Document Type : Original Articles



Background:Patient satisfaction is an integral component of service quality and obtaining feedback from patients about the quality of primary health care is the best way to extend more patient-centered goals to health care delivery. This study was conducted to measure the level of client satisfaction with Urban Family Physician and Referral System (UFPARS) programMethods: This repeated cross-sectional study was done in Fars province, South of Iran, at two sections. Totally, 5901 patients in two sections (6 and 24 months after the UFPARS startup) were selected using multi-stage random sampling. The participants answered a self-administrated questionnaire. We measured the client satisfaction using 5-point Likert-scaled score and combined the questions; for each component of UFPARS, 6 satisfaction dimensions were made. We compared the participants’ level of satisfaction in two parts, using t-test.Results: Reliability was acceptable, and equal to 85% or more in all domains .In all components of UFPARS, the mean client satisfaction score was higher than 3 out of 5. The lowest client satisfaction scores were seen in the outpatient services. In three components of UFPARS including enrolment, family medicine and para-clinics, the mean satisfaction scores significantly decreased (P<0.001) between the two sections. But other components showed no significant change. Conclusions:The level of satisfaction with UFPARS in Fars province was shown to be relatively medium to high. Low client satisfaction between the two sections could be a bad sign and we recommend that the problems should be tackled gradually. Although family physician program in Iran has some limitations, implementing this plan step by step can lead to a medical reform in Iran. We can develop better programs based on the comments from service recipients, and prompt the project and some program processes.


  1. Al-Gelban, K.S., Y.M. Al-Khaldi, and M.M. Diab, Family Medicine: A Practical Approach. 2010: Trafford Publishing.
  2. Huber, M. and E. Orosz, Health expenditure trends in OECD countries, 1990-2001. Health care financing review, 2002. 25(1): p. 1-22.
  3. Stange, K.C., et al., The value of a family physician. The Journal of family practice, 1998. 46(5): p. 363-368.
  4. Shadpour, K., Primary health care networks in the Islamic Republic of Iran. 2000.
  5. MIRAHMADIZADEH, A., et al., 20-Year Period (1990-2009) of Infant Mortality Rate in Rural Area of Fars Province, South Iran: A Time-Series Study. 2012.
  6. Takian, A., L. Doshmangir, and A. Rashidian, Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. Family practice, 2013: p. cmt025.
  7. LeBaron, S.W. and S.H. Schultz, Family medicine in Iran: the birth of a new specialty. FAMILY MEDICINE-KANSAS CITY-, 2005. 37(7): p. 502.
  8. Takian, A., A. Rashidian, and M.J. Kabir, Expediency and coincidence in re-engineering a health system: an interpretive approach to formation of family medicine in Iran. Health policy and planning, 2011. 26(2): p. 163-173.
  9. Ashrafi Z, E.H., Sarafha J, The relationship between hemodialysis adequacy and quality of life and spiritual wellbeing in hemodialysis patients. Journal of Clinical Nursing and Midwifery, 2014. 3(3): p. 44-51 [In Persian].
  10. Sans-Corrales, M., et al., Family medicine attributes related to satisfaction, health and costs. Family practice, 2006. 23(3): p. 308-316.
  11. Aharony, L. and S. Strasser, Patient satisfaction: what we know about and what we still need to explore. Medical care review, 1993. 50(1): p. 49-79.
  12. Jackson, J.L., J. Chamberlin, and K. Kroenke, Predictors of patient satisfaction. Social science & medicine, 2001. 52(4): p. 609-620.
  13. Hatam, N., et al., Cost efficiency of the family physician plan in fars province, southern iran. Iranian journal of medical sciences, 2012. 37(4): p. 253.
  14. Howard, M., et al., Patient satisfaction with care for urgent health problems: a survey of family practice patients. The Annals of Family Medicine, 2007. 5(5): p. 419-424.
  15. Kahan, B. and M. Goodstadt, Continuous quality improvement and health promotion: can CQI lead to better outcomes? Health Promotion International, 1999. 14(1): p. 83-91.
  16. Hjortdahl, P. and E. Laerum, Continuity of care in general practice: effect on patient satisfaction. Bmj, 1992. 304(6837): p. 1287-1290.
  17. Blankfield, R.P., et al., Continuity of care in a family practice residency program. Impact on physician satisfaction. The Journal of family practice, 1990. 31(1): p. 69-73.
  18. Hutchison, B., et al., Patient satisfaction and quality of care in walk-in clinics, family practices and emergency departments: the Ontario Walk-In Clinic Study. Canadian Medical Association Journal, 2003. 168(8): p. 977-983.
  19. Aldana, J.M., H. Piechulek, and A. Al-Sabir, Client satisfaction and quality of health care in rural Bangladesh. Bulletin of the World Health Organization, 2001. 79(6): p. 512-517.
  20. Borhaninejad, V., et al., Satisfaction of Service Recipients of Family Physician Program in Kerman, 2011. Journal of Health and Development, 2015. 4(1): p. 1-9.
  21. Laferriere, R., Client satisfaction with home health care nursing. Journal of Community Health Nursing, 1993. 10(2): p. 67-76.
  22. NAKHAEI, A.N., et al., Assessing the Cost-effectiveness of contraceptive methods in Shiraz. 2001.
  23. Heyland, D.K., et al., Family satisfaction with care in the intensive care unit: Results of a multiple center study*. Critical care medicine, 2002. 30(7): p. 1413-1418.
  24. Yaman, H. and M. Ozen, Satisfaction with family medicine training in Turkey: survey of residents. Croatian medical journal, 2002. 43(1): p. 54-57.
  25. Kersnik, J., An evaluation of patient satisfaction with family practice care in Slovenia. International Journal for Quality in Health Care, 2000. 12(2): p. 143-147.
  26. Fararouie, M., et al., Satisfaction levels with family physician services: a pilot national health programme in the Islamic Republic of Iran. Eastern Mediterranean Health Journal, 2017. 23(4): p. 267.
  27. Declaration of International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. Geneva: World Health Organization, 1978.