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Background. Today, the participation of local levels in the health policy process is emphasized, which can be used as a means to more appropriately solve the problems of local communities and support the health system in achieving its goals. This study aimed to design a health policy model based on participation at the local level. Methods. This multi-method study was conducted to design a model for participation in health policymaking at the local level during three phases of systematic review, semi-structured in-depth interview, and Delphi technique. The purpose of the systematic review was to identify the factors affecting this participation, which was done by searching for suitable keywords in English and Persian databases. The objective of the qualitative phase was to identify the barriers and facilitators of participation. To this end, 16 people were selected by purposive sampling method and semi-structured interviews were conducted. The elements and components of the initial model were provided to experts in this field through the Delphi technique to confirm the items and validate them, so that the final model could be designed. Results. The influential factors for participation included individual, environmental, and contextual factors, which were identified from a systematic review of 21 articles. Facilitators obstacles, challenges, advantages, and disadvantages of local level participation in the policymaking process were identified through the results of a qualitative study, which were categorized into three main themes, including the participation process, the beneficiaries of the process, and the strategies to facilitate participation. Finally, the health policy model based on participation at the city level was validated and finalized using the opinion of experts. Conclusion. Participation in the health policy process requires the use of facilitators and the removal of obstacles. Local levels in terms of health issues in Iran involve complex and diverse challenges that can be solved through real participation.

Introduction: Curriculum revision with a new perspective on knowledge, skills, and learning is a step towards evolving and updating pedagogical content. This study endeavored to review PhD curriculum of health policy based on the required capacities for graduates. Methods: This study was conducted at Tabriz University of Medical Sciences (in the academic years 2016-2018) based on Dennis Modified Model. We used a set of methods such as review of documents, comparative study, interview, focus-group discussion and panel of experts for gathering data. The study was conducted in four stages including need analysis, explaining the required competencies, modifying, adapting, and rewriting the initial curriculum, and finalizing the curriculum. Finally, the final curriculum was sent to the Ministry of Health and Medical Education. Data were analyzed through a conceptual framework approach and through content analysis. Results: The content of the course was designed based on the outcomes of the course and the plans and tasks of the graduates of this field. Graduates' abilities were extracted in 5 areas including policy making, policy analysis, leadership and social communication, as well as education and research. Some lessons were removed and some were added. Besides, the change in the content of specific courses was emphasized given the approval of similar disciplines and attention to optional courses in order to Specializing the course. Conclusion: Reviewing the curriculum of the doctoral program in health policy and its implementation can lead to develop the more purposeful teaching-learning process, implementing the capability-based training and responsive education, increasing the specialized knowledge and technical skills of graduates, that enhance their success possibility in the future job. It is suggested that special attention has been paid to this issue and the requirements, challenges and appropriate strategies for precise and scientific review of various fields in medical and paramedical education be examined.

Background and Objectives: Hospital deductions are one of the main concerns of hospital managers in cost management and also one of the most controversial issues between insurance companies and hospitals. The objective of the present study was to analyze the major causes of hospital inpatient medical records deductions.Material and Methods: This study was a mixed-method research that was done in four-step in 2017. In the first step, systematic review of the main causes of deductions in hospital inpatient medical records was done. In the second and three steps, a questionnaire was designed from the results of the first step to interview the experts in this field. In the final step, after summarizing the results of the three steps, the final causes of hospital inpatient medical records deductions were determined using Delphi technique.Results: Additional requests for encoding in surgical procedures by surgeons and anesthesiologists, sending documents with the signature of the surgeon assistant without his presence in operation, lack of interaction with insurance and its follow-up and a tendency to reform of deductions, employing people with the unrelated specialties in the relevant unit, lack of continuing and comprehensive training for staff, additional request at drugs and supplies fees, incomplete documentation, lack of documentation for full-time physicians and differences in the implementation of guidelines by the insurers were the most important causes of inpatient medical records deductionsConclusion: Given that human error is one of the main reasons for inpatient medical records deductions, justifying physicians and training staff for completing medical records on the principles of proper documentation and quality of data recording and ensuring uniformity of policies and enforcement of insurance guidelines seem essential.

