جستجوی مقالات مرتبط با کلیدواژه "بیماران سرپایی" در نشریات گروه "پزشکی"

The prevalence and patterns of antibiotic resistance among bacterial agents causing urinary tract infections (UTIs) can vary over time and across different geographical regions. This study aimed to evaluate the prevalence and antibiotic resistance patterns of bacterial agents isolated from urine cultures of outpatients referred to the Reference Laboratory in Kashan, Iran, during 2021-2022.

This cross-sectional study analyzed 7365 urine culture samples collected from patients referred to the Reference Laboratory in Kashan, Iran, between April 2021 and March 2022. Urine samples were obtained using the mid-stream method under sterile conditions and cultured on MacConkey agar, blood agar, and specific bacterial media. The identified organisms were tested for antibiotic resistance using the disc diffusion method on Mueller Hinton agar medium following the guidelines of the National Committee for Clinical Laboratory Standards (CLSI 2020).

Among the 7365 patients with urine cultures, 401 individuals (5.4%) had positive culture results, with a predominance of women (88.8%). Escherichia coli (62.5%) and Klebsiella (24.6%) were the most frequently isolated organisms. Escherichia coli exhibited the highest resistance rates to cefazolin (54.7%), cotrimoxazole (51%), and ciprofloxacin (41%), while showing the lowest resistance to imipenem and nitrofurantoin (4.4%). Klebsiella showed the highest resistance to cefazolin (58.3%) and cotrimoxazole (41.4%), with the lowest resistance to imipenem (7.1%). Gram-positive bacteria demonstrated the highest resistance to clindamycin (71.4%) and cotrimoxazole (57.9%), while displaying the lowest resistance to gentamicin (14.7%) and nitrofurantoin (17.5%).

Escherichia coli and Klebsiella were the predominant causative agents of UTIs, exhibiting similar antibiotic resistance patterns. Empirical antibiotic treatment based on these results may be considered before obtaining culture results.

The role of pharmacists in pharmacies has evolved from drug dispensers to more specialized tasks. The general purpose of this article is to analyze and investigate pharmacist intervention in controlling symptoms of outpatients suffering from common acute upper respiratory disease via prescription of non-prescription drugs according to the pharmaceutical rules and regulations in the health sector.

This is a clinical trial that was conducted on patients with one of the diseases of common cold, flu, acute rhino-sinusitis, laryngitis, or allergic rhinitis in community pharmacies with acute symptoms. The first group underwent diagnostic and therapeutic (theranostic) interventions by a pharmacist based on non-pharmacological treatment or, if necessary, non-prescription drugs. The second group received over-the-counter medicine based on their own request and without the pharmacist theranostic approach. Patient symptoms were evaluated before initiation of monitoring and then one week later.

The results of the difference in average scores of 100 patients in five diseases for the intervention and non-intervention subgroups were 23.30 and 14.45 for common colds, 20.00 and 13.35 for influenza, 11.40 and 7.15 for allergic rhinitis, 15.00 and 14.00 for laryngitis, and 30.00 and 23.00 for sinusitis, respectively. The difference in clinical improvement scores in all diseases was significantly higher in the pharmacist intervention subgroup, except for patients with laryngitis, where no significant difference was observed between the two subgroups.

Pharmacists have the potential to control the symptoms of patients with common upper respiratory tract disease. Using this capacity in primary care can improve minor ailments.

One of the components of effective health care services is measuring patient satisfaction. Patient satisfaction is the patient's perception of the care received compared to the expected care. Assessing patient satisfaction is important because satisfied patients are more likely to follow treatment. The aim of this study was to determine patients satisfaction with clinical laboratory services and related factors in outpatient and inpatient wards of Panj Azar Hospital in Gorgan. In this descriptive-analytical study in 2019, 549 patients in inpatient and outpatient wards referred to the medical laboratory of Panj Azar Hospital were included in the study by convenience  sampling method; The required information for the study was completed using a 23-item questionnaire including demographic characteristics, how to provide services to patients and facilities of the laboratory environment by face-to-face interview. The analysis of research data was performed using Spss software version 22 at the significance level of 0.05 with two methods of descriptive and inferential statistics.  Among 549 patients studied with a mean age of 38.51 and a standard deviation of 18.20, 56.1% were male and 59.9% had primary and post-graduate education, 87.8% had insurance and were among the hospitalized. 83.6% were hospitalized for less than a week. 88.9% of the patients were hospitalized and the rest were outpatients. Mean and standard deviation of satisfaction score in service dimension was 41.32 ± 5.85, satisfaction score in environment dimension was 15.02 ± 2.62 and total score was 56.34 ± 6.31. Is. Also, in the environment dimension, a statistically significant difference was observed between the available variables hospitalization frequency and length of hospitalization (P<0.05). Patients were relatively satisfied with services such as staff responsiveness, queuing for admissions, how laboratory staff treat patients, sampling skills in performing tests, and environmental factors such as cleaning of laboratory toilets, amenities, appropriate and accessible laboratory location.

