title: Health system responsiveness for outpatient care in people with diabetes Mellitus in Tehran.
abstract: BACKGROUND
  World Health Organization (WHO) defines three goals to assess the performance of a health system: the state of health, fairness in financial contribution and responsiveness. We assessed the responsiveness of health system for patients with diabetes in a defined population cohort in Tehran, Iran.
  
  
  METHODS
  Total responsiveness and eight domains (prompt attention, dignity, communication, autonomy, confidentiality, choice, basic amenities and discrimination) were assessed in 150 patients with diabetes as a representative sample from the Tehran Glucose and Lipid Study (TLGS) population cohort. We used the WHO questionnaire and methods for analysis of responsiveness.
  
  
  RESULTS
  With respect to outpatient services, 67% (n=100) were classified as Good for total responsiveness. The best and the worse performing results were related to information confidentiality (84% good responsiveness) and autonomy (51% good responsiveness), respectively. About 61% chose "communication" as the most important domain of responsiveness; it was on the 4th rank of performance. The proportions of poor responsiveness were higher in women, individuals with lower income, lower level of education, and longer history of diabetes. "Discrimination" was considered discrimination as the cause of inappropriate services by 15%, and 29% had limited access to services because of financial unaffordability.
  
  
  CONCLUSIONS
  Health system responsiveness is not appropriate for diabetic patients. Improvement of responsiveness needs comprehensive planning to improve attitudes of healthcare providers and system behavior. Activities should be prioritized through considering weaker domains of performance and more important domains from the patients' perspective.
authors.affiliation: Assistance Professor of Community Medicine , Department of Community Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran & Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran. sajjadi@bmsu.ac.ir .
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Sajjadi
authors.affiliation: Associate Professor of Community Medicine, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran & Gastro-Intestinal and Liver Disease Research Centre, Iran University of Medical Sciences, Tehran, Iran. moradi.m@iums.ac.ir.
authors.forename: Maziar
authors.initials: M
authors.lastname: Moradi-Lakeh
authors.affiliation: Professor of Community Medicine, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran. mnojomi@gmail.com.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Nojomi
authors.affiliation: Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran. baradaran.hr@iums.ac.ir.
authors.forename: Hamid R
authors.initials: HR
authors.lastname: Baradaran
authors.affiliation: Department of Endocrine Diseases, Shaheed-Beheshti University of Medical Sciences, Tehran, Iran & Research Institute for Endocrine Sciences, Endocrinology Research Center, Shaheed-Beheshti University of Medical Sciences, Tehran, Iran. azizi@endocrine.ac.ir.
authors.forename: Fereidoun
authors.initials: F
authors.lastname: Azizi
keywords: Delivery of healthcare; Diabetes mellitus; Iran; Patient satisfaction; Responsiveness