Irish Healthcare Research Articles

Insider versus outsider workplace mistreatment and their impact on affective ill-being in healthcare professionals: Can personal resources act as buffers?

Workplace stress can negatively impact healthcare providers' professionalism and quality of care. One source of workplace stress is the experience of workplace mistreatment. Drawing on the Job Demands-Resources theory, this study aimed to (a) investigate the impact of mistreatment frequency experienced by healthcare workers from insider sources (i.e. co-workers, supervisors) and outsider sources (i.e. patients, visitors) on affective ill-being and (b) the potential moderating role of trait resilience and trait self-efficacy, as personal resources, in the mistreatment-ill-being relationship. Lagged design. We collected data from 153 Irish healthcare workers between January 2018 and June 2019 via three surveys, separated by 1-week intervals. Personal resources were measured at Time 1, frequency of mistreatment from the two sources was assessed at Time 2 and affective ill-being was assessed at Time 3. We used moderated regression analyses to evaluate the association of mistreatment frequency from the two sources and affective ill-being and the moderating effect of personal resources. Only insider mistreatment frequency was positively related to affective ill-being. Furthermore, the positive impact of insider mistreatment on affective ill-being was moderated by self-efficacy (but not by trait resilience). In contrast to our expectations, the relationship was stronger at high levels compared to low levels of self-efficacy. Mistreatment from co-workers and supervisors is linked to higher levels of affective ill-being. Additionally, healthcare workers with high self-efficacy were more vulnerable to the negative consequences of co-worker and supervisor mistreatment as it impacted their affective ill-being. These findings extend the literature on workplace mistreatment by integrating insider and outsider perpetrators of mistreatment and examining their differential impact on the employees' affective ill-being. It also highlights mistreatment from organizational insiders as a significant factor in the relationship between mistreatment and affective ill-being. No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL COMMUNITY?: The findings underscore the detrimental impact of workplace mistreatment on the well-being of healthcare professionals. The study findings of higher frequency of insider mistreatment being associated with increased affective ill-being call for action, with line managers and supervisors being critical to achieving respective changes in healthcare workers' environment. The findings have implications for policymakers interested in developing a framework to support healthcare professionals in addressing workplace mistreatment, enabling them to effectively fulfil their role as care providers.

A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme

BackgroundThis study assessed whether a relatively newly developed Parent and Infant (PIN) parenting support programme was cost-effective when compared to services as usual (SAU).MethodsThe cost-effectiveness of the PIN programme versus SAU was assessed from an Irish health and social care perspective over a 24-month timeframe and within the context of a non-randomised, controlled before-and-after trial. In total, 163 parent-infant dyads were included in the study (86 intervention, 77 control). The primary outcome measure for the economic evaluation was the Parenting Sense of Competence Scale (PSOC).ResultsThe average cost of the PIN programme was €647 per dyad. The mean (SE) cost (including programme costs) was €7,027 (SE €1,345) compared to €4,811 (SE €593) in the control arm, generating a (non-significant) mean cost difference of €2,216 (bootstrap 95% CI -€665 to €5,096; p = 0.14). The mean incremental cost-effectiveness of the PIN service was €614 per PSOC unit gained (bootstrap 95% CI €54 to €1,481). The probability that the PIN programme was cost-effective, was 87% at a willingness-to-pay of €1,000 per one unit change in the PSOC.ConclusionsOur findings suggest that the PIN programme was cost-effective at a relatively low willingness-to-pay threshold when compared to SAU. This study addresses a significant knowledge gap in the field of early intervention by providing important real world evidence on the implementation costs and cost-effectiveness of a universal early years parenting programme. The challenges involved in assessing the cost-effectiveness of preventative interventions for very young children and their parents are also discussed.Trial registrationISRCTN17488830 (Date of registration: 27/11/15). This trial was retrospectively registered.

Attitudes and perceptions of Irish health care professionals regarding functional neurological disorder: A national survey.

