Family Physician Plan Research Articles

Content analysis of family physician plan using social marketing approach: Qualitative- document analysis

BACKGROUND: The family physician plan formed at the heart of the health system can play a vital role in the results and the optimal cost of resources. Social marketing is a process that uses the basics and principles of commercial marketing in the field of health to develop and implement a health plan. This study seeks to analyze the documents related to the program from the perspective of social marketing components. MATERIALS AND METHODS: This qualitative document analysis study was conducted in 2021 by reviewing the documents and content of the texts related to family physician plan. The obtained data were analyzed by the directed content analysis method after extraction and collection. RESULTS: The results showed the identification of social marketing components in the family physician plan. However, the two most essential parts of “insight” and “behavior theory,” which address the underlying issues in an intervention, were not found in the analyzed documents and texts. CONCLUSION: It is necessary to use a coherent and appropriate approach to revise and develop the family physician plan. To resolve the current challenges and problems of the family physician plan, the application of components and the social marketing approach that addresses all the required aspects of a health plan is a suitable model and approach.

Regional Mental Health Inequality in a Limited Data Region in the Northeast of Iran: A Decomposition Analysis

Background: Limited information still exists about the distribution of mental health (MH) in small districts. Considering the diversity in cultural specifications of entities in different societies, the current study aimed-assess the inequality of poor MH and corresponding socio-demographic components in a general population. Methods: This population-based cross-sectional study was conducted in Gonabad City, North Eastern Iran. Data were collected by a general health questionnaire-28 (GHQ-28) assess MH status, considering a cut-off point of 23. The concentration index defines the inequality in the MH. Decomposition analysis was done-identify the contribution of each explanatory variable-the socioeconomic inequality in MH prevalence. Results: Eight hundred subjects were recruited (response rate=98%); approximately 41.6% were aged 30 years or younger, half of whom were females. The overall prevalence of poor MH was 24.7% (95% CI: 21.8-27.9%) and the age-adjusted prevalence of poor MH was 27.5% (95% CI: 24.2-31.2%). A concentration of poor MH prevalence was observed among the poorest people (concentration index: -0.15). Socioeconomic Status (SES) (59.7%), age (24.1%), and gender (4.7%) were identified as the main contributors-socioeconomic-related inequality in poor MH prevalence. Conclusion: Poor MH is significantly concentrated among the poorest people. Therefore, SES appeared-play a key role in improving the health of individuals, which can lead-improved health status in a community. Furthermore, these data suggest that the MH initiative should target the elderly and women via a recently determined family physician plan in Iran.

Scope of Iranian community health nurses 'services from the viewpoint of the managers and nurses: a content analysis study.

BackgroundConsidering the need for nurses specializing in community health and in order to define professional duties for future planning towards creating the position of community health nurses in the primary health care system of Iran, this study aims to explain the range of services which can be provided by community health nurses from the perspective of the mangers and nurses.MethodsThe present qualitative study was conducted with the approach of contract content analysis in Iran in 2020. This study was conducted through in-depth and semi-structured interviews with 22 participants, including community health nursing faculty members, health deputies and managers, community health nurses working in health centers, and the care seekers visiting comprehensive health centers. The samples were selected through purposeful sampling. The interviews continued until data saturation. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim & Lundman’s content analysis method, and data management was done using MAXQDA software. To achieve data trustworthiness, the criteria presented by Lincoln and Guba were used.ResultsThe obtained data were classified into the two main categories of service provision settings and service provision domains. The category service provision settings covered 7 subcategories including participation in the family physician plan, activities at the centers for vulnerable groups of the community, establishing private community health clinics, leading health promotion programs in the 3rd generation hospitals, activities in comprehensive health centers, follow-ups and home visits, and activities in schools’ health units. Service provision domains consisted of 6 subcategories including participation in health planning, decision-making, and policymaking, research on the health system, health promotion, monitoring and coordination, providing care for the patients with non-communicable diseases and high-risk groups, and eldercare.ConclusionsFrom the participants’ perspective, important services that can be provided by the community health nurse are health promotion, the management of chronic patients and the elderly, follow-ups, and home visits. Therefore, it is recommended that health policy makers pay attention to the service provision areas and the services providable by the community health nurse in their macro-planning, and to provide primary health care in comprehensive health centers using inter-professional care models, integrating the community health nurse into the care team.

