|Background: The present study investigated the possibility of implementing quaternary prevention using family physicians in Iran’s health system.|
Methods: The present study was a qualitative study conducted with a grounded theory approach. Thirty-four participants, who were faculty members and experts, were selected by purposive and theoretical sampling using the snowball approach until data saturation. The data were collected through semi-structured interviews. The interviews took 20 to 60 minutes each, based on the circumstances and the participant’s willingness to continue. Data analysis was performed along with data collection by Strauss and Corbin’s constant comparative analysis. Using Lincoln and Guba criteria, the accuracy and strength of this research were confirmed.
Results: The dimensions model of quaternary prevention using family physicians in Iran were specified in six axial categories: causal conditions, contextual conditions, intervening conditions, strategies, and outcomes. The phenomenon was the promotion of quaternary prevention, including defining quaternary prevention, family physicians, the philosophy of quaternary prevention, and the philosophy of family physicians—social, political, economic, cultural, and technological conditions as contextual and intervening conditions. Causal conditions were doctors, patients, and the health system. Two main strategies were intersectoral administration and intra-sectoral governance. Outcomes included efficiency and the provision of security for society.
Conclusion: For quaternary prevention promotion and to offer ethically and rationally acceptable scientific services to the people, it is necessary to promote the position of the family physician as the primary implementer of quaternary prevention in healthcare. Getting to the PHC umbrella is achieved through intra-sectoral leadership and inter-sectoral governance, which supports the patient and reduces unnecessary care.
- Nekoee Moghaddam M, Amiresmaili M, MA. B. Health Economics Fundamentals and Flow of Funds. ed. n, editor. Tehran: Parsa; 2010.
- Rahati M, Fakharian E, Yousefianarani A, Omidvar A, Nazemi-bidgoli Z. Treatment Cost of COVID-19 in Hospitals affiliated to Kashan University of Medical Sciences:Time-Driven Activity-Based Costing. MSHSJ. 2021;5(4):306-17. doi: 18502/mshsj.v5i4.5808
- Khosravi S. Quaternary prevention education, an essential requirement. SDME. 2016;13(4):432-3.
- Voorhoeve A, Tan-Torres Edejer T, Kapiriri L, Norheim OF, Snowden J, Basenya O, et al. Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult Cases. HS&R. 2017;3(4):301-12. doi: 10.1080/23288604.2017.1324938
- Jamoulle M, Roland M. Quaternary prevention. InHong-Kong Wonca Classification Committee 1995 Jun 6.
- Pandve HT. Quaternary prevention: need of the hour. J. family med. prim. care. 2014;3(4):309-10. PMID: 25657934. PMCID: PMC4311333.
- Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J Health Policy Manag. 2015;4(2):61-4. doi: 15171/ijhpm.2015.24. PMID: 25674569. PMCID: PMC4322627.
- Martins C, Godycki-Cwirko M, Heleno B, Brodersen J. Quaternary prevention: reviewing the concept. Eur J Gen Pract. 2018;24(1):106-11. doi: 1080/13814788.2017.1422177. PMID: 29384397. PMCID: PMC5795741.
- Alber K, Kuehlein T, Schedlbauer A, Schaffer S. Medical overuse and quaternary prevention in primary care – A qualitative study with general practitioners. BMC Fam Pract. 2017;18(1):99. doi: 1186/s12875-017-0667-4. PMID: 29216841. PMCID: PMC5721694.
- Dehnavieh R, Seifaddini R, Zahedi MJ, Mehrolhassani MH, Noori Hekmat S, Ansari M, et al. Identifying the Challenges of Kerman University of Medical Sciences Iran in Achieving the Goals of Irans Health Scientific Road Map and Providing Strategies. SDME. 2013;10(2):232-46.
- Moshiri E, Takian A, Rashidian A, Kabir MJ. Expediency and Coincidence in the Formation of Family Physician and Universal Rural Health Insurance in Iran . Hakim Res J. 2013;15(4):288-99.
- Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoulle M. Quaternary prevention: a task of the general practitioner. J Prim Care. 2010;18.
- Sepehri B, Ghaffari R, Jeddian A, Salek F, Emrouzi R, Ghaffarifar S, et al. A Descriptive-Comparative Study of Implementation and Performance of Family Physician Program in Iran and Selected Countries. Iran J Public Health . 2020;49(3): :539-548. doi:18502/ijph.v49i3.3151.
- Horvath K, Siebenhofer A. The Choosing Wisely Initiative: A critical analysis with a special focus on primary care. ZEFQ. 2017;129:31-6. doi: 1016/j.zefq.2017.10.015.
- Gutkin C, Director E. Opportunities in the specialty of family medicine. Can Fam Physician. 2008;54(2):320-.