Background and Objectives: Rural family physician is one of the strategic reforms in Iranian health system. It has been implemented since 2005 with the aim of improving people's access to health services. Despite its pivotal role in health system programs, the program has not progressed according to its original policies. Therefore, in this study, we aimed to identify the challenges of the rural family physician to provide solutions to these problems. Material and Methods: The present study is in the field of qualitative studies. This was done by interviewing and reviewing the documentation. The sampling was purposive and the documents were systematically selected. In-depth semi-structured interviews were conducted with 26 key informants. Data were analyzed using MAXQDA software by content analysis method. Results: After more than a decade of practicing family physician, the program still faces a number of key challenges in the areas of leadership and governance, financing, service providers, training and making culture, customer behavior, and monitoring and evaluation. Most of the program's challenges are related to leadership and governance, such as the negligible role of the private sector in service delivery, politicians are not justified about the program, and failure to anticipate the infrastructure required for the program. Conclusion: Given the importance and key role of the family physician in the field of health and completing primary health care (PHC), especially the effective role in achieving UHC, with proper planning, appropriate and practical interventions should be designed and implemented to remove barriers and enhance the family physician program.

The spread of the new Corona virus, known as COVID-19, has raised concerns and problems for many countries, and its out-of-China exposure is worryingly increasing. This trend is increasing in our country as well and has reached a critical point in some of the infected cities. This article attempts to provide appropriate strategies for controlling the virus for Iran based on the East Asia countries response that have had the first and most exposure to the virus.

Background and Objectives: Health promoting behaviors are formed during adolescence and often remain until adulthood. This study aimed to explore related factors to health promoting self-care behaviors among adolescents. Material and Methods: A cross-sectional study was conducted in 2016 among 426 adolescents living in Tabriz. Adolescent Health Promotion (AHP) questionnaire was used to collect data. Data were analyzed using descriptive statistics, t-test, Pearson and Spearman correlation coefficients applying SPSS v.16. Results: The mean score of the health promoting behaviors was 69.83. Among six health-promoting behaviors, physical activity and health responsibility were not in good conditions among the students. Adolescents had a high score in the dimension of life appreciation (80.62). There was a significant difference in self-care score between male and female participants (p≥0.05). There were no significant relationships between self-care with age, family size, and birth rank (p≥0.05). There was a significant difference between father education level and family size with nutritional behaviors of the adolescents (p≥0.05). Conclusion: This study showed that the health responsibility among adolescents was low and their physical activities were not sufficient. These results are a warning to policy-makers to pay attention seriously to promoting school health programs in order to promote self-care behaviors among adolescents.

Immediate access to special clinical services remotely has an important role in transferring information, informing clinical diagnosis, and distance learning. Health systems have faced with various opportunities and challenges during implementation of telemedicine. This study aimed to explore the challenges and opportunities in health systems for implementation of telemedicine. In this comprehensive review, local and international databases were searched according to a search strategy from January 2000 to January 2018. Then, an analysis was conducted on 24 selected papers. Use of telemedicine technology results in many challenges related to informational and communicational infrastructures, health, standards, laws and regulations, training, and security. Despite these challenges, significant opportunities are also presented specially in regards to pervasiveness of informational and communicational information, providing universal access to updated information, and disappearance of technology gaps through globalization, which can be suitable methods for eliminating the aforementioned challenges.

