The online version of this article (doi:10.1186/1471-2296-15-38) contains supplementary material, which is available to authorized users.
An erratum to this article is available at http://dx.doi.org/10.1186/s12875-015-0293-y.
The authors declare that they have no competing interests.
ZÖ contributed to the conception and design of the study, obtained ethical approval, conducted the interviews and interpreted the data. ZÖ and MÇ both coded the interview transcripts and discussed the codes as well as the emerging discourses. ZÖ drafted the manuscript, which was extensively commented on by MÇ and UY. MÇ participated in the design of the study, the development of a conceptual framework. UY was involved in the design of the study, the collection of data, and the revision of the manuscript and RÖ conducted the interviews, participated in the coordination of the study and provided support and critical analysis of the manuscript. All authors critically revised and approved the final manuscript.
A person-list-based family medicine model was introduced in Turkey during health care reforms. This study aimed to explore from primary care workers’ perspectives whether this model could achieve the cardinal functions of primary care and have an integrative position in the health care system.
Four groups of primary care workers were included in this exploratory-descriptive study. The first two groups were family physicians (FP) (n = 51) and their ancillary personnel (n = 22). The other two groups were physicians (n = 44) and midwives/nurses (n = 11) working in community health centres. Participants were selected for maximum variation and 102 in-depth interviews and six focus groups were conducted using a semi-structured form.
Data analysis yielded five themes: accessibility, first-contact care, longitudinality, comprehensiveness, and coordination. Most participants stated that many people are not registered with any FP and that the majority of these belong to the most disadvantaged groups in society. FPs reported that 40-60% of patients on their lists have never received a service from them and the majority of those who use their services do not use FPs as the first point of contact. According to most participants, the list-based system improved the longitudinality of the relationship between FPs and patients. However, based on other statements, this improvement only applies to one quarter of the population. Whereas there was an improvement limited to a quantitative increase in services (immunisation, monitoring of pregnant women and infants) included in the performance-based contracting system, participants stated that services not among the performance targets, such as family planning, postpartum follow-ups, and chronic disease management, could be neglected. FPs admitted not being able to keep informed of services their patients had received at other health institutions. Half of the participants stated that the list-based system removed the possibility of evaluating the community as a whole.
According to our findings, FPs have a limited role as the first point of contact and in giving longitudinal, comprehensive, and coordinated care. The family medicine model in Turkey is unable to provide a suitable structure to integrate health care services.
Plochg T, Niek SK, Barbara S: Transforming medical professionalism to fit changing health needs. BMC Med. 2009, 7 (64): 1-7.
Starfield B: Primary Care: Balancing Health Needs, Services and Technology. 1998, New York: Oxford University Press
Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA: Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. 2013, 13: 1-12. CrossRef
Shi L: The Impact of primary care: a focused review scientifica. Hindawi Publ Corp Scientifica. 2012, 2012: 1-22.
Starfield B: Primary care, equity and health in an international context. A work-in-progress seminar on health & health care in changing environments: the Malaysian experience. [ http://pcdom.org.my/index.php/primary-care]
Saltman RB, Busse R, Mossialos E: Regulating Entrepreneurial Behaviour in European Health Care Systems, World Health Organization, European Observatory on Health Care Systems Series. 2002, Buckingham: Open University Press
Magnussen J, Vrangbaek K, Saltman RB: Nordic Health Care Systems. Recent Reforms and Current Policy Challenges. World Health Organization, European Observatory on Health Care Systems Series. 2009, Berkshire, England: Open University Press
Meads G: The organisation of primary care in Europe: part 2 agenda- position paper of the European Forum for Primary Care. Qual Prim Care. 2009, 17: 225-234. PubMed
World Bank: Review of experience of family medicine in Europe and Central Asia. [ https://openknowledge.worldbank.org/handle/10986/8640]
Fidler A, Bredenkamp C, Schlippert S: Innovations in health services delivery from transition economies in Eastern Europe and Central Asia. Health Aff. 2009, 28 (4): 1011-1021. 10.1377/hlthaff.28.4.1011. CrossRef
Lionis C, Symvoulakis EK, Markaki A, Vardavas C, Papadakaki M, Daniilidou N, Souliotis K, Kyriopoulos I: Special series: integrated primary health care. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review. Int J Integr Care. 2009, 9: 1-14. CrossRef
Kringos DS, Boerma WG, Spaan E, Pellny M: A Snapshot of the organization and provision of primary care in Turkey. BMC Health Serv Res. 2011, 11 (90): 1-8.
