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      Organizing palliative care in the rural areas of Iran: are family physician-based approaches suitable?

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          Abstract

          Introduction

          The provision of palliative end-of-life care (P/EOLc) for patients, wherever they live, is an increasingly important service, particularly given the increasing rates of cancer and other life-threatening diseases in Iran. However, unfortunately, those living in the rural areas of Iran are greatly disadvantaged with respect to this type of care. Therefore, the present study explored the feasibility of organizing P/EOLc in the rural areas of Iran.

          Methods

          In this qualitative study, two focus group (FG) discussions were held in Tabriz (Iran) with rural family physicians (FPs, n=23) and key P/EOLc stakeholders (n=13). The FG sessions were recorded, transcribed, and the transcriptions checked by participants before the data were subjected to content analysis.

          Results

          While most FPs indicated that they did not have sufficient involvement in providing P/EOLc, they emphasized the necessity of providing P/EOLc through four main themes and 25 subthemes. The four main themes were labeled as “structures and procedures,” “health care provider teams,” “obstacles,” and “strategies or solutions.” Furthermore, according to the main themes and subthemes identified here, the key stakeholders believed that the Iranian health system and the FPs’ team have the potential to provide P/EOLc services in rural areas.

          Conclusion

          The most feasible strategy for providing P/EOLc in Iranian rural areas would be to use the current health care framework and base the process around the FP.

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          Most cited references 55

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          Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report

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            Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

            In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national development plan (2016-2021).
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              Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network.

              The primary health care (PHC) network contributed considerably to improving health outcomes in rural Iran. However, the health system suffers from inadequate responses to ever-increasing demands. In 2005, a reform comprised of a family physician (FP) programme and universal health insurance was implemented in all rural areas and cities with a population of <20 000. We explored the role of the pre-existing PHC network on the implementation of FP programme in rural Iran.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2019
                18 December 2018
                : 12
                : 17-27
                Affiliations
                [1 ]Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
                [2 ]Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
                [3 ]Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
                [4 ]Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
                [5 ]School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus
                [6 ]Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran, saeidsafiri@ 123456gmail.com
                [7 ]Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, saeidsafiri@ 123456gmail.com
                Author notes
                Correspondence: Saeid Safiri, Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Majles Sq., Maragheh, Iran, Email saeidsafiri@ 123456gmail.com
                Article
                jpr-12-017
                10.2147/JPR.S178103
                6302809
                © 2019 Jabbari et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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