Evaluation of Urban and Rural Family Physician Program in Iran: A Systematic Review
,
Abstract
Background: Global experience as well as expert views weight the Family Physician program (FPP) as a primary solution for various problems of healthcare system in Iran. In spite of the valuable information has been collected during conducting FPP, few studies have been done to evaluate the actual performance of this program. This study reviewed the studies related to the evaluation of the FPP systematically.
Methods: The authors systematically searched PubMed, Web of Science, Scopus, Embase, Irandoc and SID for articles published in English and Persian until Nov 2017 without limitation for starting time. Selection stages of the articles were done based on PRISMA flow diagram guidelines.
Results: Of all articles evaluated, 19 were selected. Four articles were removed due to inadequate quality of the study. Only one article evaluates urban and the rest are about rural. Eight articles were categorized as the process evaluations and 12 outcome assessments (one of them was common).
Conclusion: We achieved three main findings. First, the rural FPP has improved access to the healthcare services, but improvement in patient finding and quality of cares remains questionable. Second, there are considerable concerns in the referral system between levels I and II in both urban and rural programs. Third, there was no efficient planning to implement the FP as the gatekeepers of health care system effectively. These issues deprived the efficiency aim of FPP and need serious consideration.
1. Rivo M (1997). Family practice in the new Millennium: from health care to health improvement. Fam Pract Manag, 33 (4): 259-267.
2. Davoudi S (2006). Introduction to health Sector Reform. Asare Mouaser Pub, Iran, pp.: 233-37[in Persian].
3. Nourafkan O, Yazdanpanah A, Kharazmi E (2016). The study of urban family physicians performance and its related factors in the south of Iran. J Health Man & Info, 3 (1): 10-14.
4. Strasser R (2003). Rural health around the world: challenges and solutions. Fam Pract, 20 (4): 457-63.
5. Atun RA, Kyratsis I, Jelic G et al (2007). Diffusion of complex health innovations—implementation of primary health care reforms in Bosnia and Herzegovina. Health Policy Plan, 22 (1): 28-39.
6. Takian A, Doshmangir L, Rashidian A (2013). Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. Fam Pract, 30 (5): 551-59.
7. Tabrizi JS, Pourasghar F, Gholamzadeh Nikjoo R (2017). Status of Iran’s Primary Health Care System in Terms of Health Systems Control Knobs: A Review Article. Iran J Public Health, 46 (9): 1156-66.
8. Dehnavieh R, Kalantari AR, Jafari Sirizi M (2015). Urban family physician plan in Iran: challenges of implementation in Kerman. Med J Islam Repub Iran, 29: 303.
9. Rashidian A, Joudaki H, Khodayari-Moez E et al (2013). The impact of rural health system reform on hospitalization rates in the islamic republic of iran: An interrupted time series. Bull World Health Organ, 91 (12): 942-49.
10. Majdzadeh R (2012). Family physician implementation and preventive medicine; opportunities and challenges. Int J Prev Med, 3 (10): 665-69.
11. Majidi A, Loori N, Shahandeh K et al (2014). Are people in Tehran prepared for the family physician program?. Int J Prev Med, 5 (8): 984-91.
12. Honarvar B, Lankarani KB, Rostami S et al (2015). Knowledge and practice of people toward their rights in urban family physician program: A population-based study in Shiraz, Southern Iran. Int J Prev Med, 6: 46.
13. Dehnavieh R, Movahed E, Rahimi H et al (2017). Evaluation of the referral system in Iran’s rural family physician program; a study of Jiroft University of Medical Sciences. Electron Physician, 9 (4): 4225-30.
14. Jabbari-birami H, Gasemzade H, Bakhshian F et al (2012). Evaluation of Family Physician Program Based on Family Health Indices. Knowledge & Health, 7 (3): 124-128
15. Nasrollahpour Shirvani D, Ashrafian Amiri H, Motlagh ME et al (2010). Evaluation of the function of referral system in family physician program in northern provinces of Iran: 2008. J Babol Univ Med Sci, 11 (6): 46-52.
