رسول ظفرمند

Urban family physician program is one of the relatively large reforms in Iran's health care system implemented in Fars
and Mazandaran provinces since 2012. Nearly five years after implementation of the program, this study aimed to identify the achievements and challenges of this program from the viewpoints of managers and administrators.

This cross-sectional study was conducted in winter of 2016. The research population included administrators and experts monitoring the urban family physician program and representatives of the family physicians and health care providers selected using the census method. The data collection tool was a two-part researcher-made questionnaire containing 15 questions with confirmed validity. To collect data, 29 panels of experts were held and the collected information was analyzed by SPSS 23 using independent t-tests and ANOVA.

Among the total of 647 participants in 2 provinces, 1540 achievement cases, 2387 challenge cases, and 1641 strategies were found. The average numbers of achievements, challenges, and strategies stated by each person were 2.38 ± 2.0, 3.70 ± 2.7, and 2.54 ± 2.0, respectively. The most frequent achievements, challenges, and strategies were increased disease detection and care (430), untimely payment to physicians (198), and providing sustainable resources for timely payments (119).  The means of achievements, challenges, and strategies had significant relationship with some of the individual and social variables (p < 0.05).

This study showed that increasing the rate of detection was the most important achievement and lack of timely payment was the biggest challenge of the program, which should be considered by policy makers.

The urban physician program as a new health program requires the provision of resources and facilities. This study aimed to investigate the status of physical resources and related requirements in the family physician program in Fars and Mazandaran provinces. This cross-sectional study was carried out in winter 2016. According to the sample size estimation, 98 clinics and centers, in Mazandaran province, and 135 clinics and centers, in Fars province, were selected by a systematic random sampling method. The data collection tool was a researcher-made questionnaire; its validity and reliability were confirmed. Data were analyzed using Kruskal-Wallis and Chi-square tests. Out of 233 studied units, 105 (45.3%) had more than one physician. The structural status of the physical space in 183 units (79.9%) and the general cleaning of 178 units (78.1%) were desirable. The specification of service providers in the urban family physician program was completed from 42.1% to over 70%. One hundred and four units (45.8%) had an intact EKG, 195 units (85.5%) had an intact Ophthalmoscope, 227 units (97.4%) had an intact laptop or computer, 178 units (77.7%) had an intact gynecology bed, and 125 units (58.8%) had working autoclaves. Concerning supplying physical resources and meeting the requirements, there was mostly a significant difference between the provinces (P < 0.05). The results showed that some of the facilities and requirements were not provided in a number of execution units; so, effective measures must be taken.

One of the effective teaching strategies is the educational needs assessment. Need assessment is an important tool in designing, developing and evaluating continuous education programs. This study aimed to determine the educational needs of family physicians and health care providers working in Fars and Mazandaran provinces.
This cross-sectional study was conducted in the winter 2016 on urban family physicians and health care providers who were selected by systematic random sampling. The data collection tool was a researcher-made questionnaire consisting of 2 parts: individual variables (8 open and closed questions) and 50 subjects for physicians and 47 subjects for health care providers; its validity and reliability were confirmed.
FINDINGS: Among 464 participants, 236 (50.9%) were physicians and 228 (49.1%) health care providers; 304 (65.5%) were female and the rest were male. Among the physicians, 26 (11.11%) did not require any training, and the rest declared at least one up to a maximum of 24 subjects as educational needs. The average number of subjects required training was 7.1±4.9. Among health care providers, 16 (7.0%) did not require any training, and 24 (10.5%) referred to the total 47 subjects as educational needs. The average number of required subjects was 24.16±16.6. There was a significant relationship between educational needs and some of the individual and social variables (P This study showed that the educational needs of physicians are low and health care providers are high