ABSTRACT
Background and Aim: From 2011 to 2013 some efforts had been made in Iran to implement urban family physician program. The aim of this study was to determine the viewpoints of managers, providers, and clients of health care services about the problems in the implementation of urban family physician program in Iran
Materials and Methods: This study was a qualitative study. Data were collected through holding 21 sessions of focus group discussions and 37 individual interviews with managers, providers, and clients of health care services in Alborz, West Azerbaijan, and Kurdistan Provinces in 2014. Data were analyzed by means of content analysis method
Results: According to the results of this study, the problems on the implementation of urban family physician program in Iran can be classified into seven categories including: financial, cultural, educational, motivational, structural, administrative, and contextual problems
Conclusion: We propose definition and stabilization of the financial resources and establishment of appropriate rules for payments to solve financial problems, and also training of general population and staffs and involvement of the mass media in training to solve the cultural problems. In order to solve the educational problems reforms in medical curriculum are recommended. Motivational problems can be solved via encouraging the private sector and experts to take part in the program and also through guaranteeing the continuity of the program. Establishment of appropriate organizations and provision of protocols are recommended to solve the structural problems. Finally, to overcome the contextual problems it is suggested to promote cross-sectoral and inter-sectoral coordination and also attract support from policy-makers
ABSTRACT
Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure [SBP], fasting plasma glucose [FPG], total cholesterol [TC], and body mass index [BMI] on mortality and life expectancy, nationally and sub-nationally using representative data and comparable methods. We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework. In 2005, high SBP was responsible for 41,000 [95% uncertainty interval: 38,000, 44,000] deaths in men and 39,000 [36,000, 42,000] deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years [2.6, 3.9] and 4.1 years [3.2, 4.9] in men and women, respectively; the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions. Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health