Functional neurological disorder (FND) is a common and often disabling condition. Limited access to services for FND poses challenges both for patients and their health care providers. This survey explored the attitudes, experiences, support needs and training needs of health care professionals (HCPs) who provide care to individuals with FND in Ireland. A broad range of HCPs working with patients with FND in Ireland partook in an anonymous online 12-item survey. Participants were recruited via professional bodies and snowball convenience sampling utilising social media and email invitation. Descriptive and inferential statistics were employed to analyze data. A total of 314 HCPs working in Ireland completed the survey. 80% were female and over half worked in their current role for more than 10 years. 75% of the sample encountered three or less individuals with FND per month. Identified service-related challenges to effective patient care included insufficient clinic time, lack of confidence explaining the diagnosis, and the need for greater access to specialist support. Data revealed persisting negative attitudes toward FND patients among a proportion of respondents. The majority of respondents did not feel they received adequate education on FND, with the exception of neurologists, of whom 65% felt adequately trained. The majority of respondents (85%) also felt that people with FND did not have access to appropriate FND services in Ireland. This study indicates that there is a significant need to improve FND education among HCPs in Ireland, in addition to developing appropriately resourced, integrated, multidisciplinary care pathways for the FND patient group.

Designing a model for implementing diagnosis-related groups in Iran: An action plan approach.

Implementing diagnosis-related groups (DRGs) in different countries increases the efficiency of healthcare services, improves treatment quality, and reduces treatment costs. Due to the lack of a coherent model for its implementation, the present study aimed to develop a DRGs-based implementation action plan Model for Iran. The present study was an applied, descriptive cross-sectional study conducted in three stages. In the first stage, a review of studies conducted in different countries was carried out. In the second stage, a model was designed for an action plan to implement the DRGs in Iran. In the third stage, the model was validated based on the Delphi technique. The DRGs-based implementation action plan model in Iran was designed in three primary axes, including the strategic approach of the DRGs-based implementation action plan, technical dimensions, and executive institutions involved in the DRGs-based implementation action plan. Validation of the designed model showed the agreement of experts (94%) for the mentioned axes. The significance of tailoring a DRGs-based implementation action plan to each country's unique context is well-established. Given the intricacies of the Iranian healthcare system, we recommend an initial pilot implementation of DRGs at the hospital level, followed by a gradual national rollout.

Preventive behaviors against COVID-19 among health care providers in Iran: A cross-sectional study.

During outbreaks of infectious diseases, if healthcare providers do not follow the principles of prevention, the risk of personal infection increases and they become a source of infection spread. This study aimed to determine the factors related to the preventive health behaviors of COVID-19 among Iranian healthcare providers based on protection motivation theory (PMT). This analytical cross-sectional study included 346 healthcare providers. Data was collected by an online researcher-made questionnaire based on PMT. To analyze the data, independent T tests, analysis of variance (ANOVA), Spearman correlation coefficient, multiple linear regression, and SPSS 22 software were used. α was considered as 0.05. 85.3% of the healthcare providers would always wear masks, 80.7% would always refuse to kiss and touch hands with others, and 34.7% sometimes would exercise at home. The preventive behaviors were significantly correlated with protection motivation (r = 0.84), self-efficacy (r = 0.51), response efficiency (r = 0.43), perceived severity (r = 0.41) Fear (r = 0.21), perceived susceptibility (r = 0.11), response cost (r = -0.14), and reward (r = -0.15). PMT constructs were able to predict 77% of the variance of the behaviors and the protection motivation construct was the strongest predictor (β = 0.806). Income above 300 Dolars per month was significantly related to the decrease in the mean score of preventive behaviors against COVID-19. The female sex and the individual or family history of infectious diseases were significantly related to increasing the mean score of COVID-19 preventive behaviors. Based on the study results, it is suggested that some educational interventions be designed and implemented with a focus on this construct and the perceived severity construct and that more attention be given to the education of health care providers with high-income levels, male providers, and the individuals without a history of corona infection in themselves or their family members.