The Ministry of Health of Turkey: The presidency of strategy development. Ministry of Health Accountability Report. 2012, [ http://sgb.saglik.gov.tr/content/files/FaaliyetRaporu2012/faaliyet/index.html]
World Bank: Turkey: Reforming the health sector for improved access and efficiency. [ https://openknowledge.worldbank.org/handle/10986/14766]
Chakraborty S: Health systems strengthening lessons from the Turkish experience. [ https://openknowledge.worldbank.org/handle/10986/10222]
Vujicic M, Sparkes S, Mollahaliloglu S: Health workforce policy in Turkey: Recent reforms and issues for the future. [ https://openknowledge.worldbank.org/handle/10986/13784]
Bank W: Human Development Sector Unit Europe and Central Asia Region: Report. Turkey Performance-Based Contracting Scheme in Family Medicine – Design and Achievements. 2013, USA: The World Bank
Tatar N, Mollahaliloğlu S, Şahin B, Aydın S, Maresso A, Hernandez_Quevedo C: Turkey: health system review. Health Syst Transit. 2011, 13 (6): 1-186. PubMed
Ocek Z, Soyer A: Our Experience in Primary Health Care: Picture of Turkey between the years 2000-2004. 2007, Ankara: Turkish Medical Association Publication, [ http://www.ttb.org.tr/kutuphane/birincibasamaksh.pdf]
Aksakoğlu G: Untested model: socialization. Commun Phys. 1994, 60: 52-55.
Soyer A: AKP’s Health Report. 2007, Istanbul: Universal Print Publication
Baris E, Mollahaliloğlu S, Aydin S: Healthcare in Turkey: from laggard to leader. BMJ. 2011, 342: 579-582. 10.1136/bmj.d579. CrossRef
Şahin M, Eğri M: Utilization of primary care services in Yeşilyurt district of Malatya province and related factors. Commun Phys. 1998, 13 (4): 300-309.
Çiçeklioğlu M: Evaluation of primary care services for children aged 0-5 regarding first contact-care and longitudinality. Commun Phys. 1999, 14 (5): 322-333.
Berberoğlu U, Eskiocak M, Ekuklu G, Saltık A: Utilization of primary care services by Gypsies and others in Edirne province, area of Muradiye health center. Commun Phys. 2001, 16 (6): 470-478.
Hassoy H, Çiçeklioğlu M: Utilization of health care services by the children aged 0-6 in Izmir province, area of Gülyaka Health Center and related factors. Commun Phys. 2005, 20 (5): 361-371.
Deveci SE, Açık Y, Ögetürk A, Gülbayrak C, Ozan T: The perceptions of the population regarding the concepts of family medicine and privatization of health services. A preliminary study. Commun Phys. 2005, 20 (3): 172-176.
Yılmaz BN: Family medicine in Eskisehir and thoughts on it. Commun Phys. 2007, 22 (6): 460-462.
The Ministry of Health of Turkey: The Ministry of Health budget presentation-2011. [ http://www.saglik.gov.tr/TR/dosya/1-74227/h/2012butce.pdf]
Hart TJ: The inverse care law. Lancet. 1971, 297 (7696): 405-412. 10.1016/S0140-6736(71)92410-X. CrossRef
Boerma W: Profiles of General Practice in Europe. An International Study of Variation in the Tasks of General Practitioners. 2003, Utrecht Netherlands: NIVEL
Dixon A, Robertson R, Appleby J, Burge P, Devlin N, Magee H: Patient choice: how patients choose and how providers respond. [ http://www.kingsfund.org.uk/sites/files/kf/Patient-choice-final-report-Kings-Fund-Anna%20Dixon-Ruth-Robertson-John-Appleby-Peter-Purge-Nancy-Devlin-Helen-Magee-June-2010.pdf]
World Health Organization Regional Office for Europe. [ http://data.euro.who.int/cisid/?TabID=332383]
Starfield B, Mangin D: An international perspective on the basis for payment for performance. Qual Prim Care. 2010, 18 (6): 399-404. PubMed
İlhan MN, Tüzün H, Aycan S, Aksakal FN, Özkan S: Health care service use characteristics of the primary health care center attendants and the variation with regard to some socioeconomic indicators: last determinations before the health reform. Commun Med Bull. 2006, 25 (3): 33-41.
Aycan S, Özkan S, Avcı E, Özdemirkan T, Çivil EF: Assessment of knowledge, attitude and satisfaction of people over 18 years who admitted to some family health centers in Ankara about family medicine practice. Commun Phys. 2013, 27 (6): 449-455.
Nohutçu N: Family planning practices in Izmir. Book Symposium on Family Planning Policies in Turkey Today. 2011, Izmir: Bornova
Davies GP, Perkins D, McDonald J, Williams A: Integrated primary health care in Australia. Int J Integr Care. 2009, 9: 1-9. CrossRef
Delnoij D, Klazinga N, Glasgow IK: Integrated care in an international perspective. Int J Integr Care. 2002, 2: 1-4. CrossRef
- Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers
Zeliha Asli Öcek
- BioMed Central
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