Challenges and solutions for implementing telemedicine in Iran from health policymakers' perspective.

BACKGROUND: Despite significant progress in health technology and growing interest among countries in incorporating telemedicine into healthcare delivery, its usage remains limited in Iran. The aim of this study is to investigate the challenges related to telemedicine in Iran and pinpoint potential solutions from the viewpoint of health policymakers, marking the first such endeavor. METHODS: This qualitative study was conducted in Iran in 2022. Data were gathered from 19 health policymakers who were selected using purposeful and snowball sampling techniques via in-depth and semi-structured interviews. The research findings were analyzed using the content analysis technique, with coding performed using MAXQDA software. The content analysis approach developed by Erlingsson was utilized to analyze the data. RESULTS: The study revealed eight main challenges that inhibit the widespread use of telemedicine in Iran. These challenges include policy weaknesses, uncertainty around operating mechanisms, inadequate communication and telecommunication infrastructure, insufficient cultural infrastructure, lack of electronic requirements, redundant bureaucracies, legal gaps, and economic factors. Furthermore, four key solutions to these challenges were identified. These include a national commitment to the development of telemedicine, the establishment of a telemedicine roadmap, the enhancement of e-health requirements and infrastructure, and the preparation of the community to accept telemedicine as a viable option for healthcare delivery. CONCLUSION: The implementation of telemedicine in Iran faces significant challenges, some of which are related to the national healthcare system, while others stem from various policy-related institutions and organizations. Addressing these challenges will require extensive inter-organizational cooperation and strong leadership at the governance level. However, it should be noted that fully resolving these issues is a time-consuming process.

Identification of the factors affecting the referral system of veterans' health services: A scoping review.

Referral in the health system is a systematic process for the optimal allocation of resources and improves the access of people in need of treatment services. Considering the vulnerability of the veterans and more medical needs in this group, this study aims to identify the components that affect veterans' health services referral system. MEDLINE, Scopus, Web of Science, and ProQuest databases, the international military studies website, and key journals in the field of veterans' health services were searched with related keywords including "veteran," "referral system," and "health services" for the period from January 2000 to July 2022. Studies were screened and selected in accordance with the phases of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) flow diagram 2020. Data extraction was done by two researchers independently and a thematic content analysis method was used to analyze the findings. Among 40,608 studies searched electronically and 16 studies searched manually, 19 studies that met the inclusion criteria were selected. The research method applied here is a combination of quantitative, qualitative, and mixed methods. The most important findings were extracted from the included studies and analyzed in three general categories: components related to the patient, service provider, and the structural-operational mechanisms of the referral system. The effective performance of the referral system for providing health services to veterans is influenced by the factors affecting components related to the patient, the service provider, and the structural-operational mechanisms of the referral system. Evaluating and improving each of these factors improve the performance of the referral system and provision of health services to veterans.

Applying the Delphi Approach to Prioritize Social Factors Affecting the Development of Children Under Six Years.

BACKGROUND: Social determinants of health have a key role in the growth and development of children, particularly in early childhood which is mentioned from infancy to the age of six years old. These factors might cause disparities in living conditions and consequently bring about inequities regarding different aspects of development such as emotional, psychological, social, psychological, and intellectual. This research aimed to provide a model for prioritizing social factors affecting the development of children under six years. METHODS: We used quantitative-qualitative (mixed) method to perform data analysis. The statistical population included 12 medical experts and professionals in the field of children's development and social determinants of health that were selected using the snowball method. In the quantitative section, a Delphi technique was applied to screen the extracted indicators. Then through applying a decision-making trial and evaluation laboratory (DEMATEL) method, the cause-and-effect interactions among main social determinants were identified. To analyze data, super decision software was used. RESULTS: According to literature review and the results obtained from focus group discussions, five dimensions including individual factors, family factors, environmental factors, governance, and global factors were identified. Based on the study findings, the criterion of "family factors" was mentioned as the most important priority affecting childhood development. Furthermore, the sub-criterion of "International Programs and Policies" received the greatest priority among other sub-criteria with a profound impact on children's healthy growth and development. CONCLUSION: Despite the current knowledge about social determinants of health, it is required to identify the most influential socioeconomic factors on childhood development. In such a manner, political strategies for improving the health condition of children can be implemented based on scientific evidence. Due to the crucial role of family factors, environmental factors and other socio-economic conditions, health policy makers and public health practitioners should be informed of the importance of these factors in shaping the health condition of children.

