ArticleBMJ open2019
Challenges in the implementation of primary health care reforms: a qualitative analysis of stakeholders' views in Turkey.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Turnover intention among primary health workers in China: a systematic review and meta-analysis.BMJ open · 2020Pooled it
- Exploring the association between social support and reward satisfaction: the mediating role of multi-dimensional psychological capital.BMC health services research · 2026Article
- Reforms and innovations in primary health care in different countries: scoping review.Primary health care research & development · 2024Article
- Article
- Facilitators and barriers in general practitioners' choice to work in primary care units in Austria: a qualitative study.Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2023Article
- Evaluation of a medical education policy with compulsory rural service in China.Frontiers in public health · 2023Article
- Integrating rehabilitation services into primary health care: policy options for Iran.BMC health services research · 2022Article
- The Lancet Global Health Commission on financing primary health care: putting people at the centre.The Lancet. Global health · 2022Review
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Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThis study aims to assess the implementation of the Family Medicine Programme (FMP), which has taken place in Turkey from 2005 to 2010 as a set of comprehensive primary health care (PHC) reforms and involved changes in professional organisation (eg, family medicine specialisation) and service provision (eg, patients' registration list). Our particular interest is to identify the challenges and limitations that PHC physicians and academicians have encountered in the implementation of the FMP which could have influenced the delivery of care and utilisation of services.
designWe applied the framework method to analyse data obtained through semi-structured interviews conducted in the field. This qualitative approach involved the categorisation of raw data into a predefined framework, which comprised challenges and limitations identified in the literature, and the emergence of a new framework, whose categories corresponded to challenges and limitations identified through thematic analysis of our data.
settingPHC centres and academic departments from five Turkish provinces.
participantsPHC physicians and academicians involved in training and/or research were invited to participate. 20 participants agreed to take part and, due to schedule limitations, 15 participants (seven PHC physicians and eight academicians) completed the interviews.
resultsShortcomings in the planning of the reforms, inadequate commitment to integration of PHC in the system and collateral effects of a market model in healthcare emerged as limitations to successful FMP implementation. Uncertainty about care quality and physicians' ethical values as well as perceptions of organisational injustice among healthcare workers were contributing challenges.
conclusionsA systems thinking approach in the FMP design and implementation could help foresee and address these limitations. In decentralisation processes, such as FMP, shared governance by including PHC stakeholders in policy-making and planning could alleviate misalignment of interests and positively affect PHC performance, for example, by removing barriers to gatekeeping implementation.
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