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Article: Cost efficiency of the family physician plan in fars province, southern iran.
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ABSTRACT: Background: In recent years use of family physicians has been determined as a start point of health system reform to achieve more productive health services. In this study we aimed to assess the cost-efficiency of the implementation of this plan in Fars province, southern Iran.Methods: This cross-sectional descriptive study was done in 2007 in 18 provincial health centers as well as 224 rural health centers in Fars province. Data were collected using forms, statistics, and available evidence and analyzed by expert opinion and ratio techniques, control of process statistics, and multi indicator decision model.Results: Although in the family physician plan more attention is paid to patients and the level of health training, availability, and equity has improved and the best services are presented, it has not only decreased the costs, but also increased the referrals to pharmacies, laboratories, and radiology clinics and the costs of healthcare.Conclusion: Although the family physician plan has led to more regular service delivery, it has increased the patients' referral to pharmacies, laboratories, and radiology centers and more referrals to family physicians. It seems that the possibility of setting regularity in health system can be gained in the following years of the family physician program mainly via planning, appropriate management and organizing correct health plans according to need assessments, and continual supervision on activities, which would happen according to current experiences in this plan.Iranian Journal of Medical Sciences 12/2012; 37(4):253-9. -
Article: Necessity of admissions in selected teaching university affiliated and private hospitals during 2007 in Shiraz, Iran.
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ABSTRACT: The use of acute hospital beds is an issue of concern both to policy-makers and practitioners. In most countries attempts are underway to improve efficiency in this sector. One of the most widely used instruments for assessing inappropriate hospital use is the Appropriateness Evaluation Protocol, which consists of a set of standards based on objective criteria relating the condition of the patient to the clinical services received. The aim of this study was to measure inappropriateness of admission and inpatient stays at four major hospitals in Shiraz, Iran. The results showed that 22% of the total admissions in four hospitals were rated as inappropriate. The most as well as the least inappropriate admissions were found in both teaching university affiliated hospitals. Our data has shown that a total of 29.6% (average 6.40%) of the hospital stays in the study population were judged to be inappropriate. The result of the Least Significant Difference Test indicated a significant association between the mean days of inappropriate stay and turn of admission in all hospitals. In the four hospitals, a significant association was observed between the inappropriateness of hospital stay, costs, and length of stay. Considering the findings of this study, in addition to other studies in Iran and other countries, we can conclude that the factors involving inappropriate admission of patients to hospitals are mostly similar. In order to solve this problem we can use strategies such as: improving the performance of the referral system, using standard criteria for an appropriate evaluation protocol by the medical staff, and extending outpatient diagnostic services to reduce inappropriate hospitalization.Archives of Iranian medicine 05/2010; 13(3):230-4. · 0.97 Impact Factor -
Article: The Efficiency of General Public Hospitals in Fars Province, Southern Iran
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ABSTRACT: Background: Regarding the increase in expenses for health care services in inpatient settings, much effort hasbeen made to compare the performance of hospitals in recent years and measure their efficiency. In this study,Data Envelopment Analysis (DEA) is applied to measure the technical, scale and economic efficiency of thegeneral public hospitals in Fars Province, southern Iran.Methods: Twenty one general public hospitals in Fars province, southern Iran in the first and second six monthsof the years 2005 and 2006 were enrolled. There was an attempt to compare their rate of development or otherwise,using Malmequist index and also to determine their return to scale and rank during these years. The datawere collected through a questionnaire by interview and the existing documents were analyzed separately foreach year by Algebraic Modeling System (GAMS) software.Results: Fifteen hospitals (71.4%) were technically efficient and in the next three periods, 14 hospitals proved tobe efficient. With respect to scale efficiency in the first 6 months of 2005, 7 hospitals were completely efficient(33.3%), but in the second 6 months of the same year, the number of efficient hospitals was reduced from 7 to 5.In the next two periods, 4 hospitals (19%) were recognized as highly efficient systems. As to the economic efficiencyin all 4 studied periods, 4 hospitals (19%) were recognized as completely efficient.Conclusion: As to the average technical efficiency, state-run public hospitals in Fars Province are in a higherlevel as compared with those in other studies. However, their average of the scale efficiency is less than thatreported in other studies. It seems that the hospitals under the study do not seek profitability since they are public;therefore, they lack any motivation to select a combination of inputs in order to minimize the expenses. It isrecommended that hospital managers and decision makers should use DEA to determine the best method ofusing the available resources.Iranian Red Crescent Medical Journal. 01/2010; -
Article: Quality of life and toxicity in breast cancer patients using adjuvant TAC (docetaxel, doxorubicin, cyclophosphamide), in comparison with FAC (doxorubicin, cyclophosphamide, 5-fluorouracil).
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ABSTRACT: The aim of this study was to compare two regimens of chemotherapy in patients with breast cancer, including FAC (doxorubicin, cyclophosphamide, and 5-fluorouracil) and TAC (docetaxel, doxorubicin and cyclophosphamide); and analyze the toxicity of these treatments and observe patient's health-related quality of life. Health-related quality of life was assessed for up to 4 months (from the beginning to the end of chemotherapy cycles), using European organization and cancer treatment quality of life questionnaire (EORTC) QLQ-C30. A group of 100 patients, with node-positive breast cancer were studied in order to compare the toxicity of adjuvant therapy TAC with FAC and the subsequent effects on the patient's quality of life. After a 4-month follow-up of patients, our findings showed that despite having the same mean score of QOL at the start of adjuvant chemotherapy, the QOL in TAC arm was decreased more as a result of the higher range of toxicity in TAC regimen. In spite of increase in disease-free patients who received TAC regimen and increase their survival rate, there is significant toxicity and decrease in QOL in TAC protocol compare to FAC protocol. Using prophylactic granulocyte colony stimulating factor (G-CSF) along with increased education aimed at improving patient's knowledge and also the provision of a supportive group involving psychiatrics and patients that have successfully experienced the same treatment may be helpful.Archives of Gynecology 07/2011; 284(1):215-20. · 0.91 Impact Factor -
Article: The Role of Data Envelopment Analysis (DEA) Pattern in the Efficiency of Social Security Hospitals in Iran
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ABSTRACT: Background: A remarkable increase has been observed in hospital expenditure in many countries during recentyears, drawing especial attention to the problem. This study was conducted to present one of the operationalresearch techniques pattern in evaluation of the hospital efficiency.Methods: The ratio analysis method was used to evaluate the hospital efficiency. This method is not effective in casesin which the relationship between an input and several outputs or several inputs and several outputs are involved.DataEnvelopment Analysis Pattern (DEA) is one of the operational research techniques, lacking the problems of ratio methodwhile efficiency evaluation can determine the critical parts of hospital, reducing the efficiency of the whole hospitaland meanwhile compensating the deficiency in a particular measurement. In order to introduce this method in hospitalefficacy evaluation, 18 general hospitals affiliated to Iran Social Security Organization were included.Results: This study revealed that Data Envelopment Analysis Pattern had more capacity than previous methodsin relation to evaluation of the complicated organizations like hospitals.Conclusion: Operational research techniques in efficiency evaluation would provide the possibility to comparedifferent efficiencies among various hospitals and present the necessary solutions to compensate the insufficiencyand to correct them for the managers.This technique was used for the first time in this study to measurehospital efficiency in Iran.Iranian Red Crescent Medical Journal. 01/2008;