The relationship between talent management and the efficiency of head nurses and senior and middle managers from the educational and medical centers in Tabriz, Iran - a case study.

Nowadays, organizations understand that they need the best talent to succeed in the complex world economy and survive in a competitive business environment. Therefore, talent management can ensure that each employee with a unique talent or ability will be placed in the correct position. This article aimed to study the relationship between talent management, senior and middle managers, and head nurses from educational health and research centers in Tabriz, in 2016. The target population included senior and middle managers and head nurses from Tabriz University of Medical Sciences, approximately 197 people. The sample for this study was selected based on Morgan's table, which rounds up to 123 people. The Kolmogorov-Smirnov test was used to analyze data, and if data were normal, correlation and regression analysis were performed. There was a significant relationship between talent management and the efficiency of senior and middle management and head nurses from the educational and medical centers in Tabriz. Therefore, when talent management increases, the efficiency level also rises to a noticeable degree. Also, the linear regression showed a linear relationship between talent management as an independent variable and efficiency as a dependent variable. Applying talent management strategies in the management selection process in organizations with demanding environments such as hospitals seems inevitable so that managers with the highest efficiency are hired.

Proposed Model of Management for Patients with Multi-Morbidity in Iranian Hospitals.

Background: Today, multi-morbidity (MM), the presence of more than one disease in the same person at the same time, has been prevalent. This is while the healthcare delivery systems are formed based on a single-disease-oriented approach. Hence, this study intended to address presenting a model for the management of patients with multi-morbidity in Iranian hospitals. Methods: This was a mixed-method study. The data was gathered from 54 semi-structured interviews with the participation of experts in inpatient care management who were purposefully selected. The qualitative data were analyzed using content analysis. The Interpretive Structural Modeling (ISM) via STATA and Excel software was exploited in the quantitative phase. Results: The factors affecting the management of patients with multi-morbidity were identified in 26 main themes and 142 sub-themes, and ultimately, a model for improving the management of patients with multi-morbidity in Iranian hospitals at six different levels was offered. The "Comprehensive Health Care Information System (CHIS) and Electronic Health Record (EHR)" had the greatest influence and the lowest dependency. "Efforts to remove patients' confusion" had the highest dependency and the lowest influence. The results of employing the Cross Impact Matrix Multiplication Applied to Classification (MICMAC) analysis demonstrated that most of the variables are placed in the third group of linkage variables that have high driving power and dependence power. Conclusion: Concerning the sophisticated needs of patients with multi-morbidity for the management of their clinical conditions, the presented model could be provided to policymakers and health care managers as a beneficial performance guideline for improving the quality of care.

Capability of Different Multi-Criteria Decision-Making Techniques in the Performance Assessment of the Hospitals in Terms of Medical Waste Management.

Background: Assessing the performance of hospitals in waste management requires considering several criteria of different types. The multiplicity of the criteria and how they are weighed and, ultimately, the ranking of hospitals; are among the most complex challenges faced by the environmental health authorities. This research tried to assess the capability of four commonly used multi-criteria decision-making methods, as well as a hybrid technique for performance assessment of six hospitals in Tehran City, Iran, in 2018 regarding waste management. Methods: The effective criteria and sub-criteria were identified by reviewing the relevant literature. The data collection tool was a self-constructed checklist developed based upon the identified criteria and sub-criteria and analysis of the collected data was done in MATLAB software. The sample hospitals were ranked based on the scores given to the management performance of hospitals. Results: The final rankings by the different techniques did not differ significantly. According to the results of the hybrid method, among six studied hospitals, the top three hospitals were Hospital C, B, and A respectively, regarding hospital waste reduction criteria. These hospitals generally had an acceptable performance in terms of waste management, especially waste disinfection and separation at the origin. Conclusion: In assessing the performance and ranking of hospitals in terms of waste management, hybrid multi-criteria decision-making techniques can be used as a useful tool in waste management planning. By identifying the areas in need of corrective actions and choosing the appropriate strategy, they pave the way for improving the performance of hospitals in the field of waste management.

