جستجوی مقالات مرتبط با کلیدواژه « خدمات » در نشریات گروه « پزشکی »

Access to primary healthcare services, considering equity and equality in the health system, is a right of the global community. To provide primary health services, the rural family physician program was implemented at the beginning of 2005 to achieve universal health coverage in rural areas and small cities (with a population of less than 20,000). The specific goals of this program included the implementation of the referral system, increasing the responsiveness of the health market, increasing people’s access to health services, reducing unnecessary costs in the health market, and increasing service coverage. After approximately 7 years of implementation of this program, the urban family physician program started in Mazandaran and Fars province as a pilot project. The urban family physician program started in the Mazandaran province in 2012 as the first level of providing health services. In line with the better implementation of this program and considering the wide range of expected programs and activities, it is essential to entrust the appropriate activities with the time of the service providers. This study was conducted to assess the expected duration of activities assigned to the family physician.

This cross-sectional study was conducted on 15 urban family physician centers (6 government and 9 private centers) in Golugah, Behshahr, Neka, Ghaemshahr, Noor, and Chalus cities of Mazandaran province. Out of 15 cities with more than 20,000 people participating in this program in Mazandaran province, the six cities mentioned above were randomly selected, and 15 urban family doctors were randomly selected from the existing list. Finally, the target groups were included in the study for convenience sampling. To collect the data, checklists compiled based on care packages corresponding to 8 groups of service recipients (elderly (11 services), middle-aged (7 services), youth (13 services), teenagers (24 services), under 5 years old (6 services), mana (15 services), mothers (3 services), and non-target visit) were used. For each service recipient group, at least three individuals were examined. Central and dispersion indices were used to describe the data.

The results of measuring the time of providing service to 297 people (including 90 under 5 years old, 30 people receiving Mana services, 30 people from each of the groups of mothers, teenagers, young people, middle-aged, elderly, and 27 people from non-target visit) showed that the median and mean expected time for providing daily service by an urban family physician to the covered population is 2 h and 52 min and 3 h and 23 min, respectively. The estimated time was different in the groups receiving the service, the highest time of which was related to the visit of the non-target service group with median and mean of 84.17 and 87.20 min, respectively, and the lowest time was related to Mana services with a median and mean of 3.40 and 4.34 min, respectively.

Urban family physicians have enough time to provide daily services, and therefore it seems that the health system has not assigned them more than their daily time capacity.

Active aging is among the important concepts of health influenced by effective public services; understanding adults' needs and services are of great importance. This study aims to explain understanding older adults' needs for services in public places in Yazd city.

This qualitative study was done as conventional content analysis. Participants were 20 elderly people from Yazd selected by purposive sampling.  Data were collected through semi-structured interviews. Data analysis was done in three levels of open coding and formation of sub categories and main categories. The study was evaluated and approved by four criteria of creditability, tranformability, reliability, and confirmability.

In total, 564 open codes were extracted. Then, primary codes were compared based on similarity, compatibility, and appropriateness, and 66 subclasses were obtained. 14 main categories were obtained by compressing the subcategories. The 8 main categories regarding different services included:  healthcare, recreational, government agencies, transportation, communication and interaction, educational and research, religious and pilgrimage. In addition, regarding the older adults' needs, the 6 main categories included: improving the safety of places; providing effective education, mental, spiritual and social health development programs; improving services quality, reorganizing municipal services and provision of amenities.

Paying attention to the needs of the elderly is necessary in planning for  public spaces in cities. Regarding the need for comprehensiveness of services, it is suggested that the findings of this study be used in designing, implementing, and evaluating services in public places to their service needs and solve their problems.

The healthcare providers are always seeking improvements in the health care delivery system in order to achieve better results.

This study aims to evaluate the efficacy of Family Physician Program (FPP) in providing primary care in Talesh, Iran.