The prescribing pattern of non-steroidal anti-inflammatory drugs (NSAIDs) has scarcely been studied in Iran. This study aims to evaluate the prescribing pattern of NSAIDs in the prescriptions of the patients who referred to Taleghani and Imam Khomeini educational pharmacies from March 21st to September 22nd, 2019 in order to find a way to reduce their irrational and excessive prescription as well as their serious side effects.

In this retrospective, cross-sectional study all the prescriptions containing NSAIDs from March 21st to September 22nd, 2019 in Taleghani and Imam Khomeini educational pharmacies were analyzed using the Tebyan software and the drug interactions were determined using the Lexicomp application and the data was collected.

Among the overall 47652 prescriptions analyzed in both pharmacies, the most and the least prescribed drug in both pharmacies were the 30 mg/mL ketorolac ampoule and the 250 ml mephenamic acid, respectively. The greatest number of major and moderate interactions between drugs in Imam Khomeini pharmacy were both seen in prescriptions containing the 30mg/mL ketorolac ampoule with the percentages of 41.9% and 32.1%, respectively; and in Taleghani pharmacy the greatest number of both interactions were seen in prescriptions containing the 30mg/1mL ketorolac ampoule with the percentages of 75.2% and 76.6%, respectively.

NSAIDs are widely prescribed and a high number of drug interactions are observed in prescriptions containing these drugs. We can conclude from this study that physicians need more attention and education concerning NSAID drug interactions with each other and with other drugs.

Cognitive bias modification procedures are considered therapist-independent, computer-based, and relatively new interventions, which are mainly used as outpatient therapies for anxiety, emotional disorders, and different types of addiction. This paper aimed to present the latest findings of the studies on cognitive bias modification to enhance the knowledge of experts and researchers of the effects of such procedures in both practice and theory. At first, cognitive bias modification was briefly defined. Then, its different procedures (attention bias modification, interpretation bias modification, and memory bias modification) and the therapies based on these modification procedures were introduced. Then, the studies conducted on the effectiveness of such therapies were reviewed and their results were discussed.

All the studies suggested, in a relatively consistent and significant way, that it is possible to modify cognitive bias processes in various disorders, such as anxiety and emotional disorders, mood disorders, chronic pain, obsessive disorders, addiction, and intellectual rumination. Furthermore, computer programs for cognitive bias modification and dot-probe tasks are suitable alternatives or complementary options for reducing or treating clinical symptoms and cognitive biases. In addition to the need for inventing therapy applications and adapting cultural characteristics of English versions for the Iranian population, new investigations are required to evaluate both the clinical crowd and the effectiveness of these modification procedures for various disorders.

Magnetic resonance imaging (MRI) is a valuable diagnostic tool by its noninvasive/nonionizing nature. The aim of the current study was to determine the justification of MRI in outpatients referred to Hajar university hospital, In Shahrekord City, Iran, in a one-year period of 2017.

A retrospective descriptive cross-sectional study was conducted on 438 outpatients referred for MRI during the year 2017, who were selected using systematic random sampling method. Intended data including age, gender, investigated organ, the specialty of requesting physician, MRI with or without contrast, and MRI diagnostic outcome were extracted from patient charts, and collected using checklists. Descriptive statistics and chi-square test were used for data analysis.

Requested MRI led to a diagnosis in 81.3% of the patients. Women patients represented 64.4% of the requested MRI cases. 45.2% of the exams were performed for the patient with the age range of 41 to 60 years. The most prevalent investigated organ was the lumbosacral (43.2%). Age classes significantly influenced investigated organ (P = 0.001), as well as the prevalence of MRI diagnostic outcome (P < 0.001). The percentage of MRI diagnostic outcome differed significantly among clinical physicians (P <0.001). The prevalence of MRI diagnostic outcome significantly differed in respect to the investigated organ (P < 0.001), with lumbosacral (50%) as the most prevalent.

