فهرست مطالب raana gholamzadeh nikjoo

Successful aging is the feeling of inner satisfaction and happiness of the person from his/her current and past life. Implementation of this concept in societies requires attention in macro plans and policies. This study, therefore, aimed to study the coverage of the concept of successful aging in the health programs of Iran and selected countries.

In this comparative study, the literature was first reviewed. To this end, the internal websites were searched and the documents and circulars of the Ministry of Health along with the developed and implemented programs regarding the elderly were extracted. Then, the components highlighted in each program were identified. Finally, the elements and components of the coverage of the concept of successful aging in the health programs of Iran was investigated with other selected countries in this field and the existing gaps were compared.

Elements and components of the successful aging in all programs were determined after examining the country's health programs. The sub-components of health promotion, provision of appropriate health services, as well as medical and treatment services were highlighted in most of the country's health program packages; however, the sub-components of disease prevention, long-term care, adherence of the elderly to the application of provided services, social support, education and literacy, income, insurance and social support, as well as employment were not taken into consideration in any of the programs. The health programs of the two countries (i.e., Canada and the United States) out of all other examined countries were highly compatible with the components of successful aging in the framework developed by the World Health Organization.

Since no importance was attached to the components such as prevention of diseases, long-term care, and adherence of the elderly to the application of provided services, it was recommended that the health policy makers should fill the existing gap by following the examples of successful old age programs in the selected countries. Moreover, it was found absolutely necessary to provide components such as social support, education and literacy, insurance and employment, as well as inter-sectoral conflict at the welfare, education, economy, and finance ministerial levels.

Context: 

Risk management in hospitals is essential for improving healthcare quality. This study analyzed the characteristics of risk management programs implemented in operating rooms of hospitals across countries worldwide.

Evidence Acquisition: 

This study was a scoping review of online database studies, includingWeb of Knowledge, PubMed, Scopus, Cochrane, Springer, ProQuest, Iranian SID, and Magiran databases and the Google Scholar search engine. Three people independently performed the study selection, quality assessment, data extraction, and analysis among studies that reviewed risk management programs in health systems and those conducted outside the health system. Articles in non-English languages (including Persian) were excluded.

A total of 21 studies with similar purposes and data collection methods were included. The characteristics of risk management programs were classified into six main factors: Objectives, components, steps, results, prerequisites, facilitators of risk management programs, and 35 sub-factors.

The conceptual framework of any risk management program should include at least the objectives Risk eradication, safety promotion, qualityimprovementandpreventionandreduction of risks, component: Communicationandmonitoring; steps: (1) Preoperative evaluation during (logging); (2) evaluation during surgery; (3) post-surgery evaluation (logout); and the results Achieving effective methods in reducing errors; prerequisites: Human resource, knowledge and information, and facilitators such as the use of monitoring technologies and error detection and reporting in the operating room.

This study aimed to determine the relationship between self-care and physician-patient relations in patients with Heart Failure (HF). This cross-sectional study was conducted on 200 patients with HF, referring to the outpatient clinics affiliated with Tabriz University of Medical Sciences, Iran. Utilizing a systematic random sampling method, the patients were selected from those who had made intake appointments. The Physician-Patient Relationship Questionnaire and the European Heart Failure Self-Care Behavior scale (EHFScB scale) were used to collect the data. Data were analyzed using descriptive statistics, Pearson correlation coefficient, logistic regression, Student’s t-test, and one-way ANOVA in SPSS (ver. 25). The total score of the self-care behaviors in the patients referring to the outpatient clinics was moderate (31.88 ± 8.66). Also, significant relationships were observed between the scores of self-care behaviors and physician’s gender, patient’s marital status, patient’s education, and between physician-patient relations scores and physician gender (P-value < 0.05). Moreover, physician-patient relations and marital status could predict the patient’s self-care variable by 22% (R2 = 0.221, F = 5.35). The study results revealed that physician-patient relations could explain the self-care behaviors of patients with HF.

The visit length is considered one of the indicators for assessing patients’ satisfaction. Factors such as waiting time for getting a visit affects the desirability of the visit.

This study aimed to investigate the visit length and waiting time of patients in public and private clinics in Tabriz.

This is a descriptive-analytic study conducted in five clinics in 2018. A questionnaire-based survey was used to collect data from 386 participants recruited through simple random sampling. Mann-Whitney U and Kruskal-Wallis tests were applied to analyze the data using SPSS version 22.0.