This is a cross-sectional study conducted on 50 physicians working in Talesh city as family physician in 2020, and 384 patients referred to the comprehensive health service centers of Talesh city. The census method was used for selecting physicians, and a simple random method was used for selecting patients. The data collection tool was a researcher-made two-part questionnaire with acceptable validity and reliability. The collected data were analyzed using one-sample t test in IBM SPSS Statistics software.

According to t-test results, access to services (P<0.001) and coordination of care (P= 0.028) in the FPP were significantly at a lower level according to physicians, while the continuity of care (P<0.001) and comprehensiveness of care (P=0.003) were significantly at a higher level. Furthermore, access to finance and location (P<0.001) was significantly at a lower level according to patients, while access to educational services (P<0.001), quality of services (P<0.001), and continuity of health and medical care (P<0.001) in the FPP were significantly at a higher level.

Policy makers and managers should increase the quality of services in the FPP for patients by maintaining and developing access to primary care and educational services to increase their satisfaction.

Satisfaction is a complex multidimensional phenomenon influenced by personal, psychological, social, cultural and economic factors. Health care Quality is usually defined as a set of patient satisfaction and treatment success. Patient satisfaction is a sign offering proper services that is not only the result of technology promoting, but also due to the correct behavior and good performance. The present study evaluates the patientschr('39') satisfaction from dental care services provided by the Dental Faculty of Yazd University of Medical Sciences in 2014.

This descriptive and cross-sectional study was done on 764 patients referred to Yazd dental school in 2014. Sampling was stratified by size of each class. A three part questioner including individual questions, questions about facilities & questions about dental services was designed. Data were analyzed by SPSS software, T-test, ANOVA & chi-square.

Mean age of patients was 25.11±12.08. General satisfaction from services provided, was evaluated: complete satisfaction 129 (16.89%), partial satisfaction 571(74.74%), partial dissatisfaction 52(6.8%) and complete dissatisfaction 12(1.57%). There was A significant difference between overall satisfaction with gender, age, education, marital status and place of residence (P>0.05).

As regards the results of the present study shows the patientschr('39') satisfaction from dental care services provided, in Yazd Dental School is in the desirable level and it is hoped that with solving of existing problems & improving the quality of services, the present situation can be improved.

Providing quality services is one of the important goals of the health system. Dental services and treatments are expensive. The aim of this study was to investigate the factors influencing the perceived quality of dental treatment services.

This descriptive-cross study conducted in 2 qualitative-quantitative phases. Data were collected using interviews and pairwise comparison matrix with 20 dentists working in NAJA dental clinics who were selected by targeted sampling. The validity and reliability of the interviews were determined by long-term engagement of their peers and negative case analysis. The validity of the pairwise comparison matrix was determined through the incompatibility rate (>0.1). Data were analyzed by coding and effect intensity tests (R+J), descriptive statistic test (mean, standard deviation) using SPSS23, Maxqda and matlab R2017b.

Content analysis of the interview showed that tangible factors, assurance, trust, and empathy are the factors affecting the quality of dental treatment services. In the second phase, data analysis showed that trust and empathy (28.204), assurance (24.356), and tangible factors (17.798) are the most to the least important factors in the quality of dental treatment services (P=0.1).

Trust and empathy were the most important factors in the quality of dental treatment services. Managers of dental clinics and dentist need to improve the quality of dental treatment services by emphasizing respect for patients in accordance with the promise to act in the field of providing treatments to patients.

Individuals With Disabilities (IWDs) are part of the society that, respecting their situation, have the greatest need for social support and the provision of desirable services. However, in underdeveloped and developing countries, the existence of a negative and incorrect view towards IWDs is effective in providing services to them, especially in care centers; accordingly, this condition makes this part of society encounter numerous challenges in receiving the necessary services. Factors, such as the number of IWDs in care centers, their age, their ratio to the number of caregivers, and the characteristics of caregivers, such as their professional skills and experience, are influential in the occurrence of abusive behaviors. Due to the necessity of providing efficient and effective service to IWDs, the present study aimed to identify the challenges of providing services in care centers for IWDs.