General health status and its related socio-demographic factors: a population based cross-sectional study


 Background: There is still little information on health status in small communities and also according to the different cultural characteristics of people in different societies, the present study aimed to determine the rate of general health and its related socio-demographic factors in general population.
 Methods: A population-based cross-sectional study was conducted in Gonabad city, the North-East of Iran, in 2013. We used the 28-item General Health Questionnaire (GHQ-28) to examine general health status with the cutoff point of 23. The association between general health and socio-demographic factors were reported in crude and adjusted odds ratios with 95% confidence interval.
 Results: A total of 800 subjects were interviewed (Response rate=98%). The mean age was 35.5 (SD ± 10.6) years, 49.6% were female, 41.8% were aged 30 years or younger, and 65.9% did not have academic education. According to the GHQ-28, 24.7% of the participants were categorized as not healthy people. General health status was associated with age, sex, education level, family size, residency duration in neighborhood, and SES status.
 Conclusion: General health status varied according to both the individual and socio-economic factors. Socio-economic status seems to play an important role in enhancing individual’s health and then lead to improve the health of community. These findings also suggest that mental health programs should be targeted in women and elderly population by the newly established family physician plan.

Assessing the Quantitative and Qualitative Status of the Family Physician Plan from the Perspective of Family Physicians, Health Team Members and Staff Experts

Assessing the Quantitative and Qualitative Status of the Family Physician Plan from the Perspective of Family Physicians, Health Team Members and Staff Experts

The impacts of family physician plan and health transformation plan on hospitalization rates in Iran: an interrupted time series

BackgroundLow and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran.MethodsWe conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1.ResultsA decreasing trend by − 0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 (P < 0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan (P < 0.001).ConclusionsFamily physician created a decreasing trend for hospitalization in urban area of Mazandaran province in Iran. HTP with lower user fee in governmental public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.

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

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Sokhanvar M, Kabir MJ, Bevrani H, Nosratnejad S, Hasanpoor E, Janati A. The role of the urban family physician plan in utilization of outpatient services in Iran. Family Medicine & Primary Care Review. 2020;22(4):331-337. doi:10.5114/fmpcr.2020.100444. APA Sokhanvar, M., Kabir, M. J., Bevrani, H., Nosratnejad, S., Hasanpoor, E., & Janati, A. (2020). The role of the urban family physician plan in utilization of outpatient services in Iran. Family Medicine & Primary Care Review, 22(4), 331-337. https://doi.org/10.5114/fmpcr.2020.100444 Chicago Sokhanvar, Mobin, Mohammad J Kabir, Hossein Bevrani, Shirin Nosratnejad, Edris Hasanpoor, and Ali Janati. 2020. "The role of the urban family physician plan in utilization of outpatient services in Iran". Family Medicine & Primary Care Review 22 (4): 331-337. doi:10.5114/fmpcr.2020.100444. Harvard Sokhanvar, M., Kabir, M., Bevrani, H., Nosratnejad, S., Hasanpoor, E., and Janati, A. (2020). The role of the urban family physician plan in utilization of outpatient services in Iran. Family Medicine & Primary Care Review, 22(4), pp.331-337. https://doi.org/10.5114/fmpcr.2020.100444 MLA Sokhanvar, Mobin et al. "The role of the urban family physician plan in utilization of outpatient services in Iran." Family Medicine & Primary Care Review, vol. 22, no. 4, 2020, pp. 331-337. doi:10.5114/fmpcr.2020.100444. Vancouver Sokhanvar M, Kabir M, Bevrani H, Nosratnejad S, Hasanpoor E, Janati A. The role of the urban family physician plan in utilization of outpatient services in Iran. Family Medicine & Primary Care Review. 2020;22(4):331-337. doi:10.5114/fmpcr.2020.100444.

