مروری بر مطالعات اجرای طرح پزشک خانواده در نظام سلامت ایران در سال‌‌های 1380-1399 (مقاله مروری)
محورهای موضوعی : -مدیریت اطلاعات بهداشتی و درمانی
محترم احمدی فرد
1
(گروه علوم ارتباطات اجتماعی، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران)
عبدالرضا شاه محمدی
2
(استادیار، گروه علوم ارتباطات اجتماعی، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران)
محمدرضا محمدطاهری
3
(استادیار، گروه علوم ارتباطات اجتماعی، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران)
ناز محمد اونق
4
(استادیار، گروه علوم اجتماعی، دانشگاه پیام نور، تهران، ایران)
کلید واژه: مدیریت خدمات سلامت, طرح پزشک خانواده, ارتباط موثر, بیمه سلامت, نظام ارجاع,
چکیده مقاله :
مقدمه: اجرای کامل نظام ارجاع و رفع نواقص آن یکی از موضوعات مهم خدمات سلامت در جوامع امروزی است. یکی از تبعات اجرای ناقص نظام ارجاع روستایی هزینه‌هایی است که به جیب مردم و به نظام یک کشور وارد می‌شود. از عوامل اصلی در تکمیل نظام ارجاع، با توجه به متعدد بودن ذینفعان، سیاست‌گذاران و مجریان دراین طرح، نحوه برقراری ارتباط موثر، در بین گروه‌های متعدد و متفاوت این طرح (پزشک، بیمه شده، ماما، بهورز، کادر اجرایی، کادر نظارتی و سیاست‌گذاران حاکمیتی) است. هدف این مطالعه سنجش میزان و نحوه پرداختن مطالعات طرح پزشک خانواده به مولفه‌های ارتباطی به عنوان شاخص تاثیرگذار در رفع چالش‌‌های طرح می‌باشد.روش بررسی: روش مطالعه حاضر به صورت مروری کتابخانه ای بر روی 40 مطالعه از سال 1380لغایت 1399 انجام شد. جمعیت مورد پژوهش تمامی مقاله‌های مرتبط با مولفه‌های ارتباطی در طرح پزشک خانواده می‌باشد. در راستای انجام پژوهش اطلاعات به روش مطالعه متون از کتابخانه، وب سایت‌‌های سازمان‌‌های مرتبط منتخب و در راستای جستجوی نظام‌مند براساس کلید واژه‌هایی مبتنی بر 1- طرح پزشک خانواده 2- ارتباطات در طرح پزشک خانواده 3- نظام ارجاع4- چالش‌ها و موانع طرح پزشک خانواده 5- مراقبت‌‌های بهداشت و درمان 6- استراتژی‌‌های طرح پزشک خانواده روستایی 7-ارتباط موثر در نظام ارجاع، جمع آوری و در جدول تطبیقی حیطه ها مورد ارزیابی و مقایسه واقع شد. جستجوی مقالات به صورت نظام‌مند بر اساس کلیدواژه‌های مرتبط در پایگاه‌‌های داده معتبر و تخصصی به زبان‌‌های انگلیسی و فارسی Google scholarبه همراه پایگاه‌‌های ملی شامل SID، IRANDOC، ISC انجام شد. از مجموع مقالات شناسایی شده، پژوهشگر طبق استراتژی پژوهش نسبت به ارزیابی محتوای آن دسته از مقالاتی پرداخت که به تاثیر و اهمیت مولفه‌های ارتباطی در طرح پزشک خانواده روستایی و نظام ارجاع در بخش بحث و نتیجه‌گیری مقاله مستقیم پرداخته بودند. یافته‌ها: در بررسی اسنادی صورت گرفته از 230 مقاله مرتبط با کلید واژه‌های مد نظر محقق، در 40 مقاله مشاهده شد که به موضوع مولفه‌های ارتباطی به عنوان شاخص مهم در رفع مشکلات نظام ارجاع درطرح پزشک خانواده در مباحث و نتیجه‌گیری پرداخته شده بود. 4 مولفه،رضایت سنجی، عدم آگاهی (آموزش، اطلاع رسانی، مشارکت) توانمندسازی نیروی انسانی، ارتقا شاخص‌‌های بهداشتی، مولفه‌های ارتباطی بودند که شناسایی شدند که در متن مقالات و نتیجه‌گیری به آن پرداخته شده بود. نتیجه‌گیری: پیشنهاد می‌شود با بهره‌گیری از تجارب کشور‌‌های موفق در زمینه برقراری ارتباط موثردر نظام ارجاع، با ایجاد نظام یکپارچه ارتباطی، الگوی ارتباطی برای رفع مشکلات طرح پزشک خانواده طراحی گردد. نیاز است در مطالعات به تاثیر مولفه‌های ارتباطی به عنوان شاخص اصلی و متغییر مستقل در رفع مشکلات و چالش‌‌های طرح پزشک خانواده پرداخته شود.