Identifying the preparedness components in COVID-19: Systematic literature review.

In 2019, the COVID-19 pandemic posed a major challenge to the world. Since the world is constantly exposed to communicable diseases, comprehensive preparedness of countries is required. Therefore, the present systematic review is aimed at identifying the preparedness components in COVID-19. In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Science Direct, Iran Medex, Magiran, and Scientific Information Database were searched from 2019 to 2021 to identify preparedness components in COVID-19. Thematic content analysis method was employed for data analysis. Out of 11,126 journals retrieved from searches, 45 studies were included for data analysis. Based on the findings, the components of COVID-19 preparedness were identified and discussed in three categories: governance with three subcategories of characteristics, responsibilities, and rules and regulations; society with two subcategories of culture and resilience; and services with three subcategories of managed services, advanced technology, and prepared health services. Among these, the governance and its subcategories had the highest frequency in studies. Considering the need to prepare for the next pandemic, countries should create clear and coherent structures and responsibilities for crisis preparedness through legal mechanisms, strengthening the infrastructure of the health system, coordination between organizations through analysis and identification of stakeholders, culture building and attracting social participation, and service management for an effective response.

Health needs assessment of the residents of the informal settlements in South-Eastern Iran: A case study of Bam city.

BACKGROUND: Informal settlements are considered as one of the social problems in societies. As the residents do not have adequate access to basic services, including health services, their health is at risk. This study was conducted to evaluate the access to health services and determine the health needs of informal settlements in Bam city. MATERIALS AND METHODS: This cross-sectional study was carried out in the spring of 2020 in Bam. The sample size was 400 residents of informal settlements in Bam, and the multi-stage random cluster sampling was used. A researcher-made questionnaire was used to collect the required data. The validity of the questionnaire was confirmed using the content validity, and its reliability was 85% by Cronbach's alpha. The data were analyzed using the SPSS version 23 software and descriptive statistics (frequency, mean, standard deviation, and percentage) as well as analytical statistics (Mann-Whitney and Kruskal-Wallis tests). RESULTS: More than 50% of the individuals had good access to general practitioners and health centers. However, over 50% had poor access to dental, para-clinical, specialist, and hospital services. Furthermore, 49.3% of the people assessed their health status as poor in the previous year. A total of 46 items in the areas of communicable and non-communicable diseases, women's health, mental and social health and addiction, environmental health, etc., were identified as the most important health needs of the informal settlement residents. CONCLUSION: Informal settlements are facing various health problems including environmental health, mental and social health, and addiction, meeting which requires collaboration of all stakeholders as well as provision of a comprehensive program and appropriate service packages.

Impact of comorbidities on mortality in hospitalized patients with COVID-19: An experience from Iran.

BACKGROUND: COVID-19 pandemic has spread all over the world. However, information regarding clinical characteristics and prognostic factors is scarce. The aim of this study was to explore the impact of preexistent chronic comorbid conditions and multimorbidity on risk of mortality in patients with COVID-19. MATERIALS AND METHODS: We designed a retrospective, cross-sectional, observational, single-center study. Data were analyzed from all consecutive patients diagnosed with COVID-19 who admitted in a pandemic hospital affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from February 20, 2020, to September 25, 2020. The independent effects of preexistent conditions were evaluated using multivariate logistic regression model. RESULTS: A total of 2597 hospitalized patients with COVID-19 were included. At least one preexistent condition was observed in 36.5% of study population. Multivariate logistic regression analysis showed that older age, male sex, diabetes, cardiovascular disease, hypertension, cancer, chronic kidney diseases, liver diseases, and chronic obstructive pulmonary disease were associated with increased risk of mortality. In addition, the number of comorbidities was significantly associated with increased odds of mortality compared to no-comorbidity. CONCLUSION: The results of this study suggest that patients with comorbidities have an increased risk of in-hospital mortality following COVID-19 infection.

