Drug Prescription Indicators in Outpatient Services in Social Security Organization Facilities in Iran.

OBJECTIVES: The aim of this study was to estimate drug prescription indicators in outpatient services provided at Iran Social Security Organization (SSO) healthcare facilities. METHODS: Data on all prescribed drugs for outpatient visits from 2017 to 2018 were extracted from the SSO database. The data were categorized into 4 main subgroups: patient characteristics, provider characteristics, service characteristics, and type of healthcare facility. Logistic regression models were used to detect risk factors for inappropriate drug prescriptions. SPSS and IBM Modeler software were utilized for data analysis. RESULTS: In 2017, approximately 150 981 752 drug items were issued to outpatients referred to SSO healthcare facilities in Iran. The average number of drug items per outpatient prescription was estimated at 3.33. The proportion of prescriptions that included an injection was 17.5%, and the rate of prescriptions that included an antibiotic was 37.5%. Factors such as patient sex and age, provider specialty, type of facility, and time of outpatient visit were associated with the risk of inappropriate prescriptions. CONCLUSIONS: In this study, all drug prescription criteria exceeded the recommended limits set by the World Health Organization. To improve the current prescription patterns throughout the country, it would be beneficial to provide providers with monthly and annual reports and to consider implementing some prescription policies for physicians.

Exposure to the COVID-19 news on social media and consequent psychological distress and potential behavioral change.

Exposure to coronavirus disease 2019 (COVID-19) news pandemic is inevitable. This study aimed to explore the association between exposure to COVID-19 news on social media and feeling of anxiety, fear, and potential opportunities for behavioral change among Iranians. A telephone-based survey was carried out in 2020. Adults aged 18 years and above were randomly selected. A self-designed questionnaire was administered to collect information on demographic variables and questions to address exposure to news and psychological and behavioral responses regarding COVID-19. A multivariate logistic regression analysis was performed to assess the relationship between anxiety, fear, behavioral responses, and independent variables, including exposure to news. In all, 1563 adults participated in the study. The mean age of respondents was 39.17 ± 13.5 years. Almost 55% of participants reported moderate to high-level anxiety, while fear of being affected by COVID-19 was reported 54.1%. Overall 88% reported that they had changed their behaviors to some extent. Exposure to the COVID-19 news on social media was the most influencing variable on anxiety (OR 2.21, 95% CI 1.62-3.04; P < 0.0001), fear (OR 1.95, 95% CI 1.49-2.56; P < 0.0001), and change in health behaviors (OR 2.02, 95% CI 1.28-3.19; P = 0.003) in the regression model. The fear of being infected by the COVID19 was associated with the female gender and some socioeconomic characteristics. Although exposure to the COVID-19 news on social media seemed to be associated with excess anxiety and fear, it also, to some extent, had positively changed people's health behaviors towards preventive measures.

Health Care Utilization and Expenditure in War Survivors.

BACKGROUND: To describe the utilization and out-of-pocket (OOP) payments of war survivors receiving health care services and its determinants. METHODS: A cross-sectional study was carried out by systematic random sampling at national level (n = 3079) on healthcare utilization in war survivors on their last received services. A validated questionnaire was used to gather the information of inpatient and outpatient healthcare services and OOP payment. The data were analyzed to indicate the determinants of health utilization and expenses. RESULTS: Health care utilization was reported in 91.6% (n = 2822). The majority (82.5%) received one or two services in their last visits, mostly related to physician visits and medications (65.97%). Health care utilization was higher than general population annually, especially in physician visit (6.6 versus 4.89), medication (5.1 versus 3.6), and hospitalization (0.78 versus 0.15). About 20.2% (n = 599) of the study population paid out of their pocket for their last medical care services. The frequency of OOP payment was greater for physician visit and medication. Payment for hospitalization, imaging, and lab tests were more significantly associated with proceeding to reimburse the expenses (P<0.001). The median OOP payment was US$10.8 (interquartile range US$20.6). Gender (P=0.003), area of residence (P=0.01) and being war victims (P=0.005) were the significant determinants for both OOP payments and reclaiming the expenditure. Higher amount of payments (P<0.001) and more received health services (P=0.002) were also important factors in reclaiming the expenditure. CONCLUSION: Both outpatient services and hospital admission are more frequent among war survivors compared to the general Iranian population. Future studies should attempt to explore the reasons.

Does Economic Instability Affect Healthcare Provision? Evidence Based on the Urban Family Physician Program in Iran.

BACKGROUND: The main aim of this study was to evaluate the achievements of some important goals of Iran's urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program. METHODS: We used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined. RESULTS: No changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform. CONCLUSION: The urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.

Waiting time for first outpatient visit in specialty level: assessing the provider related factors.

BACKGROUND: Recently, there is an increased focus on waiting time as a barrier to access to treatment in outpatient services. The aim of this study is to determine related factors to outpatient waiting time in specialty levels. METHODS: This was a cross sectional study. The target population of this study consisted of specialist's and subspecialist's offices in Tehran. All the population (5475 cases) was studied; however 43.4% of them were not accessible. Accessible cases consist of 3098 physicians were included. Data gathered by telephone interview and analyzed by SPSS. RESULTS: According to the findings, the level of care; type of specialty, being a faculty member, and office location was related to waiting time (p < 0.001). Waiting time was also correlated with the number of outpatient offices and clinics of each physician (rs= 0.11, P < 0.001), as well as office working hours per week (rs= -0.18, P < 0.001). CONCLUSION: The estimated waiting time was acceptable, but the range of this parameter was too wide. This situation was more severe for some specialties and need some consideration. It should be considered that this study was restricted to Tehran. Waiting time is likely to be higher in other provinces of the country especially in deprived areas.

