Challenges of Implementing Telemedicine Technology: A systematized Review.

Background: Today, the technologies in the world are rapidly evolving, and global infrastructure of information is spreading rapidly. The health system of different countries is facing a variety of challenges in order to apply telemedicine services. The aim of this study was to determine the challenges facing the health system of different countries in the application of telemedicine. Method: The present research was conducted in 2022 as a systematized review of studies related to challenges of telemedicine. In this study, Preferred Reporting Items for Systematic Reviews (PRISMA) and Critical Appraisal Skills Program (CASP) guidelines were used to assess the articles. The keywords "telemedicine," "telehealth," "E-health," and "tele care" were used in combination with the Boolean operators OR and AND. The ISI Web of Science, PubMed, Scopus, Science Direct, Ovid, Pro Quest, Wiley, and Google Scholar were searched. Results: In this study, based on the search strategy, databases were searched from January 2012 to January 2022, and in the final stage, analysis was performed on 27 selected identified articles. The use of telemedicine technology faced major formality and legality, required bandwidth, development of multilingual systems, economic efficiency, available patterns, payment for services, moral barriers, social status, differences and national and legal contradictions in the world, lack of insurance coverage challenges, and so on. Recognizing gaps and challenges can provide a way to fill these gaps and create opportunities for improvement. Conclusions: Utilizing telemedicine technology can be considered as an effective step in the health system. This technology has weaknesses that may challenge it. Successful application of telemedicine technology cannot be very effective without removing these barriers.

Iranian health financing system challenges to promote health outcomes: Qualitative study.

BACKGROUND: Adequate health financing system should have key criteria and characteristics such as risk distribution over time, risk accumulation, sustainable resource provision, and resource allocation based on meeting essential needs. Weakness of the tariff system, lack of attention to strategic purchasing, inefficient allocation of manpower, and a weak payment system are among the problems within the Iranian financing system. Given the weaknesses of the current health financing system, it seems necessary to identify challenges and provide effective solutions to address them. MATERIALS AND METHODS: This qualitative study was conducted to explore the views of a group of 32 major policymakers and planners in the various departments and levels of the Ministry of Health, Universities of Medical Sciences, Medical System Organization, and Health Insurance Organization in Iran (n = 32), selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process. RESULTS: Based on the results of data analysis, a total of 5 categories and 28 subcategories were obtained. In this study, five main categories were obtained through the content analysis method, including (1) stewardship; (2) providing services; (3) production of resources; (4) collecting resources; and (5) purchasing and allocation of resources. CONCLUSION: It is suggested that those in charge of the health system, following the reform of the organization of the health system, move toward the improvement and widespread implementation of the referral system and that clinical guidelines be carefully compiled. Also, appropriate motivational and legal tools should be used to implement them. However, insurance companies need to make cost, population, and service coverage more effective.

The economic cost of cancer treatment in Iran.

BACKGROUND: With more than 12 million new cases of cancers and nearly 7.6 million deaths worldwide in 2020, cancer is currently the third leading cause of mortality in the world. The costs spent on treating patients with cancer account for a significant amount of healthcare costs. Healthcare expenditures for cancer treatment have also increased significantly and are projected to skyrocket further over the next decade. This study was conducted to determine medical and non-medical direct costs for the prevention of cancer in patients hospitalized in 10 selected educational hospitals in Iran. MATERIALS AND METHODS: The study employed a cross-sectional design and was conducted in 10 selected educational hospitals in Tabriz, Tehran, Isfahan, Mashhad, and Shiraz in 2020. Using a researcher-made questionnaire, we assessed direct medical costs and direct non-medical costs of cancer in patients over 20 years old with kinds of breast, prostate, leukemia, lymphatic, stomach, liver, lung, bladder, uterine, and intestine cancers who undertook oncology treatments (n = 2410). Data were analyzed using descriptive statistics including mean and standard deviation and analytic statistics such as Kolmogorov-Smirnov, analysis of variance, and t-test, using SPSS 18 and P ≤0.05. RESULT: The mean direct non-medical cost paid out of pocket per month was $99.6 ± $10.81 USD, and the mean direct medical cost per month was $1029.4 ± $68.5 USD. The total cost paid by the patients was $889.4 ± 69.81 USD per month. CONCLUSION: Given the increasing number of patients with cancer, it is necessary to increase the number of special centers for the prevention and treatment of cancers. Dissemination of information about the costs of illnesses and their complications enables decision-makers to make a proper comparison between different uses of resources. Moreover, to support the patients, the health system must implement plans to decrease out-of-pocket payments by patients.

