جستجوی مقالات مرتبط با کلیدواژه « family practice » در نشریات گروه « پزشکی »
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مقدمه
برنامه پزشکی خانواده یک رویکرد ارایه خدمات یکپارچه در سطح اول ارایه خدمات سلامت است. مفهوم پزشکی خانواده در نظام مراقبتهای بهداشتی اولیه همواره چالشبرانگیز بوده است. این مطالعه با هدف تبیین اصول و مفاهیم پزشکی خانواده انجام شد.
روش کاراین پژوهش به روش مرور مفهومی انجام شد. پایگاههای داده الکترونیکی انگلیسی Pubmed، Sience Direct، Scopus، Web Of Science و موتورهای جستجوگر Google Scholar و Google جستجو شدند. محدودیت زمانی در جستجوی مطالعات قرار داده نشد. تعداد 73 مقاله و سند برای مرور نهایی انتخاب و وارد مطالعه شدند.
یافتهها:
پزشکی خانواده، برنامهای مبتنی بر جامعه برای ارایه خدمات سلامت است که در آن تیم پزشکی خانواده آموزش دیده، خدمات اولیه بهداشتی و درمانی را بهصورت جامع، هماهنگ، مستمر و فرد محور به همه افراد در هر سن و جنس با هدف تامین، حفظ و ارتقای سلامتی مردم جامعه ارایه میکند. جامعیت، تداوم، هماهنگی، بیمارمحوری، و آموزش و یادگیری و رشد از اصول مهم برنامه پزشکی خانواده است. پیشنیازهای برنامه پزشکی خانواده شامل حاکمیت و رهبری، تامین مالی، نیروی انسانی، تجهیزات و ملزومات، اطلاعات، ارایه خدمات سلامت و عوامل سیاسی، اجتماعی، اقتصادی و فناوری است. برنامه پزشکی خانواده بر دسترسی، کیفیت، کارآیی، عدالت، تابآوری و پایداری خدمات سلامت و در نهایت، سلامت مردم و پاسخگویی و محافظت مالی نظام مراقبتهای بهداشتی اولیه اثر میگذارد.
نتیجهگیری:
اجرای موفق برنامه پزشکی خانواده نیازمند شناخت اصول و پیشنیازهای آن است. فراهم بودن پیشنیازها و ارزشیابی مستمر برنامه پزشکی خانواده با استفاده از معیارهای استاندارد، دستیابی به اهداف برنامه را تسهیل میکند.
کلید واژگان: پزشکی خانواده, پزشک خانواده, مفاهیم, اصول}IntroductionFamily practice is an integrated service delivery approach at the first level of health care delivery, in which the family physician and his team members are responsible for providing comprehensive, continuous, coordinated and individual and family-based health services. However, the concept of family practice in the primary health care system has always been challenging. The aim of this study was to explain the principles and concepts of family practice.
MethodsThis research was conducted using conceptual review method. Four electronic databases (Pubmed, Science Direct, Scopus, and Web Of Science) and Google Scholar and Google search engines were searched. Finally, 73 articles and documents were selected for final review.
ResultsFamily practice is a community-based program for health services delivery in which a trained family medical team provides comprehensive, coordinated, continuous, and patient-centered primary health care services to all people of all ages and genders to promote, restore, and maintain their health. Comprehensiveness, continuity, coordination, and patient-centeredness are main principles of the family practice program. Prerequisites for a family practice program include governance and leadership, financing, manpower, equipment and supplies, service delivery, information, and political, social, economic, and technological factors. A family practice program affects the accessibility, quality, efficiency, equity, resilience and sustainability of health services and, ultimately, people health and the responsiveness and financial protection of the primary health care system.
ConclusionThe family practice program has had many achievements. Successful implementation of this program requires understanding its principles and prerequisites. The availability of prerequisites and ongoing evaluation of the family practice program facilitates the achievement of its goals.
