Comparison of pre-hospital emergency services time intervals in patients with heart attack in Arak, Iran.

BACKGROUND: After cardiac arrest, the possibility of death or irreversible complications will highly increase in the absence of cardiac resuscitation within 4 to 6 minutes. Accordingly, measuring the pre-hospital services time intervals is important for better management of emergency medical services delivery. The purpose of this study then was to investigate pre-hospital time intervals for patients with heart attack in Arak city, based on locations and time variables. METHODS: This is a retrospective descriptive cross-sectional study, which was conducted at the Arak Emergency Medical Services (EMS) during 2017-2018. Data were analyzed by SPSS version 13. RESULTS: The total number of heart attack patients registered in Arak emergency medical services was 2,659 of which 51% of patients were males. Six percent of patients were under 25 and about 49 percent were between 46 and 65 years old. The average of activation, response, on-scene, transportation, recovery and total time intervals were 3:30, 7:56, 15:15, 13:34, 11:07, 12:11, and 41:25, respectively. In the city area, the shortest and longest average response time intervals were in spring and winter, respectively. In out of the city area, the shortest average response time interval was in summer and the longest one in autumn. The shortest and the longest average response time intervals in the city area were in June and March, respectively, and in out of the city area, the shortest average response time interval was in June and the longest one in April. CONCLUSIONS: The shorter response and delivery time interval compared to the other studies may indicate improvement in the provision of EMS. Special attention should be paid to the facilities and equipment of vehicles during cold seasons to be in the shortest possible time. Also, training and informing the staff more about the code of cardiac patients along with general public education can help improve these intervals.

"We noticed that suddenly the country has become full of MRI". Policy makers' views on diffusion and use of health technologies in Iran.

OBJECTIVE: Uncontrolled proliferation of health technologies (HT) is one contributor to the increasing pressure on health systems to adopt new technologies. With limited resources, policy-makers encounter difficulties in fulfilling their responsibility to meet the healthcare needs of the population. The aim of this study is to explore how policy-makers' reason about the diffusion and utilization of health technologies in Iran using magnetic resonance imaging (MRI) and interferon beta as tracers. METHOD: This qualitative exploration complements quantitative data generated in a research project investigating the diffusion and utilization of MRI and interferon beta in Iran. Qualitative semi-structured interviews were conducted with 13 informants in different positions and levels of authority in the Ministry of Health (MOH), University of Medical Sciences, Health Insurance Organizations, and Parliament. The data was analysed using the framework approach. FINDINGS: Although policy-makers appeared to be positive to health technology assessment (HTA), the processes of policy-making described by the interviewees did not seem to be based on a full understanding of this (discipline). Several obstacles to applying knowledge about HT and HTA were described. The current official plan for MRI adoption and diffusion in the country was said not to be followed, and no such plan was described for interferon beta. Instead, market forces such as advertising, and physician and consumer demand, appear to have strong influence on HT diffusion and use. Dual practice may have increased the induced demand and also reduced the supervision of the private sector by the MOH. CONCLUSION: Management instability and lack of coordination in the MOH were found to be important obstacles to accumulation of knowledge and experience which, in turn, could have led to suboptimal managerial and policy-making processes. Furthermore marketing should be controlled in order to avoid creating unnecessary patient demands and negative influences on physicians' behavior.

Diffusion of interferon beta in Iran and its utilization in Tehran.

PURPOSE: There are few studies on the diffusion of expensive new therapies in low- or middle-income countries. The objectives of this study were to describe the diffusion of interferon beta for the treatment of patients with multiple sclerosis (MS) in Iran and to analyze its use in a cohort of 890 patients in Tehran registered in the Iranian MS Society (IMSS) registry. METHODS: Data on the diffusion of interferon beta drugs from 2000 to 2004 in Iran were obtained from the Ministry of Health (MOH). Data on the utilization of interferon beta in selected patient groups were collected from routine clinical data of the IMSS in a sample of population in Tehran province from 2003 to 2005. RESULTS: Interferon beta had a rapid diffusion in Iran during the study period, and it was used in all 28 provinces in 2004, however, much less in the poor provinces. Interestingly, interferon beta was prescribed to 68% of the patients in Tehran registered in the IMSS registry during 2003-2005. The usage of interferon beta as registered in the IMSS was higher (p < 0.0001) among insured than uninsured patients. CONCLUSION: The use of interferon beta treatment has grown considerably in Iran. In Tehran, interferon beta seems to be mainly used by young ambulatory patients with relapsing-remitting MS, indicating a rational drug use.

How is magnetic resonance imaging used in Iran?

OBJECTIVES: Analysis of and understanding the utilization patterns of diagnostic imaging technologies is important for planning health systems especially in middle- and low-income countries. Almost all published studies have been focused on utilization trends or utilization rates of magnetic resonance imaging (MRI) over time and little has been published about utilization patterns of MRI. This study aims to identify and describe the utilization pattern of MRI in Iran. METHODS: Data was collected from referrals and MRI reports of the population covered by one of the largest insurance organizations (Social Security Organization [SSO]) with more than 27 million beneficiaries in the Country. We focused on patients who had undergone an MRI examination during 1 month (October 13 to November 12), 2005. The data collected consisted of 1,656 referrals for MR imaging and 1,547 MRI reports. RESULTS: No clear association was found between the number of referrals per 100,000 population and the number of MRI machines per 100,000 population (r = 0.30; p = .13). Neurosurgeons, orthopedists, and neurologists contributed to more than 88 percent of MRI utilization. The Spinal column (55 percent), brain (25.5 percent), and knee (11.0 percent) were the most common parts of the body scanned by MRI. CONCLUSIONS: Having identified some of the most frequent users of MRI technology, any plan for modifying or improving MRI use should focus mainly on these specialties. International evidence on using the technology for examining brain and spine indicate that MRI is mainly used in diagnosing the central nervous system (CNS) diseases.

Diffusion of magnetic resonance imaging in Iran.

OBJECTIVES: The aim of this article is to describe the diffusion of magnetic resonance imaging (MRI) in Iran, including regional variations during the period of 1990 to 2005 and international comparisons. METHODS: Data on the diffusion of MRI were obtained from the Medical Equipment Office of the Ministry of Health (MOH) and, using self-administered questionnaires, from forty-one universities specializing in medical sciences. Data were gathered from the year of first purchase up to mid-2005. Information for international comparisons was obtained from the Organization for Economic Cooperation and Development health data of 2006. RESULTS: Iran purchased its first MRI unit in 1990. Since then, the number of MRI units has increased remarkably. The diffusion curve of MRI in Iran follows an S-shaped curve with a very slow speed in the period of 1991-95. Accelerated adoption occurred later coinciding with a significant influence from the private sector, especially from 1999. Iran had ninety-three MRI units in 2005, and the number of MRI units per million in the population was 1.36. CONCLUSIONS: The number of MRI units in provinces is not in direct proportion to the number of their inhabitants. Rational adoption and equitable diffusion of MRI may require the MOH and regulatory bodies to improve their ability in health technology assessment and integrate it into the policy making regarding adoption, diffusion, and utilization of health technologies.