Requested MRI in tertiary referral center of Shahrekord city led to a diagnosis in an acceptable manner. However, there is need to study appropriate imaging in view of taking most advantages from medical practice guidelines.

Nowadays, many patients refer to outpatient clinics due to anxiety, depression, and somatization disorders. These disorders have catastrophic costs for the health care system. The present study examined the relationship between depression, anxiety, and somatization in outpatients.

This descriptive-analytical study was conducted in 2018 on 400 patients over 18 years old who referred to a selected clinic in Kerman and were selected using a convenience sampling method. Data were collected using the Hospital Anxiety and Depression Scale as well as Physical Health Questionnaire. Logistic regression statistical tests were used to analyze the data. Data were entered into SPSS statistical software version 20.

The results of this study indicated that 38.8% of outpatients had a somatization disorder, 73.5% had anxiety and 61.2% had depression. Depression was associated with an increased risk of somatization in such a way that a one-unit increase in the depression score increased the risk of somatization 1.12 times.

Training physicians to timely diagnose and treat mental disorders, especially depression has a significant impact on reducing the burden of physical and mental illnesses.

The analysis of costs and incomes is an important tool for planning, controlling, monitoring and evaluating hospitals to reduce abnormal costs. The purpose of this study was to analyze the profit margins of operating units in a selected educational hospital. This descriptive cross-sectional study was carried out in a selected educational hospital affiliated to Iran University of Medical Sciences, Tehran, Iran in 2019. Cost information was collected through a researcher-made checklist. At first, direct costs were calculated separately from cost centers and then absorbed into operational units by the absorption method. The income of operating units was extracted by studying the files of 65,817 outpatient cases and hospitalized patients in the study year and finally, the operating margin of the units was calculated. Calculations were done through Excel 2017 software. Direct and indirect costs accounted for 66% and 34% of the total operating costs of operational units. Total revenue from providing services in the studied units was 1674074 $ and the cost of these units was estimated about 3488888 $. Other than the sub-specialty units of Gynecology and Pediatrics, Reconstructive Surgery Which had operating margins of 39% and 36% respectively, the rest of hospital units had significant operational losses.  Improving the processes of supplying the required facilities and services, paying attention to the human resources management and labor force and increasing the quantity and quality of services seem to be necessary.

Improving living conditions and increasing longevity and life expectancy has led to the phenomenon of aging in societies. This incremental rate causes a serious challenge for organizations that provide health and therapy services. In association to the mentioned challenge, the purpose of this study was to study Stauts and determiants of health services utilization among elderly elderly rural hubitant in Semnan City (Iran) in 2016. This was a cross-sectional study in which 395 elderly people in Semnan City were studied and the collected information was performed by using a structured questionnaire. Between the whole cases, 54% (224 people) used outpatient services. In outpatient services, 14.4% consult with specialists and 13.7% used services from educational hospital. 26% of the other cases used in patient services. That service from 56% among them used educational public hospitals. The related factors of the utilization rate of outpatient health service were: age (p=0.02), gender (p=0.02), marital status (p=0.01), income status (p=0.01), education (p=0.01). The related factors of the utilization rate of inpatient health service were: age (p=0.02), gender (p=0.03), marital status (p=0.05), income status (p=0.02). Obtaining benefit from health services has a meaningful relationship with various socio-economic factors such as sex and age, and income and education status, each of which can affect the level of health benefits of individuals. It also seems that multiplier is a multi-factor issue, and therefore proper planning for this growth demand is necessary.

One of the 8 service packages in the first phase of Iran health transformation plan (HTP) is dedicated to improving the quality of outpatient visits. We investigated the average visits/hour criterion at the Alzahra university hospital, Isfahan, Iran, as the biggest province health center, after implementation of health transformation plan.
This descriptive cross-sectional study, conducted in all 26 clinics of Alzahra hospital using visit/hour as the main indicator for evaluating the quality of outpatient services. Data gathered from June 2014 to July 2015 from clinic secretaries with the help of a checklist. Gathered data were analyzed via calculating the quarterly mean and standard deviation of visits/hour separately for internal and surgical clinics using SPSS18 software.
Considering 8 visits/hour as the desired standard number, the mean visits/hour in the internal clinics in the first, second, third and fourth quarter were 6.06 ± 2.27, 7.76 ± 4.80, 7.02 ± 4.18 and 6.37 ± 2.52, respectively. For the Surgical clinics, the mean visit/hour was 9.88 ± 6.09, 10.11 ± 5.47, 9.40 ± 6.26 and 7.63 ± 2.93 for first, second, third and fourth quarters, respectively.
After implementation of health transformation plan in Alzahra hospital in May 2014, the visits/hour criterion worsened during the second quarter but improved in the third and fourth quarters. This can be due to the increase in the number of patients at the start of the plan or financial issues and the effects of which was reduced due to better supervision later on. We suggest using different standards for surgical and internal clinics in order to improve the effectiveness of the plan.

