Health insurance deductions in Iranian public hospitals before and after the health transformation plan.

Background: Developing countries, such as Iran, have been struggling with high rates of insurance deduction. As part of the Health Transformation Plan (HTP) in Iran, a new reference book was introduced to update the medical tariffs. This study aimed to compare the rates and extent of insurance deductions before and after HTP in Iran's public hospitals. Methods: This was a quasi-experimental study. Overall, 400 medical bills were selected from Iran's national Health Information System using multilevel random sampling before and after HTP implementation (2014 and 2017). Insurance deductions were divided into 5 groups: (1) diagnostic procedures, (2) medication and medical appliances, (3) accommodation and human capital provision, (4) surgery, and (5) other services. Using STATA Version 14.0, independent t test and Fisher's exact test were used for data analysis. Significance level was set at 0.5. Results: There was a significant decrease in insurance deductions among Iran's Health Insurance (HI) and Social Security Insurance (SSI). Accordingly, before HTP, the average amount of insurance deductions was 58.9% and 71.3% in HI and SSI, respectively. Moreover, there was a significant decline in all 5 groups between the pre- and postimplementation of HTP (p<0.05). Based on the results, hospitalization time (OR=2.31, 95% CI=1.9-3.2), patients in general hospitals (OR=1.49, 95% CI=1.4-2.7), coverage by SSI (OR=2.54, 95% CI=1.8-5.6), and having surgery (OR=3.5, 95% CI=2.0-7.3) increase the chance of insurance deduction significantly (p<0.05). Conclusion: Findings of this study showed that after HTP, insurance deductions were decreased significantly. The causes of this decline may be due to the range of services covered by public insurances, increase in insurance coverage, and improvement in health providers-insurance companies communication.

Patterns, perceptions and their association with changes in alcohol consumption in cancer survivors.

Continued consumption of alcohol after a cancer diagnosis is associated with poorer outcomes. We evaluated whether perceptions of the effects of continued alcohol use and receiving information on moderating alcohol reduced alcohol consumption in adult cancer survivors. A total of 509 cancer survivors were cross-sectionally surveyed at follow-up for their alcohol use before and after cancer diagnosis and perceptions of continued drinking. Multivariable logistic regression models evaluated factors associated with changes in alcohol consumption after diagnosis. Among 299 patients who were drinking alcohol at diagnosis (13% exceeding gender-specific guidelines), 52% reduced/ceased alcohol consumption 1 year after diagnosis. Patients perceiving that alcohol worsened their own (a) quality of life, (b) cancer-related fatigue or (c) overall survival were more likely (aORs = 2.43-3.35, p < 0.002) to reduce (moderating or quitting) their alcohol use 1 year after diagnosis. Only 14% of individuals currently drinking regularly recalled receiving information/counselling from healthcare providers on alcohol consumption (7% from oncologists). However, there was a significant fourfold to sixfold increase in cessation with such information/counselling (p < 0.01). Similar trends were observed in patients exceeding gender-specific guidelines. Perception of negative effects of alcohol use on their health by cancer survivors was associated with reducing harmful alcohol consumption. Counselling, especially from the oncologist, may play a significant role for reducing consumption.

Assessment of Oral Anticoagulant Use in Residents of Long-Term Care Homes: Evidence for Contemporary Suboptimal Use.

