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

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.

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

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

Absurd Sensationalism, Receded Morality in an Urban Family in the Vultures (1971)

A family is an organized system that connects all members together to exalt happiness and share grief to each other; they do not only help and hold shoulders with shoulders to strengthens family bonds and teach each other morality of life, respect and honour but also parents scold their sons and daughters for committing any mistakes to recuperate themselves in their career. Therefore, the sacred dignity of the family has been shattered nowadays in order to grab wealth and money. As Father has certain respect and honour at home similarly brothers and sisters have assured place in their parents ‟ heart. The play The Vulture has exposed a middle class family in the urban set up that comprises many family members who can fulfil their house with happiness and pleasure but their thirst for wealth and money shattered their tranquil life. Pappa has accumulated property after so much works though he has grabbed his brother Sakharam’s part who visits his home frequently to ask his part but his all efforts turned into dust and he is insulted by his nephews Ramakant and Umakant. They all are frustrated with the established system and they all started fighting for inheritance. They batter their own father for getting his hidden money though they all know that their demands and threat are transient, they will see the same satiation as they place their father at the moment. Their pursuit has no eternity as they show themselves that they have no goal; purposelessness, meaninglessness, disillusionment prevailed in their life. They sensationalize their arguments to quench their thirst and throw out their moral duty in respect of their father and family. For gaining absurd pursuit, they replicate the vulture like behaviour to kill their own father yet they are addicted to drinking and smoking and drugs, and keeping illicit relationship and outing at night for entertainment.

Epilogue

Even when the truth isn’t hopeful, the telling of it is. —POET ANDREA GIBSON I have made it a habit to have an epilogue, which goes by many different names, as a parting effort to finish a book that simply refuses to be finished, and more so on a topic such as urban gun violence. Trauma’s reverberations are immediate and intergenerational, including the generation yet to be born, spanning multiple decades and becoming part of urban family and community narratives. These generational reverberations also compromise the nation’s moral fabric, casting it internationally as violence prone....

Legal needs of patients attending an urban family practice in Hamilton, Ontario, Canada: an observational study of a legal health clinic

Background Individuals living in poverty often visit their primary care physician for health problems resulting from unmet legal needs. Providing legal services for those in need may therefore improve health outcomes. Poverty is a social determinant of health. Impoverished areas tend to have poor health outcomes, with higher rates of mental illness, chronic disease, and comorbidity. This study reports on a medical-legal collaboration delivered in a healthcare setting between health professionals and lawyers as a novel way to approach the inaccessibility of legal services for those in need. Methods In this observational study, patients aged 18 or older were either approached or referred to complete a screening tool to identify areas of concern. Patients deemed to have a legal problem were offered an appointment at the Legal Health Clinic, where lawyers provided legal advice, referrals, and services for patients of the physicians. Fisher’s exact test was used to compare populations. Binary logistic regression was used to determine the factors predicting booking an appointment with the clinic. Results Eighty-four percent (n = 648) of the 770 patients screened had unmet legal needs and could benefit from the intervention, with an average of 3.44 (SD = 3.42) legal needs per patient screened. Patients with legal needs had significantly higher odds of attending the Legal Health Clinic if they were an ethnicity that was not white (OR = 2.48; 95% CI 1.14–5.39), did not have Canadian citizenship (OR = 4.40; 95% CI 1.48–13.07), had housing insecurity (OR = 3.33; 95% CI 1.53–7.24), and had difficulty performing their usual activities (OR = 2.83; 95% CI 1.08–7.43). As a result of the clinic consultations, 58.0% (n = 40) were referred to either Legal Aid Ontario or Hamilton Community Legal Clinic, 21.74% (n = 15) were referred to a private lawyer; one case was taken on by the clinic lawyer. Conclusion The Legal Health Clinic was found to fulfill unmet legal needs which were abundant in this urban family practice. This has important implications for the future health of patients and clinical practice. Utilizing a Legal Health Clinic could translate into improved health outcomes for patients by helping overcome barriers in accessing legal services and addressing social causes of adverse health outcomes.