Keywords: Family practice, Family physician, Concepts, Principles} -
Background
The physician-patient relationship is important because the patientchr('39')s satisfaction affects trust in physician and accepting physicianchr('39')s recommendations in medical treatment decisions. Understanding a patient’s opinion about a trustworthy and friendly physician as well as ethical issues regarding family medicine, therefore, gains double importance. This paper attempts to provide a comprehensive evaluation of the subject.
MethodsIn summer 2018, a conventional qualitative content analysis was done on 21 participants who were referred to family physicians in the North of Iran. Data were collected by means of purposive sampling and semi-structured face to face individual interviews. Participants shared their experiences about ethical considerations in family medicine. All interviews were recorded and transcribed word for word, data were analyzed using qualitative content analysis.
ResultsData analysis resulted in the extraction of 7 categories and 21 sub-categories from the 71 initial codes. The categories include "responsibility", "patientchr('39')s privacy", "informed consent", "respect and dignity of patient", "effective physician-patient communication", "trust in physician" and "conflict of interests".
ConclusionThere are some differences between the participantschr('39') perceptions of ethical considerations in family medicine and opinions of medical ethics curriculum designers in Iran and particularly in the world. Some shared elements including "resource allocation", "the beginning and end of life", "research ethics", "substitute decision-making", etc. – all of them are main titles of ethics curriculum – could not be weighed as major ethical issues from the patientschr('39') perspectives. The patientchr('39')s satisfaction and, therefore, the enhancement of mutual trust is essential. Patients’ comments should be considered when providing ethical guidelines.
Keywords: Ethical analysis, family practice, Iran, qualitative research, ethics} -
مجله سازمان نظام پزشکی جمهوری اسلامی ایران، سال سی و هشتم شماره 3 (پیاپی 151، پاییز 1399)، صص 161 -174زمینه
از آنجا که شیوه اجرای طرح پزشک خانواده می تواند در توسعه کیفیت خدمات آن اثر گذار باشد، استفاده از تجربیات سایر کشورها می تواند به فرآیند اجرا و توسعه خدمات در حوزه مراقبت های اولیه سلامت و پزشکی خانواده کمک نماید.به همین منظور مطالعه حاضر با هدف تعیین ساختار و مولفه های اجرایی طرح پزشک خانواده جهت دستیابی به کیفیت خدمات در کشورهای موفق دنیا و کشورهای مشابه به شیوه فراتحلیل و به منظور ایجاد مبانی اجرایی برای سیاست گذاران و مجریان طرح پزشک خانواده انجام گردید.
روش کاردر این مطالعه 15 پایگاه الکترونیکی و موتورهای جستجوگر با کلید واژه های مرتبط از سال 2000 تا 2019 مورد جستجو قرار گرفت و مقالات انگلیسی یا فارسی در موضوعات بهداشتی مورد بحث قرار گرفت. ارزیابی کیفیت مقالات با استفاده از چک لیست CASP انجام شد و از مجموع 3067 مقاله، درنهایت 67 مقاله با عنوان، چکیده و متن مرتبط بررسی شد.
یافته ها:
بر اساس یافته های این مطالعه، ساختارها و مولفه های اصلی اجرایی بدست آمده و استفاده شده توسط کشورهای مورد مطالعه جهت پیاده سازی طرح پزشک خانواده عبارت از ساختارهای سازمانی و مدیریتی، بیمه ای، نظارتی و کنترل، پرداخت، ارایه دهندگان، کیفیت، حمایتی و فرهنگی بود.
نتیجه گیری:
به طور کلی افزایش کیفیت خدمات در حوزه مراقبت های اولیه، نیازمند توجه به ساختار اجرایی آن می باشد. استفاده از مولفه های اجرایی بدست آمده در مطالعه اخیرکه جمع بندی اقداماتی است که در کشورهای موفق در حوزه مراقبت های اولیه سلامت و پزشک خانواده داشته اند، می تواند در جهت افزایش کیفیت خدمات در سطح مراقبت های اولیه سلامت و پزشک خانواده مورد استفاده مدیران اجرایی و سیاستگذاران قرار گیرد.
