Mohammadibakhsh Roghayeh, Sohrabi Rahim, Aghighi Negar, Alihosseini Samira, Behzadifar Masoud, Martini Mariano, Aryankhesal Aidin
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Deputy of Management and Resources Development and planning, Hamadan University of Medical Sciences, Hamadan, Iran.
J Prev Med Hyg. 2024 Oct 31;65(3):E434-E441. doi: 10.15167/2421-4248/jpmh2024.65.3.3346. eCollection 2024 Sep.
Family physicians play a crucial role in healthcare delivery systems worldwide. In Iran, the family physician program has been introduced in only two provinces, with its expansion to other regions currently stalled due to various challenges. This study aims to identify the barriers and challenges hindering the effective implementation of the family physician program in urban areas of Iran.
This qualitative study utilized purposeful sampling to select health system policymakers, senior administrators, and physicians as participants. Data were collected through semi-structured interviews with 32 participants until saturation was reached. The data were analyzed using grounded theory, involving open, axial, and selective coding to identify key themes and sub-themes.
The primary challenge in implementing the urban family physician program was conflicting interests among stakeholders, identified as the core category. Key contributing factors included payment mechanism complexities, stewardship, structural issues, financial constraints, and cultural elements. Specialist physicians, in particular, resisted the program's implementation, often employing reverse referral as a coping strategy. These challenges collectively hindered the nationwide rollout of the program.
Addressing the barriers to implementing urban family physician policies requires a comprehensive reassessment of stakeholder roles and a restructuring of the payment system. Additionally, proactive efforts to resolve the complex contextual challenges within the healthcare system are essential for the successful implementation of these policies.
家庭医生在全球医疗服务体系中发挥着关键作用。在伊朗，家庭医生项目仅在两个省份推行，由于各种挑战，目前向其他地区的扩展陷入停滞。本研究旨在确定阻碍伊朗城市地区家庭医生项目有效实施的障碍和挑战。
这项定性研究采用目的抽样法，选取卫生系统政策制定者、高级管理人员和医生作为参与者。通过对32名参与者进行半结构化访谈收集数据，直至达到饱和状态。使用扎根理论对数据进行分析，包括开放式编码、轴心式编码和选择性编码，以确定关键主题和子主题。
实施城市家庭医生项目的主要挑战是利益相关者之间的利益冲突，这被确定为核心类别。关键促成因素包括支付机制复杂、管理、结构问题、资金限制和文化因素。特别是专科医生抵制该项目的实施，经常采用反向转诊作为应对策略。这些挑战共同阻碍了该项目在全国范围内的推广。
解决城市家庭医生政策实施的障碍需要全面重新评估利益相关者的角色，并对支付系统进行重组。此外，积极努力解决医疗系统内复杂的背景挑战对于这些政策的成功实施至关重要。
