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Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M, Al-Obaid H, Rourke J, Asghari S, Hall A. Interventions to improve primary healthcare in rural settings: A scoping review. PLoS One 2024; 19:e0305516. [PMID: 38990801 PMCID: PMC11239038 DOI: 10.1371/journal.pone.0305516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. OBJECTIVE Synthesize and categorize studies that examine interventions to improve rural primary care. ELIGIBILITY CRITERIA Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. SOURCES OF EVIDENCE Pubmed, CINAHL, Cochrane Library, Embase. CHARTING METHODS We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. RESULTS 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017. CONCLUSIONS Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.
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Affiliation(s)
- Kris Aubrey-Basler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Krystal Bursey
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mark Howells
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Harith Al-Obaid
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - James Rourke
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Doshmangir L, Doshmangir P, Mobasseri K, Khodayari-Zarnaq R, Ahmadi Teymourlouy A, Sergeevich Gordeev V. Factors Affecting Health Policies for Older People in Iran. J Aging Soc Policy 2023; 35:859-881. [PMID: 37125863 DOI: 10.1080/08959420.2023.2205330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/22/2023] [Indexed: 05/02/2023]
Abstract
Globally, the number and proportion of people aged 60 years and older is growing fast. As people age, health needs become more complex, and the health system's responsiveness to older people's needs requires evidence-informed policies. Hence, this study explores the factors affecting the health policy development process for older people in Iran. We conducted 32 interviewers with people aged 60 years and older and 21 interviews with key informants involved in policy making related to older people. Qualitative data were analyzed using thematic analysis. Actors and stakeholders, policy structure, selected health policy processes, the health care service delivery system, government financial support, and community and culture building are the most influential factors in health policy making for older people. Government policies and health priority interventions are needed to address these influential factors for older people to ensure healthy aging over the life course.
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Affiliation(s)
- Leila Doshmangir
- Department of Health Policy& Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management &Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parinaz Doshmangir
- School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khorshid Mobasseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Geriatric Health, Tabriz University of Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy& Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Ahmadi Teymourlouy
- Department of Health Services Management, School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Vladimir Sergeevich Gordeev
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Zhang M, Qu H, Xia J, Hui X, Shi C, Xu F, He J, Cao Y, Hu M. Trends, influencing factors and prediction analysis of under-five and maternal mortality rates in China from 1991 to 2020. Front Public Health 2023; 11:1198356. [PMID: 37927855 PMCID: PMC10620530 DOI: 10.3389/fpubh.2023.1198356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Under-five mortality rate (U5MR) and maternal mortality rate (MMR) are important indicators for evaluating the quality of perinatal health and child health services in a country or region, and are research priorities for promoting maternal and infant safety and maternal and child health. This paper aimed to analysis and predict the trends of U5MR and MMR in China, to explore the impact of social health services and economic factors on U5MR and MMR, and to provide a basis for relevant departments to formulate relevant policies and measures. Methods The JoinPoint regression model was established to conduct time trend analysis and describe the trend of neonatal mortality rate (NMR), infant mortality rate (IMR), U5MR and MMR in China from 1991 to 2020. The linear mixed effect model was used to assess the fixed effects of maternal health care services and socioeconomic factors on U5MR and MMR were explored, with year as a random effect to minimize the effect of collinearity. Auto regressive integrated moving average models (ARIMA) were built to predict U5MR and MMR from 2021 to 2025. Results The NMR, IMR, U5MR and MMR from 1991 to 2020 in China among national, urban and rural areas showed continuous downward trends. The NMR, IMR, U5MR and MMR were significantly negatively correlated with gross domestic product (GDP), the proportion of the total health expenditure (THE) to GDP, system management rate, prenatal care rate, post-natal visit rate and hospital delivery rate. The predicted values of national U5MR from 2021 to 2025 were 7.3 ‰, 7.2 ‰, 7.1 ‰, 7.1 ‰ and 7.2 ‰ and the predicted values of national MMR were 13.8/100000, 12.1/100000, 10.6/100000, 9.6/100000 and 8.3/100000. Conclusion China has made great achievements in reducing the U5MR and MMR. It is necessary for achieving the goals of Healthy China 2030 by promoting the equalization of basic public health services and further optimizing the allocation of government health resources. China's experience in reducing U5MR and MMR can be used as a reference for developing countries to realize the SDGs.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mengcai Hu