کلید واژگان: پزشک خانواده, مراقبتهای اولیه سلامت, کیفیت خدمات, ساختار اجرایی}BackgroundThe Structure of Health System affects quality of care in family physician program. This study aimed to explore the required structures of Family Physician Program for achieving service quality dimensions in Primary Health care through analyzing country experiences. These structures will be useful in achievement of quality health care in family physician system.
MethodsIn this systematic review, 15 electronic databases and search engines were searched by appropriate keywords in the time span of 2000-19. English or Persian articles on the health issue were discussed, and their quality was evaluated using the CASP checklist.
ResultsOut of 3067 identified articles, 67 articles with title, abstract, and text were included in the study. Based on the findings of this study the main structure and executive components in Multi-Country Study for family physician program were Insurance, Monitoring and Control, Payment, Provider, Quality, Financial support and Cultural structures.
ConclusionQuality improvement in primary health care requires attention to executive structures. Use of executive experiences of other countries will be useful in achievement of quality health care in family physician system.
Keywords: Family Physician, Family Practice, Primary Health Care, Executive Structure} -
Background
Although there is a critical need for information on economic performance of Iranian general practitioners (GPs) in health policymaking, there is not any scientific evidence in this area. Therefore, in the present report, the characteristics of economic behaviors of Iranian GPs were described.
MethodsThis was a cross‑sectional study in 2015, in which the data were collected from 666 GPs. The variables including monthly gross income, hours of work, and patient visits were studied as the measures of economic behavior of GPs. Descriptive statistics, t‑test, and Analysis of Variance were used for analyzing the data. The statistical analysis was performed by STATA12.
ResultsThe annual income of the GPs understudy was 26,000 US dollar (USD) (82,680 purchasing power parity [PPP]). The ratio of this value to gross domestic product per capita and minimum wage of Iran in 2015 was 4.8 and 9.2, respectively. On average, every GP in Iran has an income of 2188.1 USD (6958.16 PPP), works 142 h, and visits an average of 494 patients/month. The results showed that the economic behavior of Iranian GPs has a significant difference in terms of gender, age, marital status, practice experience, practice location, type of practice, being a family physicians, and working in different settings (P < 0.05).
ConclusionsThe Iranian GPs understudy work less than their counterparts in other (compared) countries. The studied GPs had a higher income (adjusted by hours of work and countries’ per capita income) than their counterparts in other (studied) countries. Moreover, there are inequalities between GPs in terms of income, the volume of services provided and the work hours.
Keywords: Family practice, general practitioners, health‑care economics, organizations, officevisits, private practice} -
BackgroundGlobal experience as well as expert views weight the Family Physician program (FPP) as a primary solution for various problems of healthcare system in Iran. In spite of the valuable information has been collected during conducting FPP, few studies have been done to evaluate the actual performance of this program. This study reviewed the studies related to the evaluation of the FPP systematically.MethodsThe authors systematically searched PubMed, Web of Science, Scopus, Embase, Irandoc and SID for articles published in English and Persian until Nov 2017 without limitation for starting time. Selection stages of the articles were done based on PRISMA flow diagram guidelines.ResultsOf all articles evaluated, 19 were selected. Four articles were removed due to inadequate quality of the study. Only one article evaluates urban and the rest are about rural. Eight articles were categorized as the process evaluations and 12 outcome assessments (one of them was common).ConclusionWe achieved three main findings. First, the rural FPP has improved access to the healthcare services, but improvement in patient finding and quality of cares remains questionable. Second, there are considerable concerns in the referral system between levels I and II in both urban and rural programs. Third, there was no efficient planning to implement the FP as the gatekeepers of health care system effectively. These issues deprived the efficiency aim of FPP and need serious consideration.Keywords: Family physician program, Family practice, Referral system, Iran}