This qualitative study was conducted in 2020. The research setting consisted of all care centers for IWDs in Tehran City, Iran. Moreover, the study population included the managers of care centers for IWDs in Tehran. Using the purposive sampling method, 19 managers of the centers were selected and interviewed according to the objectives of the study. The interviews continued until reaching data saturation. For data collection, we used semi–structured interviews; the interviews were recorded, then transcribed, and analyzed with the consent of the study participants. For data confirmation, each interview was provided to the study participants after analysis, and their opinions were re–obtained concerning their interviews. The latent content analysis method was also used to analyze the collected data. For this purpose, after listening to each interview several times and reading the transcripts line by line, important phrases in the content of the data were identified; consequently, the appropriate concepts were determined and placed in the same categories. To observe ethical issues, verbal informed consent was obtained from all study participants before conducting the interviews. SPSS was used to investigate the frequency distribution of study participants respecting the demographic variables.

The mean age of study participants was 41.13 years. The majority of the study participants (57.89%) were in the age group of 41–46 years. Their average work experience equaled 14.51 years and the majority (68.42%) were in the group of 13–20 years. Additionally, most of the respondents had a BA degree (68 .</span>42%). After analyzing the interviews with 19 managers of the centers, the first 321 separate codes were obtained; after analyzing, they were grouped under 15 sub–categories. Finally, after reviewing and analyzing these subcategories, 3 main categories, including cultural–educational factors, planning, and necessary resources, as well as facilities and infrastructures were developed. Cultural–Educational characteristics, included the lack of culture creating, the lack of promotion of public knowledge, the lack of individual and public education, not introducing resources about disability, no belief in the ability of IWDs, and the lack of education and training of human resources. Planning consisted of the lack of a database, no codified service delivery programs, no plan to increase service coverage, guidelines, and specific program for use by IWDs. Necessary resources, facilities, and infrastructures included the lack of adequate equipment and items, drug shortages, human and financial resources, the lack of interdepartmental supports to support IWDs.

According to the current research findings, factors related to culture–education, planning, and the necessary resources, facilities and infrastructures were the main challenges and obstacles in providing services to IWDs.

Performance Indicators consist of standards, evaluation tools and identifications to check current situations in organizations.  Hospitals as the center of gravity to provide   health and therapy care are of no exception. The present study aimed to determe the performance indicators in selected hospitals of Tehran province.

The present inquiry was a cross-sectional descriptive-analytical study. The statistical population of all public hospitals was covered by Tehran University of Medical Sciences and Shahid Beheshti. 14 educational and 9 non-educational cases were examined. Data collection tools were data entry forms for hospital performance indicators, which included general information on the studied hospitals and performance indicators, bed occupancy rate, average patient stay, and bed turnover rate. Data were analyzed using Chi-square and Kolmogorov-Smirnov tests.

The average patient stay was 5.89 days, which was only 7.15 percent desirable by standards. The bed occupancy rate was 76.35 and the bed turnover was 45.97 times a year. The status of these two indicators was optimal based on the standards available in 92.85% of the cases. Also, based on the results of the present study, the mean average patient stay was 2.91 days, which was desirable in 77.77% of the cases according to the standards. The bed occupancy rate was 62.70 and only 11.11% of the cases were favorable. The bed turnover was set at 65.44 times a year. In relation to this index, in 100% of cases, the situation was favorable.

The non-educational hospitals of Tehran University of Medical Sciences were in a better position regarding the length of the patient's stay than the indicators of the Ministry of Health and even compared to the hospitals of other provinces. In relation to educational hospitals, due to the fact that according to the Ministry of Health, the optimal condition of the average patient stay is less than 3.5 days and more than 4 days is a sign of weakness and inefficiency of the hospital, the studied hospitals with an average of 5.69 days. They differ significantly from the standard. In the other two indicators, both educational and non-educational hospitals were in good condition.

