The role of the urban family physician plan in utilization of outpatient services in Iran

Background
The family physician (FP) is vital for the continuity of care (CoC) and is also a reliable guide in choosing the preferred treatment pathways, which lead to a reduction in the utilization of unnecessary services.

Objectives
To investigate the utilization of outpatient services in the Fars province as a pilot center for the urban family physician program (UFPP) and East Azerbaijan. East Azerbaijan is a province which has been selected for comparison (control) through clustering.

Material and methods
This population-based, comparative and cross-sectional study was conducted in Iran. Retrospective data on specialists/subspecialists visits (SSV), prescribed medicine (PM), laboratory services (LS) and medical imaging services (MIS) was obtained from administrative claims data of the Iranian Health Insurance Organization (IHIO) for a random sample of 4,800 people between September 2017 and September 2018.

Results
Overall, 50.2% of the participants were female. In the Fars province, the mean SSV, PM, LS and MIS utilization during the study period was 1.21, 3.05, 0.49, and 0.29, respectively. These amounts were 1.14, 1.71, 0.36 and 0.21, respectively, in East Azerbaijan. Multivariate analysis showed significant differences in the utilization of SSV, PM, LS and MIS between provinces (p < 0.05). The largest difference was observed in the utilization of PM by a mean difference of 1.33 (1.17–1.50, p < 0.001). Females were associated with more PM utilization (p = 0.003), and older people utilized more outpatient services (p < 0.05).

Conclusions
Unexpectedly, after five years of the implementation of UFPP, utilization of services was higher in Fras than East Azerbaijan. Improved access by removing barriers, especially for women and the poor, as well as program execution problems could be the reason for these results. Further research is urgently needed to solve this mystery.