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Satisfaction Levels with Family Physician Services: a Pilot National Health Programme in the Islamic Republic of Iran Mohammad Fararouie,1 Mehdi Nejat,2 Humidreza R

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Satisfaction Levels with Family Physician Services: a Pilot National Health Programme in the Islamic Republic of Iran Mohammad Fararouie,1 Mehdi Nejat,2 Humidreza R املجلة الصحية لرشق املتوسط املجلد الثالث و العرشون العدد الرابع Satisfaction levels with family physician services: a pilot national health programme in the Islamic Republic of Iran Mohammad Fararouie,1 Mehdi Nejat,2 Humidreza R. Tabatabaie,3 Parvin A. Kazerooni 1 and Mehdi Akbarpoor 4 مستويات الرضا عن اخلدمات التي يقدمها طبيب اﻷرسة: برنامج وطني رائد للصحة يف مجهورية إيران اﻹسﻻمية حممد فاروروي، مهدي نجات، محيد رضا طباطبائي، بروين أ. قديروين، مهدي أكرببور اخلﻻصــة: ّيقــدم أطبــاء اﻷرسة يف مجهوريــة إيــران اﻹســامية خدمــات صحيــة للمقيمــن باملناطــق الريفيــة منــذ عــام 2005، وجيــري توفــر هــذه اخلدمــات منــذ عــام 2011 للمقيمــن باملناطــق احلرضيــة يف حمافظتــي فــارس ومازانــدران. ولقــد أجريــت هــذه الدراســة يف عــام 2014 لقيــاس َّمعدل الرضــا لــدى املســتفيدين مــن اخلدمــات التــي يقدمهــا أطبــاء اﻷرسة للســكان يف املناطــق الريفيــة واحلرضيــة يف ثــاين أكــ ربمقاطعــات حمافظــة فارس مــن حيــث الكثافــة الســكانية )وهــي مقاطعــة مرودشــت والتــي يتعــدى تعدادهــا 000 330 نســمة(. واختــر 1650 منــزﻻيف ًاملناطــق احلرضيــة والريفيــة )825 منــزﻻًمــن املناطــق الريفيــة و825 منــزﻻًمــن املناطــق احلرضيــة(، منهــا 1561 منــزﻻً مأهــوﻻً )2908 ًفــردايف املناطق احلرضيــة و3062 ً فــردايف املناطــق الريفيــة(، ُوأنجــز اســتبيان عــن طريــق طــرق اﻷبــواب وإجــراء املقابــات. وبلــغ َّلمعــد الرضــا الــكيل 59.2 % عــى النحــو التــايل: 54.5 % للمناطــق احلرضيــة و63.2 % للمناطــق الريفيــة. وتــرى هــذه الدراســة أن ّمعــدل الرضــا يزيــد بــن املقيمــن باملناطــق الريفيــة وأن هنــاك حاجــة إىل خدمــات ذات جــودة أفضــل مــن جانــب أطبــاء اﻷرسة يف املجتمعــات الريفيــة واحلرضيــة عــى الســواء. ABSTRACT Family physicians in the Islamic Republic of Iran have been providing health and medical services to residents from rural areas since 2005, and from 2011 these services have been delivered to urban residents in Fars and Mazandaran provinces. This study was conducted in 2014 to measure the rate of user satisfaction with services provided by family physicians to the rural and urban population of the second most populated county in Fars province (Marvdasht county, population > 330 000). In urban and rural areas, 1650 houses (825 in rural and 825 in urban areas) were selected, of which 1561 houses were inhabited (2908 individuals in urban and 3062 individuals in rural areas) and an interview-administered doorstep questionnaire was completed. Overall satisfaction rate was 59.2%: 54.5% for urban areas and 63.2% for rural areas. This study suggests that satisfaction is higher among rural residents and that better quality services from family physicians are needed in both rural and urban communities. Programme de santé pilote national en République islamique d’Iran : satisfaction concernant la prestation de services des médecins de famille RÉSUMÉ En République islamique d’Iran, les médecins de famille fournissent des services médico-sanitaires aux habitants des zones rurales depuis 2005. Depuis 2011, les habitants urbains des provinces de Fars et Mazandaran bénéficient également de ces prestations de service. La présente étude a été menée en 2014 afin de mesurer le taux de satisfaction des bénéficiaires des services fournis par des médecins de famille aux populations urbaines et rurales du deuxième département le plus peuplé de la province de Fars, à savoir Marvdasht, qui regroupe une population de plus de 330 000 habitants. Dans les zones urbaines et rurales, 1650 maisons (825 en zone rurale et 825 en zone urbaine) ont été sélectionnées, parmi lesquelles 1561 étaient habitées (2908 individus en zone urbaine et 3062 en zone rurale), et un questionnaire a été rempli sur la base d’entretiens « pas de porte.» Le taux de satisfaction global était de 59,2 %, avec 54,5 % pour les zones urbaines et 63,2 % pour les zones rurales. Cette étude suggère que la satisfaction est plus élevée parmi les habitants ruraux, et qu’il est nécessaire d’améliorer la qualité des services fournis par les médecins de famille dans les communautés rurales comme urbaines. 