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Background: According to the importance of evidence-based policy-making in health scope, this study was conducted to investigate the present situation of decision-making among medical managers.Materials and Methods: This cross-sectional study carried out on all the managers worked in one of the hospitals, health centers, medical schools and central departments of Shiraz University of Medical Sciences in 2016. A questionnaire containing demographic data and 50 questions was applied to 5 sections: attitude (9), subjective norms (13), perceived controlled behavior (22), intention (3) and behavior (3). Choronbache α was between 0.73-0.91 emphasizing a good reliability, the questionnaire`s content and face validity were 0.83 and 0.67 respectively. Data was analyzed using Independent t-test, ANOVA, and Pearson correlation. Results: The greatest frequency of the respondents belongs to the men (77/85.1%), and the majority of the respondents were in an age range from 30 to 40 years. The highest mean score was related to the indirect attitude (8.17), and the lowest was obtained for the indirect perception (1.21). There was a statistical relationship between the mean score of direct and indirect controlled perceived behavior according to the participants’ educational level (P=0.03 and P=0.043, respectively). A significant relationship was also be observed between direct behavior and educational major (P=0.044). Pearson correlation indicates a significant positive relationship between the manager intention for evidence-based policy-making and all the other variables. Conclusion: It seems that the present situation of evidence-based decision-making is not appropriate for the university managers. In this regard, planning for the effective courses in knowledge translation, evidence-based policy-making and advanced searching along with monitoring the managers’ decision outcomes through an internal and external audit can have an effective role in improving decisions and enhancing evidence application. [GMJ.2017;6(1):30-38]

Pharmacy information system (PIS) is becoming vital in assisting pharmacists to do their responsibilities. The aim of this study was to identify the current PIS implications in teaching hospitals affiliated with Shiraz University of Medical Science. This cross-sectional study was conducted in teaching hospitals affiliated with Shiraz University of Medical Science over the year 2016. Data were collected by observing the PIS as well as interviewing its users based on the researcher-made checklist. The checklist was prepared based on reviewing the Persian and English literature and its content validity was approved by the experts. To determine the reliability of the checklist, inter-rater reliability was used. Data were analyzed using SPSS16, and hospitals were clustered using SK-means method. In this study, the least conformity to the standards was shown in smart clinical features (4.54%), pharmaceutical companies' relationship (32.6%), and optimization of drug therapy (34.6%). In contrast, the highest conformity to the standards was shown in reporting capabilities (77.3%) and entry information and input (70.4%). Medication stock checking and optimization of drug therapy were effective features that have made a distinction between hospitals and lead to 95% variance between clusters. Based on the results, the current PIS design pays less attention to clinical features. Besides, clinical information for pharmacists and outside organization relationship were not provided by the current system. Thus, emphasis should be placed on the implementation of corrective actions to eliminate the current system's deficiencies.

Introduction: The length of stay (LOS) in hospitals is a widely used and important criteria for evaluating hospital performance. The aim of this study was to determine factors affecting LOS in teaching hospitals of Qazvin Providence. Methods: In this cross-sectional study, patients’ health records were randomly selected from archives in teaching hospitals of Qazvin in 2013. Data were collected through a data entry form and were analyzed using Kolmogorov–Smirnov, Kruskal–Wallis, and Mann–Whitney U tests at the significant level of 0.05. Results: The mean of hospital LOS was 5.45 ± 6.14 days. Age, employment, marital status, history of previous admission, patient condition at discharge, method of payment, and type of treatment had an impact on LOS (p

Background Mental Health (MH) is an important part of community well-being and a remarkable portion of global burden of diseases is related to mental disorders. Despite this fact, little attention has been given to the provision of adequate and appropriate MH services and improving equitable access to these services in some parts of the world. This review was aimed to identify main global barriers to provision and utilization of MH services.Methods We carried out a systematic and comprehensive search on 7 important online databases for English-language literature on global barriers to provision and utilization of MH services applying Arksey and O’Malley guideline. The extracted materials were tabulated and synthesized using a content analysis approach.Results Three main themes were developed regarding the barriers to provision of MH services including resource and administrative barriers, information and knowledge barriers, as well as policy and legislation barriers. Five frequent barriers to utilization of MH services were attitudinal barriers, structural barriers, knowledge barriers, treatment-related barriers, and family-related barriers as well.Conclusions It is suggested that, improvement of public knowledge regarding MH, reallocation of health resources toward high-priority MH needs, developing community-based insurance, as well as integration of MH services into all levels of health-care systems and MH policy into general health policy could be considered as effective strategies to tackling the challenges especially in low- and middle-income countries. Further study is also needed for determining relative importance of the barriers and the related solutions in this regard.

Background: Management transport occurs in organizational hierarchy commonly; so, succession planning is of a great importance. In this regard, identification of the effective methods for succession planning leads to organizational success in health care systems. This study aimed to identify the dimensions of succession and formulate the components of health network managers' selection. Methods: This qualitative research was conducted by applying the content analysis approach in 2018. To glean the information, 42 semi-structured interviews were conducted using the snowball sampling method. Data was analyzed by framework analysis applying Max QDA 10 software. Results: The main effective factors for achieving the health network administrator management rank contained 4 main themes of managerial education and skills, specified education and skills, educational methods, and performance evaluation mechanism. Moreover, we identified the main applied points in monitoring the health network managers' duties. Conclusion: The basic criteria should be defined for selecting appropriate people and improving the quality of services. It also can lead to a framework for succession planning and is helpful in organizational decision making improvement.

