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Abstract Background Assessing the quality of health services gives insights to managers about the status of services delivered by them, especially from the client’s perspective. Although various tools have been developed to measure the quality of primary health care (PHC), no specific tool was found in this field in Iran. Therefore, the present study was conducted to develop and validate the quality assessment tool of PHC in Iran. Methods This methodological study was conducted in 2021. In the first step, based on a literature review, an initial questionnaire was designed, and its face validity, content validity, construct validity, and reliability were evaluated. Descriptive tests, Kolmogorov-Smirnov, exploratory factor analysis, Kaiser-Myer-Olkin (KMO), and Cronbach’s alpha were performed by using SPSS 22. Results The initial questionnaire included 33 items, of which three items were removed due to inconsistency with factorization. The final questionnaire consisted of 30 items and nine dimensions: interaction, efficiency, timeliness, accuracy, consultation, tangibility, safety, accessibility, and environment. The KMO and Cronbach’s alpha index values were 0.734 and 0.82, respectively, indicating acceptable reliability and validity. The developed dimensions represented about 73% of the total variance. Conclusion The designed questionnaire has relatively good validity and reliability and can be used to measure the quality of PHC and to identify weaknesses in service delivery. However, researchers should carefully examine it to enhance its applicability as a standard tool for measuring PHC quality.

Introduction and purpose: Despite the availability of vaccines, the use of face masks remains a recognized and effective measure in preventing the spread of COVID-19. However, it is crucial to comprehend the underlying factors influencing people's adherence to preventive behaviors, particularly mask usage within communities, as negligence and disregard for this matter persist. Therefore, the present study aimed to identify the reasons for not using masks by people during the COVID-19 pandemic from the point of view of health experts. Methods: This research employed a qualitative approach and content analysis in 2019. A targeted sampling method was employed, and 15 healthcare experts from Kashan and Aran and Bidgol, Iran, participated in this study. Participants were selected to represent maximum diversity in terms of age, gender, and education level. Semi-structured interviews were conducted as the primary method of data collection. The duration of the interviews varied between 20-30 min. The interview transcripts were carefully documented, extracted, and segmented into meaningful units. To enhance the research's reliability and confirm the accuracy of the findings, credibility criteria were employed to validate the collected data. Results: Out of the interview participants, 66.6% held a bachelor's degree, 13.4% possessed a master's degree, and 20% had a doctorate degree. Around 80% of the participants were male, with 53.5% falling within the 40-50 age range, and all were married. During the data analysis process, 40 core concepts sharing common characteristics were categorized into six subclasses, which were further condensed into three main classes based on abstract commonalities. The research findings were classified into three main categories: individual factors, interpersonal factors, and environmental factors. The subcategories included lack of awareness, behavioral and belief patterns, physical barriers, subjective norms, economic barriers, environmental barriers, inappropriate mask structure, and health policies and guidelines. Conclusion: Based on the findings of this research, in addition to individual factors (e.g., awareness and beliefs regarding preventive behaviors), interpersonal factors, abstract norms, and economic and environmental factors can significantly influence mask usage within a society. This finding highlights the necessity of government organizations' support to address these challenges effectively.

