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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers

Zeitschrift:
BMC Family Practice > Ausgabe 1/2014
Autoren:
Zeliha Asli Öcek, Meltem Çiçeklioğlu, Ummahan Yücel, Raziye Özdemir
Wichtige Hinweise

Electronic supplementary material

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.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

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.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
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