One of the most proven trajectories for analyzing the drug consumption patterns in the community is to assess the prescriptions. Using the antibiotics for prevention and treatment of infectious diseases not only leads to the loss of pathogens but also causes various complications, the most important of which is the drug resistance. The aim of current study was investigating the different antibiotics prescript by general practitioners (GPs) for outpatients in Ardabil city.
This study is designed based on the cross-sectional method. The number of 2,000 copies (according to Morgan) from total of 526000 copies sent to Ardabil health insurance during the 4 seasons of 2013 were randomly evaluated. The collected data were analyzed by descriptive statistics, ANOVA and T-Test using SPSS software. The P ≤0.05 was considered statistically significant.
In this study the average drug per prescription was 3.6 and 54.9% of the prescriptions included antibiotics so that the cefixime, azithromycin, Co-amoxiclave and penicillin 6.3.3 were the most frequently prescribed antibiotics, respectively. The highest prescriptions belonged to penicillins (39.4%) cephalosporins (27.7%) and macrolides (18.3%). The most expensive antibiotic was cefixime tablet (32% of the total cost). The most of the antibiotics were prescribed to be taken orally (tablets or capsules). The mean price of each prescription was 74539±71050 Rials. The highest rate of antibiotic prescription was related to the autumn and then winter and there was a significant relationship between the the number of antibiotics in different seasons of the year (p = 0.005).
The average drugs of each prescription are in accordance with local statistics, but much higher than the global figures. The frequency of antibiotics prescription was higher than the global, several Middle Eastern and even African countries’ indices but was lower than the average level of some regions in the country. The pattern of prescribing antibiotics among the Ardabil GPs shows the more drugs in number and expensive broad-spectrum. The average price of prescripts was higher than the national average. These findings suggest that prescription and using antibiotics is not desirable in Ardabil.

Urinary tract infection (UTI) is the commonest bacterial infectious disease in worldwide (especially in developing countries) with a high rate of morbidity and financial cost. The management of UTI infections has been jeopardized by increase in immergence of antimicrobial drug resistance. Knowledge of the local bacterial etiology and susceptibility patterns is required to trace any change that might have occurred in time so that updated recommendation for optimal empirical therapy of UTI can be made. The aim of this investigation was distribution and antimicrobial susceptibility pattern of gram negative bacteria causing urinary tract infection (UTI) and detection NDM-1 (new-delhi-metallo-beta-lactamase-1) producing isolates in Ahwaz.
This cross-sectional study was done during a period of one year from April 2013 to March 2014. Clean catch midstream urine samples were collected from suspected patients to UTI. The isolates were identified based on morphological and biochemical testes. Culture was performed on routine microbiological media. Susceptibility testing was performed according CLSI (2013) guidelines. Detection of carbapenemase producing isolates was performed by modified hodge test (MHT). Metallo-beta-lactamase isolates were detected by imipenem-EDTA combined disc test (CDT).
In this study 708 gram negative organisms were isolated from urine samples. E.coli was the most common isolated bacteria (67%) followed by Klebsiella spp. (26.5%) and Enterobacter spp. (2.5%). In antibiotic susceptibility testing more than 90% of isolates were sensitive to tetracycline, ceftazidime, meropenem, amikacin, cefotaxime, imipenem, and cefepime. Isolates were more resistant to cephalothin (32%), co-trimoxazol (30.5%), and nalidixic acid (25%).
In our results isolated organisms from outpatients showed very high sensitivity to common antibiotics. Continuous and regular monitoring of susceptibility pattern of community isolated strains is necessary. Antimicrobial susceptibility is important to guide effective antibiotic therapy.