Abstract Background Quality healthcare services are considered one of the most effective vehicles for healthcare managers to achieve organizational goals. Therefore, this study aimed to combine the findings of comparable studies to identify consistencies and contradictions in the quality of outpatient services in Iran. Methods The current systematic review and meta-analysis study was conducted in 2022 according to PRISMA guideline. All relevant English and Persian studies were searched in databases, including Web of Sciences, PubMed, Scopus, Scientific Information Database, and Magiran. No year restriction was applied. The quality of the studies was assessed by the 22-item Strengthening the Reporting of Observational Studies in Epidemiology checklist. The meta-analysis was conducted by using Open Meta Analyst, and between-study heterogeneity was investigated with I-squared statistic. Results Of the 106 retrieved articles, seven studies with a total sample size of 2600 were included in the meta-analysis. The pooled estimate of mean for overall perception was 3.95 (95% CI: 3.34- 4.55, P< 0.001, I2= 99.97), while the pooled estimate of the mean for the overall expectation was 4.43 (95% CI: 4.11- 4.75, P< 0.001, I2= 99.93). The highest and lowest perception mean scores were related to tangibility (3.52, Gap= -0.86) and responsiveness (3.30, Gap= -1.04) dimensions. Conclusion Responsiveness was identified as the weakest dimension. Therefore, managers are recommended to design suitable workforce-development programs which focus on the provision of timely and prompt services, polite and courteous interactions with patients, and prioritization of patients’ needs. Moreover, training public sector practitioners along with incentives can fill up the existing gaps.

Background and Aim: Medical tourism refers to travel for receiving health services abroad. The COVID-19 crisis affected a wide range of tourism-related businesses, including medical tourism, and caused a decrease in the supply and demand of health services in this market. This study aimed to investigate the impact of the COVID-19 pandemic on Medical Tourism in Iran. Materials and Methods: This cross-sectional study was conducted in Iran in 2021. The data used in this study were extracted from the information system of the Ministry of Health from 2018 to 2021, which includes the number, origin, and destination of medical tourists, per capita revenue, and monthly revenue two years before and one and a half years after the COVID-19 pandemic. For data analysis, t-tests of independent groups and interrupted time series regression were used in SPSS and EViews 10 software. Results: The COVID-19 pandemic has caused a 42% decrease in the average monthly number of medical tourists, a 45% decrease in the monthly revenue, and a 10% decrease in the per capita income per tourist (P

Introduction and purpose: One of the dangers that environmental health experts face at work is violence, the incidents of which are observed every year. The type and extent of this violence depend on the ethics of the operator. This s tudy aimed to determine the s tate of violence among environmental health experts in Kashan and Aran va Bidgol, Isfahan, Iran. Methods: In this descriptive s tudy, 53 environmental health inspectors working in the centers affiliated with Kashan University of Medical Sciences, Kashan, Iran, were selected. The data collection tool was a 58-item reliability-validated ques tionnaire consis ting of four parts, including physical violence (18 items), psychological violence (12 items), sexual violence (12 items), and racial violence (12 items), and there were three open ques tions at the end of the ques tionnaire. After the ques tionnaire was completed, information was recorded in SPSS software, and analysis was performed using independent t, Chi-square, and Fisher s tatis tical tes ts. Results: According to the results, 30% of the subjects experienced a physical attack, 90% verbal violence, and 7% racial violence in the pas t three years. No cases of sexual violence were reported. Moreover, the curator's insult to the inspectors had no relationship with the inspectors' behavior and was influenced by factors related to the curator himself and cultural and social factors. Conclusion: Based on the results, a combination of personnel training and improving their communication skills, as well as behavioral training for attendants, would be effective in reducing cases of violence.

Background and Aim: In recent years, public trust in health system has been considered one of the performance evaluation indicators of health systems. However, most of the research on public trust in health system is related to developed countries, and research in this regard is limited in Iran. A better understanding of trust in health system and some influential factors helps to develop targeted interventions to increase trust. The present study was conducted to investigate the level of public trust in health system in Rasht County. Materials and Methods: In this cross-sectional study, 680 households (510 urban and 170 rural) were included. The data collection tool was a questionnaire to measure public trust in health system with 30 items and six dimensions, whose validity and reliability were confirmed. Mann-Whitney and Kruskal-Wallis tests were used to compare and analyze the difference in public trust in health system between groups. Results: The overall score of trust in health system was 66.7 out of 112. The highest score for the quality-of-care dimension was 16.38 out of 28, and the lowest for the cooperation quality of providers dimension was 7.47 out of 12. Among service providers, the highest trust was in nurses and specialist doctors, and the least was in traditional medicine service providers. Women, government employees, people without health insurance, people with excellent and good health status, those who had used hospital services, and those who were satisfied with the last service received had a high level of trust in the health system (P

