Challenges in the rural family doctor system in Iran in 2013-14: a qualitative approach

The effects of positive leadership on quality of work and life of family doctors: The moderated role of culture

Background

Quality of work and life (QWL) of family doctors is highly valued in improving access and equity of healthcare; however, the current low level of QWL in many countries and regions needs to be improved urgently.

Methods

This study explored the effect of positive leadership on the QWL of family doctors, as well as the moderating role of culture, via analysis of data from 473 valid questionnaires of family doctors in China as a sample using SEM, hierarchical linear regression, and a simple slope test.

Results

The empirical results show that positive leadership promoted the QWL of family doctors by improving their achievement motivation and coordinating supportive resources. In addition, our hierarchical linear regression analysis found that the interactive items of positive leadership and culture had a positive effect on achievement motivation (β(a)  = 0.192), QWL (β(b)  = 0.215) and supportive resources (β(c)  = 0.195). Meanwhile, culture had a moderated mediating effect on the relationship between positive leadership and QWL via the achievement motivation of family doctors and supportive resources.

Conclusion

These findings suggest that the interaction among multiple factors, including environmental factors, individual physiological features and culture, may influence the impact of positive leadership on the QWL of family doctors. The possible reasons of these findings and theoretical and practical implications are discussed in this study.

Challenges in the implementation of an electronic referral system: A qualitative study in the Iranian context

Referral chain reduces patient costs and results in more efficient use of workforce and equipment. Despite the implementation of the Family Physician Programme in Iran, the referral system does not function as intended. Therefore, this study was conducted to explain the challenges in the implementation of an electronic referral system in Iran. This qualitative study was performed in Golestan province in northern Iran. The participants were 46 family physicians, specialist physicians, healthcare managers, experts, and patients who were selected through purposive sampling. Data were collected using in-depth individual interviews and were analysed using content analysis. Implementation of the electronic referral system faces management challenges (planning, organisation, motivation, control), administrative challenges (scheduling, patient load and waiting time, visit and diagnosis, feedback), and educational, policy, sociocultural, technological, and economic challenges. Policymakers can adopt appropriate strategies to improve the quantity and quality of their electronic referral system according to the challenges identified herein.

Do older people with cardiovascular-metabolic multimorbidity prefer to sign contracts for family doctor services? Evidence from a cross-sectional study in rural Shandong, China

Background

Family doctor policy is an important part of deepening healthcare reform in China. The study aimed to explore the association between cardiovascular-metabolic multimorbidity and the status of signing a contract for family doctor services among the older people in rural Shandong, China.

Methods

A cross-sectional study was conducted in 3 cities of Shandong province, China. A total of 1395 rural residents over 60 years of age were included in this study using a multistage stratified random sampling method. Covariates included demographic and socioeconomic characteristics, health-related characteristics, health service utilization, and awareness of family doctor contract services. The univariate and multivariate regression logistic analysis was used to analyze the data.

Results

There were 28.2% of the rural older people contracted for the family doctor contract services. The contract rate of seniors with cardiovascular-metabolic multimorbidity was statistically higher than those without cardiovascular-metabolic multimorbidity (OR = 1.67, 95%CI, 1.21-2.32) after controlling for confounding factors. In addition, occupation, physical activities, self-rated health status, distance from the village clinic, the awareness of family doctor contract services were found to be associated with the signing behavior among the rural older adults.

Conclusion

This study demonstrated that the rural older people with cardiovascular-metabolic multimorbidity had a higher family doctor contract rate than those without cardiovascular-metabolic multimorbidity, and there was a gap between the current signing rate and the policy goal. To increase the rate of signing for family doctor contract services, the government should take joint efforts to expand the publicity and coverage, and give priority to meeting the healthcare demands of rural older adults with cardiovascular-metabolic multimorbidity.

The preferred role of nurses in family physician team

Introduction

Nurses are considered as one of the members of family physician teams, therefore it is important to explain the role of nurses in it. The aim of study was to determination of nurses' roles in the family physician team.

Methods

This research was conducted as a cross sectional descriptive analytical study. The study population was consisted of all the nurses who were working in under the supervision of Semnan University of Medical Sciences. The participants included 150 nurses who were selected via random stratified sampling method. The research instrument was a researcher-made questionnaire.

Results

Of all the participants, 30 persons (20%) were male and the rest were female (80%). The findings of the study reported based on the mean score of five. The collected data indicated that the nurses participating in the study, as a member of family physician team, had a tendency to take part in the following activities: support (4.44), care (4.37), management (4.05), counseling (3.93), prevention (3.81), and education (3.78).

Conclusion

The results of the study showed that the nurses were more interested in playing a role in supporting and caring for patients, rather than participating in education and preventive activities. Since family physician teams must mainly provide community-based preventive services, the authorities should try to enhance the interests and capabilities of nurses to empower them to play a role in preventive and education activities.

The challenges of the family physician policy in Iran: a systematic review and meta-synthesis of qualitative researches

BACKGROUND

A good level of health requires the establishment of primary health care. Family physician policy (FPP) is probably one of such initiatives, which enables societies attaining the universal health coverage.

OBJECTIVE

The present study is the first systematic review and meta-synthesis that seeks to provide a more comprehensive understanding of the challenges for FPP in Iran.

METHOD

Several international scholarly databases (namely, ISI/Web of Sciences, PubMed/MEDLINE via Ovid, Embase, PsycINFO, Scopus and CINAHL via EBSCO), as well as three Iranian databases [MagIran, Irandoc and Scientific Information Database (SID) databases], were mined from January 2006 to December 2017. The Noblit & Hare approach was used to analyse the selected studies.

RESULTS

Based on the study inclusion criteria, seven studies were retained. Initially, 133 codes were identified. In the second step, two of the authors examined the codes and merged themes based on their similarities and shared meaning. New codes were created through discussion. In the next and final step, eight themes emerged, namely, (i) financing; (ii) motivational factors; (iii) education; (iv) referral system; (v) performance evaluation; (vi) problems with health policy; (vii) health information system; and (viii) culture-building for proper policy implementation.

CONCLUSION

Although more than 10 years have passed since the implementation of FPP in Iran, and despite its positive effects on health, there are still challenges in implementing this policy, which makes it difficult to achieve its objectives. Health decision- and policy-makers in Iran should address these challenges and use all available capacities to face them.