چکیده (انگلیسی):

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.