Background: Providing comprehensive and high-quality services is one of the most important goals of the health systems and a basic principle for Universal Health Coverage (UHC). Fulfilling this important task would be feasible through continuous evaluation and improvement of the health services quality. The aim of this study was to develop a framework for quality assessment of Primary Health Care (PHC) in Iran's health system. Methods: This study is a literature review which continued by a qualitative research. The extracted quality dimensions and indicators for initial screening were reviewed and discussed in two panel meetings attended by the experts with regard to the current package of health system in Iran. Using Delphi method, the dimensions and Quality Indicators(QIs) were evaluated and approved by 39 national health professionals in two rounds. Finally, after 4 panel sessions at ministerial level, the selected QIs were categorized in form of the final dimensions of the quality of care. Results: The literature review emerged 13 Primary Health Care Quality Assessment Frameworks (PHCQAF) including 20 and 698 QIs. Delphi study resulted in developing Iranian PHCQAF comprising 7 dimensions and 40 QIs. Among these, 8 QIs of the dimension of access and equity, 5 QIs of safety dimension, 2 QIs of efficiency dimension, 13 QIs of effectiveness dimension, 2 QIs of patient-centeredness dimension, 3 QIs of governance dimension and 7 QIs of appropriateness dimension were presented. Conclusions: The presented PHCQAF can be used as a comprehensive and practical tool for continuous improvement of the quality of PHC services at local, national and regional levels. Moreover, it can give some useful information to the health managers and policy makers on how the services are provided.

Background The Covid-19 pandemic affected the performance of Primary Health Care (PHC) worldwide. This study was performed to investigate the impact of the Covid-19 pandemic on the utilization of PHC in Iran. Method A before and after study conducted between 2019 and 2021. 56 medical science universities across the country were studied. The data extracted from Electronic Health Record (EHR) is entitled “SIB”. Three major indicators included a weighted average of essential services provided by (physician, dentist, mental health expert, midwife, nutritionist), percentage of actual delivered service, and percentage of customer satisfaction was selected as a criterion for assessing the PHC. Descriptive statistics and analytical statistics (Wilcoxon test) using SPSS 16 software were used for the data analyzing and reporting. Results There was a significant difference among the examined dimensions before and after Covid-19 separation in all studied indicators except the level of percentage of customer satisfaction (P < 0.05). So that the percentage of actually delivered services decreased about 1% and the weighted average of essential services provided by a physician, dentist, midwife, mental health experts, and nutritionist decreased 627.95, 718.81, 460.85, 2914.66, 2410.65 numbers, respectively. Conclusion Covid-19 Pandemic has affected the performance of Iranian PHC at the beginning and overall, has a negative consequence on utilization of services. Preparedness to respond to pandemics and develop programs and interventions is necessary to cover the weaknesses of the PHC.

Aim To improve the medical waste management (MWM) standards in Tabriz community health centers (CHCs) through clinical audit process. Background Management of medical waste is not only a legally necessity but also a social responsibility in health systems. Owing to the potential risks for human health and environmental impacts, MWM is a global concern. Methods This was an interventional research designed using clinical audit cycle that was implemented in Tabriz CHCs in 2016. MWM was assessed through observation, as well as reviewing relevant documents and interviews with waste workers in CHCs and completion of a researcher-made checklist. Intervention plans were developed and implemented based on the assessment results. To analyze the data, Excel 2016 software was used and information was reported as descriptive statistics through comparison of standards adherence before and after the interventions. Results Generally, 30% improvements in MWM standards adherence were experienced (45.8–75.1%) in the CHCs, after the interventions. The greatest improvement was observed in the dimensions of management and education, and separation and collection of medical waste, up to 30 and 28.5%, respectively. Conclusions As the results demonstrated, standards of MWM processes were improved in Tabriz CHCs, due to the intervention. Moreover, it was experienced that using systematic method, stakeholders’ participation and evidence-based planning would lead to process improvement. MWM was an ignored issue in primary care that must be more in attention.