International Sanctions and the Procurement of Medical Equipment in Iran: A Qualitative Study.

Background: Despite regulations to facilitate the purchase of medical equipment, the process is now faced with severe challenges due to the sanctions. This study focuses on the effects of the international sanctions on the process of procuring capital medical equipment in the Iranian health system. Methods: A qualitative study using a content analysis approach was designed to investigate the effects of the international sanctions on capital medical equipment from January 2018 to June 2019. The data were gathered through 32 face-to-face, semi-structured interviews according to an interview guide. All the interviews were transcribed verbatim and analyzed accordingly. Thematic analysis with an inductive approach was employed for analyzing the data. Results: After a comprehensive analysis of open codes, two themes and 9 sub-themes were formulated. Based on our findings, the challenges facing the Iranian health sector during international sanctions included: "procurement of capital medical equipment" (with 6 sub-themes: Capital medical equipment suppliers, Monetary and interbank transactions, Suppliers and importers of the capital medical equipment, The process of procurement of capital medical equipment, Healthcare providers and Service receivers) and "repairing and after-sales services of capital medical equipment," (with 3 sub-themes: Software and spare parts dependent repair, Specialized human resources dependent repairing and after-sales services). Conclusion: Even though the sanction has made Iranian scientists and technicians capable of re-engineering and producing some of the medical equipment and accessories, the study confirms the adverse effects of sanctions on the quality and quantity of medical equipment procurement, hence, delivering adequate and on-time medical services. In many cases, for money transfer issues, international companies were not sure they could have their money back if they sold the facilities to Iran. Fear of losing the US market was the other main consideration for the international companies.

The interaction effect of sleep deprivation and cannabinoid type 1 receptor in the CA1 hippocampal region on passive avoidance memory, depressive-like behavior and locomotor activity in rats.

Increasing evidence shows the interaction effect of cannabinoids and sleep on cognitive functions. In the present study, we aimed to investigate the interaction effect of cannabinoids type 1 receptor (CB1r) in the CA1 hippocampal region and sleep deprivation (SD) on passive avoidance memory and depressive-like behavior in male Wistar rats. We used water box apparatus to induce total SD (TSD) for 24 h. The shuttle-box was applied to assess passive avoidance memory and locomotion apparatus was applied to assess locomotor activity. Forced swim test (FST) was used to evaluate rat's behavior. ACPA (CB1r agonist) at the doses of 0.01, 0.001 and 0.0001 µg/rat, and AM251 (CB1r antagonist) at the doses of 100, 10 and 1 ng/rat were injected intra-CA1, five minutes after training via stereotaxic surgery. Results showed SD impaired memory. ACPA at the doses of 0.01 and 0.001 µg/rat impaired memory and at all doses did not alter the effect of SD on memory. AM251 by itself did not alter memory, while at lowest dose (1 ng/rat) restored SD-induced memory deficit. Both drugs induced depressive-like behavior in a dose-dependent manner. Furthermore, both drugs decreased swimming at some doses (ACPA at 0.0001 µg/rat, AM251 at 0.001 and 0.01 ng/rat). Also, ACPA at the highest dose increased climbing of SD rats. In conclusion, we suggest CB1r may interact with the effect of SD on memory. Additionally, cannabinoids may show a dose-dependent manner in modulating mood and behavior. Interestingly, CB1r agonists and antagonists may exhibit a similar effect in some behavioral assessments.

The Related Factors of Nurses' Participation and Perceived Benefits and Barriers in Health Policy Making.

