Shams Lida, Mobinizadeh Mohammadreza, Nasiri Taha, Mohammadi Fatemeh
Department of Health Policy and Management, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran.
BMC Health Serv Res. 2025 Jan 25;25(1):143. doi: 10.1186/s12913-025-12291-x.
Family physician program is one of the effective reforms of the health system in Iran, but despite the implementation of this program in rural areas and the passage of ten years since its implementation in two provinces of Fars and Mazandaran, its implementation has faced problems. The aim of this study is to identify and prioritize implementation solutions related to the challenges of the family physician program in Iran.
This is a qualitative study using semi-structured interviews with 22 snowball-sampled experts and managers of basic health insurers to extract problems and executive solutions through coding and data analysis using Atlas Ti software and content analysis in the first stage. The combined criteria were used to report qualitative studies (COREQ). In the second stage, the extracted executive solutions were ranked using multi-criteria decision-making (MADM) and a hybrid approach combining Shannon entropy with simple aggregation weighting (SAW).
Main themes were identified, including financing, management, human resources, structure, culture building, payment mechanism information systems, monitoring & control, performance of insurance organisations, and implementation. Out of these, priority was given to the information system, along with 41 sub-themes prioritising comprehensive, community-oriented physician training.
The findings of the study provide remedies for the problems of the Iranian Urban Family Physician Programme at the executive level and in priority order, from the standpoint of the insurance organisations. Making crucial decisions entails handling matters relating to funding, administration, personnel, architecture, ethos, remuneration, IT systems, oversight, insurance organization output, and execution.
家庭医生项目是伊朗卫生系统的有效改革之一，但尽管该项目已在农村地区实施，且自其在法尔斯省和马赞德兰省实施以来已过去十年，其实施仍面临问题。本研究旨在识别与伊朗家庭医生项目挑战相关的实施解决方案并确定其优先级。
这是一项定性研究，采用半结构化访谈，对22名通过滚雪球抽样选取的基本健康保险公司专家和管理人员进行访谈，在第一阶段使用Atlas Ti软件通过编码和数据分析以及内容分析来提取问题和执行解决方案。采用合并标准报告定性研究（COREQ）。在第二阶段，使用多标准决策（MADM）以及将香农熵与简单加权求和（SAW）相结合的混合方法对提取的执行解决方案进行排序。
确定了主要主题，包括融资、管理、人力资源、结构、文化建设、支付机制信息系统、监测与控制、保险组织绩效以及实施。其中，信息系统被列为优先事项，同时还有41个次主题将全面的、以社区为导向的医生培训列为优先事项。
该研究结果从保险组织的角度，按优先顺序为伊朗城市家庭医生项目执行层面的问题提供了补救措施。做出关键决策需要处理与资金、管理、人员、架构、风气、薪酬、信息技术系统、监督、保险组织产出和执行相关的事项。