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IntroductionFollowing the implementation of Family Physician (FP) Program in rural areas and cities with populations under 20000 in 2005, the Iranian Ministry of Health and Medical Education in 2012 decided to implement urban FP in large cities with populations more than 20000. Along with the development and implementation of urban FP in Iran, local websites and newspapers reflected the viewpoints of experts in various levels of health system regarding the various stages of Family Medicine (FM) development (from agenda setting to initial stages of implementation). This study aimed to explore the major infrastructures perceived to be required to achieve desirable implementation of urban FP through analyzing experts viewpoints reflected in the media and interviews.MethodsIn a qualitative study, we analyzed the contents of health related national websites as well as transcribed interviews with key informants. Documents were collected from December 2011 to January 2014 and interviews were conducted from February 2014 to June 2015. We used mixed thematic approach (inductive and deductive) for analysis that was assisted by MAXQDA 12 software.ResultsInfrastructures needed for the implementation of FP were categorized in five main themes and 23 subthemes. The themes are: Stewardship/governance, Actors and stakeholders, structural infrastructure, technical infrastructure and needed resources, and information and communication infrastructure.ConclusionsExpansion of FP program to urban settings needs appropriate attention to the principles of policy implementation as well as provision of robust infrastructures. Well-defined stewardship, revised approach to financial regulation and payment system, stakeholders commitment to collaboration, policy for conflict resolution, and universal insurance coverage are pivotal for the expansion of family physician program to the urban settings in Iran.Keywords: Family physician, family practice, health system, infrastructure, policy implementation, urban areas}
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Which Health Cares Are Related to the Family Physician? A Crit-ical Interpretive Synthesis of LiteratureBackgroundThis study provided the theoretical basis for program development through a new conceptualization of the concept of family physician related health care.MethodsCritical interpretive synthesis (CIS) was used to carry out qualitative analysis and synthesis of the literature from 2006 until 2015. At the beginning of CIS, the search strategy was designed to access electronic databases such as CINAHL, Medline, Cochrane library, PsycINFO, Embase, EBMreviews, and Thomson scientific web of science database. The main review question was the clarification of the health care related to family physician in health system, which produced over related 750 articles; 60 articles related to the research objective were studied by purposive sampling. After identifying the main categories and sub-categories, synthesis of the contradictory findings in different studies was conducted. New concepts and relationships between concepts were created using CIS of documentation related to the place of family physician in health system.ResultsTo define the original position of family physician in health system, clarify its related health care and determine its boundaries from other health care providers, and its use in the design and development of family physicians educational program, a frame of concepts related to the main concept and question was created. A more useful means of understanding family physician is offered by the synthetic constructs of this framework.ConclusionThe theoretical conceptualization of family physician position and duties in the health system can be an appropriate guide for educational program and curricula in our context.Keywords: Family practice, Family physician educational program, Iran}