Prevalence of depression, anxiety, and stress and associated reasons among Iranian primary healthcare workers: a mixed method study

BackgroundDifferent mental disorders may be associated with many work-related factors to which primary health care workers (PHCWs) are exposed. The current research aims to measure the rates of depression, anxiety, and stress among PHCWs, and their associated causes in primary health care (PHC) settings.MethodsAn explanatory sequential mixed methods design was employed in this research from January 2021 to January 2022 in Tabriz, Iran’s PHC centers. First, this study followed an online-based cross-sectional survey using a self-reported questionnaire. The Depression, Anxiety and Stress Scale-21 Items (DASS-21) and questions on demographic and work-related characteristics were completed by 303 frontline PHCWs during the quantitative phase. In the qualitative phase, a semi-structured interview was held with 12 PHCWs who had the highest level of depression, anxiety, and stress to identify the reasons and sources of mental health prevalence. Quantitative data were analyzed using descriptive statistics via SPSS-26. A content analysis was performed to analyze qualitative data.ResultsThe results showed that self-reported stress, anxiety, and depression had a prevalence of 40.3%, 42.9%, and 42.6%, respectively. Symptoms of at least one mental disorder were experienced by 54% of respondents, while 28% had all three. Major sources of stress, anxiety, and depression among PHCWs were working environment conditions, organizational policies, job-related reasons, and interpersonal relations.ConclusionsThe results of current study indicated that PHCWs experienced high levels of depression, anxiety, and stress. The main factors and reasons that contributed to these mental health issues among PHCWs were work environment conditions, organizational policies, job-related reasons and interpersonal relations. Therefore, interventions should be implemented to promote mental health of PHCWs. This can include measures such as psychological screening, supportive care, workload management, flexible scheduling, and access to mental health resources. Additionally, training programs can be implemented to enhance resilience and coping skills among healthcare professionals.

Short-term Safety of Covaxin, Sinopharm, Sputnik V, and AstraZeneca COVID-19 Vaccines Among Iranian Healthcare Workers: A Cross-Sectional Study

Background: Several coronavirus disease 2019 (COVID-19) vaccines, utilizing different platforms, have successfully obtained emergency clinical use authorization to prevent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections. Most published data from COVID-19 vaccine trials have frequently observed mild-to-moderate side effects, with varying severity depending on various vaccine types. Objectives: This study aimed to estimate the prevalence of side effects associated with four types of COVID-19 vaccines among vaccinated healthcare workers following the first and second vaccine doses and to identify possible risk factors for COVID-19 vaccine side effects. Methods: This cross-sectional study was conducted from April 2021 to March 2022 by administering a questionnaire and conducting direct interviews with healthcare workers in Kerman, southeastern Iran, who had received 2 or more doses of COVID-19 vaccines. Results: Out of 861 individuals enrolled in the study, 38.7% received Sputnik, 32.4% AstraZeneca, 19.6% Covaxin, and 9.3% Sinopharm vaccines. Overall, the most common side effects after the first and second doses included general symptoms, fever and chills, injection site reactions, neurological symptoms, and gastrointestinal symptoms. Furthermore, the frequency of symptoms significantly reduced after the second dose. Conclusions: General symptoms and injection site reactions were significantly more common after receiving the first dose of vaccines compared to the second dose. No severe vaccine side effects were observed in this study. However, further research is required to evaluate the long-term symptoms and safety profiles of COVID-19 vaccines.

Healthcare professionals' needs when providing perinatal bereavement care: A qualitative study.