Objective:To perform a systematic review and meta-analysis of self-immolation epidemiology and characteristics in Iran. Methods:This was a systematic review and meta-analysis study. PubMed, Scopus, Web of science and Science Direct were searched for English literature and SID and Magiran for Persian in the time period of 2000 to 2016. The retrieved studies were screened and reviewed then quality assessed. Random Effect model was applied for meta-analysis. The qualitative data were analyzed by content analysis method. Results:After literature screening, 39 studies included in the analysis. Women were subject to self-immolation more than men. The rate of self-immolation estimated to be 4.5 cases in every 100,000 populations and it was the reason of 16% of hospitalized burns. The average length of hospital stay calculated to be 12.24 (95% CI: 8.85-15.59) days. The total burnt surface area was 65.3% (95% CI: 56.71-73.89). Death due to self-immolation was 62.1%. The major risk factors of self-immolation were having mental health issues, family problems and characteristics and problems in relation/communication with spouses. Conclusion:Despite the low rate of self-immolation in Iran, it comprises one sixth of the hospitalized burns. The mortality rate of self-immolation also is high and this highlights the importance of providing special care. Psychological consultations and mental health screening in the primary health care would help to prevent the self-immolation.

The results of most interventional studies conducted in Iran supported the effect of the interventions on reduction of RTIs. However due to some methodological or reporting shortcoming the results of these studies should be interpreted cautiously.

Summary Objective Patient safety walkround (PSWR) is an appropriate technique for senior managers' participation and collaboration with frontline staff to promote safety culture in hospitals. This study was conducted to assess the 5‐year PSWR experience in Shahid Mahallati Hospital in Tabriz, Iran. Methods This was a triangulated cross‐sectional study. All documents, instructions, reports, action plans, protocols, and verbal feedbacks on PSWRs were reviewed from 2013 to 2017. Data were extracted using goal‐driven extraction form and analyzed using Excel 2016 software. Results A total of 174 90‐minute PSWRs were conducted during the study period, and 1372 safety issues were identified. Work environment factors (32.5%), organization and management (18.14%), and tasks (18.07%) were the most frequent identified issues, respectively. About 75.5% of the issues were resolved through corrective interventions implementation. Conclusions PSWRs provide a great opportunity to identify and resolve the safety issues in the hospitals. Senior managers' participation and their support of staffs opinions and innovations were reinforced through PSWRs. Moreover, it creates mutual trust and safety responsiveness at all organizational levels in the hospital.

Abstract:Background:Helmet use by motorcyclists decreases the incidence and severity of an injury and its related death. Unfortunately, the helmet use rate is not in an acceptable level in Iran. This study aimed to systematically identify the determinants and barriers of helmet use among Iranian motorcyclists. Methods:A systematic search of literature was done using PubMed, Scopus, Science Direct and Web of knowledge databases for English literature and SID for Persian articles by specified keywords. Manual searching and reference of references were used to improve the articles identification. Articles published before 1995 and those which did not report the barriers and determinants of helmet use were excluded. Data were extracted using an extraction table. Results:Out of 49 retrieved articles, 13 articles were included in the study. Most of them (70%) had a cross-sectional design. Personal factors (such as older age, marital status and education) and motorcyclist's attitude and beliefs about the helmet effectiveness were reported as important determinants of helmet use. Helmet weight and its visual and audial limitation for motorcyclists were known as the main reported barriers to use a helmet. Conclusions:Interventions affecting the motorcyclists' attitude must be employed along with the legal interventions. Moreover, cost-effective engineering improvements in helmet production remain an important policy to improve the compliance of helmet use.

Background Unintentional injuries in the home are one of the threats to childhood quality of life which is considered as a social determinant of health. Regarding mother's leading role in taking care of the children in Iranian families, the present study was conducted to investigate mothers' home-injury prevention attitude and performance and its contributing factors in Sahand, Iran. Methods This was a cross-sectional study conducted in 2017. Sampling was done using random sampling method among all mothers of children less than five years old who attended the health centers to receive child care services. A valid attitude questionnaire and safety performance checklist were used for data collection. Data were analyzed through SPSS-24 software using descriptive (Frequency, mean, etc.) and inferential statistics (chi-square, Kruskal-Wallis) method. Results The Mean age of mothers was 30.58 (±5.01). About 65% of the mothers held high school diplomas or lower degrees. The mean score of mothers' attitude was calculated to be 72.12(±6.79). More than 58% of the mothers had an appropriate level of attitude. The mothers' injury prevention performance mean score was 66.59 (±12.85). Family socioeconomic status, Mother's age, educational level, and job, father's job, age and gender of the child were the contributing factors (p<0.05). Conclusions Most of the mothers had an appropriate level of home-injury prevention attitude and low level of performance. Deprived residency areas should be considered for higher support to prevent injuries. Strengthening Primary Health Care system in safe communities could have a significant role in child safety promotion through mothers KAP promotion.