Five years after implementation of urban family physician program in fars province of Iran: Are people's knowledge and practice satisfactory?

Background: Urban family physician program is one of the relatively large reforms in Iran's health care system implemented in Fars and Mazandaran provinces since 2012. Nearly five years after implementation of the program, this study aimed to identify the achievements and challenges of this program from the viewpoints of managers and administrators. Methods: This cross-sectional study was conducted in winter of 2016. The research population included administrators and experts monitoring the urban family physician program and representatives of the family physicians and health care providers selected using the census method. The data collection tool was a two-part researcher-made questionnaire containing 15 questions with confirmed validity. To collect data, 29 panels of experts were held and the collected information was analyzed by SPSS 23 using independent t-tests and ANOVA. Results: Among the total of 647 participants in 2 provinces, 1540 achievement cases, 2387 challenge cases, and 1641 strategies were found. The average numbers of achievements, challenges, and strategies stated by each person were 2.38 ± 2.0, 3.70 ± 2.7, and 2.54 ± 2.0, respectively. The most frequent achievements, challenges, and strategies were increased disease detection and care (430), untimely payment to physicians (198), and providing sustainable resources for timely payments (119). The means of achievements, challenges, and strategies had significant relationship with some of the individual and social variables (p < 0.05). Conclusion: This study showed that increasing the rate of detection was the most important achievement and lack of timely payment was the biggest challenge of the program, which should be considered by policy makers.

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Family physicians' attitude and interest toward participation in urban family physician program and related factors

Journal of Family Medicine and Primary Care ◽

10.4103/2249-4863.201171 ◽

2016 ◽

Vol 5 (4) ◽

pp. 840 ◽

Cited By ~ 1

Author(s):

MonavarAfzal Aghaee ◽

Masoumeh Sadeghi ◽

Mohsen Dehghani

Keyword(s):

Family Physician ◽

Family Physicians ◽

Related Factors ◽

Urban Family

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Antibiotic Prescribing in Outpatient Before and After Implementation of the Urban Family Physician and Referral System

10.53350/pjmhs211561749 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1749-1755

Author(s):

Ehsan Nabovati ◽

Hamed Mahmoudi ◽

Reza Abbasi ◽

Saeed Barzegari ◽

Hossein Akbari ◽

...

Keyword(s):

Health Services ◽

Family Physician ◽

Positive Impact ◽

Referral System ◽

Antibiotic Prescribing ◽

Mazandaran Province ◽

Medication Prescription ◽

The Family ◽

Before And After ◽

Urban Family

Background The Family Physician and Referral System was piloted in Mazandaran and Fars provinces, Iran in 2012. The goal of this program was to improve the provision of health services including medication prescription. Objective This study aimed to determine the trends in antibiotic prescribing in outpatient before and after implementation of the Family Physician and Referral System in Babol, Iran from 2010 to 2018. Methods In this retrospective study, all prescriptions of urban family physicians in Babol, which were registered in the database of the Health Services Insurance Organization of Mazandaran province, were included. The trends of average number of items per prescription, percentage of antibiotics per prescription, frequency of antibiotic groups, and cost of antibiotics were calculated using SQL Server and IBM SPSS version 22. Results The average number of items per prescription was found to be 3.4±1.82, and 2.8±1.60, and percentage of antibiotics per prescription was 49% and 32% in 2010 and 2018, respectively. The most prescribed antibiotic groups were penicillin (54.8%) and cephalosporin (39.9%). Amoxicillin 500mg capsules (13.1%), metronidazole 250 mg (10.2%), and ciprofloxacin 500 mg (8.2%) were the most prescribed antibiotics. Also, the mean cost of prescriptions containing antibiotics compared to the total prescriptions had decreased from 22% in 2010 to 5.5% in 2018. Conclusion The pattern of medication prescription especially antibiotics, improved after the implementation of the Family Physician and Referral System. Due to the positive impact of the Family Physician and Referral System on medication prescription by physicians, we recommend the implementation of this program in low and middle-income countries. Keywords: Antibiotic, medication prescribing, Health system reform plan, Family physician, Trend

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

Korean Journal of Family Medicine ◽

10.4082/kjfm.2017.38.5.296 ◽

2017 ◽

Vol 38 (5) ◽

pp. 296 ◽

Cited By ~ 5

Author(s):

Enayatollah Homaie Rad ◽

Sajad Delavari ◽

Afsoon Aeenparast ◽

Abolhassan Afkar ◽

Faranak Farzadi ◽

...

Keyword(s):

Family Physician ◽

Evidence Based ◽

Healthcare Provision ◽

Economic Instability ◽

Urban Family

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Effect of Two Major Health Reforms on Health Care Cost and Utilization in Fars Province of Iran: Family Physician Program and Health Transformation Plan

10.21203/rs.2.15265/v2 ◽

2020 ◽

Author(s):

Mohsen Bayati ◽

Khosro Keshavarz ◽

Farhad Lotfi ◽

Abbas KebriaeeZadeh ◽

Omid Barati ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Family Physician ◽

Laboratory Tests ◽

Fars Province ◽

Short Term ◽

Utilization Of Services ◽

The Impact ◽

Care Costs

Abstract Background: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study was aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. Methods: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. Results: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in short and long term except general practitioners' and specialist visit, and medication in long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. Conclusions: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policymakers must adopt an agenda to revise and re-design the plan.

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

BMC Health Services Research ◽

10.1186/s12913-021-07367-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohammad Hossein Mehrolhassani ◽

Vahid Kohpeima Jahromi ◽

Reza Dehnavieh ◽

Mahla Iranmanesh

Keyword(s):

Family Physician ◽

Program Implementation ◽

Rural Areas ◽

Health Coverage ◽

Policy Makers ◽

International Pressure ◽

Electronic File ◽

The Family ◽

Urban Family ◽

Management Changes

Abstract Background The family physician program was launched in 2005 in rural areas of Iran and then piloted in 2012 in the cities of Fars and Mazandaran provinces due to insufficient health coverage in these cities. However, despite its pivotal role in the health system, this program has not progressed according to the policies. This study aimed to explain the underlying factors and challenges of implementing the urban family physician program in Iran. Methods This qualitative study was conducted on 44 policy-makers and managers at national and provincial levels selected via snowball and purposive sampling with maximum variation. The data were managed in MAXQDA 2020 and analyzed by directed content analysis. A triangulation method was adopted for this purpose. Results A total of 10 categories, 18 sub-categories, and 29 codes were formed. Most challenges related to underlying factors included precipitancy, economic sanctions, belief in traditional medicine, belief in the expertise of previous physicians, and global ranking of countries. For program implementation, most challenges included a diversity of insurance organizations, budget allocation, referral system, electronic file, educational system, and culture building. Conclusions The major challenges pertaining to underlying factors included international pressure for reforms and precipitancy in program implementation due to management changes. The challenges associated with program implementation included budget provision and interaction with insurance organizations. Therefore, to expand this program to other provinces in Iran, the identified factors should be carefully considered so that sufficient confidence and commitment can be guaranteed for all stakeholders.

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