Three Decades of Healthcare System Reform in Iran from the Perspective of Universal Health Coverage: A Macro-Qualitative Study.

Background: The healthcare system in Iran has undergone several reforms to achieve the objectives of universal health coverage (UHC). Some reforms have delivered positive benefits, however, still many challenges remain. Hence, the current study assessed the progress and outcomes of these reforms over the past three decades. Methods: The present nationwide macro-qualitative study was conducted in Iran during 2016-2017. Data were collected through 32 in-depth interviews with 30 high-ranking policymakers and healthcare providers at the national and provincial levels to identify their experiences and perceptions of the reforms. The data were analyzed using the constant comparative analysis method. Results: Analysis of the interview data resulted in two main themes, six categories, and 18 sub-categories. The extracted themes were adverse situational context and the chaotic healthcare system. The results showed that the Iranian healthcare system reforms could be characterized as incoherent and passive, and that these were the main reasons for not achieving the objectives of UHC reforms. It was revealed that the implemented reforms lacked a comprehensive approach and at times were counterproductive. Moreover, the situational context adversely hindered the successful implementation of the reforms. Conclusion: Despite many efforts to improve the Iranian healthcare system through reforms, the situational context and organizational factors have prevented achieving the main objectives. Iran's health policymakers should consider a phased implementation of small-scale reforms based on a comprehensive master plan that takes social, political, and economic factors into account. This approach would minimize potential risks and encourages the cooperation of the main stakeholders.

Effect of home-based nursing pulmonary rehabilitation on patients with chronic obstructive pulmonary disease: a randomised clinical trial.

Fatigue is a common symptom of patients with chronic obstructive pulmonary disease (COPD), and results in a reduction of daily activity and quality of life in patients with the disease. The authors aimed to identify the effect of home-based nursing pulmonary rehabilitation on fatigue, activities of daily living (ADL) and quality of life (QOL) in patients with COPD. A block randomisation method was used to randomise participants into case and control groups. Fatigue, ADL and QOL were assessed before and after the intervention in both groups. Independent and paired t-tests, chi-squared tests and covariance analysis were used to analysing data. Findings showed the significant decrease in the mean scores of fatigue (p<0.001) and significant improvement in mean scores of ADL (p<0.001) and QOL (p<0.001) after home-based nursing pulmonary rehabilitation in the case group. Home-based nursing pulmonary rehabilitation can be an effective, inexpensive and accessible programme for decreasing fatigue and improving ADL and QOL for patients with COPD.

Gender differences in health conditions and socio-economic status of adults with congenital heart disease in a developing country.

BACKGROUND: Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters. MATERIALS AND METHODS: The sample consisted of 347 congenital heart disease patients in the age group of 18­64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires. RESULTS: The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect. CONCLUSION: Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients' knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.