Background: Need to assess the health system performance, various models and frameworks have been developed by different groups and organizations. This study explores health system performance assessment frameworks using the comparative-analytical study. Materials and Methods: This is a comparative-descriptive study conducted using descriptive-prescriptive method based on comprehensive comparative analysis. The scope of research includes health system frameworks. The study results compared and interpreted based on identified factors in comparative tables. Results: Overall, 11 frameworks out of 16 ones described, analyzed and compared to each other. Some of the frameworks in addition to providing insight about the health system have focus on assessment of health system performance. Each framework follows especial goals which focus on importance the health systems assessment. Conclusion: During the time, health system frameworks have changed and developed according to the health systems changes. Developed Frameworks in recent years are more comprehensive than others which have been presented at first. Utilizing these frameworks in order to identify health system goals, assess based on responsibility (organizational actions or outside the organizations) and ways to reach them can be effective. Using the developed frameworks based on their domains and objectives can be considered in health system performance.

Background and Objectives: In addition to strengthening the country's economic viability, Health tourism entails providing regional security and has a special place in the financial circulation of countries. The purpose of this study was to analyze the status of the health tourism system in Iran and identify the strategies to improve this industry. Material and Methods: This qualitative research was done in three stages. In the first stage, by reviewing the literature and successful healthcare tourism reforms in successful countries were identified. In the second stage, the status analysis tool was used to analyze the status of health tourism system in Iran. In the third stage, according to the experiences of successful countries, the proposed strategies for improving the health tourism system of Iran were identified. Results: By analyzing data, strengths were identified such as the existence of specialized medical and specialist centers with low costs and the ability to treat infertility diseases and the most important weakness was identified as the lack of clarity of duties in the health tourism system of the country. The most important opportunities include: fundraising and job creation, enabling economic, social and cultural. The most important threat includes: the lack of awareness of tourists from other countries due to lack of adequate advertising of media and Internet. Based on these, institutional reforms were proposed at the levels of macro policies and strategic reform. Conclusion: Iran can play a significant role in developing this industry in the region and in the world and earn income from health tourism because of potential capabilities.

Background and Objectives: Achieving an appropriate policy needs an in-depth and comprehensive understanding of policy-making process. This study aimed to analyze HIV/AIDS policy-making process in Iran. Material and Methods: This is a qualitative/exploratory study. Data were collected through document review and semi-structured interview. Non-probability sampling was used for selecting documents and research participants. We used framework analysis approach assisted by MAXQDA for analyzing qualitative data. Results: AIDS policy is formulated in two specific ways within national work group in the format of national strategic plan and drug damage reduction committee. The main problem of the policy process is fragmentation and lack of comprehensiveness. Country approach of the policy implementation is top-down. The main duty of country committee and its sub-committees facing with some challenges is generating interaction between the relevant organizations. Despite the specific structure of evaluation process, it suffers from challenges such as lack of required implementation power, lack of resource anticipation, weakness in systematic and comprehensiveness evaluation and not-enough cooperation among plan’s stakeholders. Conclusion: It is obvious that policy-making in this area is completely governmental and the role of non-governmental organizations and civil servants is neglected. It seems that reform in AIDS policy-making structure and process can solve most of the problems of implementation, monitoring and evaluation.

Background and Objectives: Annually, a large amount of fees that are paid by hospitals, will not be reimbursed as deductions by health insurance which imposes irreparable financial losses on hospitals. The purpose of this study was to determine the amount of deductions imposed on social security and health insurance`s bills and its causes related to inpatients in two hospitals affiliated with Tabriz University of Medical Sciences. Material and Methods: This was a cross-sectional study conducted in Alavi and Madani hospitals affiliated with Tabriz University of Medical Sciences by using 2015 data. Researcher-designed checklist was used for data collecting. According to population size, census method and random sampling were used in Alavi and Madani hospitals, respectively. Gathered data were analyzed through descriptive statistics assisted by Excel v.13 software. Results: In the studied hospitals, most of the deductions in the Alavi and Madani hospitals were related to charge of surgeon and angioplasty, respectively. Also, in Alavi Hospital among deductions factors, the most repeated one was extra application in contrary to determined tariffs. In both hospitals, the role of the human factor in cases of error cannot be denied. Extra applications, inaccuracy in registration costs and lack of knowledge of the approved insurance tariffs are the main important factors influential on the deduction. Conclusion: Due to high rates of preventable deductions in both hospitals and being given the multiplicity and variety of services offered at the health centers, establishing income monitoring unit in hospitals and use of experienced staff is inevitable.