BACKGROUND: Nurses play a critical role in providing good health services. PURPOSE: The aim of this study was to examine the factors related to the participation of nurses in the provision of health services and the perceived benefits and barriers to their participation in health policy making. METHODS: A cross-sectional descriptive study was conducted in several hospitals affiliated with the Iran University of Medical Sciences during the first half of 2018 on a sample size of 220 people. A standard, self-management questionnaire was used to collect the data, and SPSS 21.0 software was used for data analysis. None of the demographic characteristics were found to be significantly associated with nurse participation in or the perceived barriers and benefits to health policy making. RESULTS: The results of this study show that the participants were involved only moderately in health policy making. "Providing written reports on problems or receiving consultation from a related official" was the performance item most frequently cited by the participants in terms of involvement, whereas "Disappointment in work procedures" was the most frequently cited barrier item affecting involvement. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Despite the importance of the nursing role in health polices, this study indicates that nurses participate at only a moderate level in health policy-making activities. Providing more information to nurses regarding health policies, enhancing nurses' image of their job and their perceptions about the importance of their participation in the health policy, increasing partnerships with nurses at the upper levels of health services management, and supporting nursing professional organizations in the field of health policy are potential strategies for encouraging greater nursing participation in health policy making.

Barriers to healthcare delivery in Iranian prisons: a qualitative study.

PURPOSE: High quality health-care delivery is not only the governments' responsibility but also every prisoner's right. Health care in prison and, particularly, of Iranian prisoners is increasingly important topic because of the rising number of the prison population. This paper aims to explore health-care managers' perspectives and experiences of prisons and the barriers to health-care delivery in Iranian prisons. DESIGN/METHODOLOGY/APPROACH: A qualitative research design was conducted in Iran from October 2018 to August 2019. The participants consisted of 51 health-care managers (50 men and one woman) from Iranian prisons. A combination of face-to-face (N = 42) and telephonic (N = 9) semi-structured interviews were used because of the geographical distribution of the respondents. The first part of the interview guide consisted of demographic characteristics, and the second part consisted of three main open ended-questions. Interviews were recorded and transcribed, and thematic descriptive analysis was used to interpret the data. FINDINGS: The barriers to health-care delivery in Iranian prisons were categorized into four main topics: human resources, financing, facilities and barriers related to the health-care delivery process. Data synthesis identified the following themes for barriers to human resources: barriers to human resources planning (with eight sub-themes); barriers to education (with three sub-themes); and motivational barriers (with seven sub-themes). Moreover, barriers to financing consisted of five sub-themes. The barriers to facilities consisted of barriers related to physical infrastructures (with two sub-themes) and barriers related to equipment (with six sub-themes). Finally, barriers to the health-care delivery process included the following themes: communication barriers (with six sub-themes); legal barriers (with five sub-themes); and environmental-demographic factors (with seven sub-themes). ORIGINALITY/VALUE: Identifying the barriers to health-care delivery in Iranian prisons plays a critical role in the improvement of planning, decision-making and the health-care delivery process.

Confirmatory factor analysis model of factors affecting the implementation of clinical guidelines in Iran.

Background: Clinical guidelines refer to a developed scientific statement to help physicians and patients for decision-making about the best care for special clinical conditions, which can be an important document to shape evidence-based medicine. This study aimed to identify factors affecting the implementation of clinical guidelines in Iran to enhance the quality of services. Methods: This descriptive analytical study was performed with combined quantitative-qualitative method in the first half of 2019. The statistical population consisted of 400 health managers and experts who were selected through multistage sampling method in 5 regions of Iran (north, south, center, east, and west). Overall, 20 academic experts were selected from each university. For data collection, a researcher-made questionnaire (n = 400) was used. To measure face and content validity, content validity ratio (CVR) and content validity index (CVI) were used. Also, to determine reliability, test-retest method, with Cronbach's alpha coefficient of 0.934 was used. For data analysis, Lisrel 8.8 and SPSS 24 were used. Finally, fitness indices were used to determine the fitness of the model. Results: Six factors, including organizational (9 components), organizational culture (8 components), the clinical guidelines feature (8 components), insurance (7 components), and trusteeship of the health care system (8 components) were identified as the main dimensions. The economic dimension had the maximum effect on implementing clinical guidelines (0.90), while the clinical guidelines feature (0.63) and organizational culture (0.63) showed the minimum extent of effect on implementing clinical guidelines. Conclusion: Evidently, imposing the mentioned interventions with the ultimate goal of sustainable behavior change in providing health care services requires contribution of all practitioners, presentation of suitable facilities for implementing clinical guidelines based on evidence, time and personnel management, training methodology and planning, developing the necessary infrastructure, supervision, and developing professional and legal motivation.

