What is the mind map of the hospital's future changes in a developing country like Iran? A qualitative study.

BACKGROUND: Hospitals have a vital role in the future of health systems with upcoming structure, resources, and process changes. Identifying the potential aspects of change helps managers proactively approach them, use the opportunities, and avoid threats. This study presents a mind map of future changes in Iranian hospitals to develop a base for further related studies or prepare evidence for interventions and future-related decisions. METHODS: This study is a qualitative-exploratory one, conducted in two phases. In the first phase, in-depth and semi-structured interviews were conducted to identify future hospital changes over 15 years. The interviews were analyzed using the content analysis method and MAXQDA 2018 software and holding two expert panels to develop the mind map using the 2016 Visio software. RESULTS: In the first phase, 33 interviews led to 144 change patterns. In the second phase, a mind map of changes was drawn according to experts' opinions with ten categories: structure and role, knowledge management and research, service delivery, health forces, political and legal, economic, demographic and disease, technological, and values and philosophy, and environmental. CONCLUSIONS: Many changes affecting hospitals rooted in the past continue to the future, but the point is the increasing intensity and speed of changes. Healthcare systems need a systematic approach to monitoring the environment to be updated, agile and proactive. These monitoring systems are essential in providing evidence for Macro-level decision-makers.

What Do Future Trends in Medical Education Mean to the Scientific Development of Iran's Health System?

Background: Medical education system in Iran has an essential role in responding to scientific development targets from both education and research perspectives. Investigating future trends and analyzing how they interact with the medical education system helps increase awareness and give insight into the preferred future. Methods: The present qualitative study consists of Systematic reviews and interviews that have been analyzed using content analysis. Afterward, the themes and codes were visualized in the form of maps and presented in a focus group discussion of experts to define how medical education trends will impact scientific development. Results: The future trends of Iran's medical education system were classified into six groups: workplace changes, demographic changes, changes in concepts, the emergence of new players, structural changes in universities, and technology development. The next point is how they will influence science development. Their impact on science development is classified into five main groups or main streams of change of new financial models, open science, redesigning the research management, the role of universities, and capacity building. Conclusion: Our findings showed that redesigning the structure of medical education is the most important priority to make the system as agile as needed to capture the signs and act. New meanings and concepts should also be considered in restructuring, like power balance, competency-based and personalized education, cost-effectiveness, and openness.

What the policy and stewardship landscape of a national health research system looks like in a developing country like Iran: a qualitative study.

BACKGROUND: The health research system (HRS) is an important national priority that requires a systematic and functional approach. Evaluating the HRS of Iran as a developing country and identifying its challenges reveals the stewardship-related role in how the whole system is operating well. This study aims to assess the HRS in terms of stewardship functions and highlight the enhancement points. METHODS: This study was carried out between March 2020 and April 2021 using a systematic review and meta-synthesis of evidence to examine the Iranian HRS stewardship challenges and interview 32 stakeholders, using a critical case sampling and snowballing approach which included both semi-structured and in-depth interviews. The interviewees were selected based on criteria covering policy-makers, managers, research bodies and nongovernmental organizations (NGOs) in health research-related fields like higher education, research, technology, innovation and science. All data were analysed using content analysis to determine eight main groups of findings under three levels: macro, meso, and micro. RESULTS: Analysis of the findings identified eight main themes. The most critical challenges were the lack of an integrated leadership model and a shared vision among different HRS stakeholders. Their scope and activities were often contradictory, and their role was not clarified in a predetermined big picture. The other challenges were legislation, priority-setting, monitoring and evaluation, networking, and using evidence as a decision support base. CONCLUSIONS: Stewardship functions are not appropriately performed and are considered the root causes of many other HRS challenges in Iran. Formulating a clear shared vision and a work scope for HRS actors is critical, along with integrating all efforts towards a unified strategy that assists in addressing many challenges of HRS, including developing strategic plans and future-oriented and systematic research, and evaluating performance. Policy-makers and senior managers need to embrace and use evidence, and effective networking and communication mechanisms among stakeholders need to be enhanced. An effective HRS can be achieved by redesigning the processes, regulations and rules to promote transparency and accountability within a well-organized and systematic framework.