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Health is regarded as one of the basic rights of each person in society; so governments are obligated to provide it equally for everyone. The best way to achieve this goal is the establishment of health insurance with the orientation of family physician and the strategic referral system. Yet, such programs will not be successful without encouraging people to participate and changing social behaviors. The aim of the present study was to investigate the administrative obstacles and problems to family physician program in urban areas of Iran. This study was a qualitative research conducted. A purposive sampling method was employed and the data were gathered via semi-structured interview with open-ended questions and document examination. All the interviews were recorded digitally and immediately transcribed verbatim. They were finally analyzed based on framework analysis. The participant's detailed descriptions showed that systemic, environmental, and human related factors were the main obstacles to the implementation of family physician plan. Since the success and performance of each program effectively cannot be obtained without peoples acceptance and collaboration, the necessity of training and giving information rapidly and timely to the residents in urban areas is felt more than ever. Also, making authorities aware of the obstacles expressed by people can be helpful in harmonizing the program with peoples requests; and can result in overcoming the challenges and obstacles facing the program.Keywords: Family, Family Practice, Physician, Primary}
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زمینه و هدفدیابت یک اختلال متابولیک و چند عاملی است که ناشی از اختلال در ترشح یا عمل انسولین و یا هر دوی آنها است. روند رو به رشد سالمندی، تحولات اقتصادی- اجتماعی و تغییرات دموگرافیک دیابت را به معضل جهانی بدل نموده است. این مطالعه با مقایسه عوارض بیماری دیابت در گروه های مطالعه سعی در ارزشیابی اثربخشی طرح ادغام برنامه کنترل بیماری دیابت در نظام شبکه های سلامت و استفاده از پزشکان خانواده در مراقبت از بیماران مبتلا به دیابت داشته است.روش کاراین مطالعه به شیوه همگروهی گذشته نگر بر روی 462 بیمار دیابتی نوع 2 روستایی فاقد عارضه در شهرستان کردکوی، استان گلستان، که در طرح غربالگری شناسایی شده بودند، انجام شد. بیماران با استفاده از روش تصادفی طبقه ای و از طریق تقسیم به نسبت انتخاب و بروز عوارض چشمی، کلیوی، سکته قلبی، سکته مغزی و زخم پای دیابتیک در دوگروه مطالعه و شاهد مورد ارزیابی و مقایسه قرار گرفت.یافته هادر این مطالعه میزان بروز رتینوپاتی، نفروپاتی و زخم پای دیابتی و همچنین سکته مغزی و سکته قلبی در کل افراد مطالعه به ترتیب 7/9 درصد، 9/5 درصد، 5/3درصد، 3/3 درصد و 1/6 درصد بود. زخم پای دیابتی و سکته قلبی رابطه معنی داری با نحوه دریافت مراقبت در بیماران داشت (05/0p<).نتیجه گیرینتایج پژوهش نشان داد که برنامه پزشک خانواده در شهرستان کردکوی نتوانسته آنطور که انتظار میرفت در رسیدن به رسالت خود که همانا پیشگیری، کاهش و تاخیر در بروز عوارض کوتاه مدت و دراز مدت دیابت بوده است، موفق باشد.کلید واژگان: دیابت, نفروپاتی, رتینوپاتی, زخم پای دیابتیک, پزشک خانواده}Journal of Health, Volume:7 Issue: 4, 2016, PP 417 -424Background and ObjectivesDiabetes is a multi-factorial metabolic disorder caused by defects in insulin secretion/function or both. Diabetes has become a global problem because of increasing trend of elderly, socio-economic transformation and demographic changes. This study tried to evaluate the effectiveness of integration of diabetes control program in health networks and utilization of family practice in caring diabetics.MethodsThis retrospective cohort study was conducted on 462 type 2 diabetic patients with no complication detected in screening program in rural areas of Kordkoy district, Golestan province. The diabetic