Background: Outsourcing is the strategy of reducing expenses and improving organizational quality whose evaluation in healthcare organizations is of special importance. This study aims to investigate the status of outsourced pharmacies of Alborz University of Medical Sciences based on personnel perspectives and available documentation. Methods: This was a descriptive analytical and cross-sectional study conducted in outsourced pharmacies of 10 teaching hospitals of Alborz University of Medical Sciences. Expenses, revenues and working time were derived from the hospitals’ information centers and the documents. 128 relevant officials were selected by census to investigate the views of managers and authorities of clinical wards on outsourcing. Authors analyzed data using descriptive statistics, t-test and chi-square test through SPSS22 software. All cost was converted to US dollar by using the average exchange rate in 2019 (1USD=110.000IR). Results: The average satisfaction of managers and staff with outsourcing pharmacies were 4.20 (82 %) and 4.45 (80 %) out of 5. The highest level belonged to medicine expiration date with the average of 4.64, and the lowest score was related to medicinal status at the time of delivery with the average of 4. Consumption expenses for a bed in outsourced pharmacies regarding all the hospitals were 123 $, and the profitability of the pharmacy for one bed was134 $ (5.540.900 Riyals). Conclusion: Based on the results, the following components had a relatively proper quality and an acceptable quality in all the respects of the staff’s view regarding the conditions in the pharmacies. They can be inferred as the most salient characteristics of the present study in investigating the quality of outsourcing the pharmacies of the teaching hospitals in Alborz medical sciences. The important components include: The time spent by executive managers of the pharmacy’s affairs, decrease of the manager’s workload, improvement of management, increase in management’s satisfaction in the organization and etc.

Background and Aim: With the outbreak of the COVID-19 pandemic, the performance of hospitals were affected, and changes were made in the utilization of hospital services. Analyzing hospital performance data during the COVID-19 pandemic can provide insights into service utilization patterns and care outcomes for managers and policymakers. This study was conducted to investigate the impact of COVID-19 on selected outcome indicators in the hospitals of Shahid Beheshti University of Medical Sciences, Tehran. Materials and Methods: This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method. Results: The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05). Conclusion: Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic.

BackgroundPayments to physicians by the pharmaceutical industry are common, but recent evidence shows that these payments influence physician prescribing behavior in the form of increased prescription of brand-name drugs, expensive and low-cost drugs, increased prescription of payer company drugs, etc. Considering that these payments increase drug costs for patients and health systems, there is a public interest in controlling them. Therefore, this study aimed to identify and propose policy options for managing physician-pharmaceutical industry interactions in the context of Iran's health system.MethodsIn the first phase, a systematic search was conducted to identify relevant policies and interventions in Web of Science, PubMed, and ProQuest databases from 2000 to 2022. Then, the opinions of the research team and an expert group (physicians, health policy and transparency experts, and industry representatives) were used to categorize the interventions and propose policy options along with their advantages, disadvantages, and implementation considerations.ResultsIn the search, 579 articles were retrieved, and 44 articles were found suitable for the final analysis. Twenty-nine interventions and strategies were identified, and based on these; Five policy options were identified: prohibition, restriction, physician self-regulation, voluntary industry disclosure, and mandatory industry disclosure.ConclusionThe proposed policies in our study include advantages, challenges, and implementation considerations based on up-to-date evidence that can help policymakers use them to manage COI in physician-pharmaceutical industry interactions in Iran's health system. A combination of measures seems to help manage COI: firstly, using self-regulating physicians and industry to institutionalize transparency, and in the next step, implementing mandatory industry disclosure policies and establishing restrictions on some financial interactions.