Insurance and Improving Its Strategic Purchase in Iran.

As in most countries, patients, health care providers, and insurance organizations are key components of the health care system in Iran. High rates of growth and development in today's financial markets, have made the insurance industry with its unique calculations and models, a prominent player in this specialized economic sector.

Underlying factors and challenges of implementing the urban family physician program in Iran.

BACKGROUND: The family physician program was launched in 2005 in rural areas of Iran and then piloted in 2012 in the cities of Fars and Mazandaran provinces due to insufficient health coverage in these cities. However, despite its pivotal role in the health system, this program has not progressed according to the policies. This study aimed to explain the underlying factors and challenges of implementing the urban family physician program in Iran. METHODS: This qualitative study was conducted on 44 policy-makers and managers at national and provincial levels selected via snowball and purposive sampling with maximum variation. The data were managed in MAXQDA 2020 and analyzed by directed content analysis. A triangulation method was adopted for this purpose. RESULTS: A total of 10 categories, 18 sub-categories, and 29 codes were formed. Most challenges related to underlying factors included precipitancy, economic sanctions, belief in traditional medicine, belief in the expertise of previous physicians, and global ranking of countries. For program implementation, most challenges included a diversity of insurance organizations, budget allocation, referral system, electronic file, educational system, and culture building. CONCLUSIONS: The major challenges pertaining to underlying factors included international pressure for reforms and precipitancy in program implementation due to management changes. The challenges associated with program implementation included budget provision and interaction with insurance organizations. Therefore, to expand this program to other provinces in Iran, the identified factors should be carefully considered so that sufficient confidence and commitment can be guaranteed for all stakeholders.

Health service delivery models for elderly people: A systematic review.

Background: Current Health care delivery systems are not effective for the elderly. Countries with high elderly populations are expected to design special models to serve their elderly population. The aim of this study is to investigate the models of health care delivery to the elderly in different countries. Methods: The present study is a systematic review based on PRISMA standard guidelines. The search for related studies was conducted in electronic databases (Cochran Library, Scopus, PubMed, Embase, Web of Science) and the Google Scholar search engine without time limits until May 2019. Keywords were extracted based on MeSH strategies. At first, 16243 articles were found. After the screening phase (elimination of duplicated articles, title screening, abstract screening, and full-text screening) 19 articles remained. Two articles deleted after text appraisal using the CASP checklist. In the next stage, after reviewing the gray literature and reviewing the references of remaining articles, three new articles were added (Included studies = 20). Results: Twenty articles (models) corresponding to the study objectives were finally extracted. These models are limited to nine countries and most have local scopes. These models mainly use a case manager, an intra- or inter-disciplinary team, and an elderly assessment tool in their structure. In addition to the use of an information system, these models provide a wide range of services to the elderly. Conclusion: Most of the models mentioned are local models. Smaller models to become applicable at the national level, they need to be reviewed and evaluated by policymakers and experts. Given the inefficiency of current systems in providing services to the elderly, it is recommended that countries use an integrated model of health care provision for the elderly.

Influential factors of out of pocket payments for health care in Iran: A foresight approach using the cross impact analysis.