- Department of Health Care, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Mohammadi N, Alizadeh A, Moghaddam SS, Ghasemi E, Ahmadi N, Yaseri M, Rezaei N, Mansournia MA. The causal effect of family physician program on the prevalence, screening, awareness, treatment, and control of hypertension and diabetes mellitus in an Eastern Mediterranean Region: a causal difference-in-differences analysis. BMC Public Health 2023; 23:1152. [PMID: 37316852 DOI: 10.1186/s12889-023-16074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 06/08/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Hypertension (HTN) and diabetes mellitus (DM) as part of non-communicable diseases are among the most common causes of death worldwide, especially in the WHO's Eastern Mediterranean Region (EMR). The family physician program (FPP) proposed by WHO is a health strategy to provide primary health care and improve the community's awareness of non-communicable diseases. Since there was no clear focus on the causal effect of FPP on the prevalence, screening, and awareness of HTN and DM, the primary objective of this study is to determine the causal effect of FPP on these factors in Iran, which is an EMR country. METHODS We conducted a repeated cross-sectional design based on two independent surveys of 42,776 adult participants in 2011 and 2016, of which 2301 individuals were selected from two regions where the family physician program was implemented (FPP) and where it wasn't (non-FPP). We used an Inverse Probability Weighting difference-in-differences and Targeted Maximum Likelihood Estimation analysis to estimate the average treatment effects on treated (ATT) using R version 4.1.1. RESULTS The FPP implementation increased the screening (ATT = 36%, 95% CI: (27%, 45%), P-value < 0.001) and the control of hypertension (ATT = 26%, 95% CI: (1%, 52%), P-value = 0.03) based on 2017 ACC/AHA guidelines that these results were in keeping with JNC7. There was no causal effect in other indexes, such as prevalence, awareness, and treatment. The DM screening (ATT = 20%, 95% CI: (6%, 34%), P-value = 0.004) and awareness (ATT = 14%, 95% CI: (1%, 27%), P-value = 0.042) were significantly increased among FPP administered region. However, the treatment of HTN decreased (ATT = -32%, 95% CI: (-59%, -5%), P-value = 0.012). CONCLUSION This study has identified some limitations related to the FPP in managing HTN and DM, and presented solutions to solve them in two general categories. Thus, we recommend that the FPP be revised before the generalization of the program to other parts of Iran.
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Affiliation(s)
- Neda Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahad Alizadeh
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Population Sciences Institute, Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Erfan Ghasemi
- Endocrinology and Metabolism Population Sciences Institute, Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Endocrinology and Metabolism Population Sciences Institute, Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Negar Rezaei
- Endocrinology and Metabolism Population Sciences Institute, Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Zaidi S, Das JK, Jamal W, Ali A, Siddiqui F, Thabet A, Salah H, Mataria A. Government purchasing initiatives involving private providers in the Eastern Mediterranean Region: a systematic review of impact on health service utilisation. BMJ Open 2023; 13:e063327. [PMID: 36813492 PMCID: PMC9950888 DOI: 10.1136/bmjopen-2022-063327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE This paper provides a systematic review of evidence of government purchase of health services from private providers through stand-alone contracting-out (CO) initiatives and CO insurance schemes (CO-I) on health service utilisation in Eastern Mediterranean Region (EMR) to inform universal health coverage 2030 strategies. DESIGN Systematic review. DATA SOURCES Electronic search of published and grey literature on Cochrane Central Register of Controlled Trials, PubMed, CINHAL, Google Scholar and web, including websites of ministries of health from January 2010 to November 2021. ELIGIBILITY CRITERIA Randomised controlled trials, quasi-experimental studies, time series, before-after and endline with comparison group reporting quantitative utilisation of data across 16 low-income and middle-income states of EMR. Search was limited to publications in English or English translation. DATA EXTRACTION AND SYNTHESIS We planned for meta-analysis, but due to limited data and heterogeneous outcomes, descriptive analysis was performed. RESULTS Several initiatives were identified but only 128 studies were eligible for full-text screening and 17 met the inclusion criteria. These included CO (n=9), CO-I (n=3) and a combination of both (n=5) across seven countries. Eight studies assessed interventions at national level and nine at subnational level. Seven studies reported on purchasing arrangements with non-governmental organisations, 10 on private hospitals and clinics. Impact on outpatient curative care utilisation was seen in both CO and CO-I, positive evidence of improved maternity care service volumes was seen mainly from CO interventions and less reported from CO-I, whereas data on child health service volume was only available for CO and indicated negative impact on service volumes. The studies also suggest pro-poor effect for CO initiatives, whereas there was scarce data for CO-I. CONCLUSION Purchasing involving stand-alone CO and CO-I interventions in EMR positively impact general curative care utilisation, but lacks conclusive evidence for other services. Policy attention is needed for embedded evaluations within programmes, standardised outcome metrics and disaggregated utilisation data.
