Physician Reluctance to Engage in Health System Program

Physician Reluctance to Engage in Health System Program The Factors Effecting the Unwillingness of Physicians to participate in the Family Physical Program in Tehran’s Province Health System Abstract Introduction: The present study is an attempt to survey the reasons for the physicians’ reluctance to take part in the family physical program in the Tehran Province health system. Methods: Considering this purpose, the study is an applied work carried out through a correlative method in Tehran’s Province Health System in 2012.(IRAN) The study population was comprised of all the physicians in the Tehran Province health system. Participants were selected through census. A questionnaire was used for data gathering and the data were analyzed using SPSS16. Results: The mean point of economic stage,  work conditions, health, welfare, structural-organizational, and social-cultural problems in the health centers under study were less than midpoint. Additionally, a statistically significant relationship was found between these problems and the tendency of physicians to take part in the family physician program (P Conclusion: The results indicated a significant relationship between the problems of physicians and their tendency to take part in the family physician program in Tehran. Given the necessity of creating motivation among physicians to take part in the program effectively and willfully, solving the physicians’ problems appears to be effective in motivating the physicians in this regard. Keywords: Family Physician, Referral System, Problems of Family Physicians, Health Centers Introduction Health is one of the principal rights and a valuable capital at every social level [1]. Along the main objective of the national health system, which is to improve public health where the healthy citizens have capability to take part in economic and social activities [2], there are other tasks to be fulfilled by the health system. These tasks include raising hope for a healthy life, responding to reasonable expectations of the public, reducing social gaps (social justice) and providing financial coverage for medical services [1]. It is essential, therefore, to design and adopt a proper model for health services to realize health objectives, maintain/improve health, and improve equal access to health services. In this regard, many have supported the idea of a health system in which all citizens regardless of their living condition and place (even those living in remote areas) have access to adequate specialized health services. Such services are provided by the facilities where experts are trained based on the available resources in the shortest feasible time and for reasonable costs as required by cultural and time constrains [3]. In fact, family physician programs and referral systems are in line with the realization of a primary care health system that actualizes considerable potential resources towards the improvement of the health conditions of the society [4]. The family physician program is a comprehensive health system and among the main achievements of this program are helping people to refer to the right specialist and an increase in the public satisfaction of health services [2]. Additionally, the American Physician Academy believes that the family physician system is the best and most effective way to provide health services for patients [3]. In spite of this, the government of the Islamic Republic of Iran, in cooperation with the Ministry of Welfare and Social Security, Ministry of Health, Treatment, Medical Education, and Health Service Insurance Org. triggered a rural health insurance programs through a referral system based on a family physician program in 2005. This program, considered as one of the main elements of health system development, was aimed to expand the health insurance coverage and to promote equal access to health diagnostic services [5]. In addition to supplying health services required by the public, the family physician program prevents negligence of patients’ right or any abuse of people’s need to health services [1]. Given that the family physician program is a nationwide program and all insurance organizations participate in this program, it is essential to survey the performance of the program regarding implementation, quality, and quantity of the services provided to insured patients. By this survey, the weakness and advantages of the program can be highlighted. Consequently, the family physician program may lead to immense changes in treatment behavior models as well as changes in consumption patterns in this field [6]. Santos and Amado believe that the knowledge of a family physician to provide primary care services leads to a long-term relation between the family and the physician; which is an advantage of the family physician program [7]. In addition, ranking the health services by the referral system gives the people in need access to more specialized services based on their true needs [8]. At first, the referral visits the family physician and, if needed, the physician recommends them to a special practitioner. The special practitioner, then, checks the patients, carries out the required measures, records the measures in the patients’ file, and returns the patients to the family physician [9]. Although, the family physician program is initially aimed to improve public access to health care systems and cuts the unnecessary medical costs, there are evidences that the program is not free of weaknesses [10]. In his study titled â€Å"challenges of family physicians in the world of the 1980s† Donald Rice (1980), studied the status of family physicians and challenges ahead of them in different countries and highlighted some main challenges including financial support for the graduates, salary of the physicians and the staff from community sources, and so on. After the implementation of health networks, family physicians are the next biggest reform in health systems, which