OBJECTIVE: To identify and explain the interactions and network of the relationship between influential factors of out-ofpocket payments for health services. METHODS: This futures study was conducted in 2015 in Iran, and comprised experts of various sectors. At first, key factors and driven forces of out-of-pocket payments were detected; then, the factors were collected in the form of a square-matrix questionnaire; and completed based on impact of each factor on the occurrence probability of others, with collective agreement, so the role of any factor in forecasting out-of-pocket status in future was identified by cross-impact analysis. MicMac software was used for data analysis. RESULTS: As many as 35 factors were identified which affected out-of pocket payments. The factors were categorised in four main roles, i.e. influencing, two-sided, dependent and independent. Some economic factors which had a higher impact on other system factors were influencing factors; they were the most critical components because the system changes were dependent on them. In contrast, some factors related to organising the health system were depending factors and were affected by the least changes in other factors. There are 10 factors in this group. These factors were mainly related to the utilisation of health services by a special look to the part of delivery (public or private). CONCLUSIONS: Policymakers should consider interactions and influencing network of out-of-pocket payment factors and should understand how a change in one factor can have a series of changes.

How do primary care providers work together in the Iranian PHC system?

Background: Providing coordinated services and forming appropriate cooperation among the members of the health team have a significant impact on other aspects of service provision, including accessibility and continuity of services. Methods: In this study information was obtained from a national study titled, "Evaluation of Primary Health Care in Iran", and framework analysis was conducted from the perspective of interprofessional cooperation status using the Amour model based on 5 underlying concepts of sharing, partnership, power, interdependency, and process. This is a mixed-method study of the transformative sequential type. In this study triangulation method was used, and data were collected by the Primary Care Evaluation Tool (PCET), interviewing experts and executive directors, and systematic review of the Primary Health Care (PHC) challenges in Iran. Results: The challenges of the PHC system in Iran are analyzed for providing coordinated care in the form of multidisciplinary teamwork based on the Amour model. The corresponding solutions for improving challenges of the concept are also presented. Conclusion: Based on the findings of this study the followings are suggested: sharing a collective specialized outlook; designing an integrated information system; improving the educational system through providing on-the-need academic education; strengthening the cooperation of community representatives and people's trustees in providing care; developing interdepartmental partnerships with related organizations with collective interests; moderating the workload of human resources; using electronic health records and automated referral of individuals in addition to appropriate training and promoting the culture from the existing philosophy of primary health care; highlighting the role of service providers as members of the care team; eliminating factors causing instability of suppliers, plans, and programs; and stability in the management approach despite changes in senior management.

Effective factors and drivers of Iran's health care financing system.

Background: Different factors affect Iran's health care financing system, and regardless of this impact, the future of this system will face fundamental challenges. In this environment, a health system is successful if it is able to anticipate the effects of these factors in the future of health care financing and preplan appropriate interventions towards health care financing system. The present study aims to identify these factors and trends. Methods: This study compiled a round view of the experts on the subject, with a future studies approach through a qualitative method. To collect data, a deep and semi-structured interview was performed. The results of the interviews were analyzed using content analysis method, and the primary and secondary themes were extracted using the Micmac software. Results: A total of 71 variables were identified in the form of 12 groups with titles of stewardship, service provision, resource gathering, purchasing and resource allocation, sociocultural, technological, environmental, economic, political, and managerial, and laws and values. Four variables, including distant-service provision, administrative bureaucracy, administrative focus and corruption, low-support decision-making, economic blockade, and sales of oil were among the influential factors and drivers. Conclusion: The findings showed Iran's financing system is relatively stable but fragile and 3 areas of technology, politics, and economics have the most impact on structuring Iran's financing system.

Challenges of implementation: Strategic purchasing in Iran Health Insurance Organization.

BACKGROUND: Strategic purchasing has been introduced as a key strategy for solving the problems faced by insurance companies. In Iran, the government has mandated the Iran Health Insurance Organization (IHIO) to implement this strategy. However, there are serious challenges to achieving that. The present study aims to identify these challenges. METHODS: In this qualitative study, a semi-structured interview was conducted on 27 health managers and experts at the national level. The dimensions of the A. Preker model were used to analyze the data. RESULTS: Challenges of strategic purchasing in the IHIO were categorized into five concepts-political economy, policy design, organizational structure, organizational environment, and management capacity; within these concepts, 22 challenges were identified. CONCLUSIONS: Improving strategic purchasing in Iran requires adopting a coherent approach and taking into account all the affecting factors. By revising some policies, and modifying and defining the rules needed to solve the infrastructural problems, the success of strategic purchasing can be obtained.

