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Technical efficiency of rural primary health care system for diabetes treatment in Iran: a stochastic frontier analysis.

ABSTRACT: Our aim was to explore the technical efficiency (TE) of the Iranian rural primary healthcare (PHC) system for diabetes treatment coverage rate using the stochastic frontier analysis (SFA) as well as to examine the strength and significance of the effect of human resources density on diabetes treatment.In the SFA model diabetes treatment coverage rate, as a output, is a function of health system inputs (Behvarz worker density, physician density, and rural health center density) and non-health system inputs (urbanization rate, median age of population, and wealth index) as a set of covariates. Data about the rate of self-reported diabetes treatment coverage was obtained from the Non-Communicable Disease Surveillance Survey, data about health system inputs were collected from the health census database and data about non-health system inputs were collected from the census data and household survey.In 2008, rate of diabetes treatment coverage was 67% (95% CI: 63%-71%) nationally, and at the provincial level it varied from 44% to 81%. The TE score at the national level was 87.84%, with considerable variation across provinces (from 59.65% to 98.28%).Among health system and non-health system inputs, only the Behvarz density (per 1000 population)was significantly associated with diabetes treatment coverage (β (95%CI): 0.50 (0.29-0.70),p < 0.001).Our findings show that although the rural PHC system can considered efficient in diabetes treatment at the national level, a wide variation exists in TE at the provincial level. Because the only variable that is predictor of TE is the Behvarz density, the PHC system may extend the diabetes treatment coverage by using this group of health care workers.

SUBMITTER: Qorbani M

PROVIDER: S-EPMC5556340 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:Smallholder agriculture in developing countries is characterized by low productivity. Improving the productive efficiency of farm households is considered one of the paths to increase productivity and reduce poverty. This study analyzed the poverty reduction effects of improving the technical efficiency of cereal-producing farm households using plot-level data from rural Ethiopia. The effects were also evaluated whether they were heterogeneous relative to the level of crop diversification. Multidimensional Poverty Index (MPI) and stochastic meta-frontier approach were used to estimate the poverty status and the technical efficiency scores, respectively, and the Herfindahl Index (HI) was used to compute crop diversification. The instrumental Tobit Model was specified to estimate the poverty reduction effect of technical efficiency. Our results revealed that the mean technical efficiency of farm households was estimated to be 58%. The poverty estimate results showed that a higher proportion of farm households were multidimensional poor. The incidence of poverty and the mean deprivation score was found to be 57.9% and 44.1%, respectively. Overall, the value of MPI estimated was 31.2%, implying the farm households experienced 31.2% of the total deprivations across all indicators. The HI was 0.51, indicating a moderate degree of crop diversification among farm households. The model results showed that a 10% increase in technical efficiency significantly drives down the household multidimensional poverty by 15.3% at 1% level, keeping other things being constant. Furthermore, ceteris paribus, a 10% increase in technical efficiency significantly reduces household multidimensional poverty by 7.0% and 7.8% at 1% level among moderately diversified and least diversified farm households, respectively. In conclusion, technical efficiency has a higher effect on multidimensional poverty among moderately diversified and least diversified farm households. Therefore, enhancing the productive capacity of farm households among the lower degree of crop diversification to efficiently use production inputs may assist in poverty reduction.

Project description:BackgroundPatients of geriatrics are often treated by several health care providers at the same time. The spatial, informational, and organizational separation of these health care providers can hinder the effective treatment of these patients.ObjectiveThis study aimed to develop a regional health information exchange (HIE) system to improve HIE in geriatric treatment. This study also evaluated the usability of the regional HIE system and sought to identify barriers to and facilitators of its implementation.MethodsThe development of the regional HIE system followed the community-based participatory research approach. The primary outcomes were the usability of the regional HIE system, expected implementation barriers and facilitators, and the quality of the developmental process. Data were collected and analyzed using a mixed methods approach.ResultsA total of 3 focus regions were identified, 22 geriatric health care providers participated in the development of the regional HIE system, and 11 workshops were conducted between October 2019 and September 2020. In total, 12 participants responded to a questionnaire. The main results were that the regional HIE system should support the exchange of assessments, diagnoses, medication, assistive device supply, and social information. The regional HIE system was expected to be able to improve the quality and continuity of care. In total, 5 adoption facilitators were identified. The main points were adaptability of the regional HIE system to local needs, availability to different patient groups and treatment documents, web-based design, trust among the users, and computer literacy. A total of 13 barriers to adoption were identified. The main expected barriers to implementation were lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues.ConclusionsParticipating health care professionals shared similar motivations for developing the regional HIE system, including improved quality of care, reduction of unnecessary examinations, and more effective health care provision. An overly complicated registration process for health care professionals and the patients' free choice of their health care providers hinder the effectiveness of the regional HIE system, resulting in incomplete patient health information. However, the web-based design of the system bridges interoperability problems that exist owing to the different technical and organizational structures of the health care facilities involved. The regional HIE system is better accepted by health care professionals who are already engaged in an interdisciplinary, geriatric-focused network. This might indicate that pre-existing cross-organizational structures and processes are prerequisites for using HIE systems. The participatory design supports the development of technologies that are adaptable to regional needs. Health care providers are interested in participating in the development of an HIE system, but they often lack the required time, knowledge, and resources.

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Technical efficiency of rural primary health care system for diabetes treatment in Iran: a stochastic frontier analysis.

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