Caring for and supporting bereaved parents with fetal loss requires preparation, training, and attention to a set of needs of health workers to provide optimal services. This is although it has been less addressed in the educational curriculum and in-service training. This study aims to investigate the experiences of Iranian healthcare professionals regarding the needs related to the care of bereaved parents with perinatal loss. This research was a qualitative study conducted in Shahroud City, Iran, to explore healthcare professionals' needs from June 2021 to December 2022. Semi-structured in-depth interviews on purposive sample of 14 participants were conducted. The participants were care providers who worked in OB-GYN ward, general midwifery clinics, and a private office. The interviews were recorded verbatim, transcribed, and analyzed using an inductive content analysis. MAXQDA software version 10 was used for data analysis. Granheim and Lundman's approach was used to analyze the data. Two major themes, four categories, and nine subcategories emerged. The themes included the "existence of protective laws and policies" and "skill and training needs." Protective laws and policies included "Government Rules and guidelines" and "organizational Rules protecting the individual." Skills and training needs consisted of two categories: "communication skills" and "Self-Care needs." Educational policies, development of guidelines for the care of bereaved mothers based on culture, training programs for dealing with bereaved parents, providing self-care programs for employees, and improving the physical and emotional conditions of the workplace were among the needs expressed by the participants. Meeting the needs of healthcare professionals is effective in job satisfaction, feeling of value, and high quality of services for bereaved parents.

Integrating Irish health care: How can we use the United Nations Convention on the Rights of Persons with Disabilities and Nine Pillars of Integrated Care?

Introduction: Over 1 billion (15%) of the world’s population are estimated to experience some form of disability, of whom up to 190 million people live with significant difficulties in functioning, often requiring health care services.
 Despite a myriad of policies and research, disabled people globally continue to be denied their human rights and face enduring barriers to full participation in society.
 The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) is an International Treaty setting out legal obligations on States to promote and protect the rights of persons with disabilities. It provides a unique opportunity to improve the quality of life of all disabled people. The convention identifies that disability arises as a result of barriers in society, including negative attitudes, inappropriate or inaccessible services that result in discrimination against persons with disabilities. The convention includes persons who are or will require Integrated Care. A number of the fifty Articles of the Convention are relevant as a framework to guide the implementation of Integrated Care for and with persons with disabilities. The aim of this workshop was to seek to understand how UNCRPD articles and the IFIC 9 pillars might inform priorities for integrated care.
 Methods: Led and co-designed by people with disabilities, a workshop was held to seek to understand from a broad audience how to use the UNCRPD to frame integrated health care in Ireland in parallel with the IFIC 9 pillars of integrated care.
 The workshop used a World Café methodology, a participatory multi-stakeholder action research process that takes place in a cafe style setting and supports the development of collective knowledge among individuals and communities to address shared problems.
 Participants were allocated into four groups to discuss the following four questions under the guidance of facilitators -
 1.In the context of the UNCRPD and the IFIC 9 pillars of integrated care what are the top 3 priorities to be addressed for people with disabilities across Ireland?
 2.What is currently happening in advancing integrated care for people with disabilities in Ireland?
 3.What would a successful, innovative integrated care system for people with disabilities in Ireland look like?
 4.What are the top 3 solutions you would like to see and work to see implemented immediately?
 Feedback and perspectives were captured on post-it notes and flipcharts and subsequently collated by facilitators. Data were reviewed, and a thematic analysis was conducted.
 Results: There were 20 participants from diverse backgrounds, including experts by experience, disabled persons organisations, academia and health services. Four key themes were generated through inductive thematic analysis: 1) the importance of co-production, 2) the need for equity as opposed to equality, 3) the need for data collection, sharing and knowledge mobilisation and 4) the need for a socioecological integrated care system for people with disabilities.
 Conclusions: Having policies and conventions, and models for the rights of persons with disabilities is not sufficient to ensure implementation. Successful implementation of integrated care needs enablers, including co-production of initiatives with persons with disabilities.

A pragmatic dialogue amongst stakeholders on the impact of COVID-19 on Irish cancer patients and healthcare services and lessons learned.

