RESUMEN
Background: The family physician program, as one of the core arms of health care systems, has faced various implementation challenges around the world. Experiences in the implementation of family physician program can be helpful for nations that seek to apply for similar programs. The aim of this study is to systematically review the implementation challenges of family physician program across the world. Methods: A systematic search was conducted from January 2000 to February 2022 across scientific databases of Embase, MEDLINE, Web of Science, Scopus, CINAHL, EBSCO, and Google Scholar. The Framework approach was used to analyze the selected studies. The quality of the included studies was evaluated using the McMaster Critical Review Form for qualitative studies. Results: 35 studies upon the study inclusion criteria were included. Based on the Six Building Blocks frame, seven themes and 21 subthemes were developed as the implementation challenges of family physician program. 1) Governance: policy guidance, intelligence, coalition, regulation, system design, and accountability; 2) Financing: financing and payment system; 3) Health workforce: education, research, recruitment and motivation opportunities; 4) Service delivery: management of health services, service package, referral system, continuity of care; 5) Health information systems: production and evaluating the health information system; 6) Availability: provision basic health services, maintenance of facilities; and 7) Cultural considerations: behavior and social determinants of health. Conclusion: Scientific governance, financing, and payment mechanisms, workforce empowerment, designing a strong health information system, and providing access to services with cultural considerations can result in the successful implementation of the family physician program in communities.
RESUMEN
Background: Burnout is one of the main factors in reducing the performance quality among hospital staff. Appropriate interventions can reduce burnout among physicians and nurses and result in promotion of the quality of services provided at hospitals. The present study aimed to provide a more comprehensive understanding of the interventions on burnout reduction among hospital physicians and nurses. Methods: Studies were searched from January 2000 to June 2017 in PubMed, Embase, Scopus, Cochrane, and Web of Science. Randomized clinical trials (RCTs) and pretest-posttest studies that had interventions to reduce the burnout of physicians and nurses were included. However, studies conducted on medical and nursing students and nonmedical providers or beyond hospitals were excluded. Results: Based on the study inclusion criteria, 12 RCTs and 6 pretest-posttest studies were included in the review. Most of the included studies were from Netherlands, the United States, and England. The interventions included team-based program, EMH-approach, and coping and communication skills training. Most of the interventions had a positive effect on burnout reduction. Nevertheless, some studies had no significant impact. Conclusion: The results showed that the most interventions used to improve burnout were improving communication skills, teamwork, participatory programs, and psychological interventions (Yoga, meditation, and mindfulness). The impact of these interventions can increase mental health in the long term. Burnout is a complicated problem and should be treated by combining interventions.