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Affiliation(s)
- Shehla Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Aga Khan University (International), AKU-UK, London, UK
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Wafa Jamal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Ammarah Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Faareha Siddiqui
- Faculty of Health Sciences, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aya Thabet
- Department of Universal Health Coverage/ Health Systems, WHO-EMRO, Cairo, Egypt
| | - Hassan Salah
- Department of Universal Health Coverage/ Health Systems, WHO-EMRO, Cairo, Egypt
| | - Awad Mataria
- Department of Universal Health Coverage/ Health Systems, WHO-EMRO, Cairo, Egypt
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Doshmangir L, Gharaee H, Babaie J, Aghdam NM, Zahmatkesh M. Retaining clinicians in suburban areas: An experience from Iran's primary health care system reform. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
- Social Determinants of Health Research Center, Health Management & Safety Promotion Research Institute Tabriz University of Medical Sciences Tabriz Iran
| | - Hojatolah Gharaee
- Department of Public Health Hamadan University of Medical Sciences Hamedan Iran
| | - Javad Babaie
- Department of Health Policy & Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| | - Nasrin M. Aghdam
- Department of Health Policy & Management, Tabriz Health Services Management Research Centre, School of Management & Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| | - Maryam Zahmatkesh
- Department of Human Resource Management and Organisation Studies Royal Holloway University of London London UK
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Bordbar N, Shojaei P, Kavosi Z, Joulaei H, Ravangard R, Bastani P. Comparison of Health Status Indicators in Iran with the Eastern Mediterranean Countries Using Multiple Attribute Decision-Making Methods. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:566-576. [PMID: 36380980 PMCID: PMC9652489 DOI: 10.30476/ijms.2021.91454.2261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/17/2021] [Accepted: 09/28/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Improving public health is the main goal of healthcare systems across the world. Healthcare policymakers often use comparisons between different healthcare systems to better position their country and use the outcome to develop novel strategies to improve their own public health. The present study aimed to compare the health status indicators in Iran with those of the Eastern Mediterranean (EM) countries using the multiple attribute decision-making (MADM) methods. METHODS A descriptive-analytical study was conducted in 2021 at Shiraz University of Medical Sciences, Shiraz, Iran. Data on the ranking of health status indicators in EM countries were obtained from the annual publications of the World Health Organization, World Health Statistics (2016-2020). As part of the MADM mathematical models, the "criteria importance through intercriteria correlation" (CRITIC) model was used to assign weights to health status indicators. In addition, the "multi-criteria optimization and compromise solution" (VIKOR) model was used to rank the EM countries. RESULTS The results showed that Bahrain and Somalia ranked first and last on health status indicators, respectively. Iran was ranked fifth among the EM countries. However, while Iran has a better status on all indicators than the mean value of all EM countries, there is a significant gap between the health status in Iran compared to the top-ranked countries. CONCLUSION Health care strategies adopted by top-ranked countries, such as Bahrain and Qatar, can be used by Iran and other EM countries as a model to improve their healthcare system.