Background Inasmuch as accreditation is of great significance for hospitals, this study aimed to explain the accreditation challenges of Iranian hospitals through a content analysis approach. Methods A qualitative study was run through the content analysis method in 2018. 19 semi-structured interviews were conducted with experts and data were saturated in this level. To increase the accuracy and precision of the study, Guba and Lincoln’s four criteria including credibility, dependability, conformability and transferability were used. MAX QDA10 was used for data analysis via 5-step framework analysis approach. Results The findings of the interview analysis led to the identification of 5 main themes and 29 subthemes. The main themes included macro problems and policy making, evaluators' problems, structural and process problems, executive problems, and problems with the accreditation measures. Conclusion The results shed light on the fact that Iranian hospitals need to experience major changes in applying accreditation as a quality assurance mechanism. In other words, it seems necessary for policy makers affiliated with Ministry of Health and Medical education to revise accreditation measures according to hospital needs and try to clarify the structure and executive process of the accreditation. Moreover, improving and standardizing the evaluators` skills is recommended.

Pharmaceutical strategic purchasing is considered as a key to improve access to medicines especially for developing countries. The aim of this scoping review is to determine the most important components affecting pharmaceutical strategic purchasing. Here, we employed a comprehensive search strategy across PubMed, ProQuest, EBSCO, ISI Web of Science, Scopus, ScienceDirect, and Google Scholar for the terms related to medicines strategic purchasing. Among 13 included studies, 7 (53.85%) and 6 (46.15%) studies belonged to the developing and developed countries, respectively. Six main variables were emphasized as the effective variables on medicines strategic purchasing, including purchasing interventions, target group and service users, providers and suppliers of interventions, methods and motivations, price, and finally structure and organization. It seems that the insurance organizations of developing countries can achieve strategic purchasing only through the modification of the pharmaceutical pricing system and payment systems. Furthermore, they should pay attention to the real needs of target groups (demand) and modify the structure and organization as well as purchasing the most effective medicines from the best pharmaceutical providers.

BACKGROUND: Oral health practitioners are at the frontline of infection, particularly with respiratory viruses such as the novel coronavirus. Knowledge, awareness, and attitude of these workers are considered important in preventing and controlling the outbreak. This study aims to review the literature to provide a better understanding of the status of dentists and other oral health practitioners' knowledge, attitude, and awareness about COVID-19. METHODS: A systematic review was conducted through Web of Science, PubMed, Scopus, and ProQuest up to May 6, 2020. All the knowledge, attitude, and practice studies on oral health workers about respiratory contagious outbreak the same as severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19 were included in the meta-analysis. RESULTS: A total of eleven studies were included in the meta-analysis. 85.5% of the dentists and oral health practitioners had a high level of awareness about virus transmission modes (95% confidence interval [CI]: 78.6%–92.4%; P < 0.001). 80.7% of the oral health practitioners gave right answers to the questions related to virus transmission modes (95% CI: 69.9%–91.4%; P < 0.001), and 79.9% of the dentists had a positive attitude about virus transmission modes (95% CI: 66.4%–93.4%; P < 0.001). CONCLUSION: This meta-analysis shows that the level of dentists and oral health practitioners' knowledge, awareness, and attitude was relatively high about the respiratory contagious diseases as well as COVID-19. The present results can shed further light for policymakers to support the best evidence medical education for all health-care workers the same as oral health practitioners. Preventing the dissemination of misinformation along with preparing comprehensive guidelines can be considered by the oral health policymakers, particularly in the more infected regions.

Introduction: Strategic purchasing is one of the mechanisms that can increase access, equity, and efficiency as well as the correct management of health resources. The aim of this study was to extract important and influential factors as necessary infrastructures to implement this method. Methods: In this comprehensive literature review, 13 databases and search engines were searched from 2000 to 2015 by applying appropriate keywords. From a total of 1403 titles and after ensuring the validity of the study by the Clinical Appraisal Skills Program (CASP) tool, 18 articles that contained title, abstract, and associated text were used in the study, and their related information was analyzed and extracted using an extraction form and LitAssist software. Results: The findings showed six categories of intervention have been effective in the strategic purchasing of all health interventions in different countries. These six categories were "The target group of users of the service" (demand side), "purchased interventions," "providers and suppliers of interventions" (the supply side), "Methods and incentives" (payment method), "price," and "Structure and organization." Conclusion: Although the necessity of performing strategic purchasing in the health sector or developing countries is an indisputable fact, it is of great importance to use the experiences of developed countries while considering the factors extracted from the study for implementing this method. In this regard, it is suggested that studies be performed that can lead to assessing the feasibility of strategic purchasing for health services in developing countries and also in Iran to help health policy makers in these countries

Introduction Public-Private Partnerships (PPPs) have been constructively considered in recent years to reform health sectors in many countries. This study aimed at explaining the strategies to develop and promote PPPs in the provision of hospital services in Iran. Methods This qualitative study was conducted in 2015. The study population consisted of experts and professionals of the health system and individuals familiar with PPPs and roles in the development of such models in hospital services in Iran that were selected through purposeful sampling, and semi-structured interviews were used for data collection. To this end, 18 experts and professionals of the health system and individuals familiar with PPPs and roles in the development of such models in hospital services in Iran were selected. The data were analyzed and classified using MAXQDA10 software and content analysis, respectively. Results According to the results of this study, four main themes and 20 subthemes in terms of strategies to develop and promote PPPs in the provision of hospital services in Iran were identified, including changes in policies and laws, socio-cultural changes, improvement of mechanisms and current processes, and financial and capital capacity building. Conclusion To develop and promote PPPs in the provision of hospital services, there is a need to consider prerequisites and measures to help such partnerships to be effective and produce valuable results.

