GhorbaniNia Rahil, Hekmat Somayeh Noori, Dehnavieh Reza, Bahaadinbeigy Kambiz, Arab-Zozani Morteza
Faculty of Management and Medical Information Sciences, Department of Health Management and Policy and Economics, Kerman, Iran.
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Int J Prev Med. 2023 Aug 28;14:108. doi: 10.4103/ijpvm.ijpvm_116_22. eCollection 2023.
Due to its ethical approach and its protection of patients and their interests, quaternary prevention can increase the quality-of-service provision and decrease costs and the wastage of resources. The present study used interpretive structural modeling (ISM) to classify the effective factors and determine a quaternary prevention model for Iran's Rural Family Physician Program.
This study was a qualitative study with an ISM approach. Twenty-five health system experts and faculty members participated in the study. The interrelationships between the factors were determined using ISM, and after classification, the driving and dependence power of the factors were specified using MICMAC analysis.
The 20 factors were classified into five levels. The results indicated that patient interest and vulnerable groups had the highest effectiveness, and officials' and policymakers' commitment to providing serious support for family physicians had the highest affectability. The factors were placed into the two groups of linkage and dependence based on the MICMAC analysis.
The new technologies are costly and sometimes only suitable for a specific group of patients. Costs and the issues of induced demand and defensive medicine necessitate a different view of health service distribution. The preventive and strategic view and the comprehensiveness of family physician services make quaternary prevention possible by providing high-risk and vulnerable groups with essential services based on patient needs and conditions with more benefit than harm.
由于其四元预防的伦理方法及其对患者及其利益的保护，四元预防可以提高服务质量，降低成本并减少资源浪费。本研究采用解释结构模型（ISM）对影响因素进行分类，并确定伊朗农村家庭医生计划的四元预防模型。
本研究是一项采用ISM方法的定性研究。25名卫生系统专家和教员参与了该研究。使用ISM确定因素之间的相互关系，并在分类后，使用MICMAC分析确定因素的驱动和依赖力量。
20个因素分为五个层次。结果表明，患者利益和弱势群体的有效性最高，官员和政策制定者对家庭医生提供认真支持的承诺的影响最大。根据MICMAC分析，这些因素分为联系和依赖两组。
新技术成本高昂，有时仅适用于特定患者群体。成本以及诱导需求和防御性医疗问题需要对卫生服务分配有不同的看法。家庭医生服务的预防性和战略性观点以及全面性使得通过根据患者需求和条件为高危和弱势群体提供基本服务来实现四元预防成为可能，且益处大于危害。
