External factors influencing the work of family physicians in Armenia: a qualitative research study

Abstract

The National Health policy of the Republic of Armenia for 2004-2015 stresses the importance of Primary Health Care (PHC) development and emphasizes the institution of Family Medicine (FM) as a main PHC provider. FM is the medical specialty that provides continuing, comprehensive health care for an individual and a family. Physicians were retrained and started to work in such settings of Armenia as rural ambulatories, Family Care Center (FCC) in Gyumri, etc. Within the framework of the Armenia Social Transition Program (ASTP) FM departments were established in urban polyclinics of pilot sites. Doctors who completed the training in FM started to work in these departments. The purpose of the present study was to reveal the knowledge of Family Physicians (FP) about the legislative field of FM in the RA, and reimbursement mechanisms; their perceptions of relationships between FP and narrow specialists (NS) and patient attitudes towards family medicine and FP; and suggestions of FP concerning ways of improvement and changes in abovementioned areas. In-depth interview guide was used. Study was carried out among certified FPs occupying the position of FP. Thirty-one FPs from Ararat, Shirak, Lori marzes and the city of Yerevan participated in the study. Respondents answered that the current legislative field of FM is imperfect; reimbursement of the labor of FP is insufficient; NS – FP relationships are problematic; and patients' attitude towards FP and institution of FM (by perceptions of FP) in general is positive with some exceptions. Respondents also made such suggestions for changes as: improvement of legislative field of FM – clearer definition of FP scope of work; increase of per capita payments; provision of trainings in narrow specialties; improvement of laboratory – diagnostic capacity of FP practices etc. Results of the study go in line with other studies that were carried out in several countries of FSU. However there are certain differences that are connected with concrete historical situation in the country. Recommendations: educational campaign among FP to improve their knowledge of legislation; define clearly the scope of work of FP by the law with provision of wide participation of FP in decision-making process, branding and image building to improve the status of family physicians; establish monitoring and evaluation mechanisms that will allow enough flexibility for policy makers to reflect adequately shortcomings in the process of family medicine establishment.