Developing Iranian primary health care quality framework: a national study

Abstract

Background: Providing comprehensive and high-quality services is one of the most important goals of the health systems and a basic principle for Universal Health Coverage (UHC). Fulfilling this important task would be feasible through continuous evaluation and improvement of the health services quality. The aim of this study was to develop a framework for quality assessment of Primary Health Care (PHC) in Iran's health system. Methods: This study is a literature review which continued by a qualitative research. The extracted quality dimensions and indicators for initial screening were reviewed and discussed in two panel meetings attended by the experts with regard to the current package of health system in Iran. Using Delphi method, the dimensions and Quality Indicators(QIs) were evaluated and approved by 39 national health professionals in two rounds. Finally, after 4 panel sessions at ministerial level, the selected QIs were categorized in form of the final dimensions of the quality of care. Results: The literature review emerged 13 Primary Health Care Quality Assessment Frameworks (PHCQAF) including 20 and 698 QIs. Delphi study resulted in developing Iranian PHCQAF comprising 7 dimensions and 40 QIs. Among these, 8 QIs of the dimension of access and equity, 5 QIs of safety dimension, 2 QIs of efficiency dimension, 13 QIs of effectiveness dimension, 2 QIs of patient-centeredness dimension, 3 QIs of governance dimension and 7 QIs of appropriateness dimension were presented. Conclusions: The presented PHCQAF can be used as a comprehensive and practical tool for continuous improvement of the quality of PHC services at local, national and regional levels. Moreover, it can give some useful information to the health managers and policy makers on how the services are provided.

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“…This finding agrees with evidence from Iranian studies. 36,37 However, these trends are in sharp contrast with the system in Brazil in which the Family Health Programme incorporates community pharmacists alongside other healthcare professionals as community health workers supporting the core family health teams of general practitioners and nurses in a unique blend of facilityand community-based care with impressive outcomes. 38 Recent evidence from South Africa also shows a shift to a multidisciplinary team approach.…”

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“…PHC focuses on population needs and preferences, individually and as community, and systematically address the health social determinants by providing proper services for health promotion [29]. PHC is the widest and first level of health services delivery in Iran with a focus on deprived population [30,31]. It is revealed in literature that trusted health team provide emotional care and also information for patients and help them in shared decision making about their health (cognitive care) [29,32,33].…”

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“…In the healthcare sector, efficacy is defined as the possibility of a beneficial change (or the therapeutic effect) as result of an intervention (e.g., drug, medical treatment, surgery, or public health intervention) under ideal or controlled conditions. Effectiveness is the ability of a [44] medical intervention (e.g., teleconsultation) to have a significant effect on patients under normal clinical conditions. In turn, efficiency must also clearly identify the inputs that are used to obtain the effect of interest (for example, hours of medical care, days when drugs are supplied or medical expenses) [45] Some authors define efficiency as achieving the desired results with the most profitable use of resources [41].…”

“…In turn, the efficiency and effectiveness dimensions were proposed by the US Agency for Healthcare Research and Quality (AHRQ) [48]. Effectiveness and efficiency were also used in the tools for quality assessment in Iran's PHC systems [44].…”

“…For instance, in the Iranian primary healthcare quality assessment framework, (QAF) out of 40 Quality Indicators (QIs), 33.5% were related to the effectiveness dimension. This dimension had the highest share among the quality dimensions [44]. The effectiveness dimension was also in common with the QAF of such countries as Australia, Canada and the United States in terms of the classification of dimensions and QIs [49,50].…”