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

Background: The expansion of outpatient services and the desire to provide more outpatient care than inpatient care create some problems such as the overcrowding in the outpatient clinics. Given the importance of overcrowding in the outpatient clinics, this qualitative study aimed to determine the factors influencing the overcrowding in the specialty and subspecialty clinic of a teaching hospital. Materials and Methods: This was a qualitative study conducted in the specialty and subspecialty clinic of a hospital using content analysis method in the period of January to March 2014. The study population was all managers and heads of the outpatient wards. The studied sample consisted of 22 managers of the clinic wards who were selected using the purposive sampling method. The required data was collected using semi-structured interviews. The collected data was analyzed using conventional content analysis and the MAXQDA 10.0 software. Results: Three themes were identified as the main factors affecting the overcrowding including the internal positive factors, internal negative factors, and external factors. Conclusions: Despite the efforts made to eliminate overcrowding, and reduce waiting times and increase access to the services for patients, the problem of overcrowding still has remained unresolved. In addition, the use of some strategies such as clarifying the working processes of the clinic for staff and patients and the relationships between the clinic and other wards especially emergency department, as well as using a simple triage system on the patients’ arrival at the clinic are recommended.

Background: The present study was conducted to examine the interns’ perceptions of safety attitude and professionalism and to explore their experiences about adherence to the principles during the COVID-19 pandemic. Method: The present study was a mixed-method that was performed in two quantitative and qualitative stages. The medical interns at X University (n = 140) were entered. In the quantitative phase, the assessment of the interns’ Safety Attitudes and Professionalism was conducted by a survey. In the qualitative phase, data were gathered by semi-structured interviews. The experiences of participants were analyzed by the inductive content analysis approach of Graneheim and Lundman. Results: Participants’ perception scores on safety attitude and professionalism were 98.02 (14.78). The results were explained in a theme of “weakness in systemic accountability in compliance with professionalism and safety”. The theme included three categories: ‘support system inadequacy’, and ‘null curriculum in safety and professionalism education’. Conclusion: The present results showed participants’ perception scores on safety attitude and professionalism were below the moderate level. The systemic issues were explored as influencing factors in the occurrence of unsafe and unprofessional behaviors. They reported the weakness of the support system (individual, teamwork, mental health, well-being, management, and culture), and the null curriculum in education of professional, and safety principles effective on unprofessional and unsafe behaviors. During the COVID-19 pandemic, it is recommended to create mechanisms to support the development of professionalism of healthcare workers, especially, novice providers and students, and pay attention to the safety and professionalism in formal and informal educational programs.

To investigate the factors affecting the hospital costs in the road traffic injuries. This applied study examined the information of patients presenting to Yazd Trauma Center in 2018. The data were extracted from Comprehensive Traffic Injuries System affiliated to the center, which were described with frequency, percentage, mean, and SD, and then analyzed using independent t-test and one-way ANOVA. Most injuries (%66.4) are caused by motorcycle and pertained to head region (%61.8). Some significant correlations were found among gender, type of injury, patient's final status, site of road accident, patient's nationality, type of vehicle used at the time of accident, length of stay (hospital stay), patient's age, and hospital costs (p<0.05). Moreover, the costs were higher in men, and in those with head and neck injuries, dead casualties, suburban high-way accidents, motor cyclists, hospital stay longer than three days, and older patients. Given the significant correlations between demographic and social variables under study, the results may be used in planning and designing strategies for controlling road traffic injuries and reducing the related hospitalization costs.

Trauma-related injuries are the leading cause of death and disability in the active population, with devastating economic, health, and social consequences for nations. TThis study aimed to assess the economic burden of injuries in Iran. In this study, the economic impact of trauma in Iran in 2019 was estimated using a prevalence-based approach. The prevalence was estimated based on available statistics in Iran and the GBD website. Direct medical expenditures were calculated using a top-down approach. The cost of lost production due to injuries and premature death was also estimated using the DALY value. Microsoft Excel 2019 and Stata software version 13.0 were used for the analysis. In Iran, approximately 16,500,000 individuals were estimated to have sustained injuries in a single year. The average direct medical expenses for each trauma patient were around $226. Fractures contributed to 39% of the financial impact of trauma. The overall economic burden of trauma in Iran was calculated to be $10,214,403,423. Approximately 66% of this economic burden was attributed to lost productivity and premature death resulting from trauma, while direct medical costs made up 34%. The economic burden of trauma in Iran is expected to significantly rise in the future. It may be necessary to enhance awareness of injury-related mortality and disability, improve therapies, and expand evidence-based interventions to reduce the economic impact of injuries.

Background: Families are willing to spend their entire lives improving their children due to emotional attachments, which, in turn, increases their exposure to catastrophic health expenditures (CHEs). The present study aimed to estimate the level of exposure to CHEs and its determinants among households with pediatric cancer and oncology disorders. Materials and Methods: This cross-sectional study was performed on 101 households with pediatric cancer and oncology patients who referred to Shahid Sadoughi Hospital of Yazd in 2021. The CHE in this regard was defined as the out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay. The data on each household were collected with reference to the patient's electronic file and through a questionnaire completed during an interview with the head of the household. The data were also analyzed with descriptive statistics and logistic regression in Excel (2019) and STATA ver.15. Results: Out of 101 households in the study, 43 (42.6%) incurred CHEs (based on a threshold of 40% of disposable income). Regarding the job of the heads of households, manual workers were vulnerable to CHEs up to 11.7 times more than employees and self-employed individuals (OR=11.7, p<0.05). Also, the lower the education level of the head of the household, the higher the risk of facing CHEs (OR=10.45, p<0.05). Similarly, the lower his or her income, the higher the CHE. Conclusion: The results showed that households with pediatric cancer and oncology disorders were significantly exposed to CHEs. Due to the limited resources of the health system in the treatment of cancer patients and the need for expenditure control programs, it seems better to focus on cost control strategies for this group of patients.