COVID-19 disrupted cancer care services in Ireland, from screening and diagnostics to treatments, possibly impacting physical health outcomes owing to delayed diagnosis and treatment changes. This study explores how cancer care and patients in Ireland were affected by COVID-19 from the perspective of Irish policy, clinical and patient stakeholders using a qualitative approach. The findings could inform future strategic and implementation plans forthe current challengesfaced and lessons learned will be identified. A thematic analysis of a multi-stakeholder online workshop representing policy and clinical and patient stakeholders was completed. The pandemic exasperated prior challenges including under-resourced services, access barriers, staff shortages and lack of interoperability in information technology (IT) systems. Overall, the measures implemented protected cancer patients from COVID-19; however, some groups were more vulnerable, with apparent demographic and socio-economic inequalities. Many hard-fought gains from the previous decade, in terms of cancer screening, diagnosis and survivorship, were eroded. As we transition to the peri-COVID-19 period, staff burnout, poor IT infrastructure and lack of good quality data must be addressed to minimise further disruptions and restore and enhance cancer services. Overall, innovations and measures adopted during the pandemic protected cancer patients; however, some groups were particularly vulnerable, and inequalities may have widened further. Only proven effective and efficient innovations introduced during the pandemic should be retained and enhanced. Good quality data is needed to inform such decisions when choosing amongst them.

Mental Health Services Integration in Primary Health Care in Iran: A Policy Analysis.

Objective: The National Mental Health Services (N-MHSs) in Iran was integrated with Primary Health Care (PHC) in 1988. This study aimeds to analyze the policy of integrating N-MHSs in PHC, focusing on the analysis of the current situation, pathology, and the existing challenge. Method : This qualitative research was conducted in 2020 using a case study approach. This study used the policy triangle model to analyze the policy. The required data were collected via interviews, literature review, and document analysis. The interviews were conducted with 23 experts, stakeholders across the country who were selected through purposive sampling, and the data were analyzed using the content-analysis method. Results: The main goals of this policy were to raise mental health literacy among the people and eliminate its stigma in the society, while implementing the referral system for N-MHSs. Twenty weaknesses were extracted in eight areas, including negative views of mental health, weaknesses in human resource training, compensation for the service of psychologists, unfavorable working conditions of the workforce, inappropriate service delivery facilities, lack of meaningful communication between different levels of service delivery, poor inter-sectorial communication, and the challenging nature of mental health care. De-stigmatizing psychological disorders in the society and identifying hidden patients are some of the most significant achievements of this policy. Conclusion: Despite the successful implementation and significant achievements in integrating N-MHSs in PHC, the results of the present study indicate that there are many challenges in this field that require serious planning and attention from relevant authorities.

HPR67 Utilisation of Intermittent and Real-Time Continuous Blood Glucose Monitoring in the Irish Healthcare System

HPR67 Utilisation of Intermittent and Real-Time Continuous Blood Glucose Monitoring in the Irish Healthcare System