Urinary tract infection or UTI is one of the most common infectious diseases in outpatients and inpatients. E.coli is the most prevalent organism in UTI. The aim of this study is to compare etiologic agents in UTI in inpatients and outpatients of Gorgan city. This descriptive- sectional study was carried out on 174 outpatients and 284 inpatients in 2011-12. For each person we filled a questionnaire including demographic information. In laboratory, samples cultured on EMB, MacConkey and blood Agar(Liofilcom co), and incubated in 37oC for 24 hours. After detection of gram of each bacteria, specialized and biochemical tests were performed. The results were compared with standard tables for identification of bacteria. Statistical analysis in SPSS18 was done and P≥0.05 was considered significant. Of 458 studied samples, just 38% were inpatients. 70.1% of 174 inpatients were women. Clinical symptoms like urgency(23.6%) and fever (43.6%) observed in inpatients that were more than outpatients. In inpatients, E.coli, the most frequent microorganism, seen 48.3%. Then Klebsiella 10.3%, Enterobacter 9.4%, Pseudomonas 7.5%, Enterococcus 1.1%, Providencia 1.1%, Seratia 2.3% and Edvardsiella 0.2% were the more frequent bacteria. S.aureus isolated just in outpatients. There were more frequent differences on etiologic agent in inpatients and outpatients. Providencia, Seratia, Edvardsiella were only isolated from inpatients. E.coli in our study, such as other studies in Iran and other countries, is the most important pathogens in UTI. Frequency of women in comparison with men in UTI, similar to other studies, was high. This characteristic is related to physiological position in women and men.

Context: one of the most important components in patient- physician relationship is the visit length. Its shortage is a concern for most patients and could affect the visit quality. The objective of this study was to measure and compare visit length of specialists with the existing standards. A cross-sectional study was conducted in Qazvin of general hospitals in 2013. A sample of 428 patients, who were referred to the outpatient clinics of the general hospitals, was randomly selected to participate in the study. Studied specialties were Internal Medicine, Surgery, Pediatrics and Obstetrics and Gynecology. A Checklist was used to collect data and be included related factors to physician and patient. Analysis was done using SPSS-19. The results showed that the average length of outpatients visits was 4.67(2.43) minutes which illustrate a significant difference from standards (p=0.000). Among the specialties, pediatrics had longest visit time 2.55(7.08) and internal physicians had the shortest 1.82(3.93). Visit time was shorter than other developed and developing countries. Various variables which affect the visit time were identified in this study, so decision makers could use the results to improve outpatients visit quality.

Service quality gap is the gap between patient's expectations and perceptions of presented services. The first step in eliminating of this gap in ensuring patient satisfaction is identification of the perceptions and expectations of them from the quality of presented services. Therefore this study is performed by the target of determination of the quality of presented services in out-patient’s clinics of Shiraz training hospitals. This cross-sectional study was conducted in 2014 and statistical population was included the outpatients that referred to the clinics of training hospitals of Shiraz. In this study, 400 outpatients were selected between the referred patients in compliance with the inclusion and exclusion criteria. Data collection tools was included demographic and SERVQUAL questionnaires. Data were analyzed at a significant level of less than 0.05 by SPSS software and use of central statistics indices, independent T-test and ANOVA. The results showed that there is a negative gap between all aspects of presented services quality and a significant difference between perceptions and expectations of patients related to the quintuple aspects of service’s quality is achieved. In this study, quality gap in the aspects of empathy, responsiveness, assurance, guarantee and tangibles were calculated-0/98, -0/73, -0/79, -0/73 and -0/58, respectively. Negative gap in the aspects of quality is indicated that the patient’s expectations are more than their perception from existent conditions and there is a distance to achieve the complete satisfaction. Therefore, it can eliminate this distance with correct management, careful planning and appropriate training.

Today, the concept of q uality of services is particularly important in health care and customer satisfaction can be defined by comparing the expectations of the services with perception of provided services. The aim of this study was to evaluate the quality of services provided for outpatients in clinic of Ardebil city based on the SERVQUAL model. This descriptive study was conducted on 650 patients referred to outpatient clinic since July to September 201 3 using a standardized SERVQUAL questionnaire (1988) with confirmed reliability and validity. The paired t-test and Friedman test were used for analysis of data by SPSS software. 56.1 % of respondents were male and 43.9 % of them were female. The mean age of patients was 33 ± 11.91, 68.9 % of patients were in Ardabil and 27.3 % of them had bachelor's or higher. The results showed that there is a significant difference between perceptions and expectations of the patients about five dimensions of the service quality (tangibility, reliability, assurance, responsiveness, and empathy) in the studied clinic (P< 0.001). The highest mean gap and minimum gap were related to empathy and assurance, respectively. Regarding to observed differences in quality, the managers and also planners have to evaluate their performance more accurately in order to have better planning for future actions. In fact, any efforts to reduce the gap between expectation and perception of patients result in greater satisfaction, loyalty and further visits to organizations.