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Affiliation(s)
- Najmeh Bordbar
- Student Research Committee, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Shojaei
- Department of Management, School of Economics, Management, and Social Sciences, Shiraz University, Shiraz, Iran
| | - Zahra Kavosi
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peivand Bastani
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Sepanlou SG, Rezaei Aliabadi H, Malekzadeh R, Naghavi M. Maternal Mortality and Morbidity by Cause in Provinces of Iran, 1990 to 2019: An Analysis for the Global Burden of Disease Study 2019. ARCHIVES OF IRANIAN MEDICINE 2022; 25:578-590. [PMID: 37543883 PMCID: PMC10685769 DOI: 10.34172/aim.2022.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 08/07/2023]
Abstract
BACKGROUND Since 1990, maternal mortality ratio (MMR) has significantly decreased in Iran. However, estimates for mortality and morbidity by cause at subnational scale are not available. METHODS This study is part of the Global Burden of Diseases study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 31 provinces of Iran from 1990 to 2019. RESULTS Since 1990, MMR declined from 44.5 (95% UI: 38.6-50.1) to 15.9 (14.7-17.3) per 100000 live births in Iran. In 1990 MMR ranged from 18.5 (11.2-26.4) to 76.9 (38.4-114.7) per 100000 live births across provinces. Respective figures for 2019 were 7.1 (5.2-9.3) to 34.0 (25.1-44.7) per 100000 live births. In 2019, MMR was higher in young women (aged 10 to 14) and older women (aged 45 or more). Percentages of deaths under 25 years was 24.8% in 1990 and 16.0% in 2019. There was remarkable decline in years lost due to premature death (YLL) rates from 1990 to 2019. While the decline was modest for years lived with disability (YLD) rates. Indirect maternal deaths and other maternal deaths ranked first or second in almost all provinces. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic Index (SDI) from 1990 to 2019 in all provinces and an evident convergence across provinces. CONCLUSION MMR has declined to levels much lower than Sustainable Development Goals in all provinces. Although there was a convergence in trends, there are still disparities across provinces. The decline in disabilities caused by maternal disorders is not as significant as mortality, which needs further actions.
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Affiliation(s)
- Sadaf G. Sepanlou
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, USA
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Wang L, Liu W. Effects of Family Doctor Contract Services on the Health-Related Quality of Life Among Individuals With Diabetes in China: Evidence From the CHARLS. Front Public Health 2022; 10:865653. [PMID: 35602141 PMCID: PMC9114482 DOI: 10.3389/fpubh.2022.865653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background Family doctor contract services (FDCS) has played a key role in diabetes management in China since 2016. The influence of FDCS on the physiological indexes of individuals with diabetes has been examined. However, little attention has been paid to its effect on the Health-Related Quality of Life (HRQoL). This study aims to fill this knowledge gap by evaluating the effect of FDCS on the HRQoL of individuals with diabetes. Methods We identified 382 individuals with diabetes receiving all follow-up surveys in 2013, 2015, and 2018 from the China Health and Retirement Longitudinal Study (CHARLS). The HRQoL of the included individuals was estimated using results from the Short Form 36 (SF-36) questionnaire. The propensity score matching with the difference-in-differences (PSM-DID) approach was applied to quantify the effect of FDCS on the HRQoL among individuals with diabetes. A robust test was performed by setting the 2015 data as the treatment group for the placebo test. Results The mean score of role-emotional (RE) increased from 54.25 to 61.63 among those who signed up to receive FDCS, while the corresponding score decreased from 57.77 to 51.04 among those who did not receive FDCS. Results from the regression analysis indicated that the use of FDCS was associated with significant improvement in RE (+14.10, p = 0.04) among individuals with diabetes. We did not find a statistically meaningful association between the FDCS and any of the other HRQoL domains: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), and mental health (MH), respectively. The robustness analysis of the model indicated that the results were robust. Conclusion The FDCS for diabetes in China was associated with a significant improvement in RE. Due to a limited time since the launch of FDCS (i.e., 2016), the recipient's physical health did not show marked improvement. In the future, FDCS should pay more attention to the physiological health of individuals with diabetes. Moreover, psychological services also need to be maintained and not slackened. At the same time, it is strongly recommended to pay more attention to the HRQoL of individuals with diabetes and more comprehensive health.
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Affiliation(s)
- Lingjie Wang
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Wenbin Liu
- School of Public Health, Fujian Medical University, Fuzhou, China
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Rouhani S, Esmaeili R, Yazdani Charati J, Khandehroo M. The impacts of family physician plan and health transformation plan on hospitalization rates in Iran: an interrupted time series. BMC Health Serv Res 2021; 21:658. [PMID: 34225708 PMCID: PMC8259001 DOI: 10.1186/s12913-021-06685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran. METHODS We conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1. RESULTS A decreasing trend by - 0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 (P < 0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan (P < 0.001). CONCLUSIONS Family physician created a decreasing trend for hospitalization in urban area of Mazandaran province in Iran. HTP with lower user fee in governmental public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.
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Affiliation(s)
- Samad Rouhani
- Department of Public Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Esmaeili
- Department of Public Health, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Jamshid Yazdani Charati
- Department of Biostatistics, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoud Khandehroo
- Department of Public Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran.