promises to solve many of the problems of the health system. It is reasonable to expect a variety of economic, social, and cultural problems ahead of the program and failures to overcome. These problems threaten first level of services and the poor’s health. Above all, solving a problem needs developing an accurate insight to the problem. Analyzing the causes and the factors effective on high turnovers of family physicians is the first step to reach a right policy to improve health services nationwide. Methods The study is a descriptive analytical work carried out on the Tehran Province health system in 2012. Given incongruity of the districts under study and sensitivity of the issue, a census was taken in the system and all 100 physicians in the system agreed to participate. No sampling was done in this study and all the study population took part in the survey. Questionnaires were used for gathering the data. These questionnaires were divided into two sections. The first section included the demographic information of those who had took part in the survey. The second section included the questions which showed the unwillingness of the physicians towards the family physician program. The results of these questionnaires were classified into five main axes; 1- economic variables (questions 1-6); 2- work conditions, health, welfare, and educational variables (questions 7-12); 3- systematic-organizational variables (questions 13-18); 4- organizational-administrative variables (questions 19-24); and 5- social and cultural variables (questions 25-30). The questionnaire was designed based on Likert’s five-point scale. The validity of the questionnaires was approved by ten experts. Also, the stability was gained by the Cronbachs alpha coefficient test. The gleaned data were analyzed using descriptive and inferential statistics in SPSS. Among descriptive statistics frequency, frequency rate, mean, and standard deviation were used. Also in order to survey the independence/dependence of the variables, Chi Square was used as inferential statistics. Results Female and male participants constituted 65% and 35% of the sample group respectively. In addition, 24% of the participants were unmarried and 76% were married. Regarding employment status, 68% had lifetime employment and 32% were employed in the program for a specific time. The average age of the participants was 34 and the youngest and oldest participants were 25 and 54 years old respectively. Moreover, 23% of the participants were at the age range of 25-35, 58% were at the age range of 35-45; and 19% were at the age range of 45-55. Work records also showed that the lowest work experience was 1 year and the highest work experience was 29 years. On average, the participants had 10 years of work experience; 30% less than 19 years, 50% between 10 to 20 years, and 20% between 20 to 30 years. Table 1. distribution and frequency rate of the response Mean point economic, work conditions, health, welfare, structural-organizational, and social-cultural problems effective on the willingness of the physicians to take part in the family physician program were below the midpoint (Table 2). Table 2. Family physician problem There was a significant negative relationship among economic, welfare, and social-cultural problems. On the other hand, there was a positive and significant relationship between work conditions, health, and structural-organization problems (Table 3). Table 3. correlation among problems of family physicians to take part in the program Discussion The family physician program has aimed to completely implement a referral system in the heath and treatment sector. Among the main advantages of the program are preventing physicians ‘confusion and, more importantly, to improve public satisfaction from health services. This research also minimizes the waste of resources and leads to great economic savings. The early years of implementing the program have been featured with an increase of availability index in different aspects of the family physician program (human resources and preclinical services). Still, the ahead challenges are not deniable. The findings showed that there was a significant relationship between economic, work conditions, health, welfare, structural-organizational, and social-cultural problems on one hand and the physicians’ willingness to participate in the family physician program on the other. This is consistent with Hosseing Fahreji’s study [11] on the family physician program in the Imam Khomeini Charity Committee. A study by Masoodi Asl [12] on the assessment of the satisfaction of the service takers under the Imam Khomeini Charity Committee program showed that 31.25% were satisfied with the program, 51.5% were relatively satisfied, and 10% were relatively dissatisfied; which is inconsistent with the present study. Motlagh (2009) in a study titled â€Å"physician’s satisfaction† on the factors effective on creating dynamism in the family physician program and rural medical insurance indicates that minimum satisfaction level in the medical education universities is with financial problems [13]. Taking into account the findings of the study and significant effect of welfare and financial problems on the physician’s tendency to take part in the program, one may conclude that poor welfare facilities and accommodations for the physicians in the health and treatment network leads to high turnover rates among the physicians. The majority of the physicians only take part in the program for short and temporary terms and to only spend their obligatory service terms. Dieleman et al. also mentioned low salaries and hard work conditions as the reasons for lack of motivation in the health and treatment system [14]. Given that a successful implementation of the family physician program needs public participation and cooperation for different sections, cultural works on all the effective actors is essential. Failure to successfully implement referral to a specialist practitioner plan, poor follow