex conditions in the maternity ward of the province hospital. According to the "BR+" model, about 60% of patients in the province hospital were in groups 4 and 5, while it was 18% in another hospital. The number of midwives required in district and province hospitals was 27 and 72, respectively, based on full-time equivalent (FTE), which was obtained by converting it into an index equivalent to one midwife for 142 and 95 annual deliveries in the mentioned hospitals.

The results of the study showed that the use of the BR+ model, considering the length of stay and the severity of clients symptoms, is a suitable model for determining the midwifery staff in the maternity ward.

Assessing health systems paves the way for reforms in structures and processes to achieve better results. Therefore, the present study was conducted to evaluate the implementation of family physician program in urban and rural areas of Mazandaran province using process approach.

This cross-sectional study was conducted in 2017 among 238 managers, health experts and health insurance experts who were selected by census from 12 cities. Data were collected and evaluated using a researcher-made questionnaire with high validity and reliability, which evaluates urban and rural family physician program in three domains of structure, process and outcomes.

The mean score of the domain of structure (4.27±27.38), process (4.33±0.41) and outcomes (4.31±0.39) of rural family physician program was significantly higher than urban family physician program (p<0.001). In the urban family physician program, the most important dimension in the domain of structure was equipment (3.35±0.76), in the domain of process was care for non-communicable diseases (3.15±1.06) and in the domain of outcomes was reasonable prescription of medicine (3.07±1.02). In the rural family physician program, the most important dimension in the domain of structure was physical space (4.41±0.60) and in the dimensions of process and outcomes, the health of mothers and children (4.20±0.90) and the improvement of health promotion indicators (4.33±0.76) were more important, respectively.

Based on the results of this study in three domains of structure, process and outcomes, the rural family physician program was relatively better than the urban family physician program.

Cancers are a wide range of diseases, and their numbers are increasing but the severity of the disease is varied in different cancers. This study was conducted to evaluate the frequency of referrals of cancer patients referred to hospitals affiliated to the Babol University of Medical Sciences based on ICD10.
This retrospective study was conducted on all cancer patients referring to hospitals affiliated to Babol University of Medical Sciences from 1992 to 2016. The information related to the patients who referred to these centers for the first time were collected and reviewed using a checklist including hospital name, case number, age, sex, occupation, marriage, place of residence, type of cancer and ICD code.
FINDINGS: The highest frequency of cancer patients was related to male gender (50.7%, 3575 patients), married patients (87.2%, 6147 patients), and were related to Babol (16.8%, 1889 patients), Amol (14.4%, 1018 patients) and Sari (11.8%, 833 patients). Most of the patients were in the age group of 70 and above and the problem was mostly associated with the gastrointestinal organs, breast and respiratory organs. There was no significant difference between the type of cancer and the place of residence, but there was a significant relationship with age, sex, type of residence, type of occupation and marital status (p=0.05).
The results of the study showed that the pattern of cancer in different cities is similar and increases with age.

One of the objectives of each system is cost management to help organizations to provide high quality goods and services at a competitive environment. The present study was aimed to calculate the costs of cardiac care unit at Imam Reza hospital of Bojnurd by activity-based costing method.
Material & This study is an applied study that cross-sectional and retrospective methods were carried out. Data gathered by observation, interviews, review documents and financial statements of Imam Reza hospital in Bojnurd in 2013. The hospital activity centers were identified. After costing each activity center, indirect costs of cardiac care unit were allocated to this sector by direct allocation method. Microsoft Excel 2007 software was used for the calculation.
The results showed that the total cost of cardiac care unite services is 19,677,265,413 Rials equivalent to 8.06% of hospital costs., that 65.1% of the costs related to personnel costs, 8.1% of the costs related to materials and supplies and expenses related to overhead costs is 26.8%.
Majority of the costs of cardiac care unit are the employee compensation costs which are among the constant costs of hospital. It seems that we should optimize the use of staff through different processes such as ward development, proper pattern of consumption material, and increased bed occupancy index.

The essence of insurance is compensating damages and replacing uncertainty with peace of mind; and insurance, as a way of dealing with risk, is a response to insecure and risky situations. This study was carried out to investigate the effect of supplemental health insurance on family quality of life.
This cross-sectional study was carried out in 2014-2015 (Hijri year 1393) using 380 families of Babol city (Mazandaran Province, Iran) in two groups; those benefiting from supplemental health insurance and those without supplemental health insurance. Quality of life (QOL) was studied and compared between the two groups using WHOQOL-BREF questionnaire. The score range was between 24 and 120. Scores lower than 60 were considered as low quality of life and scores higher than 60 were considered as high quality of life.
FINDINGS: Mean quality of life score for the group with supplemental health insurance was 86.75±10.77 while it was 68.07±13.43 for the people without supplemental health insurance (p Results of the study demonstrated that having supplemental health insurance enhances the quality of life.

