Pay-for-performance challenges in family physician program

OBJECTIVE

This study was conducted to investigate the challenges faced in the implementation of the pay-for-performance system in Iran's family physician program.

STUDY DESIGN

Qualitative.

PLACE AND DURATION OF STUDY

The study was conducted with 32 key informants at the family physician program at the Tabriz University of Medical Sciences between May 2018 and June 2018. Method: This is a qualitative study. A purposeful sampling method was used with only one inclusion criterion for participants: five years of experience in the family physician program. The researchers conducted 17 individual and group non-structured interviews and examined participants' perspectives on the challenges faced in the implementation of the pay-for-performance system in the family physician program. Content analysis was conducted on the obtained data.

RESULTS

This study identified 7 themes, 14 sub-themes, and 46 items related to the challenges in the implementation of pay-for-performance systems in Iran's family physician program. The main themes are: workload, training, program cultivation, payment, assessment and monitoring, information management, and level of authority. Other sub-challenges were also identified.

CONCLUSION

The study results demonstrate some notable challenges faced in the implementation of the pay-for-performance system. This information can be helpful to managers and policymakers.

Changes in cardiovascular risk factors and inflammatory markers of young, healthy, men after six weeks of moderate or high intensity resistance training

AIM

The present study was done to see the Influence of moderate and severe intensity resistance exercises on some cardiovascular risk factors.

METHODS

Thirty young healthy male were randomly divided in to two types of intervention [MI: moderate intensity (45-55% 1RM), HI: high intensity (80-90% 1RM)] and one Control (no intervention) groups. Subjects in MI and HI intervention groups underwent 3 supervised resistance-training sessions per week for six weeks. IL-1, IL-6, HS-CRP, fibrinogen, ApoB, ApoA, LDL, HDL, ApoB/ApoA ratio, Lipoprotein Lipase (LPL), TG, cholesterol, cholesterol/HDL ratio, body mass index (BMI), systolic pressure (Ps), diastolic pressure (Pd) and waist/hip ratio (WHR) before and after resistance training period were assessed.

RESULTS

IL-1, IL-6, ApoB, ApoA, LPL, TG levels, ApoB/ApoA ratio, Ps, Pd, WHR, BMI and CPR did not change significantly in trained groups. In post test HS-CRP was significantly lower in trained groups in comparison to control group (P≤0.05). LDL, Cholesterol and cholesterol/HDL ratio decreased significantly in trained groups (P≤0.05). In the HI group plasma level of fibrinogen were decreased while HDL level were increased (P≤0.05).

CONCLUSION

Resistance training for 6 weeks in young healthy males evoked beneficial effects regarding some inflammatory and cardiovascular risk markers. Higher-intensity resistance training was more effective in reducing plasma fibrinogen and increasing plasma HDL levels than moderate resistance training.