Overall, the mean visit length was 25.5 and 25.4 min in public and private centers, respectively, while the mean waiting time was 141.2 and 156.4 min in public and private centers, respectively. There was no significant difference between public and private centers regarding the visit length (P > 0.05); however, there was a significant difference between public and private centers in terms of waiting time (P < 0.05).

The waiting time was too much, especially in private clinics, which can negatively affect patient satisfaction. Therefore, suggested interventions may consist of using internet and telephone admission, scheduling a waiting list, and requiring physicians to be present on time.

This study aimed to reflect on the participation status of charities at different levels (i.e., prevention, treatment, and rehabilitation) of Iran’s health care system.

This descriptive cross-sectional study was fulfilled in 2019 based on 40 charitable organizations involved in health care services delivery, which were randomly selected from the Iranian Charities Portal (ICP). Data were collected via a valid and reliable researcher-made questionnaire. SPSS software version 16.0 was used to analyze data.

Direct and indirect methods of service delivery were used in 63% of organizations. The most important sources of funding were associated with public donations. Furthermore, 94% of charities were evaluating the health care services with internal and external evaluation and customer satisfaction surveys.

The charities could be a precious contribution to the health care system. To use this potential as a synergistic factor of the health system, adopting such strategies as creating sustainable funding sources and establishing more coordination between organizations are essential

An outpatient visit is the start of the treatment process, the accuracy of which determines the outcome of patient treatment.

The purpose of this study was to investigate the quality of visits in selected public and private clinics in Tabriz.

This is a descriptive-analytic study conducted in the clinics of Imam Reza Hospital, Sheykh Al-Raees, and Shahid Taleghani Hospital (public sector) and the clinics of Behboud Hospital and Tabriz International Hospital (private sector) in 2018. The sample size was 384 patients. A standard quality questionnaire was used for data collection. Data were analyzed using SPSS version 22 software.

The mean values of structural quality in public and private clinics were 75.60% ± 18.90 and 50.26% ± 15.10, respectively. The mean value of process quality was 84.08% ± 6.70 in public clinics and 81.05% ± 8.77 in private clinics. Moreover, 77.45% ± 18.45 of patients in public clinics and 77.60% ± 16.76 of patients in private clinics were satisfied with the outcomes of visits. The overall quality of services was 79.04% ± 10.05 in public clinics and 69.64% ± 9.26 in private clinics.

The overall quality of services was at a moderate level. The average quality of visits was better in public clinics than in private ones. Officials can adopt measures to improve the service quality, such as infrastructure development in private clinics, the use of the Internet and telephone reception systems, time-based scheduling programs, and requiring physicians to attend the clinic regularly.

Primary care governance has been in force since 1999 with the introduction of general practices into local primary care groups in the United Kingdom. The aim of primary health care (PHC) governance is to ensure the use of evidence-based medicine in PHC groups and to reduce the variability in access to PHC services to improve health outcomes and promote the standards of services provided to customers. This study was conducted to validate the primary health care governance model of Iran.

This is a qualitative study. The primary health care governance model components came from the literature review, focus group discussions, and interviews were sent to 40 qualified professionals through the Delphi form. Based on the median score and by holding four experts’ panel sessions, the model was approved. Evaluation indicators of the model were proposed through literature review and expert meetings. By sending these indicators along with other components of the model in the Delphi questionnaire to 30 qualified specialists, the final model was confirmed with the calculation of CVR and CVI in two Delphi rounds.

Proposed Iran’s PHC governance model, with a fundamental pillar, leadership, five main pillars (quality management, community involvement, health information management, human resource development, monitoring and evaluation), 22 components, and 64 assessment indicators, was designed to reduce the weaknesses and challenges by relying on strengths and opportunities of the system.

Iran’s primary health care governance model has the potential to improve the quality and increase accountability level in the health system of the country and to evaluate the progress of the health care system toward the excellence.

The most important strategy for controlling diabetes is self-care. This study aimed to determine self-care ability of people with diabetes who referred to clinics of Tabriz University of Medical Sciences. In this descriptive-analytical study, 350 diabetic patients referred to Clinics of Tabriz University of Medical Sciences were evaluated in 2015. Data were collected using Tubert, et al (2000) questionnaire. Data were analyzed using SPSS v.23 software and chi-square and one-way ANOVA tests. The results showed that 93.1% of the participants in the study were type II diabetes. The self-care capacity mean of the research units was moderate (3.4 of 7). The most commonly used self-care behavior was the timely use of medications (5.79 of 7), with less general physical activity, exercise, and continuous examination of shoes. Variables such as age, gender, history of illness and education showed a significant relationship with self-care capacity of individuals. Also, the highest monitoring of the complications of the disease was related to performing HbA1c test (in 78.6% of samples). Referring to ophthalmology, dentistry and flu vaccine accounted for a smaller percentage. Considering the important role of self-care activities in controlling diabetes, physicians need to plan and implement their patient’s self-care behaviors during interventions by examining their self-care behaviors and determining their self-care needs.

