Health Indicators in the Management of Diabetes in Primary Health Care: Iran-Package of Essential Non-Communicable Diseases (Irapen) Program Publisher



Molaeipour L^{1, 2} ; Koohi F^{2, 3} ; Ostovar A⁴ ; Etemad K^{5, 6} ; Hezaveh AM⁶ ; Yousefi E⁶ ; Heshmat R⁷ ; Azizi F⁸ ; Hadaegh F² ; Khalili D^{2, 9} Show Affiliations
Source: Journal of Diabetes and Metabolic Disorders Published:2025

Abstract

Objectives: This study evaluated the effectiveness of the IraPEN program, an adapted version of the WHO Package of Essential Non-communicable Disease (PEN) intervention, in managing diabetes from September 2020 to September 2021 using the Input-Process-Output-Outcome framework. Methods: In this Cross-sectional/Ecological study, aggregated data was collected from IraPEN facilities by medical universities using the electronic health system. The data was presented as numbers and proportions, for urban and rural healthcare facilities separately. Results: The study surveyed 610 NCD facilities from184 comprehensive health centers under the supervision of 56 medical universities, which provided services to 1,785,226 individuals aged > = 30 years. In terms of input/process, 78% of NCD facilities had functional point-of-care testing, and 14% of health centers with drugstore experienced a stock-out of core medications during the past three months. In urban facilities, 66% had at least a trained nutritionist, and 82% trained psychologist. Regarding output/outcome, 26% of expected diabetes and 23% of expected pre-diabetes, as estimated by the STEPS 2016 survey, were enrolled in NCD facilities, with higher rates in rural than urban areas. Among the referred patients, 38.7% took statins, 53% visited a physician in the last three months, 57.2% were referred for dietary assessment, and 72.5% were referred to secondary care. Around 39% of diabetic patients with at least one HbA1c laboratory test had good glycemic control. Conclusions: The IraPEN program has managed only a quarter of diabetic patients, and less than half of them are in good glycemic control. Urgent improvements, mainly in coverage and effectiveness, are necessary. © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2024.