fa اجرای برنامه پزشک خانواده در ایران: دست‌آوردها و چالش-ها بیوشیمی Biochemical تحقیقی Research <p><font face="Times New Roman" size="3"> </font></p><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt text-justify: kashida text-kashida: 0% mso-line-height-rule: exactly" dir="rtl"><font size="2"><b><span lang="FA" style="color: blue font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">سابقه و هدف:</span></b><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"> نظام مراقبت سلامت </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: Arial mso-hansi-font-family: Arial">به منظور افزایش کارایی و اثربخشی، ایجاد عدالت و امکان دسترسی آحاد مردم به خدمات سلامت همواره مورد اصلاحات قرار می­گیرد. برنامه پزشک خانواده و بیمه روستایی </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">از سال 1384 با اهداف: تقویت نظام ارجاع، افزایش دسترسی مردم به خدمات سلامت و کاهش هزینه­های غیرضروری در کلیه مناطق روستایی و شهرهای کمتر از 20000 ایران اجرا شده است. این مطالعه به منظور شناخت دست­آوردها و چالش­های اجرای برنامه پزشک خانواده در ایران انجام گرفته است.<b><span style="color: blue"><o:p /></span></b></span></font></p><p><font face="Times New Roman" size="3"> </font></p><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt text-justify: kashida text-kashida: 0% mso-line-height-rule: exactly" dir="rtl"><font size="2"><b><span lang="FA" style="color: blue font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">مواد و روشها:</span></b><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"> این </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">مطالعه</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">مروری</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">با</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">جستجو</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">در</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">سایت</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">های </span><span dir="ltr"></span><span dir="ltr"></span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span><font face="Times New Roman"><span style="mso-spacerun: yes"> </span>Pub Med, Google </font></span><span dir="rtl"></span><span dir="rtl"></span><span style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span><span style="mso-spacerun: yes"><font face="Times New Roman"> </font></span></span><font face="Times New Roman"><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "2 Mitra"" dir="ltr">Google scholar, SID, Inranmedex, Magiran</span><span dir="rtl"></span><span dir="rtl"></span></font><span style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"><span dir="rtl"></span><span dir="rtl"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">با</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">کلید</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">واژه­های پزشک</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">خانواده، بیمه روستایی، مرکز بهداشتی درمانی، نظام سلامت، خدمات سلامت، رضایتمندی پزشک</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">خانواده، رضایتمندی بیماران انجام</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">گرفت که</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">در</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">نهایت 68 مقاله</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">مرتبط</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">با</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">هدف</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">مطالعه،</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">استخراج</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">و</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">بررسی</span><span dir="ltr"></span><span dir="ltr"></span><span lang="FA" style="font-family: BZar mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar mso-bidi-font-family: "2 Mitra"" dir="ltr"><span dir="ltr"></span><span dir="ltr"></span> </span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt mso-ascii-font-family: BZar">شد.</span><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"> <b><span style="color: blue"><o:p /></span></b></span></font></p><p><font face="Times New Roman" size="3"> </font></p><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt mso-line-height-rule: exactly" dir="rtl"><font size="2"><b><span lang="FA" style="color: blue font-family: "2 Mitra" mso-bidi-font-size: 10.0pt">یافته ها:</span></b><span lang="FA" style="font-family: "2 Mitra" mso-bidi-font-size: 10.0pt"> مطالعات انجام شده در ایران نشان می­دهد که با اجرای برنامه پزشک خانواده بسیاری از شاخص­های بهداشتی ارتقا یافته، دسترسی مردم به خدمات سلامت بیشتر شده، هزینه­های غیرضروری کاهش یافته و رضایت گیرندگان خدمات بالاتر رفته است. اما با وجود موقعیت های مذکور، نارسایی هایی در نظام ارجاع، تشکیل پرونده سلامت و ثبت خدمات تشخیصی و درمانی و فرهنگ­سازی در سطح جامعه وجود دارد که باید ارتقاء یابد.