2300. Incidence of COVID-19 in Irish Healthcare Workers: Preliminary Results from PRECISE-5

Abstract Background Healthcare workers (HCW) are the ideal population to track the evolving epidemiology of SARS-CoV-2. Surges in breakthrough SARS-CoV-2 infection and quarantine regulations leads to staff absence at a time when hospital resources are already burdened. Methods All HCWs in 2 large teaching hospitals were invited to participate in this prospective longitudinal cohort study in November 2022. Information on demographics, SARS-CoV-2 infection history and COVID-19 vaccination dates/brands was collected. Baseline serology for anti-Nucleocapsid (N) and anti-Spike (S) antibodies was performed. Cohort seroprevalence was compared to a prior study phase (November 2021). Monthly follow-up e-surveys collected information relating to incident SARS-CoV-2 infections, symptom duration and work days missed. Results 1261 participants enrolled (Table 1). 25/1261 (0.08%) were unvaccinated. 1103/1261 (87.5%) had received a primary vaccine series and at least one booster. 1260/1261 (99.9%) of participants were anti-S seropositive. 1008/1261 (79.9%) participants were anti-N seropositive. In comparison, serology performed in November 2021 showed anti-N antibody seropositivity in 23.4% (p< 0.0001). 377/1261 (29.9%) participants denied having a prior SARS-CoV-2 infection; of these, 178/377 (47.21%) were anti-N seropositive suggestive of previously undiagnosed infection. Response rate to monthly surveys over the first 14 weeks of the study (Weeks 45-52 of 2022 and Weeks 01-06 of 2023) was 54.3%. 121/1261 (9.6%) of participants reported a positive SARS-CoV-2 test (PCR or Antigen). Incident infections peaked at Weeks 50-52 of 2022 (Fig. 1), reflective of the national trend. 41/121 (33.8%) reported a symptomatic infection, with median symptom duration 7.5 days. Over 14 weeks, total number of work days missed secondary to SARS-CoV-2 infection was 589 days (median 5 days missed per HCW). Conclusion In this interim analysis, 9.6% of participants reported an incident SARS-CoV-2 infection over 14 weeks. This was in the context of high baseline seropositivity for anti-N antibody and vaccination uptake. This suggests that SARS-CoV-2 continues to circulate widely. While morbidity and mortality is low, there are significant consequences including rostered working days lost in healthcare settings. Disclosures All Authors: No reported disclosures

Comparing the Impact of Multimedia and Educational Brochures on Knowledge, Attitude and Work Performance of Healthcare about COVID-19 Management in Pregnancy, Childbirth, and Breastfeeding

Background: In times of pandemic and quarantine, it is necessary to use new educational methods. The aim of this study was to compare the effectiveness of multimedia and booklet educational methods on knowledge, attitude, and job performance of healthcare providers in community health centers regarding COVID-19 in women during pregnancy, childbirth, and breastfeeding. Objectives: The aim of this study was to compare the effectiveness of multimedia and booklet educational methods on knowledge, attitude, and job performance of healthcare providers in community health centers regarding COVID-19 in women during pregnancy, childbirth, and breastfeeding. Methods: The population of this quasi -experimental study consisted of 90 Iranian health care providers in the community health centers of Gonabad city in eastern Iran) 2021, who were selected using the non-probability, purposive sampling method and randomly divided into three groups using a permuted block randomization design: Control group, Multimedia group and Textbook group. Knowledge, attitude and work performance were measured and compared before, after and four weeks after the intervention. The educational content was based on the Iranian Ministry of Health guidelines for the management of Covid-19 in pregnancy, childbirth and breastfeeding. Results: The results showed a significant difference between the mean score of knowledge, attitude, and work performance of the multimedia group and booklet group before and after the intervention (P<0.001), while there was no statistically significant difference between the mean score of knowledge, attitude, and work performance of the control group before and after the intervention (P<0.05). Conclusion: Multimedia teaching increases the knowledge, attitude and work performance of healthcare providers in community health centers regarding COVID.

Living With Endometriosis: A Reflexive Thematic Analysis Examining Women's Experiences With the Irish Healthcare Services.

Endometriosis is an incurable chronic condition associated with debilitating pain and subfertility, affecting 1 in 10 women. The current study aims to explore the perceptions and experiences of women with endometriosis regarding the diagnosis, support and treatment options available in Ireland. It will further determine whether additional supports or improvements are needed to care well and effectively for women with this disease in the Irish healthcare system. A qualitative study design was deemed most suitable. Twenty participants, women aged 18 and over with a diagnosis of endometriosis and experience of the Irish healthcare system, were recruited through purposeful sampling to complete semi-structured, one-to-one online interviews. Data was analysed using reflexive thematic analysis, and five themes were identified: 'dismissive attitudes normalising severe pain', 'inadequate health system', 'the impact of delayed diagnoses', 'lack of education and awareness' and 'navigating ignorance, taboo and societal views'. Insights into the experiences and needs of women diagnosed with endometriosis in Ireland were gained, and we discuss the implications of our findings for Irish healthcare services with reference to feminist health equity and recent national action plans. We propose a series of recommendations for patient-centred care models including increased access to training and education, as well as support for longer-term chronic pain management.