Drugs are essential components of health services in all communities and pharmacists play a major role in delivering appropriate health care. There are lack of comprehensive studies on the knowledge, attitude, and practice of pharmacists in dealing with prescription drugs in Mazandaran province, Iran, so, this study aimed at assessing the performance of pharmacists on these issues.

A cross-sectional study was carried out in 179 community pharmacies in Mazandaran province selected via random sampling. A trained shopper with a prescription attended the pharmacy and based on researcher-made flowchart and questionnaire, the pharmacist's performance on drug interactions, side effects, etc. was evaluated.

Among the pharmacies investigated (n=179), pharmacists were available in 154 (86%) and pharmacist consultations were observed in 67 (37%) pharmacies. Right medications were given in 157 (88%) pharmacies and in 166 (93%) instructions for use were completely correct and in accordance with the prescription.

At the community pharmacy, pharmacists usually focus on dispensing correct medication and pay less attention to pharmacy counseling. Trainings on drug interactions and adverse drug reactions could increase the awareness and knowledge of pharmacists.

Clients’ satisfaction regarding health-care services is one of the indicators of measuring the quality of services provided; therefore, this study aimed to evaluate the satisfaction rate of clients referred to the healthcare centers. This descriptive study was carried out on 385 people referring to healthcare centers in Rafsanjan in 2017. To collect data, a checklist includes demographic and proprietary information was used. The final analysis of data was performed using Chi-square and one-way ANOVA tests at a significant level of 0.05. The results showed that of 385 people, 335 people (87%) were female and 50 (13%) were male. Also, 77.4% of the clients were very satisfied with the services provided in health centers and 19.7% of them were highly satisfied. After controlling for the confounding effect of level of education variable, no statistically significant difference was observed between the private, urban-governmental and rural centers in terms of satisfaction score (p>0.05). Overall, clients had high level of satisfaction with health care centers in Rafsanjan. Investigation of clients' satisfaction rate with healthcare centers will be helpful in promoting planners' and managers' level of awareness about the status of provision of health services and the application of methods to address deficiencies.

Mobile phone, as a manifestation of modern communication technology, has a strong position in human life and is an integral part of daily life. The health industry is also one of the main areas where mobile penetration in the industry has resulted in surprising advances and various challenges. Mobile health (activities and medical operations supported by the mobile phone) serves as a digital assistant for information, health and personal care. Health commercialization is a global phenomenon and many health systems in the world are affected by it. The aim of this study was to prioritize the factors influencing the commercialization of mobile health.
In this applied study, through reviewing studies in the field of mobile health commercialization, 31 leading indicators of mobile health commercialization were identified and after obtaining the opinions of experts and explorative factor analysis, the identified indicators were categorized in 6 dimensions and ranked using a fuzzy hierarchy analysis.
The obtained indicators were respectively, service development, market management, organization and legal processes, technology and infrastructure, finances and large substrates. What is noteworthy in the proposed prioritization compared to the studied documents is the comprehensiveness of the relevant indicators and consideration of the various dimensions of commercialization in relation to similar researches.
Regardless of the prioritization of effective factors on mobile health commercialization, a noteworthy point in this framework is significant importance of convergence of this technology with the economic structure governing health care system of the country, agreement of the technology with basic health infrastructures and methods of improvement of mobile health technology that undoubtedly, each of them, by itself, is an important factor in mobile health commercialization.