Considering the importance of accreditation for hospital pharmacies, this study was to determine the challenges of medication management in hospital pharmacies affiliated with Shiraz University of Medical Sciences, Iran. The study was a mix-method research conducted in two qualitative and quantitative phases during the years 2014–2015 in Shiraz, Iran. National Accreditation Standard checklist for hospitals was used for data collection in the first phase, and Delphi method was applied in three rounds to achieve the most challenges of medication management and the related solutions. Results indicated a medium status of accreditation for all three dimensions in the above hospital pharmacies (3.53, 42.15 and 7, respectively). Lack of clinical pharmacists, nonparticipation of the pharmacy director in annual budgeting, lack of access to patient information, discontinuity of pharmaceutical care for patients discharged, defects in pharmacy staff training, lack of legislation in support of pharmacists and lack of adequate access to physicians' prescriptions, shortages in reporting medication errors, and lack of evidence related to microbial contamination are the most challenges extracted from the second phase. It seems that the studied hospital pharmacies encounter numerous problems regarding accreditation, pharmaceutical care as well as appropriate medication management and supply chain. Attempts to solve these problems can play an important role in improving the efficiency and effectiveness of pharmacies in Iran.

Objective: Pharmaceutical access for the poor is an essential factor in developing countries that can be improved through strategic purchasing. This study was conducted to identify the elements affecting price in order to enable insurance organizations to put strategic purchasing into practice. Methods: This was a qualitative study conducted through content analysis with an inductive approach applying a five-stage framework analysis (familiarization, identifying a thematic framework, indexing, mapping, and interpretation). Data analysis was started right after transcribing each interview applying ATLAS.ti. Data were saturated after 32 semi-structured interviews by experts. These key informants were selected purposefully and through snowball sampling. Findings: Findings showed that there are four main themes as Pharmaceutical Strategic Purchasing Requirements in Iran as follows essential and structural factors, international factors, economical factors, and legal factors. Moreover, totally 14 related sub-themes were extracted in this area as the main effective variables. Conclusion: It seems that paying adequate attention to the four present themes and 14 sub-themes affecting price can enable health system policy-makers of developing countries like Iran to make the best decisions through strategic purchasing of drugs by the main insurers in order to improve access and health in the country.

Context: Patients with cancer experience great pain and stress. Many studies show that palliative care has a positive effect on many clinical outcomes involving symptom distress, quality of life, satisfaction, and survival. Aims: This study aimed to survey the association between quality of life and palliative care in cancer patients. Setting and Design: This was a descriptive correlational study conducted from February 2019 to August 2019 on 399 patients diagnosed with cancer recruited from seven universities of medical sciences. Materials and Methods: The sample size consisted of 97 cancer patients who had received palliative care and 302 cancer patients who did not receive palliative care. The convenience sampling method was used. The World Health Organization quality of life (QOL)-BREF questionnaire was used for data collection. Statistical Analysis Used: Data were analyzed using SPSS software version 22. Data were described with mean, standard deviation, and frequency and analyzed using Mann–Whitney, K-S test. A generalized linear regression model was used in this study. Results: The mean score of total QoL in patients who did not receive palliative care was higher than those who received (51.038 ± 23.771 vs. 48.195 ± 27.361), and this difference was not statistically significant (P > 0.05). A statistically significant association was observed between palliative care and psychological and environmental health, total QoL, education, employment and income status (P Conclusion: The utilization of palliative care was associated with improved psychological health and environmental health.

Background and purpose: Radio Frequency Identification technology (RFID) is a beneficial tool in providing diagnostic and treatment services in the healthcare domain.This study aims to investigate awareness, attitudes, and skills of medical private and public laboratory the staff in implementing RFID. Materials and Methods: The present study was a cross-sectional study conducted based on the descriptive-applied approach in private and public medical laboratories in Shiraz in 2017. The population size of this study included all laboratories’ staff that involved technicians, technologists, and technical supervisors. 147 staffs were then assigned through census. Data was collected using a researcher-made checklist, and its validity and reliability were assessed and approved. The collected data was then analysed in asignificance levelof 0.05using descriptive statistics and t-test, ANOVA ,and Pearson correlation test in SPSS23. Results: Findings showed that the mean awareness, attitude and skill scores of participants were 3.13±0.91, 4.09 ± 0.38 and 2.39±0.65, respectively. In this regard, the staff awareness and attitude scores labelled good, and their skill score labelled medium. Also, almost all participants had a positive attitude toward executing RFID, and there was documented a significant direct association between the staff knowledge, attitudes, and skills dimensions. Conclusion: Considering the inchoate RFID technology and its limited usage, the staff RFID skills needed improvement. Therefore, the results suggested that the necessary training followed by implementing RFID technology should have received a high-level priority on policymakers’ agenda. &nbsp

Background Informing the target population plays an important role in medical tourism attraction and should be managed in order to incorporate all appropriate tools to increase it. The aim of this study was to determine the requirements and basis of a medical tourism website for hospitals. Methods This study was a cross sectional analytical study that was performed during year 2018 amongst hospital managers and faculty members of Iranian medical sciences universities that have the potential to attract medical tourism. Data gathering was done by a self-made questionnaire. From 120 questionnaires, which were distributed between samples, 82 were gathered completely. Data analysis was done by SPSS version 16 and descriptive (mean, frequency and etc.) and analytical (one-way ANOVA) statistical tests. Results The results of the study showed that from the experts point of view, the most important requirement and basis of Hospital Medical Tourism Websites) HMTW(was photo gallery (mean = 4.44) and a general guide for patients (mean = 3.85) was the least significant element in HMTW. Also, there was no difference between faculty members, staff, and different genders regarding views about HMTW items (P = 0.11). Conclusions Based on the results, it was suggested that the results of this study could be used by policymakers of medical tourism and Hospital Medical Tourism Websites (HMTW) developers. Also, the results of this study could be used as an evaluation tool for investigating hospital websites regarding medical tourism attraction abilities.

