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

Behzadifar, Masoud; Behzadifar, Meysam; Saki, Mandana; Valipour, Mehrdad; Omidifar, Roodabeh; Iranshahi, Fatemeh; Bragazzi, Nicola Luigi

doi:10.1002/hpm.2916

Cited by 6 publications

(6 citation statements)

References 31 publications

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“…Policymakers are interested in evaluating the impact of different policies in the health sector and, depending on the effects, decide whether to continue or not their implementation [ 23 ]. ITSA is widely used to monitor and track the effectiveness of both clinical and non-clinical interventions and can help provide evidence for decision-making [ 24 ]. ITSA examines a continuous time series of observations on an outcome repeatedly over time [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

The effect of COVID-19 on public hospital revenues in Iran: An interrupted time-series analysis

et al. 2022

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Background The “Coronavirus Disease 2019” (COVID-19) pandemic has become a major challenge for all healthcare systems worldwide, and besides generating a high toll of deaths, it has caused economic losses. Hospitals have played a key role in providing services to patients and the volume of hospital activities has been refocused on COVID-19 patients. Other activities have been limited/repurposed or even suspended and hospitals have been operating with reduced capacity. With the decrease in non-COVID-19 activities, their financial system and sustainability have been threatened, with hospitals facing shortage of financial resources. The aim of this study was to investigate the effects of COVID-19 on the revenues of public hospitals in Lorestan province in western Iran, as a case study. Method In this quasi-experimental study, we conducted the interrupted time series analysis to evaluate COVID-19 induced changes in monthly revenues of 18 public hospitals, from April 2018 to August 2021, in Lorestan, Iran. In doing so, public hospitals report their earnings to the University of Medical Sciences monthly; then, we collected this data through the finance office. Results Due to COVID-19, the revenues of public hospitals experienced an average monthly decrease of $172,636 thousand (P-value = 0.01232). For about 13 months, the trend of declining hospital revenues continued. However, after February 2021, a relatively stable increase could be observed, with patient admission and elective surgeries restrictions being lifted. The average monthly income of hospitals increased by $83,574 thousand. Conclusion COVID-19 has reduced the revenues of public hospitals, which have faced many problems due to the high costs they have incurred. During the crisis, lack of adequate fundings can damage healthcare service delivery, and policymakers should allocate resources to prevent potential shocks.

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Section: Methodsmentioning

confidence: 99%

The effect of COVID-19 on public hospital revenues in Iran: An interrupted time-series analysis

et al. 2022

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“…Interrupted time series analysis (ITSA) can be a useful method in order to assess the effects of the different health policies (13,14). This approach can explore temporal trends before and after the implementation of health policies and their effects on an array of outcomes (15,16). Utilizing such results can better inform decision-making processes (17).…”

Section: Interrupted Time Series Analysismentioning

confidence: 99%

Interrupted time series analysis of the implementation of social distancing policy, its lifting and the mandate of wearing face masks in Iran to mitigate against COVID-19

Saki

Behzadifar

et al. 2020

Preprint

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BackgroundCOVID-19 was first reported in Wuhan, China, and has spread rapidly around the world. The purpose of this study was to investigate the effects of implementing social distancing policy, and the impact of its lifting, with the resumption of social contacts and activities, as well as the effects of mandating face masks on the temporal trend of new COVID-19 cases in Iran. Methods We employed the interrupted time series analysis (ITSA), which is a very valuable method that can be used to evaluate the impact of the implementation of various policies in the health sector to help health policy-makers make effective decisions. Daily data were collected from the Ministry of Health and Medical Education and the World Health Organization from 954 public hospitals and health center settings. Data were extracted 14 days before and after the implementation of each policy. Results were computed with their 95% confidence interval (CI) and p-values equal to or less than 0.05 were considered as statistically significant. All data were analyzed using the open-source software R Version 3.6.1 using the “nlme” and “car” packages.ResultsThe slope of changes in new confirmed cases following the implementation of the social distancing policy decreased by 118.79 (P <0.001). With the resumption of social and economic activities in all provinces except for Tehran, initially the number of new daily confirmed cases was 3300, which was statistically significant (P <0.001). The slope of changes due to the implementation of this policy was 47.89 (P <0.001). A similar trend was detected with the resumption of social and economic activities in Tehran. With the implementation of the policy of mandatory use of masks, the slope of changes showed a decrease of 25.84 (P <0.001). Conclusion Given the absence of effective drugs and vaccines against COVID-19, policy-makers have implemented non-pharmacological interventions to reduce the transmission of the disease and prevent more deaths. Social distancing may be unsustainable in the long-term, while wearing masks is both a cost-effective and efficacious measure to curb disease transmission.