1HIV/AIDs Research Centre; 2Department of Health Affairs; 3Department of Epidemiology, School of Health; 4Department of Health Affairs, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran (Correspondence to: M. Fararouei: [email protected]). Received: 03/07/15; accepted: 19/10/16 267 EMHJ • Vol. 23 No. 4 • 2017 Eastern Mediterranean Health Journal La Revue de Santé de la Méditerranée orientale Introduction made via the family physician. As the first (6). Nevertheless, evaluation studies level of contact with the health system, on Iranian user's satisfaction with ser- Health is designated as a fundamental family physicians provide some basic vices provided by family physicians are human right by almost all countries health and medical services, including limited. and its development is considered as primary health care, drug prescription Marvdasht is one of the largest coun- one of the most important government and para-clinical services. If necessary, at ties in Fars province, with a population responsibilities (1). Quality, accessible the second and third levels, specialized of more than 330 000, 170 000 urban and cost–effective health services and out- or inpatient medical and para-med- and 160 000 rural. The county has 1 city, satisfaction of users are the core prin- ical services are delivered to patients Marvdasht, and more than 200 villages. ciples in any health care system (2). referred by their family physician. After Marvdasht is the second largest city Family physicians are used by national receiving services at the second and after Shiraz, the capital of Fars province. health systems in many countries to third levels, the results of diagnostic and According to the official report of the deliver basic medical care. The family therapeutic measures and other services Ministry of Health of Fars province, are sent back to the family physician physicians programme (FPP) seems to in this county the public sector runs 1 to be filed in the family’s health file. All be an effective approach for increasing hospital, 24 government health centres services which are provided by the FPP equitable access to health and medical and 115 health houses. Medical and are free or subsidized by the govern- services (3). health services are also provided by the ment. Patients who do not want to use The fourth national strategic pro- private sector via 310 nongovernmental referral services or want to use medi- gramme on Iran’s economy and social clinics and medical centres (run by 63 and cultural development stresses the cal services from the private sector are charged for all costs (4). In rural areas, specialists, 73 general practitioners and importance of expanding the coverage 39 dentists). of health insurance, with a significant fo- health houses run by trained health staff The aim of this study was to measure cus on the family physician and referral are responsible for primary health and the satisfaction with medical services system. The Iranian FPP and patient re- treatment care. In case of necessity or ferral system started in rural areas a long users’ request, patients may be referred provided by family physicians in rural time ago (4). The FPP is running as a pi- to the rural health centre to visit a family and urban areas of Marvdasht county. lot project in urban areas of 2 provinces, physician (4). According to World Health Organi- Fars and Mazandaran. In Fars province, Methods the fourth largest province by popula- zation (WHO) guidelines, all countries tion, the urban family physician services need to establish continuous monitor- This cross-sectional study was conduct- have been delivered to urban residences ing and evaluation programmes to ed in Marvdasht county, Fars province, since 2011. A large number of staff and evaluate the health system in order to in 2014. Sampling was done through a facilities are involved in this programme, increase effectiveness, quality of health multi-stage cluster design. The house- in fact, about 1052 general practitioners, services and user satisfaction (6). These hold was defined as the sampling unit. 1214 specialists, 376 laboratory centres, monitoring programmes are to assess 134 radiology departments and 591 short- and long-term benefits, includ- Prior to the main study, a pilot study pharmacies are working with the Minis- ing improvements in health status and on 160 households from the same try of Health and Medical Education as its related indexes, rate of accessibility, source population was carried out to a team member of the FPP (5). types and quality of care and user satis- evaluate the questionnaire and sam- According to the Iranian FPP and faction, as well as the costs of the health pling procedures. According to the re- urban referral system guidelines, the services. sults of the pilot study, although sample participating family physicians are re- Among the above indices, meas- size was estimated at 2800 households sponsible for people's primary medical uring the level of user satisfaction is (for rural and urban areas separately), care and follow-up of patients whom important as it directly and indirectly due to the expectation of the presence they have referred to the specialized represents the efficacy and quality of of temporarily or permanently uninhab- levels. Each urban residence can register health services. Rate of satisfaction with ited houses in both, 1650 houses (825 with only 1 family physician, a general health services should be regarded as in rural and 825 in urban areas) were practitioner
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