Designing and validating a measuring tool for the factors affecting the distribution of hospitals' intensive care beds in Iran.

Background: Hospital services are the most expensive medical service in modern health care systems. Intense care beds, in particular, are more important. The present study was conducted to design and validate a measuring tool for the factors affecting the distribution of hospitals' intensive care beds in Iran. Methods: In this mixed method study, first, all known factors affecting the distribution of hospitals' intensive care beds were extracted by reviewing related literature. Then, all 60 confirmed items were categorized into different dimensions. Face validity and content validity of the questionnaire was done by 20 medical experts through qualitative and quantitative methods. Validity and reliability indices, content validity index (CVI), content validity ratio (CVR), and Cronbach's alpha were measured. SPSS software were used for data analysis and significance level was set at less than .05. Results: From the 60 suggested items, 34 were confirmed by the expert panels and all items had CVR and CVI scores higher than 0.83 and 0.81, respectively. CVR and CVI for all 34 items were 0.88 and 0.89, respectively. Also, Cronbach's alpha coefficient (0.75) indicated a suitable internal consistency. The value of S-CVI / Ave was also calculated to be 0.92. Conclusion: In this study, a valid tool was designed to identify the factors affecting the distribution of hospitals' intensive care beds. This tool consists of 6 dimensions: demographic, geographic, economic, sociopolitical, organizational, and constructional.

Inequality in distribution of burn facilities in Iran.

Background: Inequality in the distribution of medical equipment and facilities has mainly been observed in health centers and, particularly, in governmental hospitals in each country. This study aimed to assess inequality in the distribution of burn facilities in Iran, including burn beds and specialist physicians needed for burn patients in 2017. Methods: This was a descriptive-analytic study, in which statistical records of the Ministry of Health and Medical Education for 2017 and the Population and Housing Report of 2016 of the Statistical Centre of Iran were used. The main variables studied were number of burn beds and number of general surgeons and plastic surgeons in medical universities in the provinces of Iran. Inequality in the distribution of these variables was evaluated using the Gini coefficient and the Lorenz curve. Excel 2010 software was used for data analysis. Results: In 55% of the provinces, the number of beds per capita for 100 000 population was lower than the average of Iran (1.26 beds of burn ward), and in 45% of the provinces, it was higher than the average of Iran in terms of this index. The results showed that burn beds were distributed unevenly in medical universities (G=0.42). However, the provincial distribution of these beds had a favorable condition (G=0.21). Also, the numerical value of the Gini coefficient showed the alert status in the distribution of specialist physicians based on the university distribution (G=0.51). Conclusion: Although solving the problems related to equality in the distribution of health resources is not an easy task, assessing this issue has a great impact on improving the policymaking procedures and allocating the health system resources. For the first time, this study presented some policies to avoid centralization and prevent some metropolitan cities from turning into cities with limited burn facilities through a comprehensive reviewing of the distribution of the main sources needed by the Iranian burn patients.

Accreditation in one teaching hospital: a phenomenology study among Iranian nurses.

PURPOSE: Accreditation helps to ensure safe and high-quality services in hospitals. Different occupational groups have various hospital accreditation experiences. The purpose of this paper is to investigate nurses' accreditation experience and its effects on Iranian teaching hospital service quality. DESIGN/METHODOLOGY/APPROACH: This was a qualitative study involving a phenomenological approach to studying nurses' hospital accreditation experience and understanding the effects on Iranian teaching hospital service quality. Data were collected using two focus groups in which nurses were selected using purposive sampling. Transcripts were analyzed using content analysis. FINDINGS: Nurses' experiences showed that hospital administrators and nurses had greater role in implementing accreditation than other occupational groups. Accreditation improved patient-centeredness, patient safety, logistics and managerial processes and decision making. However, a weak incentive system, extra documentation and work stress were negative experiences. PRACTICAL IMPLICATIONS: Nurse experience, as the most important care team member, reveals accreditation's strengths and weaknesses and its effects on service quality. ORIGINALITY/VALUE: The author used a phenomenology approach to measure accreditation effects on service quality - a valuable tool for understanding a phenomenon among those that experience hospital accreditation processes.