Introduction: The complete implementation of the referral system and the elimination of its deficiencies is one of the important issues of health services in today's societies. One of the consequences of the incomplete implementation of the rural referral system is the costs that enter people's pockets and the system of a country. One of the main factors in completing the referral system, considering the large number of beneficiaries, politicians and executives in this plan, is how to communicate effectively among the many and different groups of this plan (doctors, insured, midwives, nurses, executive staff, staff The aim of this study is to measure the extent and manner of family doctor plan studies addressing communication components as an effective index in solving the challenges of the plan.Methods: Research method: The method of the present study was conducted in the form of a library review on 40 studies from 2001 to 2020. The research population is all the articles related to communication components in the family doctor project. In order to carry out information research by reading texts from the library, websites of selected related organizations and in order to search systematically based on keywords based on 1- family doctor plan 2- communication in family doctor plan 3- referral system 4- challenges and obstacles of the plan Family doctor 5-Health care 6-Rural family doctor plan strategies 7-Effective communication in the referral system was collected and evaluated and compared in the comparison table of the fields. Articles were systematically searched based on relevant keywords in authoritative and specialized databases in English and Farsi languages, Google scholar, along with national databases including SID, IRANDOC, ISC. From all the identified articles, according to the research strategy, the researcher evaluated the content of those articles that addressed the impact and importance of communication components in the rural family physician plan and the referral system in the discussion and conclusion section of the direct article.Findings: In the document review of 230 articles related to the keywords considered by the researcher, it was observed that in 40 articles, the issue of communication components as an important indicator in solving the problems of the referral system in the family doctor plan was discussed in the discussions and conclusions. Was. 4 components, satisfaction measurement, lack of awareness (training, information, participation), human resource empowerment, improvement of health indicators, were communication components that were identified and discussed in the text of the articles and conclusions.Conclusion: It is suggested to use the experiences of successful countries in the field of effective communication in the referral system, by creating an integrated communication system, to provide a communication model to solve the problems of the family doctor plan. It is necessary to study the impact of communication components as the main indicator and independent variable in solving the problems and challenges of the family doctor plan.
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_||_1- General program of family doctor and rural. insurance.info@researchvice.tbzmed.ac.ir.
2- Reisi P, Ebadi Fardazar Farbod, Rudbari Massoud, Shabani Kia Hamidreza. The effect of family physician plan on maternal and child health indicators of rural population of Mashhad University of Medical Sciences and Health Services. health Management. 2011 [cited 2022May08]; 14 (43): 27-36. Available from: https://www.sid.ir/fa/journal/ViewPaper.
3- izadi A, nurolsana R, Izadbakhsh HR . Modeling of empowerment strategies in the health insurance system based on Zee number mapping methodJournal of Healthcare Management 2020; 11 (3) / 7.
4- WHO. World Health Report 2008: Primary Health Care, Now More Than Ever. Geneva: World Health Organization 2008; Available from: http://www.who.int/whr/2008/ whr08_en.pdf.
5- HERIMP. Proceedings of a Seminar of Challenges and Development Vision in Iran. Tehran: Higher Educational and Research Institute in Management and Planning 2004; pp. 19-26.
6- Moshiri I, Takian A H, Rashidian A, Kabir M J. Expediency and symmetry in the formation of family physician program and general rural health insurance in Iran. Hakim (Hakim) Health System Research. 2012 [cited 2022May20]; 15 (4): 288-299. Available from: https://www.sid.ir/fa/journal/ViewPaper.
7- Mansoorian M, Rastegari Mehr B, Kalantari Z, Mehram M, Hosseinzadeh Milani M, Shafieian Z,etal. Investigating the effect of family physician plan on the trend of vital signs health indicators of rural population in Qazvin province during 2003-2008. Journal of Razi Medical Sciences: December 2014: Issue 126.
8- Shafiee T, Amini Nasab Z , Barzegar A , Comparison of maternal and child health indicators before and after the implementation of the plan Family doctor of Birjand city,Fourth National Conference on Health Development Research ,birjand , Birjand University of Medical Sciences , 29 to 31 May 2015
9- Heidari A, Behmiari Z, Mansourizadeh A, Anaraki A. Investigating the effect of family physician program on some health indicators of rural population of Bushehr University of Medical Sciences and Health Services. Congress of Reproductive and Infertility Health Research Center. 2014. Volume 7.
10- Sepehrdoost H , Factors Affecting Development from the Perspective of Health Indicators. Health Information Management. 2011 [cited 2022May20]; 8.
11- Ahmadi A, Javadi A. Trends and Determinants of Infant Mortality Rate in Fars Province during 2001-2011 . JRUMS. 2015; 14 (1) :37-46
12- Reisi P, Ebadi Fardazar Farbod, Rudbari Massoud, Shabani Kia Hamidreza. The effect of family physician plan on maternal and child health indicators of rural population of Mashhad University of Medical Sciences and Health Services. health Management. 2011 [cited 2022May08]; 14 (43): 27-36. Available from: https://www.sid.ir/fa/journal/ViewPaper.