Iran's Struggling Health System in the Policy of Managing the COVID-19 Pandemic.

Background: Infectious diseases are one of the most important problems that affect the whole world. The World Health Organization (WHO), an active health organization, has identified coronavirus disease 19 (COVID-19) as a public health emergency and advises governments not to waste time on effective measures and interventions to attack and suppress the virus. In Iran, so far, the total number of screening tests has exceeded 21 million tests and more than 5 million doses of vaccine have been injected. However, we are still far from controlling the epidemic wave. Given the current situation, it is necessary to identify the challenges of managing the new coronavirus epidemic (COVID-19) in the country's medical universities. Methods: This qualitative study was conducted from January 2020 to January 2021 to explore the views of a group of service providers and staff managers of medical universities who were selected via purposeful sampling (n = 47). Data were collected through semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process. Results: Upon analysis of data by service providers and staff managers of medical universities, five main themes including governance and leadership, service delivery, human resources, medicine and technology, and financing and 15 sub-themes including management and leadership, culture and society, process, infrastructure, manpower, training and skills, mental pressure, work pressure, nutrition, safety, employee motivation, medical equipment, medicine, payment, and funds were found. Conclusions: Identification of the most important challenges of service providers and staff managers can play an important role in improving the management of the new coronavirus epidemic (COVID-19). It seems that in order to solve some of these challenges, coordination is needed outside the field of health, and considering the formation of the National Corona Headquarters at the national level, it is possible to use this infrastructure to provide the necessary policies and strategies.

Explore pre-hospital emergency challenges in the face of the COVID-19 pandemic: A quality content analysis in the Iranian context.

Background: pre-hospital emergency is a community-oriented system that responds to the medical needs of the injured or patients with acute and emergency illnesses outside of health care facilities until they are transferred to a medical center. This study aimed to explore pre-hospital emergency challenges in the face of the COVID-19 pandemic. Material and methods: This study was conducted as a qualitative content analysis in Iran. Using the purposive sampling method, data were collected through in-depth individual interviews with 28 prehospital paramedic personnel from November 2020 to November 2021. Graneheim and Lundman's conventional content analysis methods were used to analyze the data and for the trustworthiness of the data, this study used Lincoln and Guba's recommendations. Results: After multiple rounds of analyzing and summarizing the data and taking into consideration similarities and differences, four main categories and 10 subcategories were created based on the results of the data analysis and including (1) Culture and Community. (2) Service delivery (3) Human resources; (4) Medical supplies and equipment. Conclusion: According to the findings of this study emergency medical system employees are suffering from a range of psychiatric problems as a result of a lack of equipment and job overload, which has a detrimental impact on the quality of pre-hospital emergency care. Therefore, emergency care senior management should develop comprehensive guidelines, provide more equipment and minimize professional challenges to improve the quality and safety of pre-hospital emergency care services.

Exploring the challenges of Iranian government hospitals related to Covid-19 pandemic management: a qualitative content analysis research from the nurses perspective.

