Division of Health Studies, School of Health Sciences & Social Care, Brunel University London, Uxbridge, UK.
Fam Pract. 2013 Oct;30(5):551-9. doi: 10.1093/fampra/cmt025. Epub 2013 Jun 20.
The primary health care (PHC) network contributed considerably to improving health outcomes in rural Iran. However, the health system suffers from inadequate responses to ever-increasing demands. In 2005, a reform comprised of a family physician (FP) programme and universal health insurance was implemented in all rural areas and cities with a population of <20 000. We explored the role of the pre-existing PHC network on the implementation of FP programme in rural Iran.
We conducted a qualitative study involving 71 semi-structured interviews at national, provincial and local levels, and three focus group discussions at local level, plus a purposeful content analysis of documents of various types. We used a mixed inductive/deductive framework approach for data analysis.
We identified seven main aspects related to the existing primary health network, which contributed to the implementation of FP programme: 'a respected and functioning PHC network', 'accessibility and geographical coverage', 'efficient hierarchy', 'the only possible host', 'a remedy for chronic challenges in the rural PHC', 'FP as the gatekeeper?' and 'the role of the private sector'. The existence of a functioning PHC was pivotal in driving policy makers' decision to implement FP programme.
Implementing a new policy depends on its hosting context. In regards to FP programme and rural insurance in Iran, the existing PHC network proved to be a fundamental asset in facilitating the implementation of FP programme in rural areas.
初级卫生保健（PHC）网络为改善伊朗农村的健康结果做出了巨大贡献。然而，卫生系统对不断增加的需求反应不足。2005 年，在所有农村地区和人口<20000 的城市实施了一项包括家庭医生（FP）计划和全民健康保险的改革。我们探讨了现有的 PHC 网络在伊朗农村实施 FP 计划中的作用。
我们进行了一项定性研究，包括在国家、省和地方各级进行了 71 次半结构化访谈，在地方一级进行了三次焦点小组讨论，以及对各种类型的文件进行了有针对性的内容分析。我们使用了一种混合的归纳/演绎框架方法进行数据分析。
我们确定了与现有初级卫生保健网络相关的七个主要方面，这些方面有助于实施家庭医生计划：“一个受人尊敬和运作良好的初级卫生保健网络”、“可及性和地理覆盖范围”、“有效的等级制度”、“唯一可能的宿主”、“农村初级卫生保健中慢性挑战的补救措施”、“家庭医生作为把关人？”和“私营部门的作用”。一个运作良好的初级卫生保健的存在是推动政策制定者决定实施家庭医生计划的关键。
实施新政策取决于其主办环境。就家庭医生计划和伊朗农村保险而言，现有的初级卫生保健网络被证明是在农村地区促进家庭医生计划实施的一个基本资产。
