Abstract
BackgroundA person-list-based family medicine model was introduced in Turkey during health care reforms. This study aimed to explore from primary care workers’ perspectives whether this model could achieve the cardinal functions of primary care and have an integrative position in the health care system.MethodsFour groups of primary care workers were included in this exploratory-descriptive study. The first two groups were family physicians (FP) (n = 51) and their ancillary personnel (n = 22). The other two groups were physicians (n = 44) and midwives/nurses (n = 11) working in community health centres. Participants were selected for maximum variation and 102 in-depth interviews and six focus groups were conducted using a semi-structured form.ResultsData analysis yielded five themes: accessibility, first-contact care, longitudinality, comprehensiveness, and coordination. Most participants stated that many people are not registered with any FP and that the majority of these belong to the most disadvantaged groups in society. FPs reported that 40-60% of patients on their lists have never received a service from them and the majority of those who use their services do not use FPs as the first point of contact. According to most participants, the list-based system improved the longitudinality of the relationship between FPs and patients. However, based on other statements, this improvement only applies to one quarter of the population. Whereas there was an improvement limited to a quantitative increase in services (immunisation, monitoring of pregnant women and infants) included in the performance-based contracting system, participants stated that services not among the performance targets, such as family planning, postpartum follow-ups, and chronic disease management, could be neglected. FPs admitted not being able to keep informed of services their patients had received at other health institutions. Half of the participants stated that the list-based system removed the possibility of evaluating the community as a whole.ConclusionsAccording to our findings, FPs have a limited role as the first point of contact and in giving longitudinal, comprehensive, and coordinated care. The family medicine model in Turkey is unable to provide a suitable structure to integrate health care services.
Highlights
A person-list-based family medicine model was introduced in Turkey during health care reforms
Four groups of primary care workers were included in the study: 1) family physicians (FP); 2) family health workers” (FHWs); 3) community health centres (CHCs) physicians; and 4) midwives and nurses working in CHCs
The other topics are the cardinal functions of primary care
Summary
A person-list-based family medicine model was introduced in Turkey during health care reforms. Primary care’s four cardinal functions give it this central position: first contact (going to primary care first for each new need or problem), longitudinality (person-focused care over time), comprehensiveness (addressing all health-related needs in the population), and coordination (integrating care when patients have been seen elsewhere) [3,4,5]. These integrative functions of primary care are based on a person- and population-health focused view, which attempts to improve the equitable distribution of health and to link the biomedical, psychological, and social dimensions of health and well-being [5,6]. Apart from the study of Kringos et al [18], which was carried out when the reform was in the pilot phase in only two provinces (Eskisehir and Bolu), there has been limited work assessing the features of primary care in relation to its integrative structure
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