Background Iranian health sector encountered many challenges in resource allocation and health service purchasing during the past decades, the aim of this study was to determine the main challenges of the present process of health service purchasing for national policymakers and other developing countries with the same setting. Methods It was a qualitative study carried out via the complete content analysis of all relevant national documents from 2007 to 2014. In order to retrieve the related documents, we searched the official websites related to the Ministry of Health and Medical Education, four main Iranian insurance organizations, the Health Committee of the Parliament Profile, strategic vice president’s site and Supreme Insurance Council. After recognition of documents, their credibility and authenticity were evaluated in terms of their publication or adjustment. For the analysis of documents, the four step-Scott method was used applying MAXQDA version 10. Results Findings illustrated that health service purchase challenges in the country can be classified in 6 main themes of policy-making, executive, intersectional, natural, legal and informational challenges with 26 subthemes. Furthermore, 5 themes of Basic Benefit Package, Reimbursement,Decision making, Technology and Contract are considered as the main Challenges in pharmaceutical purchasing area containing 13 relevant subthemes. Conclusions It seems that according to documents, Iran has faced many structural and procedural problems with the purchase of the best health interventions. So it is highly recommended to consider consequences derived from the present challenges and try to use these evidences in their policy making process to decrease the existed problems and move to better procurement of health interventions.

Background Sufficient and sustainable financing of the health system is essential for improving the health of the community. The health systems financing of the EMR countries is facing the challenge. Assessment and ranking of healthcare financing can help identify and resolve some challenges of health systems. So, the aim of this study is to evaluate and rank the condition of the health sector financing in the EMR countries. Methods This study was a cross-sectional study. The data was of secondary type, extracted from the official WHO and World Bank data. The six healthcare financing indicators in a 10-year interval (2005–2014) in 19 EMR countries analyzed using Grey Relation Analysis and Shannon Entropy. Results On average, the countries in the EMR region spent 4.87% of their GDP on the health sector. Jordan and Qatar allocated the highest (8.313) and the lowest (2.293) percentages of their GDP to the health sector, respectively. The results showed That Qatar was in a better condition than other EMR countries during 2005–2014 in terms of the health system financing and earned the first rank. After that, the UAE and Kuwait were ranked second and third. Conclusions There is a lot of inequality among the EMR countries in terms of health financing. However, our findings confirmed that only increasing the total health expenditure in a country would not improve its financing status compared to other countries, but it also depends on financing methods.

Background: One of the most important factors determining the health of individuals is their health promoting behaviors. Objectives: This study was conducted to investigate the status of health promoting behaviors of students at Shiraz University of Medical Sciences. Methods: This cross-sectional descriptive-analytical study was conducted on 370 students of Shiraz University of Medical Sciences, during year 2017. Data were collected through a standard health-promoting lifestyle questionnaire that was designed with 10 dimensions (physical health, exercise and wellbeing, weight and nutrition control, disease prevention, psychological health, spiritual health, social health, refrain from drug, accident prevention and environmental health with a total of 70 questions). Data were analyzed using descriptive statistics, T-test, analysis of variance (ANOVA), and Pearson’s correlation coefficient by the SPSS software, version 23, at a significance level of α = 0.05. Results: The mean score of total health promoting behaviors was evaluated as 4.70 ± 1.20, which was in a good range. Avoiding medicines and drugs (5.14 ± 1.08) had the highest and exercise and health (4.07 ± 1.50) had the lowest mean score. There was a positive and significant correlation between all components of health promoting behaviors (P < 0.05). There was a significant differences between demographic variables, such as gender (P = 0.04) and university entrance year (P = 0.00), and total health promoting behaviors. Conclusions: The status of health promoting behaviors was estimated to be desirable. Also, holding health education programs focusing on exercise and health in academic settings is recommended. © 2018, Shiraz E-Medical Journal.

Objective: Gastric cancer is one of the leading causes of death worldwide, with many influences contributing to the disease. The aim of this study was to identify the most important risk factors. Methods: This study was conducted in 2017 with a structured overview in the Science Directe, Scopus, PubMed, Cochrane, Web of Science (ISI) databases. In the first step, articles were extracted based on their titles and abstracts; the quality of 43 articles was evaluated using the STORBE tool. Inclusion criteria were studies carried out on human, English language (first step), year of the study and the study type (second step). Results: Finally, 1,381 articles were found, of which 1,269 were excluded in primary and secondary screening. In reviewing the references of the remaining 44 papers, 4 studies were added. Finally, 43 articles were selected for the quality assessment process. A total of 52 risk factors for gastric cancer were identified and classified into nine important categories: diet, lifestyle, genetic predisposition, family history, treatment and medical conditions, infections, demographic characteristics, occupational exposures and ionizing radiation’. Conclusion: Several environmental and genetic factors are involved in the development of gastric cancer. Regarding the role of changes in ‘diet and lifestyle’, considering appropriate nutrition and improving the level of education and awareness of people is vital for early diagnosis and timely treatment of this disease, especially in people with a family history and genetic predisposition.

Background: The Health Transformation Plan (HTP) is one of the recent reforms adopted in the health system of Iran. Objectives: This study aimed to investigate the effect of implementing of the HSRP on the performance indicators of teaching hospitals in Iran. Methods: This descriptive-analytic study was carried out in 10 teaching hospitals of Shiraz University of Medical Sciences in 2017. After referring to the concerned hospitals, 10 performance indicators were extracted and analyzed at 2 stages (before (2013) and after (2015) implementing of the HSRP). Paired sample t-test was run in the SPSS software23 to compare the obtained data. Results: Investigating the mean differences of performance indicators before and after the implementation of the HSRP indicated a significant increase (P < 0.05) for the indicators of bed occupancy ratio, inpatient to constructed beds ratio, the mean length of stay, frequency of patients admitted in the clinical and para clinical sectors, frequency of emergency and elective operations, as well as frequency of cesarean and normal delivery. However, the hospital bed turnover rate revealed a significant decrease compared to the year prior to the implementation of the HSRP (P < 0.05). Conclusions: The implementation of the health reform plan has been accompanied by significant changes in the performance indicators of the hospitals. Regarding the reduction of the normal delivery rate in comparison with caesarean section after the implementation of the plan, it is suggested to improve the awareness and culture of mothers and society regarding the importance and benefits of natural delivery through the intersectional interactions.