Background and Objectives: Evaluation of the quality of services and provided cares through comparing them with existing standards in order to identify and prioritize problems and trying to fix them are important steps in the audit of clinical functions. This study aimed to improve the quality of performance of medical records registrations about patients admitted to hospital Shahid Madani and deals with the audit of records listed them. Material and Methods: To perform this study, data were collected using researcher checklist. Target data of 30 medical records were gathered. We used software package of Mini Tab and SPSS to develop process statistical control charts and for statistical analysis of data, respectively. Results: By plotting control charts, we determined three specific reasons in the ADMISSION AND DISCHARGE SUMMARY SHEET, four specific reasons in the SUMMARY SHEET, and three specific reasons in CONSULTATION REQUEST SHEET. The lack of the standard form (on-delivered copies of a summary form) “with 90%”, lack of the main form in patient's clinical record “with 83.3%”, lack of the patient's procedure “with 73.3%”are ranked as the most defects in SUMMARY SHEET. In the CONSULTATION REQUEST SHEET, failure to comply with doctor's stamp and signature standard with “20%” has highest percentage of defects. In the ADMISSION AND DISCHARGE SUMMARY SHEET nonconformity of standard records, patient's duration of stay “100%”, coding of diseases based on ICD"100%", recording of patient number based on signs and symptoms "93.3%", usingthe abbreviations to record the recognitions "93.3%" have highest percentage of defects respectively. Conclusion: Based on the results of this study and noting that studied standards of process statistical control charts are in the range of control, the quality of standards and the documentations of the records in the studied hospital and therefore clinical documentations of the records for Shahid Madani hospital are relatively acceptable.

Background: Medical errors and adverse events are the main reasons of many avoidable deaths and imposed expenditures in worldwide health systems. Hence, this study aimed to recognize some challenges, medical errors and adverse events, and to address the appropriate solutions in order to solve them in the Iranian health system. Materials and Methods: This qualitative study had three main data resources including key informants, national documents and expert panel. Key informants (30 persons) and experts (12 persons) were selected purposefully from macro, meso and micro levels of health system and some other health related organizations. Data were interpreted and analyzed through a mixed (inductive/deductive) thematic framework. Results: Although, most reasons of medical errors were in relation with weak patient security system and low level security culture in hospitals, other factors like manpower, physical and external agents of hospital environment induced these errors as well. The most considerable solutions to decrease the medical errors comprised identification of medical error reasons in different levels of heath system, errors documentation and generation a consolidated system for recognition and following the errors and their main causes. Conclusion: Relieveing the reasons of medical errors and adverse events can be a great step to prevent them. In order to eliminate the medical errors and its challenges, it is necessary to develop the consonant programs in national level via conclusive will of organizations, groups and related individuals.

​Background and Objectives : In recent years, policy-makers and researchers of health sector have paid more attention to considering rights of mental patients. Despite of increasing importance of the issue, there are few studies which explore rights of mental patients and the challenges for providing respective solutions. The aim of this study was to explore various studies conducted in Iran and other countries and extract respective solutions to meet the challenges. Material and Methods: To conduct this review study, we collected relevant papers, theses and dissertations as well as related reports to mental patients’ rights. Local and global databases were searched to collect relevant data. In the next step, we followed articles of some special related journals. After collecting and categorizing the data, we extracted and categorized options for challenges of mental patients’ rights. Results : Solutions to meet challenges of mental patients’ rights (weaknesses in contemporary rights of mental patients, low or lack of awareness of mental patients and health workers about mental patients’ rights,) include options in rules and regulations level, macro policy-making level, conducting research, health services delivery level and strategic options according to analysis of weaknesses and failures related to mental patients’ rights and their needs Conclusion : In order to respect mental patients’ rights and find solutions and correct deficiencies, we should improve the existing plans and policies related to mental patients’ rights, plan to identify weaknesses and failures and improve services to this group of patients.