Iran's international collaborative articles in medical sciences.

Background: Forecasting is the process of predicting future behavior. In reviewing databases, no predicted value associated with international collaboration publications in Iran was found. Thus, the present study aimed at forecasting Iran's international collaborative articles in medical sciences. Methods: The number of Iran's articles and international collaborative articles in medical sciences written over 56 years was extracted from SCOPUS. Data were extracted from 1960 up to 2016. The time series method was used for forecasting using the Minitab software Version 17. Results: There was no increase in the number of medical articles from Iran from 1960 to 2001. However, the data showed incremental growth between 2001 and 2016. This was similar to Iran's medical sciences international collaboration articles. In 2016, the percentage of Iran's international collaboration articles was 15.2, which is expected to reach 19.9 in 2025. Conclusion: An investigation was performed on the number of international collaboration articles in the field of medical sciences in Iran. Future trends show an incremental growth. The number of Iran's articles can be increased with international cooperation. However, an increase or decrease in Iran's articles without international cooperation has to be investigated.

Forecasting health expenditures in Iran using the ARIMA model (2016-2020).

Background: Accurate economic forecast has important effects on governmental policy and economic planning, and it can help policymakers to make decisions for future and create new infrastructures for the development of new forecasting methods. This study calculated total health expenditure, public health expenditure and out of pocket (OOP) payment for 2016-2020. Methods: Autoregressive Integrated Moving Average Process (ARIMA) is one of the most important forecasting models. In this study, five-year values were forecasted using EViews8 software according to health expenditures in Iran from 1971 to 2015. Results: Applying annual data for total health expenditure, resulted in the ARIMA (1,1,1) model being the most appropriate to predict these costs. The results of this study indicate that total health expenditures will reach from about 1228338 billion IRR in 2016 to 2698346 billion IRR in 2020 and the amount of out of pocket (OOP) will become more than 41% of total health expenditure in 2020. Conclusion: Total health expenditures in 2020 will become more than two halves in 2016. These expenditures indicated there is a need for continued governmental support of this sector during the upcoming years.

Chlorpromazine versus piperacetazine for schizophrenia.

BACKGROUND: Schizophrenia is a severe mental disorder with a prevalence of about 1% among the general population. It is listed among the top 10 causes of disability-adjusted life years (DALYs) worldwide. Antipsychotics are the mainstay treatment. Piperacetazine has been reported to be as clinically effective as chlorpromazine, a well established 'benchmark' antipsychotic, for people with schizophrenia. However, the side effect profiles of these antipsychotics differ and it is important that an evidence base is available comparing the benefits, and potential harms of these two antipsychotics. OBJECTIVES: To assess the clinical and side effects of chlorpromazine for people with schizophrenia and schizophrenia-like psychoses in comparison with piperacetazine. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Trials Register (6 June 2015 and 8 October 2018) which is based on regular searches of CINAHL, CENTRAL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and registries of clinical trials. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA: We included randomised controlled trials (RCTs) focusing on chlorpromazine versus piperacetazine for people with schizophrenia, reporting useable data. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS: We found 12 records referring to six trials. We included five trials, all from the 1970s, randomising 343 participants. We excluded one trial. The overall methodology and data reporting by the trials was poor. Only short-term data were available.Results from the included trials found that, in terms of global state improvement, when rated by a psychiatrist, there was no clear difference between chlorpromazine and piperacetazine (RR 0.90, 95% CI 0.80 to 1.02; participants = 208; studies = 2; very low-quality evidence). One trial reported change scores on the mental state scale Brief Psychiatric Rating Scale (BPRS); no clear difference was observed (MD -0.40, 95% CI -1.41 to 0.61; participants = 182; studies = 1; very low-quality evidence). Chlorpromazine appears no worse or better than piperacetazine regarding adverse effects. In both treatment groups, around 60% of participants experienced some sort of adverse effect (RR 1.00, 95% CI 0.75 to 1.33; participants = 74; studies = 3; very low-quality evidence), with approximately 40% of these participants experiencing some parkinsonism-type movement disorder (RR 0.95, CI 0.61 to 1.49; participants = 106; studies = 3; very low-quality evidence). No clear difference in numbers of participants leaving the study early for any reason was observed (RR 0.50, 95% CI 0.10 to 2.56; participants = 256; studies = 4; very low-quality evidence). No trial reported data for change in negative symptoms or economic costs. AUTHORS' CONCLUSIONS: The results of this review show chlorpromazine and piperacetazine may have similar clinical efficacy, but data are based on very small numbers of participants and the evidence is very low quality. We can not make firm conclusions based on such data. Currently, should clinicians and people with schizophrenia need to choose between chlorpromazine and piperacetazine they should be aware there is no good quality evidence to base decisions. More high quality research is needed.