Background: Insurances are the most important financial sources of hospitals but sometimes insurance companies deduct amounts as deductions from the sum of requested amounts after investigating financial documents sent to hospitals monthly. The current study aims at determining the level and reasons for insurance bill deductions in AL Zahra Hospital in Isfahan. Methods: This applied study is descriptive-cross sectional in method and has been conducted retrospectively. The statistical population of this study contained file information of hospitalized patients who have been referred to Isfahan AL Zahra Hospital in 2016. The sample size determined by Cochran Formula and 400 files has been investigated. Random sampling employed. The information has been extracted from patients through a checklist whose reliability and validity has been confirmed by insurance experts and management specialists. Qualitative methods of interview used to identify the most important reasons for increasing the deduction sums and statistical indices and descriptive scales (frequency, percent etc) have been analyzed. Results: The most and the least percent of insurance deductions are related to Armed Forces Insurance (36.8 %) and Social Security Insurance Organization (3.64 %) respectively. Also, the most deductions of hospitalized files were related to visiting deductions of hospitalized patients’ doctor and drug and consumables deduction, other services, surgeon and anesthetist commission, experiments and pathology, radiology and sonography are in next rates and the least deductions is related to doctors 2k visit cost, hoteling, and surgery room. Conclusion: According to high percent of insurance deductions and investigation of its reasons, it has been revealed that hospitalized files related to visit by resident year 1 and 2 and absence of resident physician in center and the academic status of hospital that managers have to clarify this issue and use residents year 3 and 4, attending and resident physicians to reduce difference between hospitals and insurance companies and consider documentation as one of main elements of their agenda. So training all individuals who are influential on patients’ bills such as doctors and nurses is essential.

The Relationship between Ethical Climate and Organizational Citizenship Behavior of Nurses in Selected Hospitals Affiliated to Shahid Beheshti University of Medical Sciences Zarei Ehsan1, Damiri Soheila2, Bagheri Ali2, Farasat Fazli Ouchhesar3* 1. Assistant Professor, Department of Health Policy Management and Economics, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. MSc Student of Health Service Management, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3. MSc of Health Service Management, Shariate Hospital, Tehran, Iran *Correspondence: Shariati Hospital, North Kargar Ave, Tehran Tel: 00982177878589 Email: fazli.farasat66@gmail.com Abstract: Background & Objectives: Ethical values act as the most powerful factors influencing citizenship behaviors. This research was conducted to investigate the relationship between ethical climate and organizational citizenship behavior in nurses of hospitals affiliated to Shahid Beheshti University of Medical Sciences. Methods: This descriptive-analytical study was performed on 307 nurses selected through random sampling in 2016. Data gathering tools were two questionnaires of ethical climate and organizational citizenship behavior. Data analysis was done through SPSS20 and using descriptive statistics, t-test, One- Way ANOVA, correlation and multiple regression tests. Results: Mean scores of ethical climate and citizenship behavior were respectively 3.51 ±0.55 and 3.49 ± 0.45 that reflects the favorable view of nurses towards ethical climate and citizenship behavior. Head nurses had the highest mean scores in the dimensions of ethical climate. Among the dimensions of citizenship behavior, the dimension of conscience gained the highest mean score among nurses. There was a significant relationship between employment status and ethical climate (P