Considering the importance of the quality of hospital hoteling services in healthcare system’s outcomes, and lack of a valid assessment method for determining and implementing required strategies for evaluation and improvement of the service quality, the aim of the present study was to determine factors affecting the hoteling services quality in public hospitals of Iran.
The present quantitative-qualitative study was conducted in two phases. In the first phase, factors affecting hospitals hoteling services’ quality were extracted from the literature as well as from in-depth interviews with 11 experts (i.e., 6 specialists in healthcare administration and 5 in hoteling industry). In the second phase, the data from the first phase were integrated and a model for improving the quality of hospitals’ hoteling services was designed resulting in a researcher-made questionnaire. The model was validated through qualitative (i.e., expert opinion), and quantitative approaches (i.e., exploratory and confirmatory factor analysis). The data for the factor analysis was collected from 960 patients and specialists in 10 teaching hospitals in 10 different cities across the country. Confirmatory factor analysis and multiple regression were used to analyze the data.
The findings of present study indicated that 11 factors (physical, functional, economical, human factor, social welfare services, clinical welfare services, safety, cultural, personnel identification, patient guiding factors, and healthcare services) were able to explain 65.81% of the hoteling services’ quality variances. Based on conformity factor analysis, functional and personnel identification factors with a coefficient of 0.953 and 0.779, respectively, had the highest and lowest impact on improvement of the quality of hoteling services in Iranian teaching hospitals.
For the improvement of the hoteling services status of Iranian hospitals and considering the 11 factors found in this study, the functional factor must be emphasized and the technical quality of health services be evaluated in the planning of hoteling services.

Access to valid and new health information as well as capabilities of medical librarians has highlighted their presence in various areas of health. The aim of the present study was to identify the new roles and services of medical librarians in the field of health. This narrative review was conducted in 2014-2016. The Data was collected through studying the articles published on information databases like Magiran, SID, Noormags, PubMed, Science Direct, Emerald, and Web of Science during the past 15 years (2002 to 2016). The keywords used in this search included "medical librarian", "medical librarianship", "clinical librarian", ý"ýrolesý"ý, ý"ýservicesý"ý, and other similar keywords. The new roles and services of librarians were identified after studying and evaluating the contents of the articles. The results showed that the areas of medical librarians’ activities go beyond libraries and according to their abilities and capabilities, they can offer their new services such as media literacy, information literacy, health literacy, health scientometrics, health information services, clinical services, health research services, and design and development of health information retrieval systems. In framework of their new roles and activities, medical librarians should satisfy patients and their families, medical staff, and students and faculty members in the field of health information.

Needle stick injuries is one of the most important problems in hospitals which puts the health of workers in serious danger. So, this study aimed to assess needle stick injuries and its relative risk factors in laboratory and housekeeping personnel of Imam Reza hospital in 2014. This is a cross-sectional study that its data were collected as census using a researcher-made questionnaire with two main parts including background variables and needle stick exposure variables. The inclusion criteria included the staff work field and presence in the studied hospital in laboratory and housekeeping departments and their agreement to participate in the study. First, the obtained data were analyzed qualitatively and the results were reported as frequency (percentages). Then, the statistical relationship between study and demographic variables were assessed using Chi-squared test. All of the analyses were performed using SPSS16 software. P<0.05 was considered significant. The results showed that 35.2 % of the studied personnel had experienced needle stick injuries in the last year and the mean of exposure rate was 0.83 time for each person in the last year. Furthermore, the study indicated that there are significant statistical relationships between background variables and some independent variables including: exposure with needle stick and its rate, antibody level of hepatitis B after vaccination, renewed immunization in low antibody, and the causes of exposure to needle stick. (P<0.05) The study results indicated the high rate of exposure with needle stick injuries which needs a proper design and conducting interventions by administrators and policy makers.

The gerontological social work is considered as a profession of social work to help elderly and their families. One of the beliefs of the population is an alarm increasing in the elderly population.
Demographers predict that the elderly population will increase to 2 billion people by 2050. However, many elderly are faced with poverty and other problems such as limited access to health care services. It seems that social work services are faced with a wide range of demands to meet the needs of this growing population. In this review article, we discuss the importance of gerontological Social Work and then we introduce the role of gerontological social workers and their challenges.
In this study, articles, books and documents related with the gerontological social work were reviewed based on library and documentary method.
In general, gerontological social work services include a range of institutional care to community-based care. These services include case management, crisis intervention, mental health care, daily care, elderly daily centers and home assistance. Of course there is more interest in community-based services, because the purpose of community-based services is, enabling the elderly to aging in their homes and workplaces.
Awareness of the role and activities of gerontological social workers will lead to greater use of the ability of workers to help seniors and their families to cope and adapt and coexist with complex situations.