BACKGROUND: The COVID-19 pandemic poses a major threat to global public health. As a result, to prepare healthcare systems for this unprecedented threat, a coordinated worldwide response is required. This study aimed to explore the hospitals challenges related to covid-19 pandemic management from the iranian nurses perspective. METHODS: This study was conducted as a qualitative content analysis in Iran. Using the purposive sampling method, data were collected through in-depth individual interviews with 35 nurse personnel. Graneheim and Lundman's conventional content analysis methods were used to analyze the data and for the trustworthiness of the data, this study used Lincoln and Guba's recommendations. RESULTS: After multiple rounds of analyzing and summarizing the data and taking into consideration similarities and differences, 5 main categories and 14 subcategories created based on the results of data analysis and including1) Leadership and management 2) Service delivery management 3) Human resources management 4) Equipment and Supplies Management and 5) Economic resources management. CONCLUSION: Identifying the most important challenges of nursing can play an important role in improving the management of COVID-19pandemic. The analysis of the challenges by managers at local, provincial and national levels can lead to the presentation of effective solutions to address these challenges and improve the pandemic management process in the country.

Evaluation of medical equipment management in educational hospitals in Isfahan.

BACKGROUND: Medical equipment plays an important role in the diagnosis, treatment, and medical education, and each year the major share of hospital costs (about 5%-15% annually) is allocated to the purchase of medical equipment. The selection and allocation of medical equipment should be appropriate and in line with the actual needs of the medical centers, clinical goals, human resources, and the conditions required to ensure safety. The purpose of this study was to study and evaluate current systems of medical equipment management and identify their strengths and weaknesses in Isfahan educational hospitals in 2018. MATERIALS AND METHODS: This is a descriptive-applied research that was done in a cross-sectional way in 2018. The statistical population of the research is the authorities of medical equipment and other persons related to the management of medical equipment of selected educational hospitals in Isfahan. The data collection tool is a questionnaire. RESULTS: The result of this study was gathered in four areas: medical equipment management, safety, preventive maintenance, and training. CONCLUSION: According to this study, there is no comprehensive program in hospitals for how to manage medical equipment, which itself causes the loss of material and equipment capital of the organization. In most cases, the lack of a system for planning and controlling the amount of inventory and purchasing and maintaining medical equipment creates many problems, such as the accumulation and depreciation of equipment or the lack of these facilities in critical situations. In this study, it is suggested initially a scientific control system. Medical equipment is designed so that the hospital's need for equipment at any time of year and the amount of its equipment are clear so that it can be easily decided in this field.

Different Approaches to Confronting the Biological Epidemic; Prevention Tools with an Emphasis on COVID-19: A Systematized Study.

BACKGROUND: The World Health Organization has identified COVID-19 as a public health emergency and is urging governments to stop the virus transmission by adopting appropriate policies. In this regard, authorities have taken different approaches to cutting the chain or controlling the spread of the disease. The aim of this study was to determine the approaches to biological epidemics and related prevention tools with emphasis on COVID-19 disease. METHODS: The present study was a systematize study of publications related to the prevention strategies for Covid-19 disease. The study was carried out based on the PRISMA guidelines, CASP and AACODS. The data resources included ISI/WOS, PubMed, Scopus, science direct, Ovid and ProQuest. WHO website, published reports of countries, as well as the Worldometer website were evaluated. The time-frame of the study was from 1 December 2019 to 30 May 2020. RESULTS: The study findings showed that in order to confronting the COVID-19 epidemic, in general, there are three approaches of "mitigation", "active control", and "suppression" and four strategies of "quarantine", "isolation", "social distance", and "lockdown" in both individual and social dimensions to deal with epidemics. Selection and implementation of each approach requires specific strategies and has different effects when it comes to controlling and inhibiting the disease. CONCLUSION: One possible approach to control the disease is to change individual behavior and lifestyle. In addition to prevention strategies, use of masks, observance of personal hygiene principles such as regular hand washing and non-contact of contaminated hands with the face, as well as observance of public health principles such as sneezing and coughing etiquettes, safe extermination of personal protective equipment must be strictly observed. The use of the previous experiences in the world, along with the current experiences of countries, can be very helpful in choosing the accurate approach for each country in accordance with the characteristics of that country and lead to the reduction of possible costs at the national and international levels.