Hospitals are the most important healthcare organizations. The aim of the present study was to develop a questionnaire for assessing outpatients’ satisfaction in hospitals of Tehran University of Medical Sciences. In this cross-sectional study، we selected 400 outpatients admitted to the hospitals of Tehran University of Medical Sciences. The preliminary items were gathered using a systematic review of the related literature. Data were analyzed using the correlation matrix، t-test، ANOVAs and confirmatory factor analysis. Totally، 66. 2% of the outpatients were satisfied with the clinics’ healthcare services. The Cronbach’s alpha was calculated as 0. 81. According to the component matrix، the most loads (0. 148، 0. 147) were related to recommendation of the clinics to others، and total satisfaction with clinics’ healthcare services (item 12 and 14). Furthermore، the least load (0. 05) was related to satisfaction with the waiting time (item 2). There was a statistically significant correlation between the outpatients’ satisfaction and other factors including gender، type of hospital، education، age and employment. The findings of the present study can help to identify weaknesses، threats، strengths and opportunities in providing healthcare services in hospitals.

Observing the principles of professional ethics in psychiatric patients not only leads to improvement of patient-doctor relationship, early recovery, preferment of treatment process, and client respect, but it also results in a reduction in the patients’ complaints about medical staff’s misdemeanors. The present study aimed to determine the level of psychiatric patients’ satisfaction with principles of professional ethics of the medical team.
This descriptive, cross-sectional study was conducted on 120 of patients referring to the psychiatric clinics of Shiraz University of Medical Sciences. The data were collected using a researcher-made questionnaire including 20 questions about patient's satisfaction level with the medical staff’s observation of professional ethics. The reliability of the questionnaire was confirmed by cronbach's alpha=0.926. The data were analyzed by SPSS using chi-square and Kruskal-Wallis tests.
The mean score of the patients’ satisfaction with the medical team’s observation of professional ethics was 46.15.47. The patients’ highest mean score of satisfaction was related to “explanations about the drugs which had to be consumed at home” and "respecting the patient's privacy", while the lowest mean score was related to "providing information about services". According to the results, women, married individuals, and those between 51 and 60 years old showed the highest level of satisfaction with observation of professional ethics principles by the medical staff. The lowest satisfaction level, on the other hand, was related to the adolescents (13-18 years old).
The results showed that the patients were averagely satisfied with observation of professional ethics in psychiatric clinics. Since the lowest satisfaction levels were related to males, adolescents, and singles, more attention should be paid to these groups.

To determine satisfaction level of out patients in teaching hospitals clinics in Shiraz city. This was a cross- sectional study that carried out on 1175 outpatients in teaching hospitals in Shiraz in 2009. The data were collected by using questionnaire by interviewing patients. The questionnaire had 17 questions in 4 scopes including satisfaction of therapeutic services, non therapeutic services, and quality of offered services and length of wait time, facilities and physical environment. Statistical analysis was performed by using SPSS software in 5% probability level. The general amount of satisfaction of services was reported low by 45.4% of patients, medium by 16.9% of patients and good by 37.6% of outpatients. The average of patient's satisfaction in Dastgheib hospital significantly was higher than other hospitals. The olds significantly were more satisfied with services. Women significantly were more satisfied than men. By increasing the level of education the amount of satisfaction decreased significantly. High percent of patients who are dissatisfied with outpatient services can be caused patient's weak cooperation, quitting the process of treatment, wasting of resources and damaging hospital fame. So it is necessary to be emphasized on increasing the level of outpatient's satisfaction by hospital managers.

The provision of high-quality services is considered as a prerequisite to the success of responsible organizations. Using SERVQUAL model, the present article seeks to delve into the quality of services provided in outpatient clinics as judged by patients in case-study hospitals throughout Tehran. This is a cross-sectional descriptive research in which 242 subjects were studied at the outpatient clinics under investigation throughout Tehran using a standardized questionnaire named SERVQUAL (1988). The results of a t-test revealed a meaningful difference between the patient's perception and their expectation about 5 factors (tangible elements, reliability, assurance, accountability and collaboration) affecting the quality of services in clinics. The patients rated ‘assurance' as the most important factor (4.41) and ‘accountability' as the least important of the 5 factors (2.21). The results indicate that the application of SERVQUAL model enables hospital managers to evaluate the quality of services as evaluated by patients as their most important clients and enhance the quality of such services through proper planning and removal of deficiencies.