Despite huge advances in improving most health indicators, Iranian primary health care (PHC) has faced several problems in improving the quality of care inside the health care system. Developed countries with similar problems have used various models of PHC governance for improving quality in their PHC system. This study aimed to obtain health professionals’ perspectives about the suitable pillars and components of Iran's PHC governance model. A purposeful sampling method was used to select seven participants who had a minimum of five years of experience in PHC and background education in the field of medical sciences. Between Jan and Jun 2015, three focus group discussions (FGD) were conducted with seven PHC experts in Tabriz. Data were analyzed using the conventional content analysis method. The eight main categories including quality improvement, management and leadership, community involvement and customer participation, effectiveness of PHC, human resource development, safety, health care evaluation and audit, and health information management plus 51 sub-categories were identified according to participants' expects about the essential pillars and components for Iranian PHC governance model. Pillars that suggested for designing Iran’s PHC governance model are presented according to internal informed expert’s opinions and taking into account PHC system real status. By adding the degree of importance for each component and proper performance indicators to this collection, assessing the progress of the PHC system towards excellence will be possible and it will prevent any mental judgments about system performance.

Strategic thinking is an approach in the organization that refers to using different mental frameworks to examine, analyze, and ultimately decide on the strategic situation of the organization. The aim of the study was to determine the status of strategic thinking in education and research managers of Tabriz University of Medical Sciences, as well as its related factors, in 2016. This is a descriptive - analytical study. The study population comprised all senior and middle managers in the fields of education and research of Tabriz University of Medical Sciences (n = 79). The employed instrument was a standard strategic thinking questionnaire, with the dimensions of future imagination and focusing on it, intelligent opportunism with systematic perspective, understanding the situation based on learning and cognitive concepts, decision-making based on hypothesis driving (creativity and diverse subjective patterns), and the ability to create organizational infrastructures. Data entered in the SPSS software version 23 and the Shapiro-Wilk test, Independent t-test, Mann-Whitney test, one-way ANOVA test, and Kruskal-Wallis test were used for data analysis. The results showed that most of the senior and middle managers in the fields of education (88.2%) and research (89.5%) had poor strategic thinking. The highest score of the dimensions of strategic thinking was related to the “future imagination and focusing on it” for education managers (28.9 out of 32) and “decision-making based on hypothesis driving” for research managers (28.8 out of 36). It was also observed that there was a significant relationship between the status of strategic thinking and work experience as a demographic variable (P = 0.03). Based on the results, it is necessary to take serious measures to improve the status of strategic thinking by providing university managers with training the relevant skills and paying attention to the skills as a criterion for managers’ selection and evaluation processes.

After the establishment of Primary Health Care (PHC) program in Iran, health indicators have improved every year. This progress was so rapid that a number of shortcomings and weaknesses of the PHC program remained silent behind its successes. This study aimed to assess the status of Iran’s PHC system (strengths, weaknesses, opportunities and threats) in terms of health system’s control knobs.
The search was conducted through two English `databases of Web of Knowledge and PubMed, two English publications of Science Direct and Springer and two Persian databases of Magiran and SID. Keywords were selected from MeSH and included primary health care, PHC and Iran in both Persian and English. No time limit was considered.
Iran's PHC system has numerous successes in dealing with health system’s control knobs; which largely part of that related to the health network implementation, the role of Behvarz, improvement of health indicators in rural areas and the elimination of urban-rural inequality, but there are some weaknesses, opportunities and threats in the Iranian PHC system as well.
By considering socio-economic changes the current structure of PHC system needs to be reformed to coordinate with phenomenon of chronic diseases, accidents and aging. The current information system in PHC does not provide the required information for decision makers and policy makers so it needs to be transformed to the electronic system with unique electronic health file for individuals.