Waiting time for specialist consultation in Tehran.

BACKGROUND: Waiting time is an important indicator of patient satisfaction and the quality of care. The aim of this study is to determine the waiting time in physician offices in Tehran, Iran.   METHODS: This was a cross-sectional study. The target population of this study consisted of specialist and subspecialist offices in Tehran. We used a census sampling method to study the population. Data of 5475 physicians was extracted from data banks, of which 43.4% were not accessible. Thus 3098 cases were included and analyzed. We conducted telephone interviews to gather data, which was subsequently analyzed using SPSS software. RESULTS: Out of the 3098 physicians interviewed, 2585 were specialists (83.4%); the remaining were subspecialists. The mean waiting time for a patient's first visit to a specialist was 4.30 days (SD = 8.10) and for subspecialists it was 7.61 days (SD = 13.98). DISCUSSION: The average waiting time in our study was less than a week for specialists and almost a week for subspecialists. The health system in Iran has not established a complete referral system and with this situation, waiting time may have adverse effects on the health of patients. Thus studying and managing waiting time in some medical specialties or regions is a priority in our country.

Mental health problems of Iranian female adolescents and its association with pubertal development: a nationwide study.

Mental health problems including emotional and behavioral problems during puberty may be under influence of different risk factors including cultures, living in urban or rural areas and ethnic factors which may vary between different countries. The main aim of this study is to investigate the profile of emotional and behavioral problems and the role of factors such as age, stage of puberty, ethnicity, rurality and living in urban area, as risk factors in Iranian girls. As a part of a large national study we evaluated the emotional and behavioral problems in different stages of puberty in a community sample of Iranian adolescent girls from public schools that were selected by clustered random sampling method. In all subjects, demographic characteristics, and pubertal stages were measured. Emotional and behavioral problems were evaluated using Strength and Difficulties Questionnaire (SDQ). The associations of age, pubertal development indices, socioeconomic and demographic factors with the behavioral problems were assessed. A total number of 4576 students enrolled the study and responded to the questions. The mean age of participants was 13.83 ± 2.19 years. The mean total score of difficulties in participants was 14.34 ± 5.81. According to these results 813 (17.8%) adolescents had total problem scores higher than Goodman's cutoff points and the most frequent problem domain was conduct problems (20.5%). According to the results the most related variable with the total difficulty score of SDQ were ethnicity, residency in urban areas and development of menstrual cycle respectively. The results of this study showed that the most correlated factors with mental health problems in Iranian girls during puberty are ethnicity, urbanity and development of menstrual cycle.

Assessment of pubertal development in Iranian girls.

OBJECTIVE: We estimated pubertal development of 7,493 normal Iranian girls aged 6 to 20 years in a cross-sectional study. METHODS: Pubertal stages were assessed according to Tanner. The mean ages to achieve secondary sexual characteristics as well as the mean age at menarche were estimated. Weight and height were measured and body mass index (BMI) was calculated. Reference curves for different breast stages and menarche were constructed. The percentiles for attaining each stage were compared to data proposed by Tanner. FINDINGS: The mean age at breast bud stage (B2) was 10.10, pubic hair stage (P2) was 9.83, and menarche age was 12.55 years. The anthropometric variables were interpreted in different maturity stages. The mean age at attainment of puberty was compared with those of other populations. CONCLUSION: Not only the onset of puberty in Iranian girls but also the duration of puberty is similar to data from most other countries. A lower age limit for the definition of precocious puberty than the traditional 8 years is documented for Iranian girls. However, it should be noted that considering the rate of evolution of pubertal findings is more important than the age of their appearance.

Weight, height, body mass index and risk of breast cancer in postmenopausal women: a case-control study.

BACKGROUND: Many women in Iran have a relatively high body mass index. To investigate whether the condition contributes to excess breast cancer cases, a case-control study was conducted to assess the relationships between anthropometric variables and breast cancer risk in Tehran, Iran. METHODS: All incident cases of breast cancer in the Iranian Centre for Breast Cancer (ICBC) were identified through the case records. Eligible cases were all postmenopausal women with histological confirmed diagnosis of breast cancer during 1996 to year 2000. Controls were randomly selected postmenopausal women attending the ICBC for clinical breast examination during the same period. The body mass index (BMI) was calculated based on weights and heights as measured by the ICBC nursing staff. Both tests for trend and logistic regression analysis were performed to calculate odds ratios and 95% confidence intervals as measures of relative risk. RESULTS: In all, 116 breast cancer cases and 116 controls were studied. There were no significant differences between cases and control with regard to most independent variables studied. However, a significant difference was observed between cases and controls indicating that the mean BMI was higher in cases as compared to controls (P = 0.004). Performing logistic regression analysis while controlling for age, age at menopause, family history of breast cancer and parity, the results showed that women with a BMI in the obese range had a three fold increased risk of breast cancer [odds ratio (OR) = 3.21, 95% confidence interval (CI): 1.15-8.47]. CONCLUSION: The results suggest that obesity in postmenopausal women could increase risk of breast cancer and it merits further investigation in populations such as Iran where it seems that many women are short in height, and have a relatively high body mass index.