The Relationship of Quality of Services Provided to Type 2 Diabetic Patients with Self- assessment in Comprehensive Health Service Centers Daneshkohan Abbas1, Zarei Ehsan1, Sadegh Tabrizi Jafar2, Ranjbar Fatemeh3* 1. Assistant Professor, Department of Health Management, Policy and Economics, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Professor, Department of Health Services Management, Faculty of Management and Medical Informatics, Tabriz Health Services Management Research Center, Tabriz, Iran 3. MSc in Health Service Management, Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran * Corresponding Author: Fatemeh Ranjbar Address: Shahid Beheshti University of Medical Sciences, School of Public Health, Chamran Shahid Highway, St. Yemen, Tehran, Iran Tel: 00982122432040 Email: fatemeh_ranjbar@sbmu.ac.ir Abstract: Background & Objectives: Ensuring high quality care for diabetic patients is a challenge for healthcare systems throughout the world. The aim of this study was to evaluate the relationship of quality of services provided to type 2 diabetic patients with self- assessment in comprehensive health service centers. Methods: This descriptive-analytic cross-sectional study was conducted on 203 patients with type 2 diabetes referred to ten comprehensive health service centers of south Tehran/ Iran in 2018 selected through convenience sampling method. Data collection tool was a questionnaire for comprehensive assessment of quality of health services. Data were analyzed through SPSS22 and using t-test, ANOVA and logistic regression statistical tests. Results: From the perspective of patients, mean score of quality of services was 7.47. Among different health services, the highest mean score of quality was related to trust and continuity of service while, support and prevention gained the lowest mean score of quality. There was a significant statistical relationship between the quality of service and self-assessment of diabetes control in the past 12 months (P= 0.007). Also, a significant relationship was found between the quality of service and diabetes complication (P = 0.04). With each unit increase of the quality of service, the odds of a standard visit increased by 27% (P = 0.013). Conclusion: Design and implementation of interventions in order to increase the social support of patients and sharing their experiences with each other as well as improving the dimensions of prevention and safety in care are essential. Key­words: Service quality, Type 2 diabetes, Comprehensive health service centers, Importance, Performance ­Citation: Daneshkohan A, Zarei E, Sadegh Tabrizi J, Ranjbar F. The Relationship of Quality of Services Provided to Type 2 Diabetic Patients with Self- assessment in Comprehensive Health Service Centers. Journal of Health Based Research 2019; 5(2): 187-201. [In Persian]

Abstract Background Measuring patients’ perception from health service quality as an important element in the assessment of service quality has attracted much attention in recent years. Therefore, this study was conducted to find out how the patients evaluated service quality of clinics at teaching hospitals affiliated with Tehran University of Medical Sciences in Iran. Methods This cross-sectional study was conducted in Tehran in 2017 and 400 patients were randomly selected from four hospitals. Data were collected using a questionnaire, the validity and reliability of which were confirmed in previous study. In order to analyze the data, T-test, ANOVA, and Pearson correlation coefficient were calculated using SPSS 23. Results The results indicated that among eight dimensions of health service quality, the patients were more satisfied with physician consultation, services costs and admission process. The highest and lowest mean scores were related to physician consultation (Mean = 4.17), and waiting time (Mean = 2.64), in that order. The total mean score of service quality was 3.73 (± 0.51) out of 5. Outpatient services were assessed as good, moderate and weak by 57.5, 40 and 2.5% of the patients, respectively. There was a significant relationship between the positive perception of service quality and reason for admission, source of recommendation, gender, education level, health status, and waiting time in the clinics (p

Background and Objective: Public private partnership (PPP) model has been recently introduced as an approach to improve functional efficiency and solving governments’ health care shortages in various aspects. The number of studies focused critically and explanatory on this model are scarce. Furthermore, lack of study organization and structural coherence for deducing practical consequences are still bold in this field. This review summarizes and categorizes these shortcommings. Materials and Methods: This study is designed in review manner: search was conducted in Pubmed, Google scholar, SID.ir and Scopus with all of the combinations of the two keyword groups with the time period search restriction of 2010 to 2017 published studies: group one included “Public private partnership”, “Public private cooperation”, “Privatization”, “Public private initiatives” and their abbreviations; and group two included “Health”, and “Hospital”. After stepwise evaluations and appropriate screening, of 145 assessed papers in the first place, 23 papers were finally selected for data extraction. After reading the full-text of included articles, all of the mentioned information about the problems and challenges of PPPs were extracted. Then, the drafted results for each study were evaluated and compared with each other and organized as main subgroups. Afterwards, the frequency of repeats and emphasis of each subgroup was calculated for all of the 23 studies. Finally, a description review was adapted and registered for each subgroup using related articles. Results: Analysis and assessment of the papers included in this study pointed to several discrete issues which were categorized and discussed in 12 main subgroups based on their conceptual coherence: complexity, low-quality evaluation and supervision, lack of transparency, inadequate coordination, neglecting justice and public interest, lack of flexibility, lack of experience and practical knowledge, insufficeient financial resources, lack of appropriate risk assessment, inadequate cooperation of stakeholders, partner choice restrictions, and paying insufficient attention to the staff. Conclusion: The most important problems and challenges currently confronting health care PPPs were assessed to be complexity, low-quality evaluation and supervision, lack of transparency, and inadequate coordination. All of the items highlight the need to enhance the comprehension of both agreement sides regarding the nature, structure, and complexity of these types of cooperation; as well as complete and precise clarifications for sides, community, and other stakeholders. DOI: http://doi.org/10.22037/ch.v5i4.19767

