Lankarani Kamran Bagheri, Honarvar Behnam, Shahabi Saeed, Zarei Fatemeh, Behzadifar Masoud, Hedayati Maryam, Fardid Mozhgan, Rafiee Fatemeh, Martini Mariano, Nejad Soheila Rafiei
Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
J Prev Med Hyg. 2023 Jun 1;64(2):E232-E264. doi: 10.15167/2421-4248/jpmh2023.64.2.3029. eCollection 2023 Jun.
Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges.
This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (organization, financing, payment, regulation, and behavior).
The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms.
Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran.
尽管城市家庭医生项目（UFPP）具有诸多优势，但在伊朗实施该项目后，UFPP与社区实际取得的成效之间仍存在差距。作为回应，本研究试图回顾与伊朗UFPP实施障碍及改进潜在解决方案相关的已发表研究。此外，还进行了一项定性研究，以了解国家层面和法尔斯省专家的观点，以便更好地理解该项目面临的挑战。
本研究分两个阶段进行。首先，进行了一项范围审查，旨在确定伊朗实施UFPP的常见障碍和潜在解决方案。其次，采用半结构化访谈进行了一项定性研究，以调查过去十年中决策和政策制定者对法尔斯省实施UFPP的障碍和解决方案的看法。研究结果使用五个控制旋钮框架（组织、融资、支付、监管和行为）进行分类。
UFPP最常见的障碍包括：1）组织（卫生部管理职能不统一、管理和规划薄弱、人力资源培训不足以及转诊系统薄弱）；2）融资（保险资金分散、财政资源不足以及财政资源不稳定）；3）支付（支付机制不当和付款延迟）；4）监管（法律繁琐和法律不明确）；5）行为（文化问题和利益冲突）。另一方面，确定了一些改进UFPP实施的解决方案，包括：加强政府作用；改善转诊系统；为UFPP提供者提供全面培训；考虑可持续财政资源；转向混合支付机制；采用适当的法律和监管框架；提高社区意识；以及提升激励机制。
我们的研究发现，尽管UFPP在伊朗已经实施了十年，但在所有五个组成部分中仍存在重大挑战。因此，推广该项目需要解决现有的实施挑战，以实现预定目标。本研究中的想法可用于改进法尔斯省目前的项目，并推广到伊朗的其他城市。