patients were divided into two groups using stratified random sampling. The incidence rates of eye and renal failure, diabetic foot ulcer, stroke and heart attack were compared between two groups.ResultsIn this study incidence rate of retinopathy, nephropathy, diabetic foot ulcer, stroke and heart attack in patients were 9.7, 5.9, 3.5, 3.3 and 6.1%, respectively. Diabetic foot ulcers and heart attacks significantly correlated with quality of the care received (pConclusionThe results of the study indicate that family practice plan was not successful enough to achieve its goals in preventing and reducing the short-term and long-term complications of diabetes in Kordkuy city.Keywords: Diabetes, Nephropathy, Retinopathy, Diabetic Foot Ulcer, Family Practice}
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پیش زمینه و هدفاختلال خوردن ازجمله اختلال های آسیب شناختی است که تاثیر بسزایی بر عملکرد روان شناختی و جسمانی نوجوانان و جوانان داشته و امروزه به عنوان یکی از مشکلات جدی سلامت مورد توجه متخصصان قرار گرفته است. ازآنجایی که در سال های اخیر میزان شیوع اختلال های خوردن در میان دختران نوجوان افزایش چشمگیری داشته است، مطالعه حاضر به بررسی و مقایسه ابعاد آسیب شناسی روانی، سبک زندگی و عملکرد خانواده دانش آموزان دختر مبتلا به اختلال خوردن و دانش آموزان غیر مبتلا به آن پرداخته است.مواد و روش هامطالعه اخیر از نوع توصیفی و جامعه آماری آن دربرگیرنده کلیه دانش آموزان دختر پیش دانشگاهی فاطمه الزهرا بودند که 200 نفر از آن ها به روش نمونه گیری تصادفی ساده انتخاب شدند و نهایتا 60 نفر از آن ها که دارای معیارهای ورودی بودند موردبررسی قرار گرفتند. برای جمع آوری داده ها از پرسشنامه چک لیست روانی (SCL-90)، پرسش نامه سبک زندگی ارتقاء دهنده سلامت HPLPII و مقیاس عملکرد خانواده بلوم (FFS ) استفاده شد. همچنین به منظور تجزیه و تحلیل داده ها از نرم افزار SPSS-16 و آزمون آماری تحلیل واریانس چندگانه (مانوا) و آزمون T مستقل استفاده شد.یافته هانتایج حاصله در این مطالعه نشان داد که بین میانگین نمرات ابعاد آسیب شناسی و روانی، سبک زندگی و عملکرد دانش آموزان مبتلا به اختلال خوردن و سالم تفاوت وجود دارد (P<0/001).نتیجه گیریبه نظر می رسد که در اختلال خوردن، ابعاد آسیب شناسی روانی، سبک زندگی و عملکرد خانواده دانش آموزان نقش تعیین کننده دارد و توصیه می شود در درمان این بیماری به متغیرهای ذکرشده اهمیت داده شود.کلید واژگان: ابعاد آسیب شناسی روانی, سبک زندگی, عملکرد خانواده, دانش آموزان, اختلال خوردن}Background and AimsIn recent years the prevalence of eating disorders in adolescents has increased Psychopathology of eating disorders, including disorders that have a significant effect on the physical and psychological functioning of adolescents and youth. The current tries to study the dimensions of psychopathology, life style and family functioning of students with eating disorders and health.Materials and MethodsThe study was comparative one. All the population of Fatemeh high school was selected by simple random sampling method, firstly 200 and finally 60 of them were selected. They were divided into two groups of patients (n=60) and the control group (n=60). Data were collected by using the questionnaires of mental checklist (SCL-90), health promoting lifestyle, and HPLPII and Family Functioning Scale. To analyze the data, SPSS-16 software by using multiple variances (MANOVA) and Independent T-test was applied.ResultsThe results showed that there is a difference (PConclusionIt seems that aspects of eating disorder psychopathology, life style and family functioning on the students have a moderating role.Keywords: Dimensions of psychopathology, lifestyle, family practice, students eating disorders}
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BackgroundUpon successful experiences of family physician program in the rural regions, Iranian Ministry of Health and Medical Education (MOHME) made a decision to expand this program to urban areas. For this reason a pilot program were designated and some cities have been selected to determine dos and don’ts of performing family physician program in the cities. Various studies were published during this period demonstrating the advantages and disadvantages of family physicians’ care in thesecities. After this process in 2012 and 2013 MOHME announced implementation