In The last two decades، nursing homes for elderly have expanded tremendously. Client satisfaction is one of the most important indicators of service quality delivered by institutes and organizations. This study was carried out to measure client satisfaction in the private nursing homes of Golestan، Mazandaran، Semnan and Northern Khorasan Provinces in 2012. In this cross-sectional study، 89 participants from all 14 nursing homes located in the pre-mentioned provinces who met the inclusion criteria including age 60 years or older، ability to communicate، Abbreviated Mental Test scores of 6 or higher، and at least 6 months stay duration were recruited by the method of census and interviewed. Data was gathered using the questionnaire of Assessing Elderly Residents'' Satisfaction of the Delivered Services in Nursing Homes. In order to analyze data، statistical parametric t-test، ANOVA، Mann-Whitney، Kruskal-Wallis test، Spearman correlation coefficient and SPSS software (version 17)، were used. Mean scores showed that satisfaction with the physical care (3. 55) and physical environment (3. 77) were higher than of satisfaction with psychological care (3. 00) and social care (3. 26). The mean score of overall satisfaction with the services was 3. 40 and indicative of satisfaction in the levels of moderate to good. There was a significant relation between mean scores of satisfaction and the way which clients had been admitted to nursing homes (p<0. 002). Lower levels of satisfaction with psychological and social care in the nursing homes points to the need of paying more attention toward these two care dimensions. Considering the significant relationship between self commitment and the level of satisfaction، psychological preparedness of older clients before committing them to nursing homes may play a role in their satisfaction with the services delivered in nursing home.

Medical Council as well as other organizations provides welfare services to its members. The aim of this study was to investigate the pattern of members’ interest and their use of services and amenities offered by the Mashhad Medical Council (MMC). In this descriptive cross sectional study, data from the MMC Welfare Club in 2012 were collected and assessed. Data collected included the gender of members and type of services offered. Data were analyzed using Excel software. Overall, 38,194 person-services were used from the MMC welfare club in 2012. Among the services offered, fast food and coffee shop (28%), catering and restaurants (20%), hypermarket (14%), clothing store (13%), swimming pool and sports club (3%) were the most common amenities used by the medical community. Moreover, members had less interest in the use of Internet services (0.3%), computer and audiovisual equipment stores (0.3%), Interior Decoration (0.3%), sports car accessories (0.04%), musical instrument store (0.02%). Pattern of use of services was different among male and females. In this regard, male members used sports car accessories (male to female ratio: 446%), Hypermarket (251%) and Internet services (207%) in higher ratios while females used wedding supplies store (0%), Interior Decoration (21%) and cosmetics shop (21%) in higher ratios. In this study, it was found that among welfare services offered by the MMC, members were mostly interested in coffee shops, restaurants, catering and hypermarkets. Medical Council, in addition to making deal with high quality amenities and welfare centers, should widely inform the members and identify their interests.

Global growth in the elderly population for both health care providers and families and also the community is an important challenge. Elders are the largest and fast factor for increasing hospital admissions in Society. Increasing costs of aging is the most concern to elders and their families. This study aimed to investigate the health team s approach about cost–effective alternatives for aging health services. This study is a qualitative research which was done through content analysis. 18 people consisting of five faculty members، 6doctors، 3 nurses and 4health public health expert were participated. Samples were selected based on purposive sampling. Data were collected through interviews. Four core themes derived from this study which included: 1- Emphasis on training for aging care (including training doctors، nurses، health professionals، public health experts، elder sand their family caregivers). 2- Emphasis on proper implementation of primary health care for the elderly. 3- Emphasis on home care for elderly. 4-attntion to mental health of elderly. It seems effectiveness of tree alternatives; emphasis to training، home care and mental health for elderly are obvious and evident، so implementing and applying these suggestions would be helpful. But the second alternative; emphasis on proper implementation of primary health care for the elderly must be performed based on a comprehensive needs assessment in elders population. Finally it is stressed that calculating and comparing actual costs of each alternative in elders caring must be measured through quantitative researches.