16. Jahromi VK, Mehrolhassani MH, Dehnavieh R, Anari HS (2017). Continuity of care evaluation: The view of patients and professionals about urban family physician program. Int J Prev Med, 8: 7.
17. Liberati A, Altman DG, Tetzlaff J et al (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 6 (7): e1000100.
18. Khayyati F, Motlagh ME, Kabir M et al (2011). The role of family physician in case finding, referral, and insurance coverage in the rural areas. Iran J Public Health, 40 (3): 136-9.
19. Nasrollahpour Shirvani SD, Mikaniki E et al (2014). Evaluation of the referral system situation in family physician program in Northern provinces of Iran: 2012-2013. J Mazandaran Univ Med Sci, 23 (109): 27-35.
20. Nasrollahpour Shirvani SD, Raeisee P, Motlagh ME et al (2010). Evaluation of the Performance of Referral System in Family Physician Program in Iran University of Medical Sciences: 2009. Hakim Health Sys Res, 13 (1): 19-25.
21. Chaman R, Amiri M, Raei Dehghani M (2012). The national family physician and the quality of referral system. Payesh, 11 (6): 785-790
22. Ebrahimipour H, hosseini SE, Mahmoudian P et al (2015). Evaluating the preformance of family physician in rural health centers, Bardaskan, 2013. Beyhagh, 20 (2): 26-34.
23. Khadivi R, Hashemi T, Siar EF, Rohani M (2012). The assessment of family physicians' performance in screening of hypertension and diabetes mellitus in rural areas of Isfahan County: A 5-year survey. Journal of Isfahan Medical School, 30 (209): 1-12.
24. Naderimagham S, Jamshidi H, Khajavi A et al (2017). Impact of rural family physician program on child mortality rates in Iran: A time-series study. Popul Health Metr, 15 (1): 21-28.
25. Raeissi P, Ebadi Fard Azar F, Roudbari M, Shabani kia H (2011). The Impact of Family Physician Program on Mother and Child Health Indices in Rural Population Auspices of Mashhad University of Medical Sciences and Health Care Services, Iran 2009. Journal of Health Administration, 14 (43): 27-36.
26. Alipour A, Habibian N, Tabatabaee S (2009). Evaluation the Impact of Family Physician Care Program on Family Planning in Sari from 2003 to 2007. Iran J Epidemiol, 5 (1): 47-55.
27. Kazemian M, Kavian-Telouri F (2016). Assessment of Access to Health Care in Family Physician Program with a Comprehensive Health Care Approach. Journal of Health Information Management, 13 (4): 304-309.
28. Kazemian M, Kaviyan Telouri F, Mirdarvatan Sa (2017). Assessment Unnecessary Costs in Family Physicians with Comprehensive Approach to Care Cuts in Family Physician Program. Journal of Healthcare Management, 7 (3): 45-53.
29. Khadivi R, Yarahmadi A, Eslamieh R, Khosravinejad M (2014). The Drug Prescription Patterns and Utilization after Family Physician Program Implementation in Rural Health Centers of Isfahan District, Iran. 2014. Journal of Isfahan Medical School, 31 (271): 1-10.
30. Fallah S, Rostamzadeh S(2016). Success of the Family Practice Plan in DiabetesControl. Journal of Health, 7(4):417-24.
31. Golalizadeh E, Moosazadeh M (2013). The effect of family physician program on customer reffence load in health centers of Mazandaran University of Medical Sciences. Journal of Medical Council of Iran, 31 (1): 9-14.
32. Watt WD (1987). The Family Physician: Gatekeeper to the Health-Care System. Can Fam Physician, 33: 1101-4.
33. Eskandari M, Abbaszadeh A, Borhani F (2013). Barriers of referral system to health care provision in rural societies in Iran. J Caring Sci, 2 (3): 229-36.