Assessing midwifery services inIran via the balanced scorecard framework.

This study investigates the impact of intra-organizational information, midwife job satisfaction and performance assessment on the quality of midwife services. The questions are empirically tested with survey data obtained from 276 midwives, specialist doctors and nurses, and mothers who recently gave birth in a cross-section of Iranian public healthcare organizations. The results from a structural equation model suggest that an improved performance assessment system leads to higher quality midwife services. In addition, the results indicate that midwife job satisfaction and intra-organizational information increases the quality of midwife services, both directly and indirectly, through the mediating effect of a performance assessment system. Our study contributes to the growing research exploring the interface between accounting and health issues by recognizing the importance of a performance assessment system of midwifery services via the balanced scorecard framework for understanding the quality of midwife services.

Cost-utility analysis of Palbociclib + letrozole and ribociclib + letrozole versus Letrozole monotherapy in the first-line treatment of metastatic breast cancer in Iran using partitioned survival model

BackgroundPalbociclib and Ribociclib are cyclin-dependent kinase 4/6 oral molecular inhibitors that have the potential to improve overall survival (OS), progression-free survival (PFS), and quality of life in patients with metastatic breast cancer (MBC). The objective of this study was to analyze the cost-utility of Palbociclib and Ribociclib in comparison with Letrozole monotherapy as the first-line treatment for hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2–) MBC patients in Iran.MethodsA Cost-Utility Analysis (CUA) was conducted using a partitioned survival model (PSM) from the perspective of the Iranian healthcare system. The comparative strategies considered were Palbociclib + Letrozole, Ribociclib + Letrozole, and Letrozole monotherapy. The model was structured with a 1-month cycle length and a 15-year time horizon. Clinical safety, efficacy, and survival data in terms of PFS and OS for Palbociclib + Letrozole and Ribociclib + Letrozole were obtained from the latest updates of the PALOMA-1, 2, and MONALEESA-2 studies, respectively. Direct medical costs, including drug costs, visits, hospitalization, CT scans, bone x-rays, monitoring and laboratory testing, as well as medication side effects, were considered. Uncertainty evaluations were performed through deterministic sensitivity analysis and probabilistic sensitivity analysis. Excel 2016 and TreeAge 2020 were used for all stages of the evaluation.ResultsThe base case results indicated that, despite its lower effectiveness, Letrozole monotherapy was the most cost-effective strategy, while Palbociclib + Letrozole and Ribociclib + Letrozole were not cost-effective. The incremental cost-effectiveness ratios (ICERs) for Palbociclib + Letrozole and Ribociclib + Letrozole compared to Letrozole monotherapy were estimated at $137,302 and $120,478 per quality-adjusted life-year (QALY), respectively, which exceeded the target threshold of $4565. Deterministic sensitivity analysis demonstrated that the CUA results were not sensitive to changes in the values of uncertain variables. Probabilistic sensitivity analysis also indicated that Palbociclib + Letrozole and Ribociclib + Letrozole had no chance of being cost-effective based on changes in various parameters and simulations.ConclusionsPalbociclib and Ribociclib showed significant efficacy in combination with Letrozole, as evidenced by improvements in PFS. However, in the first-line treatment of MBC in Iran, these strategies were not cost-effective compared to Letrozole monotherapy.

