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影响乡村家庭医生计划中全科医生退出的因素:以伊朗克尔曼为例。

Factors Affecting Leave out of General Practitioners from Rural Family Physician Program: A Case of Kerman, Iran.

作者信息

Amiresmaili Mohammadreza, Khosravi Sajad, Feyzabadi Vahid Yazdi

机构信息

Department of Health Management, Policy and Economics, Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Department of Health Management, Policy and Economics, Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

出版信息

Int J Prev Med. 2014 Oct;5(10):1314-23.

Abstract

BACKGROUND

Rural family physician program as the new reform in the Iranian health system has been implemented since 2005. Its success depends much on physicians' retention. The present study aimed to identify influential factors on physicians' willingness to leave out this program in Kerman province.

METHODS

The present cross-sectional study was performed in Kerman province in 2011. All family physicians working in this program (n = 271) were studied using a questionnaire. Data analysis was carried out using descriptive statistics and logistic regression through SPSS version 18.0.

RESULTS

Twenty-six percent (70) of the physicians had left out the program in the past. In addition, 77.3% (208) intended to leave out in the near future. Opportunity for continuing education, inappropriate and long working hours, unsuitable requirements of salary, irregular payments, lack of job security and high working responsibility were regarded as the most important reasons for leaving out the program in the past and intention to leave out in future orderly. According to univariate logistic regression, younger physicians (odds ratio [OR] =2.479; 95% confidence interval [CI]: 1.261-4.872) and physicians who had older children (OR = 4.743; 95% CI: 1.441-15.607) were more willing to leave out the plan in the near future, however it was not significant in multivariate logistic regression.

CONCLUSIONS

Physician retention in family physician program is faced with serious doubts due to different reasons. The success of the program is endangered because of the pivotal role of human resources. Hence, the revision of human resources policies of the program seems necessary in order to reduce physicians leave out and improving its effectiveness.

摘要

背景

农村家庭医生项目作为伊朗卫生系统的一项新改革,自2005年起实施。其成功很大程度上取决于医生的留用情况。本研究旨在确定克尔曼省影响医生退出该项目意愿的因素。

方法

本横断面研究于2011年在克尔曼省进行。使用问卷调查了该项目中所有在职的家庭医生(n = 271)。通过SPSS 18.0版进行描述性统计和逻辑回归分析。

结果

26%(70名)医生过去已退出该项目。此外,77.3%(208名)医生打算在不久的将来退出。继续教育机会、工作时间不合适且过长、薪资要求不合理、支付不规律、缺乏工作保障以及工作责任重大被视为过去退出该项目和未来打算退出的最重要原因。根据单因素逻辑回归分析,年轻医生(优势比[OR]=2.479;95%置信区间[CI]:1.261 - 4.872)和有较大孩子的医生(OR = 4.743;95% CI:1.441 - 15.607)在不久的将来更愿意退出该计划,但在多因素逻辑回归分析中不显著。

结论

由于各种原因,家庭医生项目中医生的留用面临严重质疑。由于人力资源的关键作用,该项目的成功受到威胁。因此,似乎有必要修订该项目的人力资源政策,以减少医生退出并提高其有效性。

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