Developing a practical model of urban family physician program ın Iran

Abstract

Abstract Introduction: Different countries need to create an effective and sustainable preventive health system in order to improve the health of their population. In this regard, they should emphasis on family medical services. Purpose: The purpose of this study is to provide an appropriate model for Iranian urban family practice program after assessing how these programs are implemented in selected countries. Materials and Methods: A mixed method study (a comparative study for 8 countries (assessment of 14 subjects including family doctors training program, referral system, information system, human resourse, community coverage, service package, monitoring and appraisal methods, payment system, contract, financing, insurance, doctor's management role, physician-patient relationship, and relationship with other organizations) and qualitative study) has been conducted. In comparative study, we used the Jordan scales, which divides countries into four groups based on insurance system. The findings from countries were presented in comparative tables. The experts panel and Delphi method were used to provide suggestions for Iran. Results: The selected countries have their own unique structure in order to provide family medicine services. Suggestions for Iran included: regional health management approach, patient-centered teamwork, pooling of insurers' funding, the purchaser–provider split, performance-based payment, scientific monitoring system, accreditation of comperhensive health centers, regional referral system, improvement of educational curriculum and empowerment of family physicians, comprehensive and active information system, definition of services provided by nurses and community health workers, and reducing workload for family physicians, developing a comprehensive service package and special attention to caring for chronic and elderly patients, integrated and interactive communications with the community and organizations, optimal use of private sector capacity. Conclusion: Using the proposed model in this study could be an important step to strengthening of health system and improving the effectiveness and efficiency of policies for urban family practice program implementation. Keywords: Family practice, reform , comparative