مجله تحقیقات نظام سلامت حکیم
سال بیست و دوم شماره 3 (پیاپی 86، پاییز 1398)

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

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.

Due to Iran’s privileges to manufacture medicines and the capacity of the Middle East market, foreign investment in the pharmaceutical industry can be a solution for realizing the “General Policies of Resilient Economy” in the area of comprehensive and targeted support of exports and services.

In this study, for the first time, we used three steps to extract the permits and procedures required by foreign investment to take or pass in manufacturing drugs. The three steps included the collection of laws, codification to recognize valid from invalid regulations, and analyzing valid regulations in the area of foreign investment in manufacturing pharmaceutics. Besides reckoning, we examined the impacts of regulations on facilitating or impeding foreign investment.

For investing in drug manufacturing, in addition to the legal requirement for obtaining permits and passing general procedures prescribed in the “Foreign Investment Promotion and Protection Act” (FIPPA), it is necessary to obtain special permits asserted in different laws and regulations. Therefore, the dispersion of rules and the multiplicity of permits and processes make it difficult to attract foreign capital. Under such circumstances, the obligation to release business licenses and the limitation of permits to issued cases set forth in the “Law of Implementation of General Policies of Principle (44) of the Constitution” cannot be effective.

To eliminate unnecessary procedures, licenses, and authorities, as well as to reduce the burden of scattered laws and regulations, solutions such as electronic permit issuance, codification of health code and strict implementation of article 7 of the “Law of Implementation of General Policies of Principle (44) of the Constitution” and articles 6 and 7 of FIPPA can be considered in policymaking in the health system.

The edentulous index periodically evaluated at specific age intervals is a determinant of oral and dental health condition and an indicator of access to dental care.

In this descriptive-analytical study, we studied the edentulous status of 600 people over 35 years of age. We used an oral health status questionnaire for adults provided by the Ministry of Health and Medical Education in Iran. The sample was selected based on convenience sampling proportional to each city’s population. We evaluated the edentulous relationships with age, sex, job, education level, insurance status, location, and family size.

In this study, the highest frequency of edentulous was in women, urban residents, 44 - 35 years’ age group, bigger households, and insured persons. People with higher education had fewer missing teeth and housewives had more missing teeth.

To improve oral and dental health and prevent edentulous and its associated problems, we should improve the access of high-risk groups to oral healthcare and dental care services and promote community awareness.

The contamination of agricultural products to heavy metals possesses one of the serious health hazards to consumers, as some of these elements have carcinogenic properties and others can cause damage to various organs of the human body.

The purpose of this study was to determine the carcinogenic and non-carcinogenic risk of some heavy metals due to the consumption of raisin produced in Malayer city.

For the purpose of this study, 50 raisin samples including Sultanu raisin (13 samples), Golden raisin (12 samples), Shade-dried raisin (13 samples), and Sun-dried raisin (12 samples) were collected from industrially and traditionally produced raisin. Then, heavy metals including cadmium, lead, nickel, copper, zinc, and arsenic were measured in the samples by graphite furnace atomic absorption spectrophotometry. The quantitative risk assessment was conducted based on the United States Environmental Protection Agency method.

According to the obtained results, the mean concentrations of arsenic, copper, and nickel in raisin samples were 0.17 ± 0.06 (accepted level 0.1), 3.07 ± 0.09 (accepted level 0.3), and 4.72 ± 0.99 (accepted level 0.5) mg/kg. The highest average concentration of heavy metals was related to Sultanu and Golden raisins. The highest estimated daily intake (EDI), target hazard quotient (THQ), and carcinogenic risk (CR) belonged to the nickel element.

The results showed that the mean concentrations of As, Ni, and Cu in raisin samples were higher than the level recommended by the FAO/WHO. The EDI level of all elements in all types of raisin was less than the provisional tolerable daily intake (PTDI) proposed by the FAO/WHO and Joint FAO/WHO Expert Committee on Food Additives (JECFA) and the Iranian Institute for Standard and Industrial Research (IRIS). Thus, their long-term uses do not have any specific non-carcinogenic effect on consumers while they can possess carcinogenic effects.

Leadership is the science and art of influencing, motivating, and empowering employees to achieve organizational vision and goals. Managers’ leadership traits can affect the success of change management in a hospital. This study aimed to explore the characteristics of effective leaders in managing hospital changes.

This case study was conducted in 2018 at Hasheminejad Hospital in Tehran, Iran. Research participants were drawn from a purposive sample of hospital managers and employees (45 persons). Semi-structured interviews were conducted using open-ended questions. Thematic analysis was used for data analysis, consisting of coding, pattern identification, and theme development using MAXQDA 11 software.

Transformational leadership was the dominant leadership style of hospital managers. Implementing changes in the hospital during the period of 2002 and 2018 increased inpatient numbers by 270%, outpatient numbers by 330%, surgery operations by 220%, and hospital bed turnover rate by 290%. The success of a leader in change management depends on his/her aptitude and personality. A leader’s intelligence, knowledge, and skills form his/her aptitude and the personality encompasses the leader’s beliefs, values, attitudes, and behaviors.

Transformational leadership is affected by the leader’s aptitude and personality and it enhances hospital performance.

The Ministry of Health and Medical Education of Iran in 2016 established a 2025 road map for the treatment sector to more carefully plan for the development of strategic health resources to achieve essential standards. This road map estimated the required human capital, health care facility, hospital beds, and emergency facility. The current study aimed to assess the costs of implementing the road map and its feasibility for the health care system.

We used the 2015 costs of achieving each goal in the road map to estimate the costs in the next 10 years. Similarly, we calculated the accessible resources of the health system in the same year. We proposed different possible scenarios to implement the road map based on the costs being higher than resources.

In 2025, the highest cost of the road map will go to human capital (71%), followed by providing equipped hospital beds (20%), while providing equipment will have the least share of costs (1.1%). According to the basic scenario, considering the 10 to 16% annual inflation rate, 10 to 14% increased rate of wages, 3 to 5% economic growth, and 7 to 8% GDP share of health system expenditure, the health system can implement 80% of the road map in 2015.

Considering the Iran economic turmoil after finalizing the road map, it is necessary to revise the resources of the health care system and reduce the costs of the road map for the complete implementation of the map.

The rapid decline in the fertility rate has placed Iran among the countries with “below replacement fertility”, which represents a single-child behavior. Social networks (as one of the components of social capital) have been considered in recent years to understand fertility behaviors and changes in the levels of fertility. This study was conducted to investigate the relationship between social capital and single-child behavior in Iranian women workers.

In a cross-sectional study, 600 female workers were recruited by stratified sampling in health care settings in Babol, a city in northern Iran, in 2018. Data collection tools consisted of a questionnaire for demographic characteristics, fertility behavior, and social capital. Data analysis was performed by SPSS-21 software using Poisson regression and logistic regression at a significance level of 0.05.

In this study, 45% of women were single-child and 54.5% did not intend to be pregnant again. There was a significant relationship between the number of pregnancies and social capital (P = 0.039). Similarly, in women with low social capital, the odds of single-child behavior increased although it was not significant (95% CI: 0.899 - 2.220, OR = 1.41).

The results of this study showed that increased social capital was associated with an increase in the number of pregnancies. Attention to social capital should be taken into account in population planning and policy-making.

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.