Document Type : Original Article
Authors
1 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences
2 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Health Managers Development Institute (HMDI), Ministry of Health and Medical Education
3 Health Managers Development Institute (HMDI), Ministry of Health and Medical Education, Secretariat of Supreme Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran
Abstract
BACKGROUND: Family physician (FP) is one of the best strategies to reform health system and
promote population health. Due to the different context, culture, and population, implementing this
reform within cities would be more challenging than in rural areas. This study aimed to assess the
challenges and strengths of Urban FP Program in Fars Province of Iran.
MATERIALS AND METHODS: It was a qualitative study using framework analysis for collecting and
interpreting data. The participants included health policy‑makers, top managers, and involved health
staff selected through purposive and snowball sampling. Participating in the program or working
as a physician in urban areas were among inclusion criteria. Three focus groups with experts as
well as the content analysis of national documents were also performed. The research tool was a
semi‑structured interview guide. Interviews and focus groups were recorded and transcribed word
by word. The framework of triangle for data analysis and the content was analyzed using MAXQDA
2010 software.
RESULTS: The participants’ mean age was 44.9 ± 6.4 years, with a mean work experience of
13.2 ± 7.4 years. The transcripts revealed six themes and 17 subthemes. The emerging themes
included three challenges and three solutions as following: social problems, financial problems, and
structural problems as well as resistance reduction, executive meetings, and surveillance.
CONCLUSION: Resolving staff shortage, decreasing the public resistance, and eliminating
unnecessary referrals were among the strategies used by Fars, during FP implementation. To
be successful in implementing this program, the required perquisites such as infrastructures
and culture growth must be undertaken. The current study suggests the establishment of the
electronic health record to improve the pace and quality of service provision as well as reducing
violations.
Keywords
- Majdzadeh R. Family physician implementation and preventive
medicine; opportunities and challenges. Int J Prev Med
2012;3:665‑9.
2. Khayyati F, Motlagh ME, Kabir M, Kazemeini H, Gharibi F,
Jafari N, et al. The role of family physician in case finding, referral,
and insurance coverage in the rural areas. Iran J Public Health
2011;40:136‑9.
3. Hatam N, Joulaei H, Kazemifar Y, Askarian M. Cost efficiency of
the family physician plan in Fars Province, Southern Iran. Iran J
Med Sci 2012;37:253‑9.
4. Kalhor R, Azmal M, Kiaei MZ, Eslamian M, Tabatabaee SS,
Jafari M, et al. Situational analysis of human resources in
family physician program: Survey from Iran. Mater Sociomed
2014;26:195‑7.
5. Sabet Sarvestani R, Najafi Kalyani M, Alizadeh F, Askari A,
Ronaghy H, Bahramali E, et al. Challenges of family physician
program in urban areas: A Qualitative research. Arch Iran Med
2017;20:446‑51.
6. Cotlear D, Nagpal S, Smith O, Tandon A, Cortez R. Going
Universal: How 24 Developing Countries are Implementing
Universal Health Coverage from the Bottom Up. Washington,
DC: World Bank Group; 2015.
7. Khayatzadeh‑Mahani A, Takian A. Family physician program
in Iran: Considerations for adapting the policy in urban settings.
Arch Iran Med 2014;17:776‑8. - 8. Amiresmaili M, Khosravi S, Feyzabadi VY. Factors affecting
leave out of general practitioners from rural family physician
program: A Case of Kerman, Iran. Int J Prev Med 2014;
5:1314‑23.
9. Vosoogh Moghaddam A, Damari B, Alikhani S, Salarianzedeh M,
Rostamigooran N, Delavari A, et al. Health in the 5th 5‑years
development plan of Iran: Main challenges, general policies and
strategies. Iran J Public Health 2013;42:42‑9.
10. Mohaghegh B, Seyedin H, Rashidian A, Ravaghi H, Khalesi N,
Kazemeini H, et al. Psychological factors explaining the referral
behavior of Iranian family physicians. Iran Red Crescent Med J
2014;16:e13395.
11. Manca DP, Varnhagen S, Brett‑MacLean P, Allan GM, Szafran O,
Ausford A, et al. Rewards and challenges of family practice:
Web‑based survey using the Delphi method. Can Fam Physician
2007;53:278‑86, 277.
12. Takian A, Doshmangir L, Rashidian A. Implementing family
physician programme in rural Iran: Exploring the role of an
existing primary health care network. Fam Pract 2013;30:551‑9.