Evaluation of Burnout among Primary Health Care Providers in Markazi Province Zarei Ehsan1, Daneshkohan Abbas1, Khodakarim Soheyla2, Abbasi Reza3* 1. Assistant Professor, Department of Public Health, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3. Assistant Professor, Department of Public Health, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4. MSc Student, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran *Correspondence: School of Management and Medical Education, Parkway Valiasr Street, Tehran, Iran Tel: 00982126215328 Email: abbasireza1500@gmail.com Abstract: Background & Objectives: Nowadays, burnout as a psychological syndrome is a major problem, especially in health services, that has been identified in a large number of health care providers. The aim of this study was to determine the extent of burnout and the relationship between demographic characteristics and burnout dimensions among primary health care providers. Methods: This cross-sectional descriptive-analytic study was conducted in 2019. The statistical sample included all primary health care providers (n=335) working in one of the medical colleges in Markazi province. Data were collected using Maslach Burnout Inventory (MBI). Simple and multiple regression tests were used. Data were entered into SPSS version 23 software. Results: The mean score of emotional exhaustion, depersonalization, and personal accomplishments was 15.5, 4.9, and 33.8, respectively. Among health care providers, 21.8% had high emotional exhaustion, 23%, high depersonalization, and 47.5% had low personal accomplishments. The results of multiple regression tests indicated a significant relationship between gender, work experience, and place of service with burnout. Conclusion: Some strategies such as conducting training courses, providing advisory services, and optimizing human resources management, especially for women, urban employees, and those with high work experience, are suggested to reduce burnout. Key­words: Burnout, Emotional exhaustion, Depersonalization, Personal accomplishment, Primary health care providers ­Citation: Zarei E, Daneshkohan A, Khodakarim S, Abbasi R. Evaluation of Burnout among Primary Health Care Providers in Markazi Province. Journal of Health Based Research 2018; 4(2): 135-45. [In Persian]

Background & Objectives: One of the most valuable assets of any organization is its brand because it causes more profit margins, better cooperation channels and other benefits for the organization. The aim of this study was to investigate the factors affecting brand identity of hospitals in a semi- governmental hospital in Tehran/ Iran. Methods: In this descriptive-analytic study, 403 hospitalized patients in a semi-governmental hospital were selected by available sampling method in 2016. The data gathering tool was a researcher-made questionnaire based on the Kapferer model (including 30 questions in 6 domains of brand personality, brand physique, brand culture, relationship, self-image and reflection). Data were analyzed using one-sample t-test in SPSS 16 software. Results: The highest mean scores were attributed to the importance of service quality (4.21), known cases (4.15) and easy access (4.02). The least mean scores belonged to patients' mental and psychological needs (2.31), the distinctive character (2.45) and happy and motivated staff (2.63). There was a significant relationship between total mean score (3.51) and brand personality, brand physique and brand culture (P

