An Examination of Family Physicians Plan Implementation in Rural Areas from Perspectives of Managers, Personnel and Clients in Context of Health System: Strengths and Weaknesses

Abstract

Background: Family physician plan (FPP) and referral system (RS) is one of the major plans in Iran’s health system with the aim of increasing the accountability in the health market, enhancing the public’s access to the health services, lowering the unnecessary costs and equitable distribution of health across the society. Aim: Taking these into consideration, this study assessed the strengths and weaknesses of the Family Physician Plan in the Iranian villages based on the perspectives of the family physicians, managers, employees and clients in the health system in 2014. Subjects and Methods: A descriptive-applied and cross-sectional design was used for this study. Its statistical population consisted of two groups: the first group included all the family physicians and the managers, employees practicing in the health system of Borujen town (n=62 subjects) who, using 2-round consensus Delphi technique, were asked what are 4 main strengths and 4 weaknesses of the Family Physician Plan implemented during the past few years. This was done using an open questionnaire. The second group included village households and clients. The size of the second group was 400 heads of the households. Similarly, using SERVQUAL questionnaire, their ideas regarding 4 strengths and 4 weaknesses observed for the Family Physician Plan were asked. Subsequently, their given responses were compared and similar ideas were merged into one and for prioritization, the second questionnaire was prepared. But, it was just given to the employees. The responses to the questionnaire were ranked according to Likert scale. Finally, the collected data were put into SPSS software 13 to be analyzed. Results: As the results indicated, among the strengths reported in the implementation of the Family Physician Plan by the respondents the following ones had the highest frequency: the timely follow-up care of the patients with mental disorders, blood pressure (hypertension) and diabetes (55.4%), permanent caring for the patients from the start of the disease stage to the treatment or death stage (54.3%), elderly care (45.7%), equal enjoyment of the right to health expenditure per capita by all the society members and implementing the principle of justice in the health-care and the presence of physician in all villages (44.6%). On the contrary, the following weaknesses had the highest frequency: lack of provision of transportation needs for the Family Physician Plan’s employees (53.2%), insufficient funding (48.4%), the high workload for the physician (46.8%).
Conclusion: To enhance the public’s accessibility to the health services and enable their just utilization from such services, the Family Physician Plan must be assessed by the respective health care organization. In this way, it will be possible to identify its shortcomings paving the path to more effective measures towards promoting the quality of the medical-related activities.

Keywords: Family Physician, Health system, Assessment, Employees