PMID- 30647030 OWN - NLM STAT- MEDLINE DCOM- 20200115 LR - 20200309 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 9 IP - 1 DP - 2019 Jan 15 TI - Impact of rural Family Physician programme on maternal and child health indicators in Iran: an interrupted time series analysis. PG - e021761 LID - 10.1136/bmjopen-2018-021761 [doi] LID - e021761 AB - OBJECTIVES: The establishment of the Family Physician (FP) programme in the rural areas of Iran in 2005 has made health services accessible and affordable. This paper aims to assess the overall trends of maternal and child health (MCH) indicators in a 20-year period and possible effects of the FP programme (intervention) on these indicators in Iran. DESIGN AND SETTING: An interrupted time series analysis was conducted on 20 annual MCH-related data points from 1994 to 2013. The intervention time was at the 12th data point in 2005. OUTCOMES: MCH indicators were grouped into three categories: structure (mother's age, education, occupation and gravidity), process (number of antenatal care visits (ACVs), laboratory tests, ultrasounds and natural vaginal deliveries (NVDs)) and outcomes (maternal mortality ratio (MMR), neonatal mortality rate (NMR), birth weight (BW), history of abortion and/or stillbirth, and haemoglobin level (Hb)). RESULTS: The adjusted slope of the ACV trend decreased sharply after the intervention (b=-0.36, p<0.01), whereas it increased for the frequency of ultrasounds (b=0.2, p<0.01) and did not change for number of laboratory tests (b=-0.09, p=0.95). The intensification of the descending slope observed for NVD (b=-1.91, p=0.03) disappeared after the adjustment for structural confounders (b=1.33, p=0.26). There was no significant slope change for MMR (b=1.12, p=0.28) and NMR (b=0.67, p=0.07) after the intervention. The slope for the history of abortion trend was constant before and after the intervention, but it considerably intensified for the history of stillbirths after the intervention (b=1.72, p<0.01). The decreasing trend of BW turned into a constant mode after the intervention (b=33.2, p<0.01), but no change was observed for Hb (b=-0.02, p=0.78). CONCLUSION: Although the FP programme had a positive effect on the process and proximal outcome indicators (BW), no dramatic effect on mortality outcome indicators was distinguished. It shows that there should be determinants or mediators of mortality outcomes in this setting, other than accessibility and affordability of MCH services. CI - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Jabbari Beyrami, Hossein AU - Jabbari Beyrami H AD - Department of Community Medicine, School of Medicine, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran. FAU - Doshmangir, Leila AU - Doshmangir L AD - Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. AD - Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. FAU - Ahmadi, Ayat AU - Ahmadi A AD - Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. FAU - Asghari Jafarabadi, Mohammad AU - Asghari Jafarabadi M AD - Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. AD - Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran. FAU - Khedmati Morasae, Esmaeil AU - Khedmati Morasae E AD - National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health and Society, Health Services Research Department, University of Liverpool, Liverpool, UK. FAU - Gordeev, Vladimir S AU - Gordeev VS AD - Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. LA - eng PT - Evaluation Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20190115 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 SB - IM MH - Adult MH - Child MH - Child Health MH - Child Mortality/trends MH - Child, Preschool MH - Family Practice MH - Female MH - *Government Programs MH - *Health Services Accessibility MH - Humans MH - Infant MH - Infant Mortality/trends MH - Infant, Newborn MH - Interrupted Time Series Analysis MH - Iran/epidemiology MH - Male MH - Maternal Health MH - Maternal Mortality/trends MH - *Maternal-Child Health Services MH - Physicians, Family/*supply & distribution MH - Pregnancy MH - Pregnancy Outcome/epidemiology MH - Primary Health Care MH - Program Evaluation MH - *Rural Health Services MH - Rural Population MH - Workforce MH - Young Adult PMC - PMC6340439 OTO - NOTNLM OT - Iran OT - family physician OT - health reform OT - interrupted time series analysis OT - maternal and child health indicators COIS- Competing interests: None declared. EDAT- 2019/01/17 06:00 MHDA- 2020/01/16 06:00 PMCR- 2019/01/15 CRDT- 2019/01/17 06:00 PHST- 2019/01/17 06:00 [entrez] PHST- 2019/01/17 06:00 [pubmed] PHST- 2020/01/16 06:00 [medline] PHST- 2019/01/15 00:00 [pmc-release] AID - bmjopen-2018-021761 [pii] AID - 10.1136/bmjopen-2018-021761 [doi] PST - epublish SO - BMJ Open. 2019 Jan 15;9(1):e021761. doi: 10.1136/bmjopen-2018-021761.