What do Iranian general practitioners expect from family physician contracts?

Family medicine has become a main prerequisite of providing primary healthcare and a main reforming strategy to ensure the delivery of efficient and high-quality health services. This study aimed to...

The preferences of general practitioners regarding family physician contract in the underprivileged areas of Iran in using conjoint analysis

Background: One of the most important methods for improving the fair access of people to health services is the family physician program, which is facing many challenges. One of these challenges is the lack of policymakers' understanding of physicians' preferences regarding the provisions of the family physician contract. Therefore, this study was aimed to investigate general practitioners' preferences regarding the type of family doctor contract in one of the underprivileged regions of Iran. Methods: An analytical-cross-sectional study was conducted among 150 general practitioners (GPs) who registered in Ministry of Health and Medical Education (MoHME) family physician plan and were working in the health network of deprived regions in Iran. A discrete choice experiment (DCE) questionnaire was developed by the researchers and then distributed to GPs. Results were analyzed using Ordered Logistic Regression. Data were collected using a questionnaire designed by orthogonal method in SPSS 20. Data analysis was performed using logistic regression model in Stata 13 software. Results: Findings revealed that “type of employer” had the most significant effect on GPs’ preferences (OR = 2.5), followed by “allocating quota for admission to medical specialty courses after 5 years” (OR = 2.25), being allowed to give medical services to population without geographical restriction (OR = 2.8), being allowed to provide services out of the defined service packet (OR = 1.4), and “decreased length of contract” (OR = 0.93). Conclusion: The amendment of the provisions of the family physician contract in accordance with physicians' preferences increases the probability of their participation in and compliance with the family physician program. However, the compliance of the provisions of this contract with relevant international standards and upstream laws of the country should be maintained as much as possible.

Investigation of the Trend of Vital Horoscope Indicator in the Year Following the Implementation of Rural Family Physician Plan in North Khorasan Province

Investigation of the Trend of Vital Horoscope Indicator in the Year Following the Implementation of Rural Family Physician Plan in North Khorasan Province

Factors affecting public dissatisfaction with urban family physician plan: A general population based study in Fars Province.

BackgroundUnderstanding the level of public satisfaction with a family physician plan as well as the relevant factors in this respect, can be employed as valuable tools in identifying quality of services.ObjectiveTo determine the factors affecting public dissatisfaction with an urban family physician plan in Iran.MethodsThis cross-sectional study was conducted from January 2014 through June 2015 on Fars Province residents in Iran, selected based on cluster sampling method. The data collection instrument was comprised of a two-part checklist including demographic information and items related to dissatisfaction with the family physician plan, specialists, para-clinic services, pharmacy, physicians on shift work, emergency services, and family physician assistants. Data were described by SPSS 20.ResultsIn this study, 1,020 individuals (524 males, 496 females) were investigated. Based on the results, the most frequent factor affecting dissatisfaction with physicians was their single work shifts and unavailability (53%). In terms of dissatisfaction with family physicians’ specialist colleagues and para-clinic services, the most common factors were related to difficulty in obtaining a referral form (41.5%) and making appointments (21.6%), respectively. Given the level of dissatisfaction with pharmacies, the significant factor was reported to be excessive delay in medication delivery (31.6%); and in terms of physicians on shift work and emergency services, the most important factor was lower work hours for family physicians (9.2%).ConclusionIt seems that, the most common causes of dissatisfaction with the urban family physician plan are due to the short duration of services, obtaining a referral form and making appointments, and providing prescribed medications.

48: EFFECT OF EDUCATION EMPOWERMENT PROGRAM THE FAMILY PHYSICIAN IN MEDICINE STUDENT FASA UNIVERSITY OF MEDICAL SCIENCES

Background and aims:Based on the resolutions of the World Conference in Edinburgh Scotland in 1988 community health and how to care and maintain the health of the population increase, which...

Does Economic Instability Affect Healthcare Provision? Evidence Based on the Urban Family Physician Program in Iran.