Cost analysis can lead to optimal utilization of the resources and can improve the performance of the health care system. The present study was carried out to analyze, and compare the costs of the services provided in urban and rural health care centers in Shahroud. This is a cross-sectional descriptive study. All urban and rural health care centers in Shahroud were studied in this study in 2009. The required data were collected through more than 70 forms. The data were analyzed through EXCEL and SPSS software programs. Out of the 496 health care personnel, 42.5 % of the personnel were working in urban centers and 57.5 % were working in rural centers. Among all the urban and rural centers, 66.1% of the costs were personnel costs and 33.9% were other costs. The number of services provided in urban canters was 777383 and in rural centers it was 828888. The mean cost of one service provided in urban centers was 27228 rials and in rural centers it was 34354 rials. The mean cost of one case of coverage in urban centers was estimated to be 29601 rials and in rural centers it was 37266 rials. In general, the number of the services and the coverage provided in urban centers was less than the ones provided in rural centers. The most important factor influencing the total cost of the services is the personnel cost, thus staff cutback and optimal use of the work force, using modern technologies and utilizing the capabilities of the private sector in providing health care services in urban centers can lead to better and more efficient productivity of the resources.

The status of providing medical services to patients in the emergency wards can be indicator of medical service delivery in every part of hospital. The objective of this study is to determine the rate of patients’ satisfaction from General physicians’ services in Fasa.

The study was application and descriptive and analytical. Designed questionnaire in five-part Likert scale has completed through the interview. Sampling method was random and 400 Patients were interviewed. Data was collected through SPSS 18 and Minitab 15 software is analyzed by using appropriate tests. Validity of questionnaire is provided through structural and content method. To determine reliability, Cronbach alpha is calculated which 0.93 is.

Among the demographic and contextual variables, there was statistically a meaningful relationship between satisfaction and education, job, sex, married. Correlation coefficient between Patient's overall satisfaction and loyalty index, is calculated which is 0.792. The key improvement priorities from General physicians’ services respectively, "Physician’s skill and expertise", "Careful consideration to the patient and complete patient history taking and physical examination by a physician" and "Physician response to patient questions about disease and treatment methods" were identified.

The findings highlight the need to improve the quality of General physicians’ services. It appears that by reforming system's defects based on Patients’ opinions higher satisfaction would be obtained.

Calculating cost is an important management tool for programming, control, supervision and evaluation of health services in order that informed decisions can be done. This study was done to determine the cost of services provided by health centers, and health house in Shahroud in 2009. In this study, all health centers in urban and rural regions were studied. 70 forms for provided services, public and specific materials used for each service, medicine and equipment, time required for each service and activities, buildings and equipment depreciation costs were used to collect the data. Then the costs of each unit including direct and indirect costs (overhead), as well as the costs of one center and one health care home were calculated through cost analysis software. Findings from data analysis showed that 44.4% of health care providers were male and 55.6% were female. 22.8% of the personnel were working in health house, 26.1% in rural health centers, 9.1% in urban health centers, health centers 24.5% in urban boarding health centers, 2.6% in health care posts and 14.9% were working in Healthcare Department. The highest cost were personnel costs (66.1%) followed by central department costs (12.8%). Next were the costs for drug consumption with 11.0% and specific use with 3.8%. The highest cost was also for training healthcare providers (1325209 RLS) and lowest cost was for sampling of influenza (3872 RLS). Due to high personnel costs, increasing of productivity will play an important role in reducing labor costs. Also, moderating workforce and the using private sector participation in services and outsourcing costly units can play an important role in optimum utilization of resources.