Workplace violence and influencing factors among paramedic pre hospital paramedic personnel (city and road) in Iran: a quality content analysis.

BACKGROUND: The goal of every emergency department is to provide the highest quality services in the shortest time using limited resources. However, occupational violence is so prevalent among pre-hospital paramedic personnel that some experts claim that it is impossible to find pre-hospital personnel without an experience of violence in the workplace. Therefore, it seems necessary to investigate the causes of violence among this population group and find ways to control it. AIM: The present study aimed to investigate the Violence and influencing factors among paramedic pre-hospital personnel. METHOD: This qualitative study was conducted to explore the views of a group of pre-hospital paramedic personnel (n = 45) selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process. RESULTS: Based on the results of the analysis of data collected from prehospital paramedic personnel, three main categories including: human factors, organizational factors, and environmental factors and 20 subcategories were detected. CONCLUSION: If authorities neglect violence in the workplace and do not take serious actions to prevent it, violence and, more importantly, "hostility" will gradually prevail in the workplace. It also increases the stress and anxiety of staff and consequently severely deteriorates their job performance. Hence, authorities are strongly recommended not to ignore this issue and, instead, take measures, for instance hold workshops, to train personnel about the techniques of anger and violence control.

Challenges of the Health System in Preventing Non-Communicable Diseases; Systematized Review.

BACKGROUND: The basis of prevention of non-communicable diseases is the identification of primary risk factors and the prevention and control of these factors. The purpose is to prevent the spread of the disease and to control it as much as possible. If population growth continues at this rate, by 2030, 52 million people will die from these diseases each year. The aim of this study was to evaluate the challenges of preventing non-communicable diseases. METHODS: The present study was a systematic review that conducted in July 2020 and the articles related to prevention of non-communicable diseases on databases of web of science, PubMed, Scopus, science direct, Ovid, Pro Quest and Google Scholar. Strategy for searching and selecting the articles was PRISMA Guidelines. RESULTS: Challenges of non-communicable disease prevention, in 4 main codes, including infrastructure, economic, demographic and management and 12 sub-codes that include, lack of preventive infrastructure, restrictions on access to medicine, restrictions on primary health care, restrictions on access to Technology, disease-oriented disease, unsustainable financial resources, failure to implement poverty reduction projects, increase in aging population, migration, rapid and unplanned urban planning, hasty planning and lack of internal and external coordination were classified. CONCLUSIONS: To reduce non-communicable diseases, strengthen global capacities, reduce risk factors for NCDs and place social determinants by creating health-promoting environments, strengthen health systems to implement prevention and control of NCDs, and place determinants Social can play an effective role through people-centered primary health care.

The Cost-Effectiveness and Cost-Utility of Statin Drug for the Treatment of Patients with Cardiovascular Disease, A Systematic Review.

Cardiovascular diseases impose a burden of disease and economic burden on society. With regard to different drugs are used to treat cardiovascular disease; these interventions should be economically evaluated and them that the most cost-effective were selected. The aim of this study was to investigate the studies carried on the cost-effectiveness and cost-utility of statin drugs for the treatment of patients with cardiovascular disease between 2004 and 2020. Quality assessment of the articles was examined by Drummond's checklist. Given that the inclusion criteria, 26 articles included in the review. The results of this review showed that many articles related to the economic evaluation of statin drugs adhered international standards for performing economic evaluation studies. All the studies mentioned the source of effectiveness (the second criteria) and alternative options for the comparison (the third criteria). Atorvastatin and rosuvastatin drugs were the main options for the comparison in the studies. Although the results of the studies were different in some aspects, such as the type of modeling, costs items and the study perspective, they reached the same results which the use of statin drugs versus no-drug can decrease cost, cardiovascular events and deaths and increase QALY. The results were nearly different due to study design, time horizon, efficacy, and drug prices.

