Access to Healthcare in Urban Family Physician Reform from Physicians and Patients' Perspective: a survey-based project in two pilot provinces in Iran

Introduction: Iran introduced the urban family physician reform, based on the primary healthcare (PHC) approach, in 2012. The reform is restricted to two pilot provinces, which are Fars and Mazandaran and its policymakers request evidence of the reform progress. The study aimed to determine the accessibility of health care in the two pilot sites.

Methods: A cross-sectional study using Primary Care Evaluation Tool (PCET) questionnaires was performed with a multistage stratified cluster sample of the family physicians (n=141) and patients (n=710) in the two provinces between September 2015 and March 2016. The questionnaires contained essential dimensions of health accessibility: organizational, financial, geographical, and cultural access. The data were analyzed by IBM-SPSS software and the descriptive statistics.

Results: With an average population of 2,332, the main daily task for family physicians was patient visits (n=39). Most patients were satisfied with the current hours (80%) but visiting a family physician on holidays or after working hours were only rarely possible. The co-payment was an inconvenience to access health services in getting medicines, getting paraclinic exams and a visiting specialist. At least 70% of patients could receive their preferred healthcare facilities within 40 minutes. The majority of FPs (64%) believed there were some cultural characteristics in the population that made a limited role for providing better health services.

Conclusion: In the reform the providers were geographically well distributed and some features of the organizational access were relatively high. However there were some difficulties in the financial, cultural, and other features of organizational access.