7000 patients with diabetes registered at the Center for Control and Prevention of Diabetes in Iran

The center is in Mashad, northeast of Iran. The CEO of the center Javad Jahani Mehr says that this center was established in 2005 with the mission to provide care to patients with diabetes and control the disease. He emphasizes that such infrastructure will be coming along soon in other major cities of Iran. He stressed the point that more than half of patients with diabetes in Iran are not aware of their high blood sugar. On the other hand 99 percent of those who know they have diabetes are under poor blood sugar control he added. The major policy intervention to be implemented is to educate people how to deal with the condition , which is the core policy intervention devised for such clinical centers , he said.

My comment: It’s very promising that targeted interventions for high-cost /high mortality diseases and risk factors are getting attention by Iranians. It would be great if the clinical effects of such interventions could be measured and compared with traditional care being received by the rest of patients with diabetes.

Link to the news: http://www.irna.ir/NewsShow.aspx?NID=30525826

Source: Irna, online, Accessed on August 18,2011. News Code: 30525826

Inadequate insurance and shortage in providers to support patients with burn

"Tehran Province has the highest burn-related mortality among all provinces in the country" says the officials of the Forensic Medicine Center. It is claimed that Tehran has only one hospital (Shahid Motahhari) that deals with burn cases at sub-specialty level. There are handful of other private hospitals giving care to patients with mild to moderate burns but not to severe cases. The ILNA's journalist reports that 2,690 people with burns die annually [in the country]. However, the number of beds per capita for burn cases has been going down in recent years. The CEO of the Motahhari Inpatient Burn Center (Hospital) says that insurance plans do not cover all costs of patients with significant burns and charities have to be more active to collect money to support these patients. He says that adding one Burn-ICU bed to the hospital costs some 60,000 dollars and the hospital is struggling with economic barriers to expand its facilities to provide adequate care to patients with burn.

My comment: The highest mortality may be due to the fact that cases with severe burn may be constantly referred to hospitals in Tehran.

Reference: Iranian Labor News Agency, online , accessed on August 17, 2011. News Code:202485

Link: http://www.ilna.ir/newsText.aspx?ID=202485

High utilization of pharmaceutical in Iran

According to the report of the Ministry of Health and Medical Education Iran is among the top 20 countries whose people utilize the highest amount of pharmaceuticals. Iran ranks second after China among Asian countries on pharmaceutical utilization. The report also explains that 46% of the medicines used are injection drugs while this figure for the globe is only 11%.

My note: From my practice long time ago in Iran I can tell that the figures can be all true. A dominant belief among people regarding medicine is that injection drugs are much stronger than oral medications. I have seen evidence from India and Pakistan that a large fraction of population in theses countries think the same way. I hope the Family Physician Program started a few years ago is able to change the false paradigms and help regulate the outpatient healthcare.

Source: http://techdaily.ir/?p=324 , accessed on March 19, 2011

Family Physician Plan starts today Feb 12, 2011

The plan is to be started functioning in 3 provinces Sistan & Baloochestan, Charmahal, and Khozestan as of today, Feb 12, 2011. In brief the plan focuses on a referral system involving 3 levels. General practitioner level, Specialty level, and subspecialty level. The primary level of care is given by a team that includes at least a General practitioner, a Community Health Worker (Behvarz in Farsi), and a trained nurse or obstetrics assistant (Mah-Mah in Farsi). The team is in charge of the patients' health. The plan assumes that all people registered are insured. The consultations provided by the first layer of referral is free of charge for people and the team are reimbursed by the insurance company. The distribution of the first-level services are equal such that 4 physician and 17 other medical staff provide services for every 10,000 population.

The hope is that the plan increases quality of care and reduces the costs. It is said that there are so many obstacles toward the end of the plan. One important one is that around 20 million of the country's population are uninsured and that around 20 million of the insured hold dual insurance coverage (quoted from Sadegh Mahsooli, the current Welfare Minister) .

It's worthy noting that the centers executing the plans are equipped with Electronic Health Record system.

My comment: Outpatient health services in Iran have been historically in the private sector and quite unregulated. It's really hard to put the doctors under a unique gate keeper system. Subspecialty level doctors are powerful agents. Their income is super high. Also, many of them have high political leverage. Having said that, expecting a full collaboration across different levels of the system may be achieved only based on some crude evaluations. General practitioners , on the other hand, are the weakest (both in terms of income, and the political power) among the physician population. The plan is revolutionary on many fronts and its full implementation is hard to achieve.

Reference: http://www.bbc.co.uk/persian/iran/2011/02/110212_l19_dastjerdi_mahsoli_doctor_family.shtml

'Health Houses' in Iran is getting attraction!

It's not long ago that Mississippi has decided to plan for establishing health houses model to serve its medically undeserved areas. They picked the Iranian model and I would say it was just a right pick. Iran started its primary preventive health care network more than 40 years back. The plan has shown a high degree of success. Although the model and its implementation has not been fully presented through international publications and media , the Mississippi's collaboration with Iranian health officials on building its counterpart in the US may help the plan get international recognition. Below is a link to a website through which you can find useful information on this collaborative effort.
http://www.fic.nih.gov/news/publications/global_health_matters/2009/1209_health-house.htm