Strategic purchasing and the performance of health-care systems in upper middle income countries: A comparative study.

BACKGROUND: Providing financial resources for health services is one of the most important issues in the study of health systems, of which purchasing health services is very essential. The World Health Organization considers strategic purchasing as a key option for improving the performance of health systems. The aim of this study was to identify payment methods for service providers and strategic purchasing strategies in upper middle income countries. MATERIALS AND METHODS: The present study was conducted in the form of a comparative analysis involving comprehensive surveys from 2000 to 2019, by searching keywords for the objective of the study by the search engines through databases including ProQuest, PubMed, Google Scholar, Irandoc, SID, Magiran, Science Direct, Scopus, ISI Web of Science, EBSCO, and Cochrane. RESULTS: A total of five upper middle income countries that used strategic purchases entered the study. Overall, all of them implemented rather similar strategies in terms of strategic purchasing and paying to the providers of the services. CONCLUSION: According to the results of this study, per capita payment for primary health-care and outpatient services seems to be the best option for controlling the costs of the health sector, while the appropriate option for the inpatient department is the most common use of diagnosis-related group. The payment method is to control the costs of the inpatient department.

Barriers in the performance-based payment in Iran health system: Challenges and solutions.

BACKGROUND: One of the main goals of hospital management is to attract, maintain, and increase the number of qualified and efficient human resources, and one of the key and most important factors in achieving this goal is to design and implement a fair and efficient payment system. The purpose of this project is to determine the challenges of the performance-based payment system and provide solutions to overcome its obstacles in the city of Tehran. MATERIALS AND METHODS: This qualitative research sought to perform content analysis so as to explore the experiences and perceptions of a purposeful group of specialists and managers of Tehran's educational and medical centers (n = 10). Data were collected using in-depth semi-structured interviews and were ongoing until the point of saturation. RESULTS: On analysis of data by Specialists and managers of Tehran's educational and medical centers, three main themes including behavior, organization, rules and regulation were defined alongside seven subthemes includes scheduling, platform, education, quantity-oriented, motivation, implementation, and payment system. CONCLUSION: In general, it can be concluded that for the successful implementation of any project, the necessary infrastructure must be provided for implementation. In this plan, despite the challenges in the field of behavior, organization, and rules and regulations, the need for necessary training before implementing the plan, special attention to quality instead of quantity, motivating employees to cooperate in implementing the plan as successfully as possible, creating a platform Appropriate before the implementation of the plan and most importantly, the pilot implementation of the plan before its widespread implementation seems necessary.

What is the impact of clinical guidelines on imaging costs?

Inappropriate and irrational use of numerous advanced diagnostic imaging technologies has recently been highlighted in many countries and has gathered the attention of policymakers. This matter has not only increased health costs in countries but also resulted in adverse health results. Various factors are involved in the inappropriate or unnecessary use of advanced medical imaging techniques including patient-related, physician-related, technological, and ultimately radiologist-related factors. This calls for the provision of new guidelines by policymakers to encourage all service providers to make appropriate use of such techniques. One of the main approaches in this regard is the application of clinical guidelines and decision support systems. The present study was a systematized review that conducted in January 2019, and the articles related to palliative care requirements on databases of Web of Science, PubMed, Scopus, ScienceDirect, Ovid, ProQuest, Wiley, and Google Scholar from January 1, 2009, to January 20, 2019, were searched. Strategy for searching and selecting the articles was Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. Overview of the studies shows that various reasons for the overuse of diagnostic imaging technologies and effects of applying clinical guidelines on reducing diagnostic costs of treatment are investigated in this article with respect to various aspects and viewpoints. Clinical guidelines can be significantly effective in evaluating suitability and quality of referrals for diagnostic imaging, if only adapted properly.

Model-based Cost-effectiveness Analysis of Atorvastatin Drugs for Prevention of Cardiovascular Diseases in Iran.