up by the family physicians, and poor public support for the program are the signs of low public participation rates in the program. The reasons of poor cooperation are lack of cultural and public informing measures regarding family physician programs and negative attitudes and distrust in family physicians. Nasrollahpour et al. highlighted resistance among family physicians and specialist practitioners against the family physician program [15]. Professional satisfaction of the family physicians is a key factor in the health system. In addition, professional satisfaction might be related to the quality and effectiveness of the health services provided [16]. On the other hand, probability of attracting new work forces decreases with an increase of professional dissatisfaction among family physicians and replacement applications by the physicians. Payment terms and work conditions are key factors in attracting and keeping skillful physicians [17]. In regards to the causes of dissatisfaction among the family physicians are high workloads, being busy doing supportive works in health centers, lack of welfare, negligence of specific needs of different regions, and lack of proper cultural preparation (the public and specialist physicians are not properly trained). Ebadifardazar et al. [18] found that issues like low salaries, delay in payments, remote work place, long working hours, and no promising future for this national program are the causes of dissatisfaction of family physicians that increases turnover rates. Understaffed work force and high rates of turnover or replacement during the first 5 years of family physician program indicate problems of attracting and keeping general practitioners in the program. Also decreasing the number of service takers assigned to each practitioner, proving decent work conditions, providing welfare facilities to attract physicians and keeping the balance between demand and supply, clarifying health service packs, and providing required equipment and support are the effective factors in attracting and keeping the physicians [19]. Conclusion In conclusion, the results showed that there was a significant relationship between the problems experienced by physicians and their willingness to participate in the family physician program in the health centers located in Tehran. In spite of the fact that satisfactory implementation of the program is the intention of the policy makers, solving the problems participating physicians face and increasing their willingness to participate appears to be an effective approach to improve the outcomes of the program. References Jamshid Beigi M, Mardfar N. Executive performance of family physician program and rural insurance. Tehran: Arvij; 2007. Persian. Ghoharinejh ad S. Health system decentralization on Iran University of Medical Science. Proceeding of 5th National Congress of Healthcare Administration Student, 2007 May 9-12, Iran, Tabriz; P.32. Persian. Rasoulid Nejad S. A survey of referral system in health care service system and ways to improve Isfahan Health system. [Ph.D. Dissertation]. Tehran: Islamic Azad University, Research and Science Branch; 1996. Family physicians and referral system in Islamic Republic of Iran, Ministry of Health, Treatment, and Medical Education, Health Department, Summer, 2006. Persian. Ministry of health and medical education. Illustration of health team and family physician services. First ed. Tehran: Arvij Publishers; 2006. Persian. Khayyati F, Motlagh ME, Kabir MJ, Kazemeini H. The role of family physician in case finding, referral, and insurance coverage in the rural areas. Iranian journal of public health. 2011; 40(3): 136. Amado CA, Santos SP. Challenges for performance assessment and improvement in primary health care: the case of the Portuguese health centers. Health Policy. 2009;91(1):43-56. Davoudi S. Introduction to health sector reform. 1st ed. Tehran: Asar-e-Mouaser; 2006. Persian. Ministry of Health and Medical Education. Family physician instructions, 2010. Persian. Kersnik J. An evaluation of patient satisfaction with family practice care in Slovenia. Int J Qual Health Care. 2000;12(2):143-7. Hosseini Fahreji H. Assessment of family physician performance in Yazd Imam Khomeini Charity Committee [M.A. Thesis]. Tehran: Iran University of Medical Sciences; 2004. Persian. Masoudi Asl I. A survey of family physician program from the physicians’ viewpoint in Yasouj Imam Khomeini Charity Committee. [M.A. Thesis]. Tehran: Islamic Azad University; 2002. Persian. Motlagh MI, Pourshirvani N. Doctors consent of dynamic factors affecting the insurance plan and rural family physicians in Gilan University of Medical Sciences. Journal of Guilan University of Medical Sciences. 2004;19:55-48. Persian. Dieleman M, Cuong PV, Anh LV, Martineau T. Identifying factors for job motivation of rural health workers in North Viet Nam. Hum Resour Health. 2003;1(1):10. Nasrollahpour Shirvani D, Ashrafian Amiri H, Motlagh ME, Kabir MJ, Maleki MR, Shabestani Monfared A, et al. Evaluation of the function of referral system in family physician program in Northern provinces of Iran 2008. J Babol Univ Med Sci. 2010;11(6):46-52. Landeck M, Garza C. Utilization of physician health care services in Mexico by US Hispanic border residents. Health marketing quarterly. 2003;20(1):3-16. Abma J C, Chandra A, Mosher WD, Peterson LS, Piccinino LJ. Fertility, family planning, and womens health: new data from the 1995 National Survey of Family Growth. Vital and health statistics. Series 23, Data from the National Survey of Family Growth. 1997;(19):1-14. Mahmoodi A, Kohan M, Azar FE, Solhi M, Rahimi E. The impact of education using Health Belief Model on awareness and attitude of male teachers regarding their participation in family planning. Journal of Jahrom University of Medical Sciences.  2011:9(3):21-8. Persian. Cates W, Karim QA, El-Sadr WM, Haffner DW, Kalema-Zikusoka G, Rogo K, Averill EMD. Family planning and the millennium development goals. Science. 2014;329(5999):1603.