Population and mortality profile in the Islamic Republic of Iran, 2006-2035.

BACKGROUND: The Islamic Republic of Iran has encountered demographic and epidemiological changes as a result of the transformation of health measures. AIMS: This study aimed to calculate the population and mortality in the Islamic Republic of Iran during the years 2006 to 2035. METHODS: We carried out a cross-sectional analytical-descriptive account. We calculated the age and sex structure of the Iranian population using census data as well as mathematical methods. The crude and causal death rates were calculated and their 20-year trend was predicted using the Lee-Carter model. RESULTS: In 2035, the age group 60 years and over will reach 17.6% of the total population. Endocrine, nutritional and metabolic diseases will be the biggest causes of an increase in the rate of death in the general population. The largest decline in cause of death is for unintentional injuries. CONCLUSIONS: Noncommunicable diseases will increase as the aging population grows. Identification of their primary causal and risk factors can, therefore, contribute to prevention and control.

A Successful implementation of an idea to a nationally approved plan: Analyzing Iran's National Health Roadmap using the Kingdon model of policymaking.

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts' viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran's health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.

Foresight in health sciences using CLA method.

Background: Development in health is not possible without progress of science. Rapid changes in the various areas make the future health system more complex and risky. Therefore, foresight of health sciences is very important. Methods: This futures studies was conducted in 4 steps; also, literature and documents review, statistics and information review, focus group discussions, working group, and scenario planning were used. Cause level analysis was used for data analysis and syntactic as main frameworks. Results: The findings in legal health sciences documents revealed that the value system was not defined clearly and coherently and that logical linkage among myths, discourse, and social structural layers was ambiguous. In trend analysis, 24 trends were recognized; however, political and economic streams were strong, independent, and uncertain factors which created 4 main scenarios although the social and environmental factors divided them into 16 subscenario tunnels. Postmodern discourse in probability scenarios will be dominant and science will be understood as tools for generation of wealth. University structure will be decentralized and transformed into similar R&D to join the health industry, and our quantitative growth (articles, disciplines, and students) in health sciences will decrease. Conclusion: If the current trends (probability scenarios) continue, we will move to an undesirable situation. The main challenge in this regard is the lack of a unique and dominant discourse in health sciences based on the Islamic Republic of Iran doctrine. Therefore, in this study, shifting the paradigm by a new approach and discipline in the health sciences is suggested.

Appropriate types of futures studies scenarios in health.

Background: Scenario is the primary method in futures studies, and thus its improper use can undermine the credibility and claims of the results. There are many scenario types, and here we aimed at understanding whether these scenarios are being used properly in the health field. Methods: In this study, a combination method was used in 3 phases, and 8 + 2 steps were considered to accommodate the needs of the health sector with capabilities of the main types of scenarios. One of the appropriate methods of futures studies was used at each step. Results: Scenario planning has evolved along with futures studies paradigms. Trend-based scenarios, intuitive logic, and structural analysis approaches have had the most use in futures scenarios and health section. Quantitative techniques, which are close to the positivist paradigm, have been most widely used; however, participatory methods of futures studies paradigm have been used the least in the health sector. Conclusions: Health scenario writing in its current state is targeting short- to medium- term futures and does not respond to all requirements. Thus, other backup methods should also be considered.