34. Brondani JE, Leal FZ, Potter C et al (2016). Challenges of referral and counter-referral in health care in the workers’ perspective. Cogitare Enferm, 21 (1) : 1-8.
35. James Kamau K, Onyango Osuga B, Njuguna R (2017). Challenges Facing Implementation Of Referral System For Quality Health Care Services In Kiambu County, Kenya. Health Syst Policy Res, 4 (1): 48-55.
2. Davoudi S (2006). Introduction to health Sector Reform. Asare Mouaser Pub, Iran, pp.: 233-37[in Persian].
3. Nourafkan O, Yazdanpanah A, Kharazmi E (2016). The study of urban family physicians performance and its related factors in the south of Iran. J Health Man & Info, 3 (1): 10-14.
4. Strasser R (2003). Rural health around the world: challenges and solutions. Fam Pract, 20 (4): 457-63.
5. Atun RA, Kyratsis I, Jelic G et al (2007). Diffusion of complex health innovations—implementation of primary health care reforms in Bosnia and Herzegovina. Health Policy Plan, 22 (1): 28-39.
6. Takian A, Doshmangir L, Rashidian A (2013). Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. Fam Pract, 30 (5): 551-59.
7. Tabrizi JS, Pourasghar F, Gholamzadeh Nikjoo R (2017). Status of Iran’s Primary Health Care System in Terms of Health Systems Control Knobs: A Review Article. Iran J Public Health, 46 (9): 1156-66.
8. Dehnavieh R, Kalantari AR, Jafari Sirizi M (2015). Urban family physician plan in Iran: challenges of implementation in Kerman. Med J Islam Repub Iran, 29: 303.
9. Rashidian A, Joudaki H, Khodayari-Moez E et al (2013). The impact of rural health system reform on hospitalization rates in the islamic republic of iran: An interrupted time series. Bull World Health Organ, 91 (12): 942-49.
10. Majdzadeh R (2012). Family physician implementation and preventive medicine; opportunities and challenges. Int J Prev Med, 3 (10): 665-69.
11. Majidi A, Loori N, Shahandeh K et al (2014). Are people in Tehran prepared for the family physician program?. Int J Prev Med, 5 (8): 984-91.
12. Honarvar B, Lankarani KB, Rostami S et al (2015). Knowledge and practice of people toward their rights in urban family physician program: A population-based study in Shiraz, Southern Iran. Int J Prev Med, 6: 46.
13. Dehnavieh R, Movahed E, Rahimi H et al (2017). Evaluation of the referral system in Iran’s rural family physician program; a study of Jiroft University of Medical Sciences. Electron Physician, 9 (4): 4225-30.
14. Jabbari-birami H, Gasemzade H, Bakhshian F et al (2012). Evaluation of Family Physician Program Based on Family Health Indices. Knowledge & Health, 7 (3): 124-128
15. Nasrollahpour Shirvani D, Ashrafian Amiri H, Motlagh ME et al (2010). Evaluation of the function of referral system in family physician program in northern provinces of Iran: 2008. J Babol Univ Med Sci, 11 (6): 46-52.
16. Jahromi VK, Mehrolhassani MH, Dehnavieh R, Anari HS (2017). Continuity of care evaluation: The view of patients and professionals about urban family physician program. Int J Prev Med, 8: 7.
17. Liberati A, Altman DG, Tetzlaff J et al (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 6 (7): e1000100.
18. Khayyati F, Motlagh ME, Kabir M et al (2011). The role of family physician in case finding, referral, and insurance coverage in the rural areas. Iran J Public Health, 40 (3): 136-9.
19. Nasrollahpour Shirvani SD, Mikaniki E et al (2014). Evaluation of the referral system situation in family physician program in Northern provinces of Iran: 2012-2013. J Mazandaran Univ Med Sci, 23 (109): 27-35.