13. Golalizadeh E, Moosazadeh M, Amiresmaili M, Ahangar N.
Challenges in second level of referral system in family physician
plan: A qualitative research. Journal of Medical Council of I.R.I
2012;29 (4):309‑321.
14. Honarvar B, Lankarani KB, Rostami S, Honarvar F, AkbarzadehA,
Odoomi N, et al. Knowledge and practice of people toward their
rights in urban family physician program: A Population‑based
study in shiraz, Southern Iran. Int J Prev Med 2015;6:46.
15. DehnaviehR, Kalantari AR, Jafari SiriziM. Urban family physician
plan in Iran: Challenges of implementation in Kerman. Med J
Islam Repub Iran 2015;29:303.
16. Mohammadi M. Patient satisfaction with urban and rural
insurance and family physician program in Iran. J Fam Reprod
Health 2011;5:11.
17. Damari B, Vosough Moghaddam A, Rostami Gooran N,
Kabir MJ. Evaluation of the urban family physician and referral
system program in Fars and Mazandran Provinces: History,
achievements, challenges and solutions. J Sch Public Health Inst
Public Health Res 2016;14:17‑38.
18. Takian A, Rashidian A, Doshmangir L. The experience of
purchaser‑provider split in the implementation of family
physician and rural health insurance in Iran: An institutional
approach. Health Policy Plan 2015;30:1261‑71.
19. Stephen W. Primary medical care and the future of the medical
profession. World Health Forum 1981;2 (3):316.
20. Nasrollahpour Shirvani, Raeisee, P, Motlagh, ME, Kabir, MJ.
Evaluation of the performance of referral system in family
physician program in Iran University of Medical Sciences: 2009.”
Hakim Research Journal 2010: 13 (1): 19‑25.
21. Forrest CB, Nutting PA, Starfield B, von Schrader S. Family
physicians’ referral decisions: Results from the ASPN referral
study. J Fam Pract 2002;51:215‑22.
22. Nasrollahpour Shirvani D, Ashrafian Amiri H, Motlagh M,
Kabir M, Maleki MR, Shabestani Monfared A, et al. Evaluation
of the function of referral system in family physician program
in northern provinces of Iran: 2008. J Babol Univ Med Sci
2010;11:46‑52.
23. Nasiripour A, Motaghi M, Navvabi N. The performance of referral
system from the perspective of family physicians of Kashan
university of medical sciences: 2007‑2012. J Health Promot Manag
2014;3:58‑68.
24. DehnaviehR, Kalantari AR, Jafari SiriziM. Urban family physician
plan in Iran: Challenges of implementation in Kerman. Med J
Islam Repub Iran 2015;29:1219‑28.
25. Lankarani KB, Alavian SM, Haghdoost AA. Family physicians
in Iran: Success despite challenges. Lancet 2010;376:1540‑1.
26. Janati A, Maleki MR, Gholizadeh M, Narimani M, Vakili S.
Assessing the strengths and weaknesses of family physician
program. Knowledge & Health 2010;4 (4):38‑43.
27. Hafezi Z, Asqari R, Momayezi M. Monitoring performance
of family physicians in Yazd. Toloo‑e‑Behdasht 2009;8,
Number1‑2 (26):16‑25.
28. Tavoosi A, Zaferani A, Enzevaei A, Tajik P, Ahmadinezhad Z.
Knowledge and attitude towards HIV/AIDS among Iranian
students. BMC Public Health 2004;4:17.
29. Majidpour A, Habibzadeh S, Amani F, Hemmati F. The role
of media in knowledge and attitude of students about AIDS.
J Ardabil Univ Med Sci 2006;6:67‑72.
30. Safizadehe Chamokhtari K, Abedi G, Marvi A. Analysis of the
patient referral system in urban family physician program, from
stakeholdersperspective using swot approach: A qualitative
study. J Mazandaran Univ Med Sci 2018;28:75‑87.
31. Vosoogh Moghaddam A, Damari B. The Effects of Family
Medicine on Promoting Service Quality and Controlling Health
Costs. The 2nd National and the1st International Conference on the
Appropriate Experiences and Functions of Primary Health Care
System; 2013.
32. Barati O, Maleki MR, Gohari M, Kabir M, Amiresmaili M, Abdi Z,
et al. The impact of family physician program on health indicators
in Iran (2003‑2007). Payesh 2012; 11 (3):361‑63.
33. Zarea K, Negarandeh R, Dehghan‑Nayeri N, Rezaei‑Adaryani M.
Nursing staff shortages and job satisfaction in Iran: Issues and
challenges. Nurs Health Sci 2009;11:326‑31.
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