Cost-Utility Analysis of Mirabegron Compared to Solifenacin in the Treatment of Overactive Bladder (OAB) in Iran

Background: Overactive bladder (OAB) is a symptomatic condition characterized by urinary urgency with or without incontinence, usually associated with frequent daytime urination, enuresis, and nocturia. Objectives: This economic evaluation was aimed at assessing the cost-effectiveness of mirabegron versus solifenacin in the treatment of OAB patients from a payer’s perspective in Iran. Methods: A Markov model with a 5-year time horizon was used. The model consisted of five health states, and OAB patients with an average age of 60 years entered the cycle from the persistent state. Transition probabilities were based on published trials, clinical judgments, and expert opinions. Resource use and costs, including those for medications and adverse events, were extracted from the literature and tariff book, and all costs are presented in 2019 US dollars with a 5% discount rate for the costs and utilities. The incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALYs) were computed for medications, and sensitivity analyses were used to test the robustness of the results. Results: Average per-patient treatment costs were $24,720.7 and $24,668.6 for mirabegron and solifenacin, respectively. Mirabegron was expected to produce higher QALYs than solifenacin (3.20 vs. 3.19). Mirabegron had an ICER of $531.3 over solifenacin, lower than the willingness-to-pay (WTP) threshold. The probabilistic analysis showed mirabegron cost-effectiveness in 80% of simulations at the WTP of $2709/QALY. Conclusions: Compared to solifenacin, mirabegron was more cost-effective in OAB patients in the Iranian healthcare system.

Developing Environmental Scanning in Iranian Healthcare: A Comparative Review and a Proposed Model

Context: In recent years, environmental scanning has attracted noteworthy attention within health research in healthcare organizations harnessing this technique to perform their operations. Objectives: This study aimed to compare environmental scanning models and provide a model for Iran’s health system. Evidence Acquisition: This qualitative and comparative research employed an applied purpose in four stages: Description, interpretation, juxtaposition, and comparison. The primary data collection tool was comparative tables to gather data by reviewing articles, documents, and books using scientific databases. The collected information was analyzed by the Beredy method. Results: The most significant models were presented by countries including Singapore, Canada, Iran, and the United States. Most health environmental scanning studies were conducted in countries such as Canada, Australia, the United States, and England. Notably, esteemed researchers such as Albright, Daft, Xue Zhang, Choo, Costa, and Nezhadi introduced influential environmental scanning models. Conclusions: Environmental scanning is a powerful tool in decision-making and strategic planning for organizations, fundamentally impacting their survival and progress. The healthcare system’s general model for environmental scanning is presented in five steps. Based on the results, the environmental scanning model can enable managers and strategic teams to identify risks, opportunities, constraints, and threats and determine suitable strategies for organizational growth and success.

Psychological Symptoms Among Iranian Healthcare Workers During COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic affected working conditions in healthcare systems and caused occupational stress and challenges for the majority of healthcare workers (HCWs). Objectives: This study aimed to examine the prevalence of anxiety, depression, burnout, and career resilience and assess the personal and occupational risk factors contributing to psychological symptoms in Iranian HCWs during the COVID-19 pandemic. Methods: Through a cross-sectional study, HCWs were surveyed within January to February 2022 to evaluate the prevalence of anxiety and depression (using the Hospital Anxiety and Depression Scale [HADS]), burnout (using the Maslach burnout inventory health services survey for medical personnel [MBI-HSS-MP]), and career resilience (using the Career Resilience Questionnaire [CRQ]). The correlation between demographic-occupational factors and psychological symptoms was analyzed. A total of 610 complete responses were received from Iranian HCWs. Results: Approximately 87.9% of HCWs had symptoms of both anxiety and depression (HADS score ≥ 11). The results indicated that most HCWs experienced various signs of burnout (i.e., emotional exhaustion, decreased sense of personal accomplishment, and depersonalization, respectively). The mean score for career resilience reported by the participants was appropriate; however, a fifth of the HCWs had poor career resilience. The highest scores of burnout, anxiety, and depression, in addition to the lowest scores of career resilience, were reported by intensive care unit (ICU) professionals. Conclusions: Marital status, long daily working hours, night shift work, access to personal protective equipment (PPE), and direct exposure to patients with COVID-19 had a significant impact on the anxiety, depression, burnout, and resilience of the HCWs.