20. Nasrollahpour Shirvani SD, Raeisee P, Motlagh ME et al (2010). Evaluation of the Performance of Referral System in Family Physician Program in Iran University of Medical Sciences: 2009. Hakim Health Sys Res, 13 (1): 19-25.
21. Chaman R, Amiri M, Raei Dehghani M (2012). The national family physician and the quality of referral system. Payesh, 11 (6): 785-790
22. Ebrahimipour H, hosseini SE, Mahmoudian P et al (2015). Evaluating the preformance of family physician in rural health centers, Bardaskan, 2013. Beyhagh, 20 (2): 26-34.
23. Khadivi R, Hashemi T, Siar EF, Rohani M (2012). The assessment of family physicians' performance in screening of hypertension and diabetes mellitus in rural areas of Isfahan County: A 5-year survey. Journal of Isfahan Medical School, 30 (209): 1-12.
24. Naderimagham S, Jamshidi H, Khajavi A et al (2017). Impact of rural family physician program on child mortality rates in Iran: A time-series study. Popul Health Metr, 15 (1): 21-28.
25. Raeissi P, Ebadi Fard Azar F, Roudbari M, Shabani kia H (2011). The Impact of Family Physician Program on Mother and Child Health Indices in Rural Population Auspices of Mashhad University of Medical Sciences and Health Care Services, Iran 2009. Journal of Health Administration, 14 (43): 27-36.
26. Alipour A, Habibian N, Tabatabaee S (2009). Evaluation the Impact of Family Physician Care Program on Family Planning in Sari from 2003 to 2007. Iran J Epidemiol, 5 (1): 47-55.
27. Kazemian M, Kavian-Telouri F (2016). Assessment of Access to Health Care in Family Physician Program with a Comprehensive Health Care Approach. Journal of Health Information Management, 13 (4): 304-309.
28. Kazemian M, Kaviyan Telouri F, Mirdarvatan Sa (2017). Assessment Unnecessary Costs in Family Physicians with Comprehensive Approach to Care Cuts in Family Physician Program. Journal of Healthcare Management, 7 (3): 45-53.
29. Khadivi R, Yarahmadi A, Eslamieh R, Khosravinejad M (2014). The Drug Prescription Patterns and Utilization after Family Physician Program Implementation in Rural Health Centers of Isfahan District, Iran. 2014. Journal of Isfahan Medical School, 31 (271): 1-10.
30. Fallah S, Rostamzadeh S(2016). Success of the Family Practice Plan in DiabetesControl. Journal of Health, 7(4):417-24.
31. Golalizadeh E, Moosazadeh M (2013). The effect of family physician program on customer reffence load in health centers of Mazandaran University of Medical Sciences. Journal of Medical Council of Iran, 31 (1): 9-14.
32. Watt WD (1987). The Family Physician: Gatekeeper to the Health-Care System. Can Fam Physician, 33: 1101-4.
33. Eskandari M, Abbaszadeh A, Borhani F (2013). Barriers of referral system to health care provision in rural societies in Iran. J Caring Sci, 2 (3): 229-36.
34. Brondani JE, Leal FZ, Potter C et al (2016). Challenges of referral and counter-referral in health care in the workers’ perspective. Cogitare Enferm, 21 (1) : 1-8.
35. James Kamau K, Onyango Osuga B, Njuguna R (2017). Challenges Facing Implementation Of Referral System For Quality Health Care Services In Kiambu County, Kenya. Health Syst Policy Res, 4 (1): 48-55.
| Files | ||
| Issue | Vol 48 No 3 (2019) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v48i3.882 | |
| Keywords | ||
| Family physician program Family practice Referral system Iran | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
KHEDMATI J, DAVARI M, AARABI M, SOLEYMANI F, KEBRIAEEZADEH A. Evaluation of Urban and Rural Family Physician Program in Iran: A Systematic Review. Iran J Public Health. 2019;48(3):400-409.
