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

Abstract

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.