Background & Objectives: The ability to attract tourists in international health markets depends on the quality standards. The aim of this study was to determine the state of educational hospitals of Shahid Beheshti University of Medical Sciences based on organization-oriented standards of joint commission international. Methods: This Descriptive study was performed in four selected teaching hospitals of Shahid Beheshti University of Medical Sciences in Tehran. Data collection was carried out using the questionnaires of the organization-oriented standards of joint commission international including 76 questions in 6 areas of improving quality and patient safety, infection prevention and control, leadership and guidance, safety and facility management, training and staff competence and information and communication management. Descriptive statistics were used as mean and percentage. Data were entered into SPSS20 software. Results: The compliance rate of organization-oriented standards in the hospitals was 81.2% that indicated the relative readiness with regard to the standards of joint commission international in attracting medical tourists. The highest compliance rate of standards was related to safety and facility management (84.4%) and the lowest compliance rate was related to quality improvement and patient safety (75.2 %). Conclusion: Hospitals should pay more attention to the quality improvement and patient safety in order to meet international standards and obtain an international accreditation certificate, and they are supposed to improve standards in this area through corrective actions. Keywords: Medical Tourism, Joint Commission International, Quality Assurance, Organization-Oriented Standards, Teaching Hospital Citation: Zarei E, Ahmadi Kashkoli S, Khezeli MJ, Fazli Ouchhesar F, Azizi A, Shamsadini Lori A. Readiness of Teaching Hospitals to Attract Medical Tourists Based On Organization-Oriented Standards of Joint Commission International (JCI): a case study. Journal of Health Based Research 2017; 3(3): 253-265.

Background: One of the main goals of health sector evolution plan is reducing the amount of out of pocket payment by patients receiving hospital services in public sectors. This study aimed to assess the amount of out of pocket payment by inpatients in public hospitals affiliated to Shahid Beheshti University of Medical Science in Tehran city in 2015. Materials and Methods: In this cross-sectional study, 405 discharged patients from four public and teaching hospitals were selected using convenient sampling method. Data were collected using a researcher made checklist and investigating the hospital bills. In order to data analysis, descriptive statistics and regression analysis were utilized through SPSS Software version16. Results: The amount of out of pocket payment was 10.2 percent included 9.9 percent formal payment, 0.2 percent bought & brought goods and 0.1 percent informal payment. The most portion of the hospital costs was related to medical supplies and pharmaceuticals, surgeries services and hosteling with 32.6, 20.6 and 17.36, respectively. Type of hospital, having surgery, average length of stay, family size and gender had significant effect on the out of pocket payment amount (p ≤ 0.05). Conclusion: The amount of out of pocket payment by inpatient in public hospitals was in accordance with goal of the health sector evolution plan, which reveals the appropriate government support. It is recommended to tailor and implement enormous plans regarding outpatients and private sector in national level to attain sustained reduction in out of pocket payment.

Abstract Background The inappropriate use of drugs due to irrational prescriptions is a common problem in Iran, but there is little evidence of prescription patterns in rural family physicians. This study aimed to explore the prescribing pattern and rational drug use indicators for family physicians using Index of Rational Drug Prescribing (IRDP) in Kermanshah Province, Iran. Methods In this retrospective study, 352,399 prescriptions from 184 family physicians in 103 primary health care (PHC) centers were examined. As stated, an analysis was done for rational use indicators suggested by World Health Organization (WHO): e.g., the percentage of prescriptions containing antibiotics, injections, and those prescribed by a generic name and from a national essential medicine list, plus the average number of drugs per prescription; these factors were all taken into account. Rational drug use was studied with the IRDP. Results The average number of drugs per prescription was 3.14 (± 1.2) and the average cost per prescription was 116,740 IRR (USD 3.6). Around 19% of prescriptions had more than four drugs, while the percentage of prescriptions involving antibiotics and injections was 52.1% and 24.4%, respectively. There was 95.1% drugs prescribed by their generic name and 95.9% were retrieved from the essential drugs list. The value of the IRDP was 3.70 out of 5. Conclusion The findings of this study showed that some degree of irrational drug prescribing exists among family physicians, especially in terms of injections, antibiotics, and polypharmacy. It is recommended that there be continuing education programs for physicians regarding rational prescribing for different kinds of medical indications. Clinical practice guidelines should also assist with the rational use of medicine.

