Challenges and strengths of implementing urban family physician program in Fars Province, Iran

Family physician (FP) is one of the best strategies to reform health system and promote population health. Due to the different context, culture, and population, implementing this reform within cities would be more challenging than in rural areas. This study aimed to assess the challenges and strengths of Urban FP Program in Fars Province of Iran.

It was a qualitative study using framework analysis for collecting and interpreting data. The participants included health policy-makers, top managers, and involved health staff selected through purposive and snowball sampling. Participating in the program or working as a physician in urban areas were among inclusion criteria. Three focus groups with experts as well as the content analysis of national documents were also performed. The research tool was a semi-structured interview guide. Interviews and focus groups were recorded and transcribed word by word. The framework of triangle for data analysis and the content was analyzed using MAXQDA 2010 software.

The participants' mean age was 44.9 ± 6.4 years, with a mean work experience of 13.2 ± 7.4 years. The transcripts revealed six themes and 17 subthemes. The emerging themes included three challenges and three solutions as following: social problems, financial problems, and structural problems as well as resistance reduction, executive meetings, and surveillance.

Resolving staff shortage, decreasing the public resistance, and eliminating unnecessary referrals were among the strategies used by Fars, during FP implementation. To be successful in implementing this program, the required perquisites such as infrastructures and culture growth must be undertaken. The current study suggests the establishment of the electronic health record to improve the pace and quality of service provision as well as reducing violations.