Primary care organizations are the entities through which clinical governance is developed at local level. To implement clinical governance in primary care, awareness about principles, prerequisites and barriers of this quality improvement paradigm is necessary. The aim of this study is to pool evidence about implementing clinical governance in primary care organizations. Data sources: The literature search was conducted in July 2012. PubMed, Web of Science, Emerald, Springerlink, and MD Consult were searched using the following MESH keywords; “clinical governance” and “primary care” Study selection: The search was limited to English language journals with no time limitation. Articles that were either quantitative or qualitative on concepts of implementing clinical governance in primary care were eligible for this study. Data extraction: From selected articles, data on principles, prerequisites and barriers of clinical governance in primary health care were extracted and classified in the extraction tables. We classified our findings about principles of clinical governance in primary care in four groups; general principles, principles related to staff, patient and communication. Prerequisites were categorized in eight clusters; same as the seven dimensions of National Health System (NHS) models of clinical governance. Barriers were sorted out in five categories as structure and organizing, cultural, resource, theoretical and logistical. Primary care organizations must provide budget holding, incentivized programs, data feedback, peer review, education, human relations, health information technology (HIT) support, and resources. Key elements include; enrolled populations, an interdisciplinary team approach, HIT interoperability and access between all providers as well as patients, devolution of hospital based services into the community, inter-sectorial integration, blended payments, and a balance of clinical, corporate, and community governance.

hospitals performance indicators will help monitoring, evaluation and decision making and therefore must be selected and ranked accurately. The aim of present study is identifying and selecting key hospitals performance indicators. This is a descriptive and mixed (quantitative-qualitative) study. literature review and expert panel has been done to identify all performance indicators. we prioritize performance indicators by Analytical Hierarchy process (AHP) technique. The data were analyzed by Excel 2007 and Expert Choice11 software’s. hospital performance indicators are classified to three areas as quality- effectiveness, efficiency- financing and accessibility – equity. Indicators like the rate of hospital average length of stay in hospital based on different diagnosis and the mean rate of inpatient waiting time are considered with highest priority performance indicators of public hospitals. Identifying hospital’s key performance indicators provides an opportunity for health stakeholders to identify critical and problematic points with lower costs and time and to the best correction action.

Discharge Against Medical Advice (DAMA) is the common problem of the health care systems. DAMA also increases the mortality, morbidity and disease exacerbation. Understanding the reasons that patients choose DAMA has an important role in reducing mortality and morbidity rate and also reduces hospital costs. This study aimed to investigate the rate and causes of DAMA in patients in a private hospital in Tabriz city in the first half of 1391. This descriptive-analytical study was conducted in a cross-sectional form in 1392 in one of the private hospitals in Tabriz city. Study population consisted of all patients with DAMA in the first half of 1391. To collect data, a valid and reliable check list made by researcher was used. Data were entered into SPSS 17 software. Descriptive statistic, Chi-square, t-test and multiple logistic were applied for data analysis. According to the findings, DAMA rate in the first half of the year was 1.82% and most of the patients were female, housekeeper, native of Tabriz, admitted to CCU, had basic and supplementary insurance, discharged in the morning with an average age of 53.33 years and an average length of stay of 3.15 days. The most frequent cause of DAMA was based on hospital condition by (48.47%). Other causes were related to the patients (39.40%) and the relevant hospital personnel (12.13%). Based on the findings of this study, risk factors for DAMA are age, basic insurance, supplemental insurance and hospital ward. The very important DAMA reasons are hospital condition and high costs of hospital. Hospitals can use contracts with various insurance companies and charitable organizations to reduce costs and decrease DAMA rate.

The present study was conducted to scrutinize Public- Private Partnership (PPP) models in public hospitals of different countries based on performance indicators in order to se-lect appropriated models for Iran hospitals. In this mixed (quantitative-qualitative) study, systematic review and expert panel has been done to identify varied models of PPP as well as performance indicators. In the second step we prioritized performance indicator and PPP models based on selected performance indicators by Analytical Hierarchy process (AHP) technique. The data were analyzed by Excel 2007 and Expert Choice11 software’s. In quality – effectiveness area, indicators like the rate of hospital infections (100%), hospital accidents prevalence rate (73%), pure rate of hospital mortality (63%), patient satisfaction percentage (53%), in accessibility equity area indicators such as average inpatient waiting time (100%) and average outpatient waiting time (74%), and in financial – efficiency area, indicators including average length of stay (100%), bed occupation ratio (99%), specific income to total cost ratio (97%) have been chosen to be the most key performance indicators. In the pri oritization of the PPP models clinical outsourcing, management, privatization, BOO (build, own, operate) and non-clinical outsourcing models, achieved high priority for various performance in dicator areas. This study had been provided the most common PPP options in the field of public hospitals and had gathered suitable evidences from experts for choosing appropriate PPP option for public hospitals. Effect of private sector presence in public hospital performance, based on which PPP options undertaken, will be different.