OBJECTIVE: To describe the quality of warfarin use in residents of long-term care facilities and investigate potential predictors oral anticoagulant use. DESIGN: Retrospective chart review (August 2013 to September 2014). SETTING: Thirteen long-term care (LTC) and assisted living facilities (ALF). PARTICIPANTS: Residents from LTC or ALF settings who ( a) received warfarin or direct-acting oral anticoagulants (DOACs) and ( b) residents with a valid indication for oral anticoagulants such as atrial fibrillation, venous thromboembolism, but were not receiving these drugs. PRIMARY OUTCOME: Time in therapeutic international normalized ratio (INR) range (TTR). RESULTS: A total of 563 residents (70% female) with an average age of 85 years were identified. Participants had an average of 7.5 comorbidities and 9 medications. A total of 391 (69%) residents with indications for OACs were receiving such medications. Indications were atrial fibrillation (63%), venous or pulmonary embolism (16%), cardiac valves (0.4%); 26% did not have documented indications. Warfarin and DOACs were prescribed for 213 (38%) and 178 (32%) respectively, and 172 (31%) received no OACs The TTR ranged from 56%-75% (mean 63%). The frequency of INR determinations ranged from every 7 to 20 days, (mean 13 days) with no apparent relationship between frequency of testing and TTR. CONCLUSION: The TTR was higher (63.8%) than literature average (50%), but remains suboptimal given expected benefits of TTRs >75% versus TTRs circa 60%. Documentation of indications for OACs needs improvement, and it is possible that OACs are underused. Further work is necessary to understand how OAC use may be optimized in these facilities.

T1 colorectal cancer management in the era of minimally invasive endoscopic resection.

T1 colorectal cancer (CRC), defined by tumor invasion confined to the submucosa, has historically been managed by surgery. Improved understanding of recurrence and lymph node metastases risk, coupled with advances in endoscopic resection techniques, have led to an increasing capacity for organ-sparing local excision. Minimally invasive management of T1 CRC begins with optical evaluation of the lesion to diagnose invasive disease and quantify depth of invasion, which informs therapeutic decision making. Modality selection between various available endoscopic resection techniques depends upon lesion characteristics, technique risk-benefit profiles, and location-specific implications. Following endoscopic resection, established histopathology features determine the risk of recurrence and subsequent management including surveillance or adjuvant surgical excision. The management of non-operative candidates deviates from conventional recommendations with emerging treatment strategies in select populations.

Chronic Disease Self-Management Among Iranian Older Adults: A Scoping Review.

Background: Implementing care models that emphasize chronic disease self-management (CDSM) strategies may be an effective approach to the growing prevalence of chronic conditions in Iran. We, therefore, conducted a scoping review on CDSM among older Iranians to identify existing gaps and opportunities to improve chronic disease care. Method: We conducted a search in CINAHL, EMBASE, MEDLINE/PubMed, and Cochrane library. Selected articles were charted based on year of publication, language, objectives, methods, target chronic disease(s), sample demographics, self-management type, and key findings. Results: We selected 73 articles. The main components of CDSM addressed were social support, education, physical activity, nutrition, self-monitoring, spirituality, and financial support. Older Iranians reported low levels of physical activity. Conclusion: Enhancing the quality of CDSM research and provision of coaching to enhance older adults' social and mental health are among the main strategies to enhance CDSM among the Iranian older population.

Applications of information and communications technologies to public health: A scoping review using the MeSH term: "public health informatics".

OBJECTIVE: To investigate the public health domains, key informatics concepts, and information and communications technologies (ICTs) applied in articles that are tagged with the MeSH term "public health informatics" and primarily focus on applying ICTs to public health. MATERIALS AND METHODS: The MeSH term "public health informatics" was searched on MEDLINE-PubMed. The results of the search were then screened in two steps in order to only include articles about applying ICTs to public health problems. First, articles were screened based on their titles and abstracts. Second, a full-text review was conducted to ensure the relevance of the included articles. All articles were charted based on public health domain, information technology, article type, and informatics concept. RESULTS: 515 articles were included. Communicable disease monitoring (N=235), public health policy and research (N=201), and public health awareness (N=85) constituted the majority of the articles. Inconsistent results were found regarding the validity of syndromic surveillance and the effectiveness of PHI integration within the healthcare systems. DISCUSSION: PHI articles with an ICT focus cover a wide range of themes. Collectively, the included articles emphasized the need for further research in interoperability, data quality, appropriate data sources, accessible health information, and communication. The limitations of the study include:1) only one database was searched; 2) by using MeSH tags as a selection criterion, PHI articles without the "public health informatics" MeSH term were excluded. CONCLUSION: Due to the multi-disciplinary nature of PHI, MeSH identifiers were not assigned consistently. Current MeSH-tagged articles indicate that a comprehensive approach is required to integrate PHI into the healthcare system.