Factors Affecting the Location of Road Emergency Bases in Iran Using Analytical Hierarchy Process (AHP).

OBJECTIVE: To identify and prioritize factors affecting the location of road emergency bases in Iran using Analytical Hierarchy Process (AHP). METHODS: This was a mixed method (quantitative-qualitative) study conducted in 2016. The participants in this study included the professionals and experts in the field of pre-hospital and road emergency services issues working in the Health Deputy of Iran Ministry of Health and Medical Education, which were selected using purposive sampling method. In this study at first, the factors affecting the location of road emergency bases in Iran were identified using literature review and conducting interviews with the experts. Then, the identified factors were scored and prioritized using the studied professionals and experts' viewpoints through using the analytic hierarchy process (AHP) technique and its related pair-wise questionnaire. The collected data were analyzed using MAXQDA 10.0 software to analyze the answers given to the open question and Expert Choice 10.0 software to determine the weights and priorities of the identified factors. RESULTS: The results showed that eight factors were effective in locating the road emergency bases in Iran from the viewpoints of the studied professionals and experts in the field of pre-hospital and road emergency services issues, including respectively distance from the next base, region population, topography and geographical situation of the region, the volume of road traffic, the existence of amenities such as water, electricity, gas, etc. and proximity to the village, accident-prone sites, University ownership of the base site, and proximity to toll-house. CONCLUSION: Among the eight factors which were effective in locating the road emergency bases from the studied professionals and experts' perspectives, "distance from the next base" and "region population" were respectively the most important ones which had great differences with other factors.

Factors contributing towards patient's choice of a hospital clinic from the patients' and managers' perspective.

INTRODUCTION: Given the competitive nature of the health market and the multiplicity of factors that may contribute towards patient's choices of a hospital, patients' needs and preferences for a hospital must be considered in the planning and decision making of hospitals and health care organizations. This study aimed to identify the factors that contribute to patient's choices of a clinic and the importance of each factor. METHODS: A mixed-method approach was used to collect quantitative and qualitative data in two phases. The study was conducted in a hospital clinic in 2014. Qualitative data were collected by face-to-face semi-structured interviews of a sample of 22 managers and heads of outpatient wards. The self-administered questionnaire designed for this study collected quantitative data from a stratified random sample of 381 patients referred to this clinic. The qualitative data were analyzed by a system of coding, while parametrical statistical analyses were conducted to analyze the quantitative data using the independent-samples t-test and ANOVA in SPSS software, version 21.0. RESULTS: The qualitative data indicated that there were 21 factors that may contribute to patient's choices of a clinic, and these factors were classified into six categories, i.e., facilities and physical assets, physicians and employees, location and place, services, price, and promotion. Among the 16 questions studied in the quantitative questionnaire, the highest and lowest means were related to "appropriate clinic environment" (2.47 ± 0.58) and "advertising through TV and radio, the Internet, newspapers, etc." (1.77 ± 0.75), respectively. There were significant associations between "having experienced and responsive personnel, including physicians and employees" and the patient's gender and frequency of referrals, between "belonging to the Armed Forces" and the patient's age and frequency of referrals, between "advertising through TV and radio, the Internet, newspapers, etc." and shifts and frequency of referrals, between "inadequate facilities and poor quality of services provided in other health care organizations of the Armed Forces" and "adornment and good behavior of staff" and shifts (p < 0.05). CONCLUSION: The most significant contributing factors to attract patients were the "physicians and employees," and "the clinic's environment." Therefore, it is essential for clinic managers and heads of outpatient wards to focus on and strengthen these two factors. Also, since the means of the factors were better in the morning shift, the employees should perform their duties properly and consistently in all shifts.