Background and Objectives : Technical quality of health care, compared with whatever is presented on the basis of scientific evidence as a standard service, is an important aspect of the quality in health services and everything that customer receives. The purpose of this study was to assess the technical quality of prenatal care according to the standards of the Ministry of Health from the perspective of pregnant women at Shahid Chamran Health Centers in Tabriz. Material and Methods : This was a cross-sectional study based on CQMH model. Forty pregnant women were selected randomly from the women who referred to Shahid Chamran Health Centers. We used standard questionnaire for collecting data which its validity has been tested and its reliability was confirmed. (Cronbach's alpha, .952) Results: The findings of the study showed that the highest level of compliance with the standard was the examining of women and listening to fetal heartbeat (16.7%) in the clinical examination. Regarding the prenatal care standard, the highest level of compliance was in oral health education (6.8%) which is 80% lower than the standard and 13.3% higher than the standard. These findings also indicated that education about bleeding and spotting is 90% lower than standard. Prescribing pharmaceutical supplements was higher than standard. In part of paraclinical services, the highest level of compliance with standard was the number of blood tests (50%) that was 6.7% lower than standard and 43.3% higher than standard. Conclusion : A significant proportion of pregnant women statements indicated the underuse and overuse of the standard which leads to a need for indispensable changes in order to improve the quality of prenatal care according to the standards of the Ministry of Health. Standards were in poor condition at the clinical examinations and prenatal care educations fields which require appropriate intervention based on the results of this study. ​

Introduction: Increasing elderly population has increased attention to improve quality of life in elderly people. This paper aimed to study the effect of educational intervention based on the PRECEDE model to promote quality of life in elderly. Materials and Methods: In this experimental study, 80 elderly people were randomly divided into two intervention and control groups. Planning of educational program was performed according to the PRECEDE model. Before implementing the program, Quality of life questionnaire and a self-designed and standard questionnaire according to the PRECEDE Model were filled in both groups. Both groups were followed up one month after the intervention and previous questionnaires were filled again. Collected data was analyzed using paired T-test, independent sample T-test, one way ANOVA, Chi-square and ANCOVA by SPSS-21 software. Results: Through health promotion intervention, the mean score of quality of life increased from 76.77±13.23 to 82.87±12.25. There was a significant difference between the total score of quality of life of intervention and control groups (P=0.031). In addition, findings showed a significant difference in physical, mental, environmental and social dimensions before and after the intervention (P

Objectives: Adopting healthy life style in elderly is very important. Iranian elderly population is increasing gradually, so identifying influencing factors on their healthy life style promotion is one of the concerns for policy makers in our country. Therefore this study explored elderly viewpoints about influential factors on their healthy life styles. Methods & Materials: This was a qualitative study involving face to face interviews with 15 elderly in Shabestar`s health center in Iran. All interviews were written and recorded . We used the thematic framework method for analyzing such qualitative data. Results: Three factors which found to be as as key influencing factors on elderly healthy lifestyle were as "Dimensions of healthy lifestyle", "social support" and ”facilitator factors in adopting a healthy lifestyle". Descriptive concepts of healthy lifestyle founded as safety precautions, social engagement, spirituality and daily life habits. Descriptive concepts of social support included family, friends, officials, media and finally descriptive concepts related to facilitator factors included meeting the needs of elderly and elderly self efficacy. Conclusion: Promoting healthy lifestyles in the elderly people is influenced by several factors. Identifying such influential factors on elderly healthy life style has an important role in promoting life style in this age group. It is suggested the outcomes of this study can be a step in developing of educational strategies and promotion of healthy lifestyle in elderly people.

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