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Lai S, Lu L, Zhou Z, Shen C, Yang X, Zhao Y, Zhang X. The effects of family physician-contracted service on health-related quality of life and equity in health in China. Int J Equity Health 2021; 20:15. [PMID: 33407523 PMCID: PMC7788691 DOI: 10.1186/s12939-020-01348-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
Background Family physician-contracted service (FPCs) has been recently implemented in Chinese primary care settings. This study was aimed at measuring the effects of FPCs on residents’ health-related quality of life (HRQoL) and equity in health among the Chinese population. Methods The study data was drawn from the 2018 household health survey (Shaanxi Province, China) using multistage, stratified cluster random sampling. We measured HRQoL using EQ-5D-3L based on the Chinese-specific time trade-off values set. Coarsened exact matching (CEM) technique was used to control for confounding factors between residents with and without a contracted family physician. The concentration index (C) was calculated to measure equity in health. Results Individuals with a contracted family physician had significantly higher HRQoL than those without, after data matching (0.9355 vs. 0.8995; P < 0.001). Additionally, the inequity in HRQoL among respondents with a contracted family physician was significantly lower than those without a contracted family physician (Cs of EQ-5D utility score: 0.0084 vs. 0.0263; p < 0.001). Conclusions This study highlights the positive effects of FPCs on HRQoL and socioeconomic-related equity in HRQoL. Future efforts should prioritize the economically and educationally disadvantaged groups, the expansion of service coverage, and the competency of family physician teams to further enhance health outcome and equity in health.
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Affiliation(s)
- Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China
| | - Li Lu
- Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China
| | - Xiaowei Yang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China.
| | - Yaxin Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China
| | - Xiaolong Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China
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Fardid M, Jafari M, Vosoogh-Moghaddam A. A policy brief on improving the finance of family physician program: An experience from urban areas of Iran. J Family Med Prim Care 2020; 9:1413-1417. [PMID: 32509625 PMCID: PMC7266260 DOI: 10.4103/jfmpc.jfmpc_997_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/23/2020] [Accepted: 02/07/2020] [Indexed: 11/04/2022] Open
Abstract
In the current scenario, financing suffers from problems related to lack of specific line for UFFP, lack of resource pooling, delay in payment to physicians, and conflict of interests among family physician team. As a result, this policy brief was formulated based on the role of FPs in public access to general practitioner (GP) services in the referral system on one hand, followed by the impact of it on health costs reduction on the another hand, and further considering the necessity of financing system audit to find a sustainable resources for this program to be implemented at a national level in the country of Iran.
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Affiliation(s)
- Mozhgan Fardid
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mehdi Jafari
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.,Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
| | - Abbas Vosoogh-Moghaddam
- Society and Health Policy Group, Secretariat for Supereme Council of Health and Food Security, Tehran, Iran.,Leadership and Governance Scientific Group, Health Manager's Development Institute (HMDI), Ministry of Health and Medical Education, Tehran, Iran
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13
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Doshmangir L, Moshiri E, Farzadfar F. Seven Decades of Primary Healthcare during Various Development Plans in Iran: A Historical Review. ARCHIVES OF IRANIAN MEDICINE 2020; 23:338-352. [PMID: 32383619 DOI: 10.34172/aim.2020.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/26/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore historically primary healthcare (PHC) development in Iran in the light of development plans before and after the Islamic Revolution. The results of this study can be used to outline the future of PHC in the Iranian health system. METHODS We conducted a retrospective analysis of the PHC development in the Iranian health system using data from relevant published and unpublished policy documents. The literature was retrieved and reviewed on the basis of predetermined inclusion criteria with no language or date restriction. The data were integrated and analyzed using content analysis. RESULTS During various upstream development plans, the attitude of the policy makers to PHC has been very different, resulting in fundamental differences in addressing such an important issue and the consequent outcomes. In the aftermath of Iran's revolution, due to more understanding of PHC services importance and the principal slogans of the revolution to pay attention to villagers and vulnerable people, health policymakers paid more attention to PHC, which was not evident in previous periods. CONCLUSION Despite considerable achievements in PHC, the history of PHC in Iran indicates frequent changes in planning and health provision structure. This suggests that the challenges facing the health sector today, the evolving needs and demands of the people, and population changes necessitate reinforcement and reform in the structure of the current PHC network as the main mission of Iran's Ministry of Health.
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Affiliation(s)
- Leila Doshmangir
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmaeil Moshiri
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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