13- Mohaddes Hakak HR, Hosseini Sa, Farahmand D, Rajabzadeh R. Siraj Akbari n, Sadeghi A. Journal of Medical Sciences of North Khorasan. 2018. Volume 10. Number 1.
14- Razavizadeh N, Peykani T. A review of social studies of family planning and fertility reduction in Iran. Journal of Culture Strategy. 2015 [cited 2022May20]; 8 (30): 35-65. Available from: https:// www.sid.ir/fa/journal /ViewPaper.aspxid.
15- Farahbakhsh M, Nik Niaz AS, Zakeri A. Review of health data management in
System of providing primary health care in East Azerbaijan province. Journal of health system. 2010; 2 (2,1).
16- Khadivi R, Karamin Forouzandeh A. Journal of Isfahan Medical School. Volume 32, Issue 286.
17- Najimi A, Alidosti M, Sharifiurad Gh. A survey of knowledge, attitude and satisfaction of villagers in Isfahan towards family physician program. Journal of Health System Research. 2011; 7 (6)URL: http://hsr.mui.ac.ir/article-۱-۳۲۸-fa.html
18- Nasrallah Pourshirvani d, Reisi P, Motlagh Ma, Kabir MJ, Ashrafian Amiri H. Evaluating the performance of the referral system in the family physician program in Iran University of Medical Sciences: 2008. Hakim (Hakim) Health System Research. 2010 [cited 2022May20]; 13 (1): 19-25. Available from: https://www.sid.ir/fa/journal/ViewPaper.aspxid.
19- Rouhani P, Baqir M. The experience of rural family physicians in referring patients and ways to improve it. Journal of Mazandaran University of Medical Sciences (University Letter), 25 (131), (2015): 1-13.
20- Torabi Ardakani, Hosseini, Urmia, Mirzaei. Understanding, awareness and expectations of people and physicians from the implementation of the family physician plan. Scientific Journal of the Organization of the Medical System of the Islamic Republic of Iran. 2015 [cited 2022May20]; 33 (2) .47-155. Available from: https://www.sid.ir/fa/journal/ViewPaper.aspx?id=262354.
21- Tavassoli A, Alidosti M, Khadivi R, Sharifi GH, Hassanzadeh A. Investigating the relationship between knowledge and attitude of villagers with sources of information in the field of family physician program in Shahrekord city in 1388: Health System 498-505. https://www.sid.ir/fa/journal/ViewPaper.aspx?id=20117
22- Vaziri R., Movassaghi F., Deh Bozorgi F. A survey of the awareness of the people living in Sepidan city about the family doctor plan in 2016. The sixth national conference on health promotion strategies and challenges. Sari 2016.
23- Riahi A, Hariri N, Noushin Fard F. Health information needs and health of foreign immigrants with cancer in Iran. 2016. https://civilica.com/doc/764208.
24- Sedighi, S, Amini M, Pourreza A, Journal of Health Management, Volume 5, Number, 4.2012:33-43.
25- Jannati A, Gholamzadeh Nikjoo R, Portaleb A, Gholizadeh M. Satisfaction of family physicians in Mashhad with family physician program. Journal of Zahedan Medical Sciences Research (Tabib Shargh) (2011): 39-39.
26- Abdollahipour F, Rahimi Foroushani AS, Jafari Pouyan Ebrahim. Assessing insurance literacy and factors affecting the insured of the Health Insurance Organization.2020. https://JOURNAL.IHIO.gov.ir.
27- Farzadi F, Mohammad K, Moftoon F, Labaf Ghasemi, Tabibzadeh Dezfuli R. Number of general practitioners in the country and the possibility of implementing a family doctor plan in terms of manpower. Monitoring. 2009 [cited 2021May17]; 8 (4): 415-421.
28- Chaman R, Amiri M, Rai M, Ali Nejad M, Nasrallah Pourshirvani d. Implementation of the national plan of family physicians in Shahroud city: the status of implementing centers and reviewing the quality of implementation. Hakim Health System Research. 2011 [cited 2022April04]; 14 (2): 123-129. Available from: https://www.sid.ir/fa/journal/ViewPaper.
29- Rahbar A , Heydari F. The effect of social capital on policy promotion. Quarterly Journal of International Relations Studies 2011. 4 (14). 219-253.
30- Raisian Sh, Islamian M, Azmal M, Bastani P, Kalhor R. Evaluation of urban family physician plan in pilot centers under the auspices of Ahvaz Jundishapur University. Health care. 2013 [cited 2022May20]; 7 (1): 11-20. Available from: https://www.sid.ir/fa/journal/ViewPaper.
31- Golalizadeh Ra, Musazadeh M, Amirasmaili M, Ahangar N. Second level referral challenges in the family physician program. Scientific Journal of the Organization of the Medical System of the Islamic Republic of Iran. 2011 [cited 2022May20]; 29 (4): 309-321. Available from: https://www.sid.ir/fa/journal/ViewPaper .
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