Additional file 1: Table S1. Normalized performance matrix and reference sequence. Table S2. The difference matrix. Table S3. The grey relational coefficients.

Due to the increasing elderly population and the subsequent increase in their need for medication and more referrals to the pharmacy, this study was conducted to investigate the Iranian hospital pharmacies in terms of age-friendliness criteria. This was a cross-sectional study conducted in 2017. The study population included 3 metropolitan hospital pharmacies selected through clustered sampling, and all their 67 pharmacies were included by census. Data collection tool was a reliable researcher-made checklist (t = 0.85, α = 0.9) Data analysis was performed using Kruskal-Wallis test and Mann-Whitney test through SPSS version 24. The results in these three cities showed that only two pharmacies were in a high level of age-friendly. The relationship between type of pharmacy and the final score of age-friendly situation in these cities showed no significant relationship. There was no significant relationship among the average of the final score of the age-friendly situation in three studied cities. Due to the increasing elderly population and the aging society, readiness of Iranian hospital pharmacies to provide services to the elderly will be one of the most challenging issues in the long term. With proper legislation and policies on health-care systems, especially pharmacies, physical and psychological problems in elderly can be reduced in the future. Furthermore, with advancing toward age-friendly pharmacies, the community can be empower and become ready encountering elderly problems.

Objective: The aim of this study was to review the current methods of pharmaceutical purchasing by Iranian insurance organizations within the World Bank conceptual framework model so as to provide applicable pharmaceutical resource allocation and purchasing (RAP) arrangements in Iran. Methods: This qualitative study was conducted through a qualitative document analysis (QDA), applying the four-step Scott method in document selection, and conducting 20 semi-structured interviews using a triangulation method. Furthermore, the data were analyzed applying five steps framework analysis using Atlas-ti software. Findings: The QDA showed that the purchasers face many structural, financing, payment, delivery and service procurement and purchasing challenges. Moreover, the findings of interviews are provided in three sections including demand-side, supply-side and price and incentive regime. Conclusion: Localizing RAP arrangements as a World Bank Framework in a developing country like Iran considers the following as the prerequisite for implementing strategic purchasing in pharmaceutical sector: The improvement of accessibility, subsidiary mechanisms, reimbursement of new drugs, rational use, uniform pharmacopeia, best supplier selection, reduction of induced demand and moral hazard, payment reform. It is obvious that for Iran, these customized aspects are more various and detailed than those proposed in a World Bank model for developing countries.

Background: This study was conducted to compare the main performance indicators of Hasheminejad hospital before and after implementing PPP model. Methods: This cross sectional study was conducted in Iran in 2015. Performance indicators of Hasheminejad hospital, the only Iranian unit that implemented PPP model, were applied. Data were collected based on a researcher-designed checklist after ensuring its validity and reliability. Data were analyzed applying SPSS21, and the Shapiro-Wilk test was used to examine the relevant data normalization. After confirming the normality of the data, descriptive statistics and paired t test were used to analyze the data at a significant level of 0.05. Results: Dramatic variations were observed in the status of the studied indicators after the implementation of PPP in Hasheminejad hospital, and the changes were statistically significant in all these indicators (p

Background: A four-step map of financial reform in Iranian health sector has been proposed with the aim of increasing efficiency and resource allocation. Objectives: This study was conducted to investigate the necessary requirements to establish the three last phases of this reform in Iran, during year 2015. Methods: A qualitative study in the form of framework analysis approach was conducted. An interview guide was used for interviewing 22 purposefully selected experts individually in a semi-structured format and data were saturated at this level. Data were analyzed using five-stage method of framework analysis (familiarization, identifying a thematic framework, indexing, charting and mapping, and interpretation) using the Atlas Ti software, by two experts with no conflicts of interest. Results: Six main themes and 18 sub-themes were extracted that introduced six groups of requirements including economic, functional, legal, organizational, informational, and educational, as the most vital needs for conducting financial reform in the Iranian health system. Conclusions: Findings showed that there are numerous problems with conducting financial reform despite spending a decade after its implementation in the Iranian health system. Therefore, the current results as well as planning to recognize and promote the modifiable parts in this field might be beneficial for policy-makers of the country to make a definite plan for revising this process with drafting a long-term perspective and a tailored context for complete and successful executing.

To review the experiences of selected countries in the use of public-private partnership in the provision of hospital services.This comparative study was conducted in 2015 in Iran. To collect data, valid databases as well as articles, theses, reports and related books in the field of private-sector partnership in hospital services were employed. Using purposive sampling, countries such as the United Kingdom, Spain, Canada, Turkey, Australia and Lesotho, which had successful experiences in the field of application of the public-private partnership in hospital services, were included. Likewise, the only experience in Iran in this field was also reviewed. Studies done between 1980 and 2015 were examined. The results obtained from each country were compared.Implementing public-private partnership had great and valuable outcomes and achievements for governmental hospitals. Moreover, clinical and nonclinical service delivery, hospital utilisation and management along with building, repairing and supportive operations through public-private partnership contracts can be differently divided among the partners. Furthermore, duration of the projects ranged from 12 to 40 years in different countries, depending on the type of the model used.A successful experience in the use of the public-private partnership in the provision of hospital services was observed.