of family physician program in Tehran. Our study investigated public attitudes, knowledge and practice about the newly introduced program.MethodsThis cross-sectional study was performed in Tehran during November to December 2012. A telephone survey was carried out using the Random Digit Dialing (RDD) method and data was gathered by a researcher designed questionnaire. A total of 386 residents aged 18 years and over participated in the study. To compare the differences between various groups’ knowledge scores data were analyzed performing Chi-square test, t-test, ANOVA, and logistic regression by SPSS software version17, to find factors that affected individuals’ agreement with the program.ResultsAmong all samples 214(57.4%) knew about the program and almost 120(85.1%) of these aware people were planning to participate in the program. Television and Radio were the major information resources. After adjusting for Educational status, Access to Internet and Socio Economic Status(SES) those peoplewho didn’t have any kind of health coverage systems(Health insurance) were most likely to accept the program and agree with that[OR= 2.38(1.05-5.38)].ConclusionsThe fact that despite low levels of information, most of aware people intend to enroll in the new program reveals that expanding informative programs would bring more participation and involvement among community.Keywords: Family medicine, family physician, family practice}
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Urology Journal, Volume:11 Issue: 2, Mar-Apr 2014, PP 1429 -1434PurposeTo evaluate the awareness of non-urological doctors for their role in evaluating prostate cancer (Pca) in scientific manner which may be a possible probability for late diagnosis of Pca.Materials And MethodsA total of 936 non-urological specialists working in 1 university and 4 education and research hospital who were able to evaluate male patients over 50 years of age were included to the survey. A face to face questionnaire had been administered to all participants.ResultsA total of 92 (9.8%) participants were evaluating prostate-specific antigen (PSA) level to all their elderly male patients while 404 (43.2%) participants had never made this evaluation. Among the participants who were evaluating PSA, none was performing an informed decision making consult and even they did not have any idea about the meaning of this strategy. About the criteria for urological consultation, 56 (6%) reported that they consult all their elderly male patients, whereas 880 (94%) answered that they perform consultation if their patients has sought help for any urological symptom.ConclusionUrologists must remind the non-urological specialists that their approaches to Pca evaluation may change mortality rates of this disease and give them proper information about the scientific evaluation of Pca. This may help us to decrease the mortality rates of Pca.Keywords: prostate, specific antigen, early detection of cancer, prostatic neoplasms, physicians, family practice}
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زمینه و هدفنمودار قیفی ابزاری ترسیمی برای بررسی سوگیری انتشار در مطالعات متا آنالیز است. هدف مقاله حاضر معرفی کاربردی دیگر از این نمودار به عنوان وسیلهای برای پایش یکی از شاخصهای اجرایی برنامه پزشک خانواده و مشخص کردن وضعیت هر یک از مراکز بهداشت شهرستانهای تابعه استان مرکزی از نظر وضعیت ارجاع بیماران از سطح اول به سطح تخصصی و مقایسهی آن با دو نمودار دیگر میلهای و کاترپیلار از این نظر میباشد.
مواد و روشها: در این مطالعه مقطعی برای رسم نمودار قیفی، درصد ارجاعات هر شهرستان با توجه به متوسط ماهانه ویزیت و ارجاع انجام شده، محاسبه گردید. بر اساس دستورالعمل کشوری برنامه پزشک خانواده، مقدار استاندارد ارجاع، حد 10 درصد در نظر گرفته شد. برای هر شهرستان یک حدود اطمینان 99 درصد با در نظر گرفتن سه انحراف معیار نسبت به عدد 10 درصد بر مبنای متوسط کل ویزیت ماهیانه هر شهرستان محاسبه شد.
یافته ها: بر اساس نمودار قیفی شهرستانهای آشتیان، ساوه، تفرش، کمیجان و خمین، در حد انتظار ارجاع قرار داشتند. این در حالی است که شهرستانهای اراک، شازند، زرندیه، دلیجان و محلات دارای ارجاع بیش از حد انتظار بودند که در این میان ارجاع به سطح تخصصی در محلات بیش از سایر شهرستانها بود.