<b><span style="color: blue"><o:p /></span></b></span></font></p><p><font face="Times New Roman"><font size="3"> </font><b><span lang="FA" style="color: blue font-family: "2 Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-fareast-font-family: "Times New Roman" mso-bidi-language: FA mso-no-proof: yes mso-ansi-language: EN-US mso-fareast-language: EN-US" dir="rtl">نتیجه گیری:</span></b></font><span lang="FA" style="font-family: "2 Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-fareast-font-family: "Times New Roman" mso-bidi-language: FA mso-no-proof: yes mso-ansi-language: EN-US mso-fareast-language: EN-US" dir="rtl"> نتایج این مطالعه نشان داد که بعضی از اهداف برنامه پزشک خانواده تحقق یافته و برای رسیدن به بعضی از اهداف دیگر باید مداخلات متناسب در سطح ملی و منطقه­ای انجام گیرد.</span></p> <font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt unicode-bidi: embed direction: ltr mso-line-height-rule: exactly"><font face="Times New Roman"><b><span style="color: blue mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman""><font size="2">BACKGROUND AND OBJECTIVE:</font></span></b><span style="font-size: 13pt mso-fareast-font-family: Calibri mso-bidi-font-family: "Times New Roman" mso-bidi-language: AR-SA"> </span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman""><font size="2">Health care systems are constantly reforming in order to increase efficiency and effectiveness, equity, and public access to health care services. Family physicians and rural health insurance program performed in 2005 with the following objectives: strengthening the referral system, increasing access to health care services and reducing unnecessary costs in all urban and rural areas with fewer than 20,000 inhabitants in Iran. This study was designed to recognize the achievements and challenges of the implementation of family physicians programs.<o:p /></font></span></font></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt unicode-bidi: embed direction: ltr mso-line-height-rule: exactly tab-stops: 147.75pt"><font size="2"><font face="Times New Roman"><b><span style="color: blue mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">METHODS:</span></b><span style="mso-bidi-font-size: 10.0pt mso-fareast-font-family: Calibri mso-bidi-font-family: "Times New Roman" mso-bidi-language: AR-SA"> </span><span style="mso-bidi-font-size: 10.0pt mso-fareast-font-family: Calibri mso-bidi-font-family: "Times New Roman"">The present review article was conducted using the databases: Pub Med, Google scholar, Google, SID, Iranmedex, Magiran with Keywords such as family physicians, rural insurance, health center, health systems, health services, family physician satisfaction and patient satisfaction </span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">that 68 articles related to the objective of study were extracted and assessed.<o:p /></span></font></font></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt unicode-bidi: embed direction: ltr mso-line-height-rule: exactly"><font size="2"><font face="Times New Roman"><b><span style="color: blue mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">FINDINGS:</span></b><span style="mso-bidi-font-size: 10.0pt mso-fareast-font-family: Calibri mso-bidi-font-family: "Times New Roman" mso-bidi-language: AR-SA"> </span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "B Nazanin"">The related studies in Iran showed that health indices, further access to health services, reduction of unnecessary costs, and patient satisfaction have been improved by implementing the family physician program. But in spite of mentioned successes, there are some problems in referral system, filing and registration of diagnostic and treatment services and practice in culture in society that should be promoted. </span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman""><o:p /></span></font></font></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: 16pt unicode-bidi: embed direction: ltr mso-line-height-rule: exactly"><font size="2"><font face="Times New Roman"><b><span style="color: blue mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman"">CONCLUSION:</span></b><span style="mso-bidi-font-size: 10.0pt mso-fareast-font-family: Calibri mso-bidi-font-family: "Times New Roman""> This study showed that some of the goals of this program were achieved and to reach the other goals need interventions at the national and regional levels.</span><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman""><o:p /></span></font></font></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: left line-height: 16pt unicode-bidi: embed direction: ltr mso-line-height-rule: exactly"><span style="mso-bidi-font-size: 10.0pt mso-bidi-font-family: "Times New Roman""><!--stripped--><font face="Times New Roman" size="2"> </font><!--stripped--></span></p><font face="Times New Roman" size="3"> </font> برنامه, پزشک خانواده, عملکرد, دست‌آوردها, چالش‌ها, نظام سلامت Program, Family physicians, Practices, Achievements, Challenges, Health system 15 26 http://jbums.org/browse.php?a_code=A-10-1370-997&slc_lang=fa&sid=1 S.D. Nasrollahpour Shirvani (PhD) سیدداود نصرالله پور شیروانی 10031947532846006255 10031947532846006255 Yes مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشگاه علوم پزشکی بابل