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Abstract
Objectives This 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.
Design We 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.
Setting PHC centres and academic departments from five Turkish provinces.
Participants PHC 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.
Results Shortcomings 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.
Conclusions A 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.
- primary care
- health policy
- qualitative research
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Footnotes
Contributors AEG and CN designed the study. AEG conducted the interviews and analysis and wrote the initial draft with inputs from CN. CN reviewed the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The views expressed in the article are solely the responsibility of the authors and do not represent the positions of the institutions in which they work.
Competing interests None declared.
Ethics approval The study was approved by the Health Policy & Management / Centre for Global Health Research Ethics Committee in Trinity College Dublin (Application 15F/2015/02) and was assessed by the Research Ethics Committee in Ankara University, which did not require additional ethical approval for this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Analytical process and code index are provided in supplementary materials. No additional data are available.
Patient consent for publication Not required.