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“…According to available evidence, women attending preparation courses for childbirth are better adapted to labor pain, use less medications during labor, and are less likely to need instrumental vaginal birth ( 10 ). Although evidence in Iran shows that attending educational antenatal classes has been effective in empowering pregnant women ( 11 ), and that these classes could reduce fear, anxiety and depression in primiparous women ( 12 ), the rate of cesarean section in Iran is still much higher than that in most developed countries ( 13 ). Based on a systematic review, the prevalence of cesarean birth in Iran has increased six-fold from less than 7% in the 1970s to over 48% in 2018 ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…The high rate of cesarean section has raised serious concerns among health policy-makers and decision-makers in Iran ( 32 ), and the health system needs to undertake appropriate initiatives in this respect ( 13 ). Numerous attempts have been made in recent years in order to decrease the rate of unnecessary cesarean sections in Iran.…”

Section: Introductionmentioning

confidence: 99%

Effect of birth plans integrated into childbirth preparation classes on maternal and neonatal outcomes of Iranian women: A randomized controlled trial

Mohaghegh

Javadnoori

Najafian

et al. 2023

Front. Glob. Womens Health

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BackgroundInvolvement of women in the decision-making process during childbirth plays an important role in their physical and psychosocial preparation. A birth plan allows the woman to express her expectations and facilitates her participation in her own care. The present study is the first to assess the implementation of birth plans integrated into childbirth preparation classes in Tehran, Iran.MethodsThis study is a randomized controlled clinical trial performed on 300 pregnant women at 32–33 weeks of gestation referring to four public health centers in Tehran, Iran. The participants were randomly allocated into intervention and control groups using block randomization method. A training session on the items of the birth plan checklist was held in the fifth session of childbirth preparation classes for the participants in the intervention group. Accordingly, a birth plan was prepared according to the requests of mothers. The birth plan was implemented after the women were admitted to the maternity ward. The primary outcomes were frequency of vaginal birth, mean duration of labor stages, and mean score of childbirth satisfaction. We used a checklist of maternal and neonatal outcomes, Mackey's childbirth satisfaction questionnaire, and a partogram form for data collection. Independent t-test, Mann–Whitney U-test, Chi-square test, Fisher's exact test, and logistic regression were used for data analysis.ResultsVaginal birth rates were significantly higher in women who had birth plans compared with those without (81.9% vs. 48.7%, p < 0.001). Also, the lengths of the first and the second stages of labor were significantly shorter in women having a birth plan (p = 0.02). Women in the birth plan group were significantly more satisfied with the process of labor and childbearing (p < 0.001), and started breastfeeding after birth earlier than those in the control group (p < 0.001).ConclusionHaving a birth plan and attending childbirth preparation classes can increase the rate of normal vaginal birth. Also, according to our results, women's participation in the decision- making process and fulfilling their preferences during birth can improve maternal and neonatal outcomes and childbirth satisfaction.Trial registration: IRCT20190415043283N2. 2020-12-07.

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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

Cited by 6 publications

References 31 publications

The effect of COVID-19 on public hospital revenues in Iran: An interrupted time-series analysis

The effect of COVID-19 on public hospital revenues in Iran: An interrupted time-series analysis

Interrupted time series analysis of the implementation of social distancing policy, its lifting and the mandate of wearing face masks in Iran to mitigate against COVID-19

Effect of birth plans integrated into childbirth preparation classes on maternal and neonatal outcomes of Iranian women: A randomized controlled trial

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