Background and Aim:Iran's health sector has been engaging the services of physicians and midwives in healthcare centers since 2005, with the hope of improving the quantity and quality of family planning services. The aim of this study was to assess the effect of serving physicians and midwives on the quantity and quality of family planning services in the healthcare centers of Iran.Materials and Methods:The present cross-sectional study (Jan 2010 until Sep 2011) was carried out on 600 eligible families who were clients of healthcare centers of Tabriz, Azarshahr and Osku, cities of Northwest Iran from 2006 until 2011, in two groups (before and after). Some of the characteristics of the participants and the data on the quality and quantity of family planning services provided were grouped in a checklist of 16 variables by comparing the patients’ past medical histories.Results:In comparison with 3 years prior to engaging physician and midwife services in health care centers, the Couple Year Protection (CYP) and the quantity of family planning service indexes significantly increased among eligible families. The family size of participants declined significantly after family physicians and midwives became available in the healthcare centers (P < 0.005).Conclusion:Our findings showed some improvement in the quantity of services without any noticeable changes in the quality of services provided as a consequence of this huge intervention. Therefore, it is suggested that there should be proper oversight of the duties of the health team in order to keep a close watch on primary healthcare, design of proper mechanisms for collecting and maintaining performance reports and statistics, and continuously monitor and control the quality of services.
The low scores of family physicians in performance and job satisfaction are obvious indications for more extensive research in identifying causes and finding mechanisms to improve the situation, especially in payment methods and work condition, in existing health system.
Background
To achieve efficiency and high quality in health systems, the appropriate use of hospital services is essential. We identified the initiatives intended to manage adult hospital services and reduce unnecessary hospital use among the general adult population.
Methods
We systematically reviewed studies published in English using five databases (PubMed, ProQuest, Scopus, Web of Science, and MEDLINE via Ovid). We only included studies that evaluated interventions aiming to reduce the use of hospital services or emergency department, frequency of hospital admissions, length of hospital stay, or the use of diagnostic tests in a general adult population. Studies reporting no relevant outcomes or focusing on a specific patient population or children were excluded.
Results
In total, 64 articles were included in the systematic review. Nine utilisation management methods were identified: care plan, case management, care coordination, utilisation review, clinical information system, physician profiling, consultation, education, and discharge planning. Primary case management was shown to effectively reduce emergency department use. Care coordination reduced 30-day post-discharge hospital readmission or emergency department visit rates. The pre-admission review program decreased elective admissions. The physician profiling, concurrent review, and discharge planning effectively reduced the length of hospital stay. Twenty three studies that evaluated costs, reported cost savings in the hospitals.
Conclusions
Utilisation management interventions can decrease hospital use by improving the use of community-based health services and improving the quality of care by providing appropriate care at the right time and at the right level of care.
Medical waste management (MWM) is an important public health concern worldwide. Although physicians must participate in medical waste management, their personal and organizational predictors in this process are unknown. This study aimed to the determinants of physicians' knowledge, attitudes and practices related to MWM in eight hospitals of Mazandaran province, northern Iran. A validated, reliable self-administered questionnaire was used including 30 questions about the respondents' knowledge, attitudes and practices (KAP) and personal and professional variables. Of a total of 200 physicians, 150 persons completed the questionnaire (response rate of 75%). The average score (± SD) for physicians' knowledge was 6.50 (± 1.50) out of 10, whereas those for attitudes and practices were 4.44 (± 0.88) and 4.02 (± 1.35) out of 5, respectively. Surgeons and orthopaedists had the lowest scores, whereas para-clinical specialists and internal medicine specialists had the highest scores. The score of knowledge showed significant differences among speciality groups and the various speciality groups' scores differed significantly only for knowledge (P = 0.024) and the mean of total KAP was significantly different between educational and non-educational hospitals (P < 0.05). As hospital type and physician speciality was related to the KAP concerning MWM, therefore it is recommend that all hospitals should develop appropriate protocols for medical waste management based on the this variables using a participatory process with teamwork and continuous training.
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