Underlying factors and challenges of implementing the urban family physician program in Iran

Mehrolhassani, Mohammad Hossein; Jahromi, Vahid Kohpeima; Dehnavieh, Reza; Iranmanesh, Mahla

doi:10.1186/s12913-021-07367-3

Cited by 15 publications

(29 citation statements)

References 24 publications

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“…Since the initiation of FPP in Iran, many studies and reports (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) have provided some lines of evidence that show a variety of challenges in the educational system of FPs in Iran. As this program is going to be expanded across the country, this systematic review of the literature was performed to provide a comprehensive view of the existing challenges associated with the education of family physicians in Iran. This current review of the literature identified consistent themes associated with the educational system and challenges encountered in preparing physicians for FPP upon graduation.…”

Section: Discussionmentioning

confidence: 99%

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Challenges Associated with the Education of Family Physicians in Iran: A Systematic Review

Heidarzadeh¹,

Hedayati²,

Huntington

et al. 2022

J Med Edu

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Context: Nearly 20 years ago, the family physician program (FPP) was established in Iran in rural areas and was expanded to some cities about 10 years ago. Different studies reported different challenges associated with the efficacy of human resources and their training or educational program. Objectives: This systematic review of the literature was conducted to comprehensively identify and collate the challenges associated with the education of family physicians in Iran. Evidence Acquisition: All published articles related to FPP in Iran were the subject of this study. The eligibility criteria included original articles, case studies, and reports published in English or Persian during 2011 - 2021 related to the challenges in the training and educational system of FPP in Iran. Data were extracted based on the SPIDER (sample, phenomenon of interest, design, evaluation, research type) technique and were reported based on the structure of PRISMA (preferred reporting items for systematic reviews and meta-analyses). International credible scholarly databases were searched. The search strategy was defined based on the search syntax and keywords. Results: The search strategy yielded 5570 potentially relevant articles and reports, of which 70 studies met the inclusion criteria. Following the full-text review, 58 studies were excluded, and, finally, 11 empirical studies and 1 report were included in the review. The study attempted to identify challenges associated with the educational system; knowledge and awareness of the FPs of the nature, activities, policies, and protocols of the FPP; and also challenges associated with the competencies of the FPs in areas like social conditions, clinical competencies, public health, and managerial skills. Conclusions: The current study identified consistent themes associated with the educational system and challenges encountered in preparing physicians for FPP upon graduation. These difficulties are not insurmountable.

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Section: Discussionmentioning

confidence: 99%

“…The treatment-oriented approach in medical schools does not include meaningful training for the individual health-promotion and prevention-oriented approach of FPP. Training in public health was also minimal (6,8,(10)(11)(12)(13)(14). The current hospital-centered model focuses on complicated diseases.…”

Section: Educational Systemmentioning

confidence: 99%

Challenges Associated with the Education of Family Physicians in Iran: A Systematic Review

Heidarzadeh¹,

Hedayati²,

Huntington

et al. 2022

J Med Edu

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“…One of the most critical reforms in the health system is the service-leveling method. The family physician provides prevention and treatment services at the first level, directs patients to specialized levels, and pursues the results, if necessary (4,5). The achievements of the family physician program have led the World Health Organization (WHO) to designate it as the center of global efforts to improve quality, effectiveness, equity, and reduce costs in the health care system (6).…”

Section: Introductionmentioning

confidence: 99%

“…In urban areas, the physicians' duties in the health team are defined as health management, population health care and appropriate referral measures, implementation of empowerment programs based on local capacity, and monitoring the performance of the health team (9). Previous studies stated that increasing work-load, quantity, and quality of medical facilities in the workplace are the most critical problems of physicians (4). On the other hand, it has resulted in family physicians' insufficient knowledge and skills compared to the health system's expectations (13).…”

Section: Introductionmentioning

confidence: 99%

Explaining the Role of Physicians in Urban Comprehensive Health Service Centers After Implementing Health Transformation Plan in Southeast of Iran: A Qualitative Study

Shahabianmoghaddam

Baygi

2022

Health Scope

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Background: Health transformation plan (HTP) in Iran was established in 2014 to promote primary health care through expanding and strengthening the first level of services in urban and rural areas. The activities of physicians and their colleagues in comprehensive health service centers have increased access and improved community health. Conducting various studies on the urban physicians’ roles can help policymakers achieve the goals. Objectives: This study aimed to explain the role of physicians working in urban, comprehensive health service centers after implementing the HTP. Methods: Participants in this qualitative study consisted of physicians, healthcare providers, managers, and experts, working in urban health centers selected by a purposive sampling method. The data were collected by semi-structured interviews. After data saturation, they were analyzed by conventional content analysis. Results: After interviewing 35 people and several stages of review, coding, and using the experience of experts, the data were classified into six main categories, 11 subcategories, and 33 codes. Factors influencing the role of physicians were service delivery, electronic health records, resources, community culture, monitoring, supervision, and practical suggestion. The participants expressed the workload, referral system, integrated electronic health record, financial resources, human resources, equipment, and public participation as some aspects related to the role of physicians. Conclusions: Based on the current study, human and financial resources should be managed to retain the physicians in this plan. In addition, increasing the quality of services, improving electronic health records, and attention to public culture can be considered.

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“…All cities with a population of over fifty thousand have at least one public hospital, whereas almost all private hospitals are located in provincial capitals [ 7 ]. Lastly, In Iran’s health system, due to the lack of a mandatory referral system, people can choose the service provider, the level of specialization, and the geographical location to receive the service [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with patients’ mobility rates within the provinces of Iran

Hekmat

Haghdoost

Zamaninasab

et al. 2022

BMC Health Serv Res

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Background The absence of a referral system and patients’ freedom to choose among service providers in Iran have led to increased patient mobility, which continues to concern health policymakers in the country. This study aimed to determine factors associated with patient mobility rates within the provinces of Iran. Methods This cross-sectional study was conducted in Iran. Data on the place of residence of patients admitted to Iranian public hospitals were collected during August 2017 to determine the status of patient mobility within each province. The sample size were 537,786 patients were hospitalized in public hospitals in Iran during August 2017. The patient mobility ratio was calculated for each of Iran’s provinces by producing a patient mobility matrix. Then, a model of factors affecting patient mobility was identified by regression analysis. All the analyses were performed using STATA14 software. Results In the study period, 585,681 patients were admitted to public hospitals in Iran, of which 69,692 patients were referred to the hospital from another city and 51,789 of them were admitted to public hospitals in the capital of the province. The highest levels of intra-provincial patient mobility were attributed to southern and eastern provinces, and the lowest levels were observed in the north and west of Iran. Implementation of negative binomial regression indicated that, among the examined parameters, the distribution of specialist physicians and the human development index had the highest impact on intra-provincial patient mobility. Conclusion The distribution of specialists throughout different country areas plays a determining role in patient mobility. In many cases, redistributing hospital beds is impossible, but adopting different human resource policies could prevent unnecessary patient mobility through equitable redistribution of specialists among different cities.

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Underlying factors and challenges of implementing the urban family physician program in Iran

Cited by 15 publications

References 24 publications

Challenges Associated with the Education of Family Physicians in Iran: A Systematic Review

Challenges Associated with the Education of Family Physicians in Iran: A Systematic Review

Explaining the Role of Physicians in Urban Comprehensive Health Service Centers After Implementing Health Transformation Plan in Southeast of Iran: A Qualitative Study

Factors associated with patients’ mobility rates within the provinces of Iran

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