Health technology assessment on super oxidized water for treatment of chronic wounds.

BACKGROUND: Super oxidized water (SOW), as a novel antiseptic solution, is used with claims of effectiveness and cost effectiveness in healing chronic wounds such as diabetic foot, infectious postoperative ulcers and burn ulcers. We conducted a health technology assessment to evaluate the clinical evidence from clinical and randomized trials for this disinfection. This study aims to evaluate the safety, effectiveness and cost-effectiveness of this technology in Iran, for using as a wound disinfectant. METHODS: Systematic literature searches were conducted from October 2013 to March 2014 for the following medical databases: OVID MEDLINE, CINAHL, the Cochrane Library and the PICO terms were included and then analyzed by Cochrane assessment criteria. RESULTS: Out of 705 articles, twelve potentially relevant trials were identified. Others that didn't come with the PICO criteria were excluded. 5 randomized controlled trials, 5 clinical trials, a rapid HTA and a case series that had studied the effectiveness of super oxidized water on patients with different chronic wounds, were included. Most of these trials were assessing similar sets of outcomes as the Safety and Effect on Healing days to re-epithelization, healing rate, effect on Infection bacterial counts and infection rates. CONCLUSION: Super oxidized water is a safe, effective and cost effective irrigation and cleansing agent due to the performed analysis in comparison with current treatment as povidone iodine for treating wound infections.

Health technology assessment: Off-site sterilization.

BACKGROUND: Every year millions of dollars are expended to equip and maintain the hospital sterilization centers, and our country is not an exception of this matter. According to this, it is important to use more effective technologies and methods in health system in order to reach more effectiveness and saving in costs. This study was conducted with the aim of evaluating the technology of regional sterilization centers. METHODS: This study was done in four steps. At the first step, safety and effectiveness of technology was studied via systematic study of evidence. The next step was done to evaluate the economical aspect of off-site sterilization technology using gathered data from systematic review of the texts which were related to the technology and costs of off-site and in-site hospital sterilization. Third step was conducted to collect experiences of using technology in some selected hospitals around the world. And in the last step different aspects of acceptance and use of this technology in Iran were evaluated. RESULTS: Review of the selected articles indicated that efficacy and effectiveness of this technology is Confirmed. The results also showed that using this method is not economical in Iran. CONCLUSION: According to the revealed evidences and also cost analysis, due to shortage of necessary substructures and economical aspect, installing the off-site sterilization health technology in hospitals is not possible currently. But this method can be used to provide sterilization services for clinics and outpatients centers.

Urban family physician plan in Iran: challenges of implementation in Kerman.

BACKGROUND: The Family Physician Plan has recently been implemented in three provinces of Iran on a pilot basis and is going to be implemented throughout Iran in the future. Through a qualitative design, this study aims to determine probable implementation challenges of Family Physician Plan in Kerman. METHODS: This study was conducted in Kerman in 2013. Data were collected through interviews with 21 experts in the field. Sampling continued until data saturation level was achieved. All interviews were recorded and then analyzed, and main themes and subgroups were extracted from them based on a framework analysis model. RESULTS: most prevalent establishment challenges of Family Physician Plan were classified into policy-making, financial supply, laws and resources. CONCLUSION: The urban Family Physician Plan can be carried out more effectively by implementing this plan step by step, highlighting the relationships between the related organizations, using new payment mechanisms e.g Per Capita, DRG, make national commitment and proper educational programs for providers, development the health electronic Record, justifying providers and community about advantages of this plan, clarifying regulatory status about providers' Duties and most importantly considering a specific funding source.