Background: Health literacy can be considered as a factor affecting healthcare providers' decision-making. The aim of this study was to investigate health literacy status and its relationship with quality of life among the nurses working in teaching hospitals affiliated with Shiraz University of Medical Sciences in Iran. Materials and Methods: This cross-sectional study was conducted in 2017. To this end, 185 nurses from hospitals were selected by stratified random sampling. The data collection instruments included the standardized Health Literacy Questionnaire and the 36-Item Short Form Health Survey. The data were analyzed through descriptive statistics as well as t test, analysis of variance, Pearson correlation coefficient, and multivariate linear regression analysis using SPSS23 (α = 5%). Results: The mean scores for health literacy and quality of life were 70.06 (12.98) and 60.86 (17.26), respectively. A significant relationship was observed between the health literacy and quality of life (p

Background and purpose: According to developments related to the relative autonomy of universities and acquired extensive powers by the board of trustees of universities of medical sciences and healthcare services in a twenty-year perspective of country and in the context of the fourth and fifth socio-economic cultural development of country, necessity of developing financial and transactional bylaw of universities of medical sciences has become increasingly clear throughout country. Materials and Methods: Grounded theory is the qualitative methodology used for this study in order to identify the threats and opportunities of new financial tax bylaw of universities and faculties of medical sciences and through the study of documents, surveys of experts and beneficiaries and elites by Delphi method. Results: Releasing potential of public administration in order to control sources and uses, increasing management confidence in documented decision making, establishing organizational concentration on controlling costs, providing conditions of decision-making according to financial reports, independency in firing and hiring manpower by adopting specific provisions and creating independency in method of keeping accounts are among the most important opportunities. While poor organizational structure, lack of knowledge and skills in the existing structure, mental processes caused by reactions and incompatibility of staff, lack of criteria and rules in selection appointment and dismissal of managers and employees, lack of discipline and proper mechanisms in order to pursue the purposes, calculating financial burden and human resources required and finally, passing through traditional thinking and management system are among the most threats. Conclusion: Considering the mentioned threats and opportunities, financial and transactional bylaw of universities and faculties of medical sciences was basically revised and modified in January 2006, and then after the case reform in July 2009 it was announced in October 2011.

Background and purpose: To determine an appropriate financial model for the health system of Iran, several studies have been conducted. But it seems that these studies were not comprehensive and further investigation is required. So to design a valid and enforceable mechanism, the study of policy interventions will be considered through consensus of all stakeholders. This investigation was done to determine the necessary policies and internal interventions for health care system financial improvement in Iran. Materials and methods: The present work was carried out through investigating all key stakeholders in the medical system and the related sectors in Iran, along with the analysis of internal and external communication by using SWOT and STEEP.V methods. Results: Strategic management of health-care costs, the development of a new financial system, clarity of costs, benefiting from health national accounts, the regulation of budget based on operations, preparing the credit of per capita from prepayment and risk accumulation, the development of referral systems and mechanisms, the establishment of public fund for services purchase, preventing the involvement of insurances in non-insurance cases, competing services with the private sector and increasing resources for the promotion of equality level have been determined as the key proposed interventions. Conclusion: It seems that the interventions based to the development of improving health financial system including the deployment of full accrual basis instead of cash basis, preparing and using services cost and operational budgeting and finally, cost management and productivity are the prerequisites of reforming health financial system.

Background There are various criteria and methods to develop Basic Health Benefit Package (BHBP) in world health systems. The present study aimed to extract criteria used in health systems in different countries around the world using scoping review method. Methods A systematic search was carried out in Cochrane Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, World Bank, World Health Organization, and Google databases between January and April 2016. Papers and reports were gathered according to selected keywords and were examined by two authors. Finally, the criteria were extracted from the selected papers. Results The primary search included 8876 papers. After studying the articles’ titles, abstracts, and full texts, 9 articles and 14 reports were selected for final analysis. After the final analysis, 19 criteria were extracted. Due to diversity of criteria in terms of number and nature, they were divided into three categories. The categories included intervention-related criteria, disease-related criteria, and community-related criteria. The largest number of criteria belonged to the first category. Indeed, the most widely applied criteria included cost-effectiveness (20), effectiveness (19), budget impact (12), equity (12), and burden of disease (10). Conclusion According to the results, different criteria were identified in terms of number and nature in developing BHBP in world health systems. It seems that certain criteria, such as cost-effectiveness, effectiveness, budget impact, burden of disease, equity, and necessity, that were most widely utilized in countries under study could be for designing BHBP with regard to social, cultural, and economic considerations.

Background: Hypothyroidism, a preventable cause of mental retardation, is one of the most common diseases of the endocrine gland in children. The disorder can be corrected if it is identified and treated within the first few days of birth. In Iran, hypothyroidism is estimated to affect one out of 400 to 900 neonates, which is much higher than the global average. Objectives: This article is conducted to investigate the most cost–utility option i.e. whether to implement the neonatal screening of genetic hypothyroidism or to merely treat such patients in the absence of the screening process. Patients and Methods: The present research is a cross-sectional, descriptive and analytical study. The provider perspective was employed to calculate the direct costs imposed on Shiraz University of Medical Sciences, insurance organizations, charities and patients concerning the implementation of screening program and the treatment of detected cases along with the direct costs related to patients treated in the absence of the screening process; costs related to death were excluded. The statistical population of the study consisted of all 81837 newborns referred to university laboratory in Shiraz in 2010. In order to measure the utility, time-trade-off method was employed to determine the life quality of patients. Results: The incremental cost-effectiveness ratios (ICER) of hypothyroidism, calculated through dividing the cost difference (∆C) by utility difference (∆QALY), indicated that screening saved a total of 13413 US. $. Conclusions: The economic evaluation (cost-utility analysis) resulted from the comparison of the above choices revealed that implementing the screening plan can actually be better and more cost-effective.