A Man That Holds My Heart Essay

Many people have ways of influencing others. Most people use words to affect other people. An amount of individuals would utilize their gift of persuasion to convince others of their causes or maybe arguments, while some use authority to force people to do as they are told. These several differences can apply to fathers as well. Not all fathers are similar when it comes to educating their children. Many are gentle, while some are more dominant. Randy T Caldwell, a somewhat young spirited middle aged man. Dark skinned with black Gucci frames to accommodate his big brown eyes. Standing 5’11, board shoulders, happy, loving, man of Christ and always seen with a look upon his face that means business falls under those descriptions of a father. My father is a man of many words. He is a very talkative man, somewhat quiet but only when listening to someone of when needed. He is not a very persuasive person like others, nor does he use authority to get his message across. All the lessons I’ve learned from my father were never taught in lectures or by long stories. Instead, he gave me real life examples for me to follow. I learned everything I needed to know from my father, through his own life. It was the way he lived his poverty stricken and fearful life which taught me how to live a more effective, goal reaching, non-poverty stricken live. Indeed, my father was a man of many words and was a man of many words but yet he had a soft heart. My father has simple interests. He is very fond of watching college football, and often watches when he can. When he has time he would go hiking occasionally. However, his favorite thing to do is go fishing. At such a young age, I was very fascinated with the fact that he would bring home huge, 10 foot long, stinky fish but I always loved it. Aside from being an outdoor, outgoing , talkative man ; my father was a man of Christ. Just like on the man that are always, dressed up , Stay Adams , the best pen striped suit, at the front of the church serving communion on first Sundays . That’s My Father! Even though he had a horrible, poverty stricken, gangster life as a child he is a firm believer in Christ. He has not preached about his faith even though he is very talkative; he has never given lessons on religious and mortality. He just simply lived by example. Whenever faced with difficulty, he simply thinks about what Christ would do in a situation as such. It was one the most remarkable things I find remember able about him. In one instance, I went fishing with my father. I’m not really fond of the outdoors like he was, but I loved spending time with him. It had been raining earlier that morning, so the fishing area was wet. He insisted we go to is regular spot so we did. It was under an old rugged beat down bridge that was covered with green algae. By the time we were done fishing we both were hungry. We proceeded to the nearest fast food place, which happened to be McDonald’s. As I ate my lunch it began to rain very badly; I than begin to look out the window at an old man whose clothes torn with the look of death in his eyes, standing in the middle of the parking lot. As my father made his way to the table where I was dining he caught my gaze. He immediately re packed his Big Mac fully made all the way everything on it , his supersized fry, and even his drink and went right out the door. Just as hungry as he was he gave the old man his meal. On the way home my father said nothing. Again, he taught me a lesson through his own example. My father can be described as many things talkative, outgoing, loving, caring, and firm believer in Christ. But one thing he will always be described as to me would be the man that has taught me to be the best I can be. My father is a good father, he is rather different than other fathers; but that’s what makes him the best.