BackgroundThe main aim of this study was to evaluate the achievements of some important goals of Iran's urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program.MethodsWe used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined.ResultsNo changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform.ConclusionThe urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.

Satisfaction of Family Physician Plan: Viewpoint of Physicians and Health Service Consumers in Kerman, Southeast of Iran

Background: Family Physician plan is known as one of the most appropriate strategies to implement rural health insurance program in the form of referral system in Iran. This study aims to determine the satisfaction of family physicians and service consumers and its causes of dissatisfaction in the South of Iran. Materials and Methods: This cross-sectional study was performed in Kerman Health Network. Nineteen family physicians and 370 service consumers were selected using stratified random sampling. Data was gathered using two standardized questionnaires. Frequency tables, frequency percentage, mean graphs, Z and Freedman statistical tests were used to analyze the data. Results: Mean scores of physicians’ satisfaction were 9.10 and 4.12 in staff performance and payment system, respectively. Service consumers were satisfaction of physician delivery care (7.25), and para-medical (3.61). Moreover, most physicians were interested in per capita (31/6%). Conclusion: Family physician and health service consumers are highly satisfied. Satisfaction is an important factor for ensuring service quality and any ignorance in this regard can reduce the quantity and quality of delivered care. Physicians are recommended to respect their consumers and consider their waiting time. Meanwhile, health system managers should promote physicians’ payment. [GMJ.2015;4(2):96-102]

The Effect of Education on Administrators and Service Providers′ Knowledge of the Family Physician Plan and Referral System in Urban Areas

Context: As one of the important changes in the health system, family physician plan, and referral system need to be taken into consideration, so as to make the administrators informed of the best ways of its implementation. Aims: This research has been carried out to study the effect of education on the knowledge level of administrators and service providers. Settings and Design: This study was analytical and interventional and conducted in Isfahan in 2012 with a statistical population of 2851 and a sample size of 118 people. Materials and Methods: This quantitative study was an interventional comparison group applying pre- and post-tests. Random sampling was used to select physicians, administrators and service providers in the family physician plan. A researcher-made questionnaire was filled out by the sample before and after the intervention, and the collected data were analyzed descriptively and inferentially. Statistical Analysis Used: The data were analyzed by using the SPSS 16 software and the mean scores of knowledge level, before and after the intervention, were compared. Demographic variables, also, were described and their relationship with the knowledge level scores was determined. A t -test was used, too. Results: The findings showed that the mean scores of knowledge level were 46.18 ΁ 15.37 before the intervention and 50.14 ΁ 14.46 after the intervention. Moreover, the t -test result, with 95% certainty, was significant ( P = 0.043). Conclusion: Considering the meaningfulness of the results of t -test, it can be concluded that education has a high effect on the knowledge level of administrators and service providers. The results, also, showed that for having a more effective education, face to face education and active and practical teaching methods such as workshops and group discussions as well as different informative materials like brochures and media (radio, television and press) can be used. In addition to these factors, the age and work experience of people receiving education should be considered, too.

Structural and contextual dimensions of Iranian primary health care system at local level.

Background:In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago.Objectives:This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level.Materials and Methods:A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests.Results:Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value < 0.001). Goals and culture dimensions had strongest effects on structural dimensions.Conclusions:Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system.

The quality assessment of family physician service in rural regions, Northeast of Iran in 2012.

Following the implementation of family physician plan in rural areas, the quantity of provided services has been increased, but what leads on the next topic is the improvement in expected quality of service, as well. The present study aims at determining the gap between patients' expectation and perception from the quality of services provided by family physicians during the spring and summer of 2012. This was a cross-sectional study in which 480 patients who referred to family physician centers were selected with clustering and simple randomized method. Data were collected through SERVQUAL standard questionnaire and were analyzed with descriptive statistics, using statistical T-test, Kruskal-Wallis, and Wilcoxon signed-rank tests by SPSS 16 at a significance level of 0.05. The difference between the mean scores of expectation and perception was about -0.93, which is considered as statistically significant difference (P≤ 0.05). Also, the differences in five dimensions of quality were as follows: tangible -1.10, reliability -0.87, responsiveness -1.06, assurance -0.83, and empathy -0.82. Findings showed that there was a significant difference between expectation and perception in five concepts of the provided services (P≤ 0.05). There was a gap between the ideal situation and the current situation of family physician quality of services. Our suggestion is maintaining a strong focus on patients, creating a medical practice that would exceed patients' expectations, providing high-quality healthcare services, and realizing the continuous improvement of all processes. In both tangible and responsive, the gap was greater than the other dimensions. It is recommended that more attention should be paid to the physical appearance of the health center environment and the availability of staff and employees.