The aim of this study was to compare the differences between the level of whole quality of life and its subscales after receiving two common treatment of breast cancer in women with early stage of breast cancer. A double-blinded cohort study was done in 100 breast cancer patients with node positive that used fluorouracil, doxorubicin, cyclophosphamide (FAC) and docetaxel, doxorubicin and cyclophosphamide (TAC) regimen as adjuvant therapy. Patients were followed for 4 months since the end of chemotherapy. Health-related quality of life was assessed using questionnaire (QLQ-C30) from European Organization for Research and Treatment of Cancer (EORTC). Independent t-test analysis was used at the significant level of 0.05 for analyzing the results. The mean of age was 48.49 ± 10.63 in these patients. QoL scores were 64 and 68 in TAC and FAC groups, respectively (P < 0.001). After 4 months, patients in TAC and FAC groups experienced 11.45 and 7.14 units of improvement in QoL scores, respectively (P = 0.02). Although, TAC had a more negative impact on QoL during chemotherapy, it created a higher improvement than FAC during 4 months since the end of treatment. These effects on quality of life should be considered in making decision for providing and financing cancer treatments in Iran.

Background: Health care is a vitally sensitive area, in which the smallest medication error may lead to patient's loss that cannot be compensated. In this area, information technology is a useful tool for practical improvement of health-care units such as hospital and community pharmacies. The aim of this study was to investigate the pharmacists' knowledge, attitude, and practice in applying radio-frequency identification (RFID). Methods: This is a cross-sectional research carried out in 2016. Research population and sample included 196 pharmacists in Shiraz city, the largest metropolitan in the South of Iran. The data were collected using the researcher-made questionnaire, and its validity and reliability were confirmed. Data were analyzed using descriptive indices and Pearson's correlation in SPSS 23. Results: The results showed that the means of practice, knowledge, and attitude of the participants were 1.64 ± 0.5, 1.82 ± 0.61, and 3.62 ± 0.62 (out of 5), respectively, showing weak practice and knowledge but good attitude toward RFID technology. In addition, the majority of the pharmacists' attitude toward applying RFID technology was evaluated as positive. There was a significant relationship between the items of pharmacists' knowledge and attitude toward RFID technology ( P = 0.03, r = 0.36). Conclusion: Considering the fact that the concept of technology was newly developed in health area, we concluded that the studied pharmacists were not familiar with RFID technology and its advantages and they doubted its application. Therefore, it is suggested that required instructions should be taken into consideration by health authorities for introducing and applying the technology.

Background: This study will provide detailed specification of those variables and determinants of unpredictable health expenditure in Iran, and the requirements to reduce extensive effects of the factors affecting households’ payments for health and other goods and services inappropriately. Method: This study aims to identify measures of fair financing of health services and determinants of fair financing contribution, regarding the required share of households that prevents their catastrophic payments. In this regard, analysis of shares of households’ expenditures on main groups of goods and services in urban and rural areas and in groups of deciles in the statistics from households’ expenditure surveys was applied. Results: The growth of spending in nominal values within the years 2002–2008 was considerably high and the rate for out-of-pocket payments is nearly the same or greater than the rate for total health expenditure. In 2008, urban and rural households in average pay 6.4% and 6.35% of their total expenditure on health services. Finally three categories of determinants of unfair and catastrophic payments by households were recognized in terms of households’ socio-economic status, equality/inequality conditions of the distribution of risk of financing, and economic aspects of health expenditure distribution. Conclusion: While extending the total share of government and prepayment sources of financing health services are considered as the simplest policy for limiting out-of-pocket payments, indicators and policies introduced in this study could also be considered important and useful for the development of health sector and easing access to health services, irrespective of health financing fairness.

PURPOSE: According to the importance of strategic purchasing as a prerequisite for overall access and universal health coverage, this study was conducted to explore requirements and incentives for implementation of pharmaceutical strategic purchasing in the Iranian health system.METHODS: This was a qualitative study conducted through content analysis with an inductive approach applying a five-stage framework analysis. Data analysis was started right after transcribing each interview applying MAXQDA10. Data was saturated after 32 semi-structured interviews with experts. These key informants were selected purposefully and through snowball sampling.RESULTS: The findings are categorized under three main themes: “Payment Mechanisms to Service Providers”, “Insurance Reimbursement Mechanisms” and “Rules and Regulations”, and eight related subthemes.CONCLUSIONS: According to the importance of incentive interventions in pharmaceutical strategic purchasing, it is necessary to pay close attention to pharmaceutical price, realistic and fair premiums and appropriate contracts with suppliers, along with estimation a reasonable profit margin for pharmaceutical suppliers and the appropriate reimbursement mechanisms as the most significant incentives for increasing access to pharmaceuticals and implementing strategic purchasing.

Objective: The aim of current study was to evaluate the changes of health-related quality of life (HRQoL) and its clinical, demographic and socioeconomic determinants during chemotherapy and 4 months follow-up in women with breast cancer using a repeated measures framework. Methods and Materials: A double blind cohort study was performed in 100 breast cancer patients given fluorouracil, doxorubicin and cyclophosphamide (FAC) or docetaxel, doxorubicin, cyclophosphamide (TAC) in south of Iran. HRQoL was assessed at baseline, end of chemotherapy and four months thereafter using the QLQ-C30 questionnaire from European Organization for Research and Treatment of Cancer (EORTC). Generalized estimating equations (GEE) was applied for statistical analysis. Results: The mean of age at baseline was 48.5∓ 10.6. 70% and 14% of patients were married and smokers, respectively, and 20% suffered from another disease besides breast cancer. The results of GEE showed that after control for baseline scores, the HRQoL significantly improved over time. Although, the patients in FAC group had higher scores than the TAC group, the differences also diminished over time. Smoking, marital status and having child affected some scales of HRQoL. None of other variables were significantly related to HRQoL. Conclusion: Although patients in TAC groups had lower level of HRQoL over 8 months follow up, they experienced faster improvement than the FAC group. This implies that in long-term, improvements in TAC group are higher than FAC. Having children was positively correlated with HRQoL. Generally, there were no demographic and socio-economic differences in HRQoL in these patients between the chemotherapeutic regimens.