- Morgan DJ, Brownlee S, Leppin AL, Kressin N, Dhruva SS, Levin L, et al. Setting a research agenda for medical overuse. BMJ. 2015;351:h4534. doi: 10.1136/bmj.h4534. PMID: 26306661. PMCID: PMC4563792.
- Strauss A, Corbin J. Basics of qualitative research techniques: Citeseer; 1998.
- Eddy BP, Fife STJFR. Active husband involvement during pregnancy: A grounded theory. Fam. Relat. 2021;70(4):1222-37. doi: 1111/fare.12486.
- Reagan L, Nowlin SY, Birdsall SB, Gabbay J, Vorderstrasse A, Johnson C, et al. Integrative review of recruitment of research participants through Facebook. Nurs. Res. 2019;68(6):423-32. doi: 10.1097/NNR.0000000000000385.
- Parker C, Scott S, Geddes AJSrmf. Snowball sampling. 2019.
- Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA: Sage Publications.; 1985.
- Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches: Sage publications; 2016.
- Zamani AF, Niknami S, Mohammadi I, Montazeri A, Ahmadi FE, Ghofranipour F, et al. High risk behaviors among Iranian motorcyclists: a qualitative study. Payesh. 2010;9(3):269-278. URL: http://payeshjournal.ir/article-1-565-en.html.
- Powell AA, Bloomfield HE, Burgess DJ, Wilt TJ, Partin M. A conceptual framework for understanding and reducing overuse by primary care providers. Med. Care Res. Rev.2013;70(5):451-72. doi: 10.1177/1077558713496166.
- Mehtarpour M, Tajvar MJH-BR. Policy Analysis of Family Physician Plan and Referral System in Iran Using Policy Analysis Triangle Framework. Health_Based Research 2018;4(1):31-49. URL: http://hbrj.kmu.ac.ir/article-1-251-en.html.
- Park JE. Text book preventive and social medicine. 1989.
- Mahdavi J, Simbar M, Amir Aliakbari S, Alavi Majd H. Correlation between quality of care and clients' satisfaction in family planning units of healthcare centers affiliated with Shahid Beheshti University of Medical Sciences and Health services. Adv Nurs Midwifery. 2010;19(69):31-9. Available from: https://journals.sbmu.ac.ir/en-jnm/article/view/1787
- Organization WH. Primary health care: report of the International Conference on primary health care, Alma-Ata, USSR, 6-12 September 1978: World Health Organization; 1978.
- Zwarenstein M, Barron P, Tollman S, Crisp N, Frankish J, Toms I, et al. Primary health care depends on the district health system. 1993. p. 558.
- Baygi MZ, Seyedin HJIjoph. Imbalance between goals and organizational structure in primary health care in Iran-a systematic review. Iran J Public Health.2013; 42(7): 665–672. PMID: 24427745. PMCID: PMC3881612.
- Lankarani KB, Alavian SM, Peymani P. Health in the Islamic Republic of Iran, challenges and progresses. Med J Islam Repub Iran.2013 Feb; 27(1): 42–49. PMID: 23479501. PMCID: PMC3592943.
- Kumar R. Revitalize primary health care for confronting current public health challenges. Indian J Community Med.2008 Jan; 33(1): 1–2. doi: 4103/0970-0218.39233. PMID: 19966986. PMCID: PMC2782219.
- TorabiArdakani A, Hosseini S, Oroomiehei N, Mirzaei S. Study perception, knowledge and expectations from population and physicians points of view about implementation of family physician program: a case study in Shiraz. J. Med. Counc. Islam. Rep. Iran. 2015;33(2):147-55. em Persa Moderno | IMEMR | ID: emr-179343.
- Kabir MJ, Ashrafian Amiri H, Hassanzadeh-Rostami Z, Momtahen R, Zafarmand R, Nasrollahpour Shirvani SD. Achievements and Challenges in Implementing Urban Family Physician Program in Iran: Viewpoint of Managers and Executives . Manage Strat Health Syst. 2019;4(2):148-59. doi: 18502/mshsj.v4i2.1410.
- Pausch M, Schedlbauer A, Weiss M, Kuehlein T, Hueber S. Is it really always only the others who are to blame? GP’s view on medical overuse. A questionnaire study. Plos one. 2020;15(1):e0227457. doi: 10.1371/journal.pone.0227457.
- Rashidian A, Yousefi NR, Azemikhah A, Heydarzadeh M, Changizi N, MAHTA BF, et al. Perinatal care regionalization and geographical distribution model in the Islamic Republic of Iran. Hakim Res J. 2008; 11(2):1–11. URL: http://hakim.tums.ac.ir/article-1-439-fa.html
- Rashidian A, Omidvari A, Vali Y, Mortaz S, Yousefi-Nooraie R, Jafari M, et al. The effectiveness of regionalization of perinatal care services-a systematic review. Public Health. 2014;128(10):872-85. doi: 10.1016/j.puhe.2014.08.005.