The effect of the health transformation plan on cesarean section in Iran: a systematic review of the literature

Behzadifar, Meysam; Behzadifar, Masoud; Bakhtiari, Ahad; Azari, Samad; Saki, Mandana; Golbabayi, Farnaz; Bragazzi, Nicola Luigi

doi:10.1186/s13104-019-4081-y

Cited by 16 publications

(22 citation statements)

References 30 publications

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“…The authors found a significant reduction in the rate of cesarean section in both health‐care settings . In a review study by Behzadifar et al, an overall decrease in cesarean section after the implementation of the HTP was found …”

Section: Discussionmentioning

confidence: 94%

“…The HTP policy was aimed to expand medical coverage and provide more high‐quality services in Iran. Reducing unessential cesarean sections, which could endanger the mother's health, and increasing the propensity to choose vaginal delivery were among the important goals of the HTP …”

Section: Discussionmentioning

confidence: 99%

“…In 2014, one of the most important reforms of the health system implemented in the recent decades was the Health Transformation Plan (HTP) in Iran, which comprises several health‐care packages, including programs promoting vaginal delivery. The goals of this ambitious package were to increase the satisfaction of pregnant mothers by improving the physical space available in public hospitals and enhancing labor‐related services and providing them free of charge …”

Section: Introductionmentioning

confidence: 99%

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The impact of the “Health Transformation Plan” and related policies on the prevalence rate of cesarean section in Iran: Insights from an interrupted time series analysis

Behzadifar

Saki

et al. 2019

Health Planning & Management

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Background:The high prevalence of cesarean section represents a major public health challenge worldwide. In 2014, the Iranian Health Transformation Plan (HTP) included programs promoting vaginal delivery. Aim:The aim of this study was to investigate the effect of the HTP on the rate of cesarean section in Iran. Method: The interrupted time series analysis (ITSA) was used. Cesarean section-and vaginal delivery-related monthly data were collected from eight public hospitals affiliated with the Lorestan University of Medical Sciences, from March 2012 to February 2019. The autocorrelation plots and the Durbin-Watson test were used for evaluating the autocorrelation between data points in the generalized least squares regression model. Results: The ITSA showed that the rate of cesarean section decreased immediately after the HTP, by −0.002 per 1000 persons (95% CI, −0.004 to −0.001; P = .069). After the HTP, a significant decreasing trend of cesarean section per month was computed (−0.003; 95% CI, −0.005 to 0.012; P = .043). Conclusion:The present study showed that the implementation of the HTP policy was effective in reducing the rate of cesarean section. This policy should continue, involving

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of the “Health Transformation Plan” and related policies on the prevalence rate of cesarean section in Iran: Insights from an interrupted time series analysis

Behzadifar

Saki

et al. 2019

Health Planning & Management

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“…According to literature [16,[27][28][29], despite the health interventions and even some great economic and demographic changes, the rate of CS was still in an increasing trend [24]. In Iran, similarly, after implementing the special package provided by the Ministry Of Health (MOH) in 2013 to reduce unnecessary CS rate, some reduction was happened, but there is still a long way to achieve a desired rate, as noted in previous studies [30,31]. Some measures have previously been recommended to reduce the CS rate including better coordinating maternity care, collecting and measuring more data, tying Medicaid payment to quality improvement, enhancing patient-centered decision making through public reporting [28] and health instructions [32,33].…”

Section: Discussionmentioning

confidence: 95%

Impact of Urban Family Physician Program on health indicators in Iran: an interrupted time series analysis