INTRODUCTION: The educational service is expensive and having the right financial information is one of the most important tools for managing financial resources. Therefore, due to the importance of this issue, this study aimed to determine the cost of educational services for medical sciences students at Alborz University of Medical Sciences. METHODOLOGY: A cross-sectional study was conducted between March 20, 2018, and March 20, 2019, at Alborz University of Medical Sciences. The current and capital cost data were extracted from the university's financial database, and the cost price of services provided was calculated using the activity-based cost model. RESULTS: The mean annual cost of services per student was $4778, and the mean cost of education per hour was $113. The total cost price of services provided per student at the school was 65% for wages and salary, 26% for depreciation of building and equipment, and 9% for consumable goods and services. Furthermore, the share of different cost centers to the total cost price of services provided per student was 82% for educational services, 11.9% for student welfare services, and 6.1% for research services. CONCLUSION: Costs of personnel, especially pays to faculty members and the costs of capital expenditures, are the most important costs in higher education institutions. It seems reducing of pay to faculty members through novelty approach of education and evaluation, reducing capital expenditures through use effective of buildings and equipment that can be placed higher education institutions in the path to productivity.

Background and Aim: Over the past decade, the number of private centers providing health care services in Iran has had a continuous growth and the highly competitive market in private hospitals industry has caused increasing pressure on them to provide services with a higher quality. The purpose of this study was to assess the quality of services being provided in private hospitals of Tehran as judged by patients. Materials and Methods: This cross-sectional study was conducted in 2010 in Tehran. The study sample comprised 983 patients, randomly selected from 8 private hospitals. The survey instrument was the standard SERVQUAL questionnaire. Wilcoxon, t-test, and Kruskal-Wallis tests were used for statistical analyses. Results: The total mean scores of patients' expectation and perception were 4.92 and 4.02, respectively. The highest figures were related to the tangible factors dimension and the lowest ones to the empathy dimension. The differences between the perception and expectation for all the 22 items and the 5 dimensions were found to be statistically significant(p< 0.001). Conclusion: SERVQUAL is valid and reliable in hospital settings as a standard tool for the assessment of quality. The results of the present study have revealed the areas that need to be improved as far as the patients are concerned. Measuring the opinion of patients can help facilitate the provision of hospital services, and improve the quality of such services and patients' satisfaction.

Background and Aim: Over the past decade, the number of private centers providing health care services in Iran has had a continuous growth and the highly competitive market in private hospitals industry has caused increasing pressure on them to provide services with a higher quality. The purpose of this study was to assess the quality of services being provided in private hospitals of Tehran as judged by patients. Materials and Methods: This cross-sectional study was conducted in 2010 in Tehran. The study sample comprised 983 patients, randomly selected from 8 private hospitals. The survey instrument was the standard SERVQUAL questionnaire. Wilcoxon, t-test, and Kruskal-Wallis tests were used for statistical analyses. Results: The total mean scores of patients' expectation and perception were 4.92 and 4.02, respectively. The highest figures were related to the tangible factors dimension and the lowest ones to the empathy dimension. The differences between the perception and expectation for all the 22 items and the 5 dimensions were found to be statistically significant(p< 0.001). Conclusion: SERVQUAL is valid and reliable in hospital settings as a standard tool for the assessment of quality. The results of the present study have revealed the areas that need to be improved as far as the patients are concerned. Measuring the opinion of patients can help facilitate the provision of hospital services, and improve the quality of such services and patients' satisfaction.