Sexual Violence And The Pregnancy - 2584 Words

Introduction For most women, pregnancy is a time of joy and happiness for the life she is about to bring into this world. Unfortunately, this is not the case for women who experience intimate partner violence during such a precious milestone in their life. Intimate partner violence during pregnancy refers to violent acts including physical, sexual, or psychological/emotional violence or threats of sexual violence committed by an intimate male partner such as a husband, boyfriend, or common law partner that are inflicted on a pregnant woman. Intimate partner violence can affect women during pregnancy and during the postnatal period with devastating effects on both the women and the unborn child. Domestic violence against women is more†¦show more content†¦This being said, the best prevalence estimates are most likely underestimates. Violence during pregnancy poses a threat to health and the death of the mother and her infant can be resulted. Pregnancy and the immediate period following birth is a time when partner support and being in a confiding trusting relationship is supposed to be particularly important for psychological health (Mezey, Bacchus, Bewley, White, 2005). Women may feel more physically vulnerable and emotionally dependent on their partners during the postnatal period and as a result implications of domestic violence may be more profound, as violence poses the safety of both mother and the baby (Mezey, Bacchus, Bewley, White, 2005). Direct and indirect mechanisms of violence may result adverse pregnancy symptoms or even during the postnatal period, including postpartum depression (Newberger et al 1992). Women that are victims of Domestic Violence are subject to a higher relative risk of postnatal depression or some other psychological morbidity during the postpartum period (Golding 1999; Coid e t al 2003). Furthermore, some studies support that the application of physical or sexual violence on pregnant women is an inclination factor for postpartum depression (Buist Janson 2001, Records Rice 2004). Physical violence duringShow MoreRelatedCase Analysis : V Hutchinson876 Words   |  4 Pageswith aggravated sexual assault in the lower court after the complainant had consented to have sexual intercourse but wanted Hutchinson to wear a condom. However, Hutchinson poked holes in the condom unknown to the complainant. This resulted in pregnancy. In the Supreme Court case, the file says, â€Å"Mr. Hutchinson was charged with aggravated sexual assault. The complainant said that she did not consent to unprotected sex. 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Is Abortion Morally Wrong - 1704 Words

One of the major debates in today’s society is how the legalities apply to the process of abortion. In this debate, most people usually connect with either the â€Å"pro-life† argument, or the â€Å"pro-choice† argument. Before developing a position, it is important to understand both sides of the argument and weigh the consequences of each. The common ground between the two is often mistaken, making it difficult for people to find their position. People who support banishing legal abortions are usually referred to as â€Å"pro-lifers.† They usually believe in standing up for the unspoken rights of the fetus and believe that the practice of abortion is morally wrong. Expanding upon the theory of predestination, it is believed that the fetus itself has its own freedom, and it is their job to represent and protect those God-given rights. The â€Å"pro-choicers,† on the other hand, are commonly mistaken as people who not only support the process of abortion, but it. This stereotypical theory addresses the pro-choice advocates as â€Å"modern-day monsters† who worship the idea of abortion and take action to promote the process. Not only is this strikingly fallacious, but it also covers up what the advocates are truly arguing for. Instead of being an abortion advocate, the pro-choice movement provides exceeding opportunities for the prospective mothers. According to Bertha Alvarez Manninen, a journalist for , the pro-choice movement is about â€Å"ensuring that women can have a safe and legal abortion,†Show MoreRelatedIs Abortion Morally Wrong?1397 Words   |  6 PagesAbortion is viewed as an ethical issue worldwide as it has many debates which causes question: Should it be considered morally ethical or not? Should it be legal or illegal? Is it wrong, is it, right? In addition to multiple theories: Beliefs, Morality, Logic, Science and many others. Some argue that abortion is morally wrong because it has a right to life. 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Essay1372 Words   |  6 Pagesten of these end in abortion† (Guttmacher Institute). Although today the United States is split among many controversial issues, one of the most disputed controversies is abortion, which has taken our country by storm over the last decade. As more and more unexpected pregnancies are occurring, many women find themselves faced with the financial and social burdens of potentially raising a child. Helpless and faced with a life- changing dilemma, these women turn to abortion as their only choiceRead MoreAbortion Is Morally Wrong?2405 Words   |  10 Pages Introduction We can all agree that abortion is a controversial issue debated in our society today, especially in Texas, which is one of the most conservative’s states in the nation. Some people argue that abortion is morally wrong, because it has to do with ending a life which, according proponents begins at conception, not at birth. Others contest that it is a woman s constitutional right to make reproductive decisions, particularly in situations of rape, incest, and health risks. In this paperRead MoreIs Abortion Morally Wrong?3071 Words   |  13 Pages Abortion -Final Mariel Timothy Howard University October 2014 Abortion, according to dictionary.com (2014) is the deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy. When it comes to abortion many ethical issues, and questions become a great concern. Some questions of great concern are: is abortion morally wrong? Should abortion be illegal? Is the fetus an innocent person? What’s the right of the motherRead MoreWhy abortion is morally wrong1412 Words   |  6 Pagesyou slice it, abortion is morally wrong. Although that should not be misinterpreted for a pro-life stance on abortion because there are numerous circumstances that must be considered in each situation. 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Nearly half think abortion is utterly wrong and should not be a choiceRead MoreWhy Abortion Is Morally Wrong1559 Words   |  7 PagesIMPORTANCE OF THE TOPIC: The morality of abortion is a topic that has long been discussed by both those for and against the act. Until 1972 when the Supreme Court case of Roe v. Wade made abortion legal in all 50 states, the act of getting an abortion was illegal in many states. Both sides of the moral arguments explain the reasoning behind their arguments. The moral question is if the act of getting an abortion is the same as murdering another human being. YES ARGUMENT PATRICK LEE AND ROBERT P