Hajibadali

Hashemiparast

Iraji

et al. 2020

Preprint

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Background: In 2015, the Iranian Urban Family Physician Program (UFPP) was implemented in urban health centers. In the present study, we aimed to evaluate the trend of health indicators across a ten-year period in an Iranian population and to measure the possible effects of this intervention on health indicators.Methods: An interrupted time series analysis (ITSA) was performed on a ten-years (from 2009 to 2018) of annual data set covering all healthcare indicators associated to the UFPP in Bonab County, Iran. The time of intervention was at the 7th data point in 2015. Health indicators were divided into two groups including process indicators (Modern Contraceptives Use (MCU), Prenatal and Postpartum care visits, Clinical Breast Examinations (CBE), brucellosis and tuberculosis (TB) incidence), and outcome indicators (Total fertility rate (TFR), Maternal Mortality Rate (MMR), Stillbirth Rate (SBR), Infant mortality Rate (IMR), Neonatal Mortality Rate (NMR), 1-59 months old Mortality Rate, Low Birth Weight (LBW), crud birth rate (CBR) and the rates of Infants fed by Formula milk.Results: The ratio of some process indicators, including the MCU (b = -5.13. 95% Confidence Interval (CI): -8.01 to -2.26), incidence of tuberculosis (b = .016. 95% CI: -1.01 to 1.34) and brucellosis (b = 3.04. 95% CI: -3.4 to 9.50) had a decreasing trend from 2008 to 2018. However, the CBE (b = 0.60. 95% CI: -4.97 to 6.18), prenatal care visits, (b= -4.25. 95% CI: -10.4 to 1.5) postpartum care visits (b = -22.83. 95% CI: -31.44 to -14.21), and first time care visits during pregnancy (b = -5.59. 95% CI: -14.52 to 3.32) were found with increasing trends. In contrast, the rate of at least six-time care visits during pregnancy was found to be in a decreasing trend (b = -10.32. 95% CI: -16.82 to -3.82). A series of outcome indicators including MMR (b = 24.78. 95% CI: 2.88 to 46.61), TFR (b= 0.07. 95% CI: 0.01 to 0.13), 1-59 Month old Mortality Rate (b = -.16. 95% CI: -.45 to .12), LBW (b = .33. 95% CI: -.08 to .40), Formula-fed infant rate (b = .48. 95% CI: -.007 to .97), Delivery rate in high-risk groups (b = 1.85. 95% CI: 1.22 to 2.49) and CS (b = -3.43. 95% CI: -5.73 to -1.12) had increasing trends from 2008 to 2018. In contrast, SBR (b = -.04. 95% CI: -.21 to .12), NMR (b = -.77. 95% CI: -2.91 to 1.36), IMR (b = -1.05. 95% CI: -2.99 to .89) and CBR (b = -.97. 95% CI: -1.85 to -.09) were in decreasing trends. Conclusion: The UFPP was found with positive impacts on some process, proximal and distal outcome indicators, but its positive impacts on the trends of some critical indicators, including MMR, NMR and IMR remained questionable. Our findings may shed light on the role of some other factors like social determinants of health in the programs like the UFPP.

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“…HTP implementation guidelines state that "all hospitals affiliated with the MoHME are subject to HTP" and, as such, the effects of the HTP can be observed for the above-mentioned hospitals, while private hospitals are not included in the HTP. At the time of the HTP implementation, 570 hospitals affiliated to the MoHME and 337 private hospitals were active [5,7,8]. According to the MoHME policies, public hospitals in each province should cover the needs of women and children, surgeries, public referrals, and should ensure healthcare provisions for each type of hospital (general or specialized hospital, characterized by specialized equipment) and division [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The effect of the Iranian health transformation plan on hospitalization rate: insights from an interrupted time series analysis

Beiranvand

Saki

Behzadifar

et al. 2020

BMC Health Serv Res

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Background: Healthcare policy-and decision-makers make efforts to build and maintain high-performing and effective health systems, implementing effectiveness programs and health reforms. In May 2014, the Iranian Ministry of Health and Medical Education has launched a series of ambitious reforms, known as the Health Transformation Plan (HTP). This study aimed to determine the effect of the HTP on hospitalization rate in Iranian public hospitals affiliated to the Ministry of Health and Medical Education. Methods: This study was designed as a quasi-experimental, counterfactual study utilizing the interrupted time series analysis (ITSA), comparing the trend of hospitalization rate before and after the HTP implementation in 16 hospitals in the Lorestan province. Data was collected from March 2012 to February 2019. Results: In the first month of the HTP implementation, an increase of 2.627 [95% CI: 1.62-3.63] was noted (P < 0.001). Hospitalization rate increased by 0.68 [95% CI: 0.32-0.85] after the HTP implementation compared to the first month after the launch of the HTP (P < 0.001). After the HTP implementation, monthly hospitalization rate per 1000 persons significantly increased by 0.049 [95% CI: 0.023-0.076] (P < 0.001). Conclusions: The HTP implementation has resulted in an increased hospitalization rate. Health planners should continue to further improve this service. ITSA can play a role in evaluating the impact of a given health policy.

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The effect of the health transformation plan on cesarean section in Iran: a systematic review of the literature

Cited by 16 publications

References 30 publications

The impact of the “Health Transformation Plan” and related policies on the prevalence rate of cesarean section in Iran: Insights from an interrupted time series analysis

The impact of the “Health Transformation Plan” and related policies on the prevalence rate of cesarean section in Iran: Insights from an interrupted time series analysis

Impact of Urban Family Physician Program on health indicators in Iran: an interrupted time series analysis

The effect of the Iranian health transformation plan on hospitalization rate: insights from an interrupted time series analysis

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