Barriers and facilitators for implementation of family medicine–oriented model of primary care in B B osnia and H H erzegovina: A A qualitative study

摘要

Summary Introduction A health care system reform and the development of a new primary health care model, oriented toward family medicine, have been implemented to improve the quality of health services in Bosnia and Herzegovina. The primary objective of this article was to identify factors that hinder or facilitate implementation of family medicine in the country. Methods The qualitative study was performed by focus groups sessions, involving 54 family physicians, selected from 15 geographical regions in Bosnia and Herzegovina. Consolidated criteria for conducting and reporting qualitative research were used for conceptualizing the study. The discussions were transcribed verbatim and content analyzed. Results Family medicine is found to be partially implemented, mainly because of weak collective action of stakeholders, different degrees of consolidation and lack of coordination between primary and secondary health care. Physicians' workload, perception of financial pressure, and negative aspect of contracting were identified as barriers to implementation as well. Focused patient education or advertising campaigns are seen as the important activities assisting the promotion of family medicine. Conclusion Although many steps forward have been made in the reform and implementation of the family medicine–oriented model of primary health care in Bosnia and Herzegovina, our results revealed that there is still much room for improvement. Particular attention should be paid to establishing common goals and reaching mutual understanding with key stakeholders.