Purpose: Today, cancers have become a major cause of mortality in developed and developing countries. Among various cancers, gastric cancer imposes a huge economic burden on patients, their families, and on the health-care system. This study aimed to determine the economic burden of gastric cancer in Kohgiluyeh and Boyer Ahmad province of Iran in 2016. Methods: This was a cross-sectional cost of illness study conducted in Kohgiluyeh and Boyer Ahmad province of Iran in 2016, using a prevalence-based approach. All patients were studied using the census method (N = 110). The required data on direct medical, direct nonmedical, and indirect costs were collected using a data collection form from the patients’ medical records, tariffs of diagnostic, and therapeutic services approved by the Ministry of Health and Medical Education in 2016. Results: The total cost and burden of gastric cancer in Kohgiluyeh and Boyer Ahmad province of Iran in 2016 were $US436 237, among which the majority were direct medical costs (59%). The highest costs among direct medical costs, direct nonmedical costs, and indirect costs were, respectively, related to the costs of medications used by the patients (35%), transportation (31%), and absence of patients’ families from work and daily activities caused by patient care (56%). Conclusion: Our study has revealed for the first time high costs of gastric cancer in Iran. To decrease the total costs and burden, the following suggestions can be made: increasing insurance coverage and government subsidies for purchasing necessary medications, providing the required specialized care and services related to cancer diseases such as gastric cancer in other provincial cities rather than just in capital cities, and so on.
Background: Health Transformation Plan (HTP) was occurred in 2014 to improve access and equity and reduce out of pocket payments in Iranian Health Care System. In this regard the aim of this study is evaluating and ranking the service provider's infrastructures among the country provinces as an indicator of equity before and after implementation of the HTP. Methods: This cross sectional study is conducted in 2017. The study population included 31 provinces of the country. Data related to 4 years from 2012 to 2016 were included from the data bases of Ministry of Health and Medical Education as well as the statistics yearbook of the country. The obtained results of multi-criteria decision-making methods were analyzed as well. SPSS 18 and Excel 2013 software were used for data analysis. Results: Based on the VIKOR method, in 2012, Mazandaran, Tehran and Fars provinces and in 2013, the provinces of Tehran, Fars and Isfahan ranked from first to third respectively. Similarly after HTP, in 2015, the provinces of Tehran, Khorasan Razavi and Fars and in 2016 the provinces of Tehran, Fars and Khorasan Razavi have ranked from first to third respectively. Paramedic, dentist, pharmacist, medical institutions and hospital bed had a significant difference before and after the implementation of Health Transformation Plan, so that the number of these indicators increased after implementation of the HTP (P value < 0.05). Conclusions: According to the results, there are many differences between the provinces and these disparities have not decreased significantly after HTP. Consequently, it is suggested to the health sector policy makers to make regional plans and allocate the budget of HTP, based on the status of the provinces. In addition, responding to these inequalities requires a transparent and systematic approach to provide the budget for allocating to the population, health needs, and the lack of development and geographical isolation of regions.
Background: Efforts to reduce inappropriate hospital stay, including alternatives such as homecare, are important to improve patient care and reduce health care costs. Aims: This study evaluated inappropriate hospital stay in Shiraz, Islamic Republic of Iran and the extent to which these stays were due to lack of homecare services and others factors needed for homecare. Methods: This cross-sectional study was conducted between January 2018 and September 2019 at two public hospitals in Shiraz. All adult patients hospitalized in these two hospitals in the study period were included, except patients in mental care wards. Appropriateness of patients’ hospital stay was assessed on a daily basis using the Iranian version of the Appropriateness Evaluation Protocol. The chi-squared test was used to assess association between need for homecare and patient characteristics. Results: Of 6458 hospitalization days assessed (for 1954 patients), 710 (11.0%) days were inappropriate. The greatest proportion of causes of inappropriate stay were physician-related (32.9%). Of the 710 inappropriate hospitalization days, 231 were due to lack of homecare services. Most patients who were inappropriately hospitalized because of lack of homecare services were insured through Salamat insurance (64.0%). A statistically significant relationship was found between the need for homecare services and the type of health insurance (P = 0.01). Of the patients admitted to hospital because of lack of homecare services, 36.8% had endocrine diseases, especially diabetes, and 21.8% needed oxygen services. Conclusion: Institutionalizing home health care in the Iranian health system could encourage more home health care referral and reduce inappropriate hospitalization, especially for diabetes.
Background: Nurses are the largest providers of care services in the health care system who play an important role in the community health by providing health care. Therefore, maintaining and developing them is an integral part of human resource management in the health system. Considering that one of the tools for career development is determining job anchors, this study was conducted in 2020 to identify the career anchors of nurses from Shiraz University of Medical Sciences in order to develop their career path. Methods: This cross-sectional study was performed on 268 nurses working in hospitals and educational centers of Shiraz University of Medical Sciences who were selected by convenience sampling. Data were collected using the standard Schein questionnaire and analyzed by independent t-test and ANOVA in SPSS 23 software. Results: Among career anchors, service and dedication (24.74 ± 1.72) had the highest, and managerial competence (16.35 ± 2.32) had the lowest mean score. Furthermore, the average entrepreneurial creativity in women was significantly higher than men (p = 0.04). And in men, the average of pure challenges was significantly higher than women (p = 0.04). In addition, people with undergraduate degree showed a greater tendency to technical/functional competence (p = 0.02). Clinical nurses were more likely to become managers (p = 0.04), and corporate nurses were more inclined to have a lifestyle anchor (p = 0.04). Conclusion: Regarding service and dedication anchor, which had the highest average score among the interviewed nurses, individuals are motivated by pursuing valuable goals and meeting the needs of others. Whilest managerial competencies were not the priority of the studied nurses. Therefore, the opportunity for promotion in nurses is not just focused on reaching a managerial position. Therefore, it is suggested that the management of human resources in university define the career path of people based on their anchors and specific interests to people in terms of mental and mental health for creating a favorable atmosphere and better performance.
Background: Family physician program is a complete health-care system, and its human resources are the most important resources like any other healthcare program. Organizational Commitment (OC) and Quality of Work-Life (QWL) are important factors in attracting and retaining employees. Objective: To investigate the association of OC and QWL with the intention to leave the job by family physicians in Shiraz, Iran in 2017. Methods: This was a descriptive analytical study conducted on a sample of 268 family physicians in 2017. For data collection, Porter's organizational commitment, Walton's Quality of Work Life, and Cammann's intention to leave the job questionnaires were used. The collected data were analyzed using SPSS 23.0. Results: The results showed that the levels of OC, QWL, and the intention to leave the job were moderate among the studied family physicians. In addition, the results showed that QWL and OC had negative and significant associations with the intention to leave the job (p-value<0.001), and the QWL had a greater association (Beta=-0.348). Conclusion: It is suggested that more attention should be paid to the family physicians at the Ministry of Health and the provincial level to improve the QWL and OC of the family physicians, and thereby preventing the physicians from leaving their job from the family physician program.
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