The agility of a hospital represents responsiveness of the hospital in the face of internal and external changes and agile hospitals are able to compete with other hospitals in providing services to patients. Therefore, this study aimed to determine the factors affecting agility supply chain in hospitals of Iran.
This applied research study was conducted in 2014- 2015. The population of this study included all managers, administrators, faculty members and experts of health care centers. A sample of 260 hospitals was selected based on cluster sampling from 5 regions of country. A 53 item researcher- developed questionnaire of agility was distributed among the sample. The construct validity and reliability of the questionnaire was confirmed by confirmatory factor analysis and Cronbach's alpha (r=0.97). The collected data were entered in SPSS ¡lisrel software and were then analyzed with relevant tests.
The development of employee's skills (p =0.008), The use of information technology )p =0.008), The integration of processes )p =0.001), The sensitivity and responding to market )p =0.000), appropriate planning )p =0.004), the introduction of a new product )p =0.008), reduction in costs )p =0.000), customer satisfaction )p =0.005), and product quality )p =0.005) appeared to have a significant impact on agility of public hospitals in Iran. While the introduction of new products received the highest rating, developing the skills of employees received the lowest rating.
Rapid response to increasing and changing needs of customer is necessary to gaining a competitive advantage for hospitals that can increase their agility capabilities by creating the new strategies and improving their infrastructure.

Patient satisfaction in emergency departments is an indicator of healthcare quality, evaluation of which can promote awareness of the relevant authorities regarding its status. This study aimed to evaluate patient satisfaction in emergency departments in hospitals affiliated to Babol University of Medical Sciences.
This cross-sectional study was performed in patients admitted to emergency departments in hospitals affiliated to Babol University of Medical Sciences, Babol, Iran, during a period of eight months (2013-2014). The participants were chosen through convenience sampling. Information regarding hospital environment, facilities, and nursing team was collected using a standard questionnaire. Standard questionnaire responses were classified to” don’t happen, dissatisfied, low, medium and high satisfaction”. Then medium and high responses classified to favorable satisfaction (above average) and low or dissatisfied responses were classified to unfavorable satisfaction. In case the patients were unable to fill-out the questionnaire, their companion completed it for them.
FINDINGS: Overall, 444 (87.9%) patients expressed optimum satisfaction. The highest rate of dissatisfaction (14.8%, n=74) was related to environment and services, while the highest rate of satisfaction (49.3%, n=246) was pertinent to nursing staff. The results indicated that the rate of satisfaction in residents of rural areas was 0.55 times higher than in urban residents (OR: 1.55, 95% CI: 1.12-2.70, p=0.02), 50% lower in patients compared to companions (OR: 0.55, 95% CI: 0.36-0.83, p=0.05),and in the evening shift was 0.65 times higher than in those admitted in the morning (OR: 1.65, 95% CI: 1.06-2.58, p=0.03). Moreover, this rate in patients admitted at night shift was 0.74 times higher than in those admitted in the morning (OR: 1.74, 95% CI: 1.12-2.70, p=0.01).
This study demonstrated optimum patient satisfaction in emergency departments in hospitals affiliated to Babol University of Medical Sciences.

Globalization and planning for global thinking and institution's activity that could work and act out of national limit are important actions which should be taken in Iran. Globalization is a progressive power in health index promotion. This aim of this study was to design a model for globalization of hospital services in Iran in order to promote the participation in patient attraction for diagnostic and medical services in hospitals from different countries in 2009.

This descriptive-comparative and cross sectional study was performed on some selected countries such as United States of America, England, India, Thailand and Malaysia. The hospital's information related to selected countries was marketing mechanism, equipment and hospital's facilities. The original model prepared based on data gathering form. This model was tested using Delphi technique and obtained data were analyzed and then the final model was introduced.

The results of studies in selected countries showed that developed countries like America and England have strong basis of management structure, knowledge, modern and complex technology. India, Thailand and Malaysia because of their success to present hospital services on the international level and successful marketing in this connection and arrived the developed countries technologies in previous decade have been able to have effective part presented international services. The designed model in this research, in attention to basis obtained has presented according to Iran qualifications.

According to the results of this study, with utilization of possibilities and capacities in Iran, the proposed model can greatly contribute to globalization of hospital services.