BACKGROUND: Today, cardiovascular disease is one of the main causes of mortality and disability in most developed and developing countries. The prediction of the major causes of deaths all over the world at all ages shows that 61% of deaths are due to chronic diseases, of which 30% is due to cardiovascular disease. The aim of this study was to assess the cost-utility analysis of atorvastatin for the prevention of cardiovascular diseases using the Markov model. METHODS: Markov model with a lifetime horizon was developed to evaluate economic and health outcomes for atorvastatin drugs for the prevention of cardiovascular diseases for a cohort of 1,000 patients. The effectiveness indicator in this study was quality-adjusted life-years (QALYs); robustness of results was examined by one-way and probabilistic sensitivity analysis. RESULTS: The results showed that the use of atorvastatin compared to no drug intervention was highly cost-effective with USD173 per additional QALY. The results of one-way and probabilistic sensitivity analysis confirmed the results of this study. The findings of this study also showed that the highest cost items were hospitalization costs in the cardiac care unit (CCU). Also, the highest cost items in para-clinical services were related to echocardiography costs, and troponin constituted the largest cost of laboratory tests. CONCLUSIONS: Based on the results of this study, it is recommended that cardiologists use atorvastatin in the prevention of cardiovascular disease.

Exploring Challenges of Health System in Iranian Traditional Medicine: A Qualitative Study.

BACKGROUND: Traditional medicine is a complete system, including diagnostic methods, etiology and treatment based on interpersonal differences.Owing to a lack of investigations in the field of Iranian traditional medicine as well as its many present challenges, certain studies in this area can prove quite practical in identifying and solving ongoing challenges. This study investigates the challenges of the health system in Iranian traditional medicine in the context of control levers. METHODS: The study was qualitative content analysis. A framework analysis, "Control Knob Approach", was considered appropriate to promote apprehension of challenges of health systems in Iranian traditional medicine. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 35 experts of Iranian traditional medicine. Directed content analysis was used to analyze the data, which extracted the initial codes after performing the recorded interviews on paper and immersing them in the data analysis. RESULTS: Upon analysis of data by Iranian medicine experts, five main categories including financing, payment system, regulations, behavior and organization were defined alongside 13 subcategories. CONCLUSION: According to current challenges and the tendency of society to receive traditional medicine services, as well as the long history of traditional medicine in Iran, fair access to traditional medicine services should be provided. This access must be through the production of indigenous knowledge and the formulation of regulatory and educational policies and guidelines and the empowerment of relevant, healthy, effective, evidence-based and cost-effective forces.

Iran's Struggling Health System: An Increase in Natural Childbirth: A Case Study.

BACKGROUND: The 7th package of health reform in Iran has been implemented in May 15, 1393, is concerned with the "promotion of natural childbirth." It has been focusing on reducing cesarean section (CS) and promoting normal vaginal delivery (NVD) as broadly as possible. This study evaluated the changes in the vaginal delivery and cesarean before and after implementation of the 7th package of health reform in public and private hospitals of Isfahan Province in 2014. METHODS: This was a quasi-experimental research. The population of this study contained all public and private hospitals in Isfahan Province covered by the Health Reform Program. It included 22 public and 6 private hospitals. The data collected from the vice chancellor of treatment in 6 months before and after the implementation of the program have been analyzed. SPSS software version 18.0 (SPSS Inc., Chicago, IL, USA) and independent t-test have been employed for data analysis. RESULTS: It was demonstrated that the increasing rate of NVD (P = 0.001) and decreasing rate of CS in public hospitals (P = 0.027) after the implementation of the plan were significant. On the other hand, the increasing rate of CS in private hospitals was significant (P = 0.026). CONCLUSIONS: Although this scheme has achieved its targets in public hospitals of Isfahan Province, it has not met its objectives in private hospitals. It seems CS operations were shifted from public hospitals to private ones, which is conflict with the objectives of the health reform plan.