نتیجه گیری: نمودار قیفی توانست بهتر از دو نمودار دیگر وضعیت ارجاع به سطح تخصصی را برای مراکز بهداشت شهرستانها نشان دهد، از این رو میتواند در پایش برنامه های سلامت کشورابزاری مفید واقع شود.کلید واژگان: پزشک خانواده, نمودار قیفی, استان مرکزی, نظام ارجاع, نظام مراقبت}BackgroundFunnel plot is a graphical tool for investigating publication bias in meta-analysis studies. The aim of this study is to introduce another application of funnel plot that is monitoring one of the Iranian family performance indices and determining the position of each health center of Markazi province in terms of patient referral rates by general practitioners to specialists and to compare it with bar and caterpillar plots.Materials And MethodsIn order to draw the funnel plot، the average monthly percent of referrals for each district of Markazi province in 2011 was computed. In this study، Iranian Ministry of Health and Medical Education standard figure of 10% was considered as the limit of referral to the second level of Iranian health services. The 99% confidence interval of the control limit for each district was computed according to 3 standard deviations of the percent of referrals relative to the total patient visits.ResultsBased on funnel plot results، five out of ten districts were in the expected range of referral (Ashtian، Saveh، Tafresh، Khomein، and Komijan). However، in other five districts، the referral rate was greater than the expected rate (Arak، Shazand، Zarandiyeh، Delijan، and Mahallat). Mahallat district had the highest rate of referral.ConclusionThe funnel plot was more informative than the other two plots; thus، it can be viewed as a useful tool in monitoring health programs throughout the country.Keywords: Family practice, funnel plot, Markazi province, referral system, surveillance system} -
زمینه و هدفپزشک خانواده مرکز تلاش های جهانی برای بهبود کیفیت، هزینه اثربخشی و برابری در سیستم های مراقبت سلامتی است. افزایش رضایتمندی مردم از خدمات از جمله اهداف برنامه پزشک خانواده است. این مطالعه با هدف تعیین میزان رضایتمندی دارندگان دفترچه بیمه روستایی از خدمات پزشک خانواده در جمعیت تحت پوشش دانشگاه علوم پزشکی سبزوار انجام گرفت.مواد و روش هامطالعه از نوع توصیفی- مقطعی بود. داده ها با استفاده از پرسشنامه دو بخشی برای 1250 نمونه که به صورت تصادفی در هر طبقه انتخاب شده بودند، جمع آوری و میزان رضایتمندی در 8 حیطه بررسی شد. داده های جمع آوری شده با استفاده از نرم افزار SPSS 17 و با استفاده از آزمون های آماری تی مستقل، همبستگی پیرسون و آنووا مورد تحلیل قرار گرفت.
یافته ها1199 پرسشنامه مورد تحلیل قرار گرفت. 4/69 درصد از نمونه های پژوهش خانه دار بودند. همچنین 1/72 درصد زن بوده، 3/85 درصد متاهل، 4/86 درصد ساکن روستا و 9/90 درصد از مراکز دولتی خدمات دریافت کرده بودند. در 8 حیطه مورد بررسی، بیشترین و کمترین میزان رضایتمندی به ترتیب از هزینه پرداختی و اعتماد و اعتقاد به عملکرد پزشک خانواده به دست آمد. بر اساس آزمون های انجام شده بین جنس، سن، شغل و وضعیت تاهل با میزان رضایتمندی از برنامه پزشک خانواده رابطه معنی دار آماری وجود نداشت. اما رابطه بین محل سکونت، تحصیلات و نوع مرکز ارائه دهنده خدمات با میزان رضایتمندی از برنامه پزشک خانواده از نظر آماری معنی دار بود.نتیجه گیرینتایج نشان داد که تحصیلات بالاتر، دریافت خدمات از مراکز بهداشتی درمانی شهری و مراکز خصوصی ارائه دهنده خدمات پزشک خانواده رضایتمندی بیشتری را برای مراجعین به همراه دارد.
کلید واژگان: رضایتمندی, پزشک خانواده, ایران}Backgroundfamily medicine is a global effort to improve quality، cost-effectiveness and equity in health care systems. Family medicine is bound to maintain and promote family and community health. Increase people satisfaction of family medicine plan is from these goals. This study aimed to determine the satisfaction of family medicine in insured people has done in Sabzevar University of Medical Sciences.Materials And MethodsThis was a cross sectional study. Data were collected by two-part questionnaire that measures satisfaction in 8 scope and 1250 samples selected randomly in each class. Also analyze it by SPSS 17 and using independent t-test، ANOVA and Pearson Correlation coefficient.Results1199 questionnaire was analyzed. 69/4% of samples were housewives. Also 72/1% of them were female، 85/3% married، 86/4% rural residents and 90/9% of them received services from public centers. In surveyed scopes، the highest and lowest level of satisfaction observed in payment costs and trust and belief to family medicine performance respectively. Relationship between sex، age، job and marital status whit satisfaction rate was no significant. Also relationship between residence، education level and type of center whit satisfaction rate of family medicine was significant statistically.ConclusionResults show that higher education level، receiving services from urban and private centers lead to more satisfaction for clients.Keywords: Satisfaction, family practice, Iran}
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