Adherence to Iran’S Package of Essential Noncommunicable Diseases (Irapen) Program for Regular Follow-Up to Reduce the Risk of Cardiovascular Disease in Healthcare Centers



Hadavand Siri F¹ ; Khalili D² ; Hashemi Nazari S³ ; Ostovar A⁴ ; Mahdavi A⁵ Show Affiliations
Source: Iranian Journal of Endocrinology and Metabolism Published:2020

Abstract

Introduction In Iran, cardiovascular disease is the leading cause of mortality, accounting for 46% of all deaths. Iran’s Package of Essential Noncommunicable Diseases (IraPEN) program was adapted from the comprehensive World Health Organization (WHO) PEN program with a ten-year risk calculation approach for cardiovascular diseases to control the main risk factors for noncommunicable diseases in Iran. This study aimed to examine the client's adherence to the visitation schedule recommended by health centers in IraPEN, based on their cardiovascular risks. Materials and Methods: The pilot IraPEN program was established in four cities of Naqadeh, Maragheh, Shahreza, and Baft from 2016 to 2018, and this program is still ongoing. In this program, the risk of cardiovascular disease is calculated by SIB, as a comprehensive electronic health record system, with the help of the WHO risk assessment chart. Individuals were divided into four groups in terms of risk: low, medium, relatively high, and high. In the present study, 160,833 individuals were followed-up over a year to measure the number of timely visits to receive primary healthcare services in the pilot phase of the program. Results: Adherence was low in all four evaluated cities. The overall adherence rate was 19.73% in this study, and timely referral was higher in women than men (21.98% vs. 16.37%). The rate of adherence in low-risk individuals (<10%) was higher after the first visit and decreased after the second visit. In individuals with relatively high and high risks (20-30% and ≥30%, respectively), adherence was low after the first visit, but increased after the second and third visits. Conclusion: Among the participants of this study, the rate of adherence to the referral time recommendations was low. Also, this rate was lower in men than women, which shows that men paid less attention to their health status and care proceedings. Overall, there is a need for further training in the pilot cities of the program to clarify the importance of healthcare services and improve adherence to the proposed schedules. © 2020, Research Institute for Endocrine Sciences. All rights reserved.