تامين منابع، تجهيزات و الزامات اجراي طرح پزشك خانواده و بيمه روستايي در استان هاي شمالي ايران: از تئوري تا عمل

Resources, equipment and requirements for the implementation of Rural family physicians and insurance programs in northern

مقدمه: برنامه ملي پزشك خانواده و بيمه روستايي يكي از اصلاحات بزرگ نظام سلامت كه از سال 1384 اجرا شده، مستلزم تامين منابع و امكانات مورد نياز مي­ باشد. اين مطالعه به منظور بررسي كميت منابع و الزامات اساسي تامين شده در برنامه پزشك خانواده در استان هاي شمالي ايران انجام گرفت. مواد و روش­ ها: مطالعه از نوع توصيفي مقطعي بوده كه در شش ماهه دوم 1391 انجام گرفت. 25 درصد مراكز مجري طرح پزشك خانواده و بيمه روستايي در سه استان گلستان، مازندران و گيلان، مجموعاً 139 مركز از 552 مركز مجري به صورت تصادفي سيستماتيك به عنوان نمونه پژوهش انتخاب شدند. ابزار جمع ­آوري داده­ ها پرسشنامه محقق ساخته بوده كه روايي و پايايي آن مورد تاييد قرار گرفت. داده ­ها با استفاده از آزمون­ هاي كروسكال واليس و مجذور كاي تحليل شدند. يافته­ ها: از 139 مركز مطالعه شده، 48 مركز (34/5 %) داروخانه دولتي، 62 مركز (44/6 %) داروخانه خصوصي داشتند كه 72 مركز (51/8%) از آنها از 279 قلم داروي كامل برخوردار بودند. 133 مركز (95/7 %) واحد تزريقات و پانسمان، 84 مركز (60/4 %) واحد بهداشت دهان و دندان و 42 مركز (30/2 %) واحد فعال آزمايشگاه داشتند. 138 مركز (99/3 %) حداقل يك دستگاه كامپيوتر سالم، 135 مركز (97/1 %) حداقل يك كپسول اكسيژن داراي مانومتر سالم، 131 مركز (94/2%) ترالي اورژانس، 129 مركز (92/8 %) حداقل يك دستگاه فور سالم، 99 مركز (71/2 %) حداقل يك نگاتوسكوپ سالم، 92 مركز (66/2 %) ECG سالم داشتند. از 188 پزشك خانواده شاغل در مراكز مطالعه شده، 140 پزشك (74/5 %) اطاق (مطب) مستقل، 165 پزشك (87/8%) ميز سالم اداري، 144 پزشك (76/6 %) اتوسكوپ سالم، 71 پزشك (37/8%) آفتالموسكوپ سالم، 131 پزشك (69/7 %) كامپيوتر سالم داشتند. ميزان برخورداري بعضي از منابع و امكانات در استان­هاي شمالي ايران تفاوت معني ­دار وجود داشت (0/05>p). نتيجه­ گيري: نتايج نشان داد بعضي از امكانات و الزامات در تعدادي از مراكز مجري تامين نشده است كه براي تامين آن بايد اقدامات موثرتري به عمل آيد.

Introduction: The national rural family physicians and insurance plan, as one of the major reforms of the health system implemented since 2005, need to be supplied with the resources and facilities required. In this regard, the present study was carried out to evaluate the quantity of essential resources and requirements provided in family physician program in the northern provinces of Iran. Material and Methods: This cross-sectional study was conducted in the second half of 1391 25% of centers implementing rural insurance and family physician programs in three provinces of Golestan, Mazandaran and Gilan -a total of 139 centers out of 552 centers performing the program were selected through systematic random sampling as the study samples. A researcher-made questionnaire was used for data collection, the validity and reliability of which were confirmed. Data were analyzed by tests of chi-square and Kruskal- Wallis Results: Out of the 139 centers studied, 48 centers (34.2%) had public pharmacies, 62 centers (44.6%) had private pharmacies, among which 72 centers had a total of 279 items of drugs. 133 centers (96%) had injection and dressing room facilities, 84 centers (60%) had oral health unit (30.2%) and 42 centers (30.2%) had an active lab unit 138 centers (99%) were found with at least one normal-operating computer, 135 centers (97%) with at least one oxygen capsule, 131 centers (94 percent) with emergency tralee and at least one intact tracheal tube, 129 centers (93%) with at least one intact four (dry heat), 92 centers (66%) with a normal ECG. Out of the 188 family physicians working in the study centers, 140 physicians (74%) had separate rooms (clinics), 165 physicians (88%) had a normal desk, 144 physicians (76%) had a normal otoscope, 71 physicians (38%) had an intact ophthalmoscope and 131 physicians (66%) had a normal-operating computer. There was a significant difference in the levels of some resources and facilities provided in the northern provinces of Iran (p<0/05) Conclusion: The study findings confirmed that enough facilities and equipments are not provided in a number of centers implementing the program, and effective measures should be taken to supply these items.