Patient Migration for Hospital Utilization: Case of Iran

Introduction: Adequate information about patient using health care facilities is a critical element in planning activities and allocation resources in health sector. In Iran, with performing family physician plan and attempt to reform referral system, the study of mobility of patients between regions (patient migration) has more importance. The aims of the study are: 1) to describe patients’ migration across cities of Iranian Kerman province; 2) to analyze the role of possible determinants affecting the mobility flows. Methodology: using hospital inpatient records of all public hospitals around Kerman province during 2011, we run logit models that compare patients who were admitted in hospital and received health services in cities where they lived and patients received them out of their local hospitals. We studied 21 patient groups according to ICD10 chapters (Appendix 1) to compute the effect of geographic distance, kind of insurance, number of physiccians involved, hospital bed and patient demographic factors. Results: About 40 percent of hospital admissions in Kerman are emigrant patients that quality or quantity of local provided services didn’t satisfy. Constant negative coefficients of geographic distance, hospitals physician and bed and positive coefficients for insurance in all groups do not show any difference in patient migration, between groups. Discussion: According to results of this research, existence of local services, distance, kind of illness and other factors are not more important than patients’ feeling about services in their migration. Paying no attention to this reality in planning health system reforms, especially referral systems, leads to important problems for health system in equity, patient satisfaction and finance aspects.

How to Implement Clinical Practice Guidelines in Iran

Background:Evidence-based medicine would come to the result by evidence-based implementation. Clinical Practice Guidelines (CPG) as one of the evidence-based knowledge products requires appropriate interventions after being produced to be applied.Objectives:The aim of this qualitative study was to identify the strategies for application of CPGs produced in Iran.Materials and Methods:The purposive snowball sampling was performed and it continued until reaching the theoretical saturation. In-depth semistructured individual interviews and Focus Group Discussion (FGD) were performed aiming at triangulation. The thematic framework approach was used for the analysis.Results:Twelve interviews were conducted with three health system policy makers and decision makers, four experienced in the production or adaptation of clinical practices, and five experts in evidence-based medicine development and education. In addition, 11 policy makers, managers, and decision makers of the health system took part in FGD. The proposed interventions were classified in the following themes: Health professionals-oriented, Financial, Organizational, Regulatory, and Multifaceted interventions.Conclusions:Along with adaptation and development process of CPGs, their utilization should also be planned; otherwise spent time and money would be in vain. Certainly, imposing above-mentioned interventions with the ultimate goal of sustainable behavior change in health system service providers is beyond the capacity of specific groups or few academic centers. It requires the participation of all practitioners under the monitoring and support of the Ministry of Health and Medical Education. Deployment of the family physician plan and referral system is an opportunity which must be considered a trophy.

The Effect of the Family Physician Plan on the Performance of the Medical and Health Centers of the Ghorveh City

The aim of the present research is to investigate the effect of the family physician plan on the medical and health centers of Ghorveh. The type of the research is semi empirical and is applied in nature. The research universe includes 15 medical and health centers of Ghorveh. The tools for collecting the data were information collection forms of the available statistical forms. The findings revealed there was a meaningful difference (P &lt; 0/001) with regards to the performances among the average monthly services in 2005 and 2009 at the 15 centers under study in 2005 (prior to the implementation of the plan) and in 2009 (at the time of the implementation of the plan). The performance at such centers in 2009 with regards to the mentally ill patients under care has decreased substantially.