Background Epidemic COVID-19 in 2020 was one of the crises that confronted the Islamic Republic of Iran's health system as a developing low-income country with many challenges. The purpose of this study is to explain the requirements of similar health systems in facing epidemics such as COVID-19 as well as sharing experiences of Iran. Methods The present study was a qualitative study using content analysis of the Iranian Ministry of Health website (behdasht.gov.ir) during the official onset of COVID-19 in Iran (February 20) to March 7, 2020. To Integrate data, interviews with experts were used. In this regard, 4 national health policymakers and 5 provincial health managers were interviewed. After implementation using 8-step content analysis method, data were analyzed using MAXQDA software by research team members who had no conflict of interest. Results The findings show that the disease began on February 20, 2020, with two cases of death from COVID-19 in Qom province in central Iran and within two weeks it has widely affected 31 provinces, with 4747 approved cases and 124 deaths. According to the results, the Islamic Republic of Iran's health system faced five major challenges to confronting with COVID-19: 1- Medical consumables supply 2- Hospital beds allocation and intensive care units (ICU) equipment 3-The lack of a comprehensive COVID-19 protocol in the country 4- the lack of a single command authority to deal with the crisis 5- Insufficient public health literacy and information as a result of social anxiety. Conclusions Experiences of this case indicate that health systems require policy action to prevent and control diseases rather than other implementations. In this regard, training should be given to children and adolescents, at-risk persons and health system staff. In addition, to confront with COVID-19, an integrated policy implementation team should be established in collaboration with the health sector and other relevant bodies. Key messages It seems obvious that policy implementation requires to prepare the country for future contingencies. A comprehensive National Prevention Protocol needs to be developed.

Background: Due to consuming about 50%–80% of health resources, hospitals are the greatest and costly operational units in Iranian Health system. so allocation of resources specially human and space resources as the most expensive ones is really important for further controlling of costs, analysis of costs and making suitable policies for increasing the profitability and allocation of resources and improvement of quality. Method: This paper intends to describe and analyze any allocation of resources in 530 university hospitals in Iran. The final goal of this research is to provide a data bank according which there is a basis for more scientific budget allocation of state’s hospitals from the size and type of application points of view. Results: The relevant index of person to bed was 2.04 for human resources. All hospitals more than 300 beds are located in benefiting areas from which 17 cases are educational and 2 cases are therapeutic. This is necessary to mention that the rate of management group forces to total personnel at deprived areas is about 2.5% more than benefiting areas. Conclusion: Because 60–80% of hospital costs are applied for human forces, all managers of hospitals are obliged to revise their policies in attraction and employment of human force in order to benefit from such a valuable resource and prevent from expensive costs. So any employment of personnel should be based upon real needs of hospital.

Increasing knowledge of people about health leads to raising the share of health expenditures in government budget continuously; although governors do not like this rise because of budget limitations. This study aimed to find the association between health expenditures and economic growth in ECO countries. We added health capital in Solow model and used the panel cointegration approach to show the importance of health expenditures in economic growth. For estimating the model, first we used Pesaran cross-sectional dependency test, after that we used Pesaran CADF unit root test, and then we used Westerlund panel cointegration test to show if there is a long-term association between variables or not. After that, we used chaw test, Breusch-Pagan test and Hausman test to find the form of the model. Finally, we used OLS estimator for panel data. Findings showed that there is a positive, strong association between health expenditures and economic growth in ECO countries. If governments increase investing in health, the total production of the country will be increased, so health expenditures are considered as an investing good. The effects of health expenditures in developing countries must be higher than those in developed countries. Such studies can help policy makers to make long-term decisions.

Patients and Methods: This was a cross-sectional study conducted on 64 hospitals affiliated with SSO during 2007-2009. The CobbDouglas model was applied, estimating the above hospitals production functions. The numbers of physicians, nurses, other staff and active beds were considered as inputs and the numbers of outpatients and inpatients were mentioned as the study outputs. Log form of production function, EViews 5 and SPSS, were used. Results: The production function of the studied hospitals showed that all the production factor indexes except for other staff had significant positive relationships with the number of inpatients as our output; meanwhile, the most and the least marginal production rates were related to active beds and other staff, respectively. Other findings showed a decreasing return to scale (DRS) in these hospitals. Moreover, during the whole study period, the highest average of surplus belonged to other staff. Conclusions: According to the present results, it seems that these hospitals have to revise their human resource management policies to be able to apply this valuable input in an optimum manner. Furthermore, using appropriate economical tools may help them to recognize their surplus factors and in this way improve their productivity and efficiency.

Background: The present study aimed to determine attitudes and effective factors in the acceptance of smart phones by physicians of the largest University of Medical Sciences in the south of Iran. Methods: This cross-sectional study was performed using Structural Equation Modelling (SEM) in 2014. Study participants included 200 physicians working in the hospitals of Shiraz University of Medical Sciences selected through two-stage stratified sampling, but 185 participants completed the study. The study data were collected using a researcher-made questionnaire completed through a 5-point Likert scale. The content validity of the questionnaire was confirmed by a panel of experts, its construct validity by confirmatory factor analysis, and its reliability by Cronbach’s alpha of 0.802. All data analyses were performed using SPSS (version 22) and LISREL (version 8.8). Results: Results showed that most physicians had a desirable attitude towards using smart phones. Besides, the results of SEM indicated a significant relationship between attitude and compatibility, observability, personal experience, voluntariness of use and perceived usefulness. Moreover, some important fitness indices revealed appropriate fitness of the study model (p=0.26, X2/df=1.35, RMR=0.070, GFI=0.77, AGFI=0.71, NNFI=0.93, CFI=0.94). Conclusion: The results revealed that compatibility, observability, personal experience, voluntariness of use and perceived usefulness were effective in the physicians’ attitude towards using smart phones. Thus, by preparation of the required infrastructures, policymakers in the field of health technology can enhance the utilization of smart phones in hospitals.