Introduction
The healthcare providers are always seeking improvements in the health care delivery system to achieve better results. A family physician can refer patients to a specialist to maintain and promote health, but s/he is responsible for continuing delivery of healthcare services. A group of people with knowledge and skills in the field of health services who provide healthcare services to the community including health workers, technicians and experts in the paramedical profession help family physicians [1]. There are few studies on evaluating the efficacy of urban and rural Family Physician Program (FPP) in Iran. Having information about its efficacy can provide the basis for the right decision and policy regarding the continuation or modification of this program [2]. This study aims to evaluate the efficacy of FPP in providing primary care in Talesh, Iran.
Methods 
This is a cross-sectional study conducted on 50 physicians working in Talesh city as family physician in 2020, and 384 patients referred to the comprehensive health service centers of Talesh city. The census method was used for selecting physicians, and a simple random method was used for selecting patients. The data collection tool was a two-part questionnaire, one part for physician with 68 items and other part for patients with 29 items in the form of closed questions rated on a 4-point Likert scale. Its content validity was assessed by Lawshe method, and Cronbach’s alpha was used to determine its reliability. The validity was obtained 0.982 and the alpha coefficient was reported 0.713 which were acceptable. A one-sample t-test was used to examine the research hypotheses in IBM SPSS v.20 software.
Results 
According to t-test results (Table 1), access to services (P <0.001) and coordination of care (P= 0.028) in the FPP were significantly at a lower level according to physicians, while the continuity of care (P<0.001) and comprehensiveness of care (P=0.003) were significantly at a higher level.


Furthermore, access to finance and location (P<0.001) was significantly at a lower level according to patients, while access to educational services (P<0.001), quality of services (P<0.001), and continuity of health and medical care (P<0.001) in the FPP were significantly at a higher level.
Discussion 
The urban FFP in Talesh city has increased the availability of care services which, despite the average number of covered population, was effective in terms of the number of visits to family physicians (high number of visits). Access to services, continuity of care, coordination of care, and comprehensiveness of care were appropriate according to physicians, while access to finance and location, access to educational services, quality of services, and continuity of health and medical care were appropriate according to patients. 
Although the implementation of FFP was successful in most areas, but there were some challenges in their execution. Therefore, it is better to find the root causes of these challenges before expanding the program to other cities. Evaluating and determining the degree of compliance of the program with the specified goals and showing its strengths and weaknesses to managers and executives can provide them a clearer picture of how activities are carrying out. The relevance and progress of the program should be ensured and the problems should be minimized. Therefore, reviewing the duties of the healthcare team, paying more attention to primary health care, designing appropriate mechanisms for collecting and maintaining statistics and reports of performance, monitoring and quality control of services, along with mechanizing household files and conducting similar studies to determine the quality of services through interviews are recommended. Policymakers and managers should increase the quality of services for patients by maintaining and developing access to primary care and educational services to increase their satisfaction.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences (Code: IR.SBMU.SME.REC.1399.087). All procedures were according to ethical guidelines. Participants were allowed to leave the study at any time. They were informed about the study process and were assured of the confidentiality of their information.

Funding
The study did not receive any funding from public, commercial, or nonprofit organizations.

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
The authors would like to thank the officials of Shahid Beheshti University of Medical Sciences and comprehensive health centers in Talesh city.


References

1. Khayati F, Saberi MH. [Primary health care (Phc) an ever strategy for health equity extension (Persian)]. Journal of Health Administration. 2009; 12(35):33-40. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=143594
2. Kazemian M, Kavian Telluri F, Mirdarotan SA. [Assessment unnecessary costs in family physicians with comprehensive approach to care (cuts in family physician program (Persian)]. Journal of Healthcare Management. 2017; 7(3):45-54. http://research.shahed.ac.ir/WSR/SiteData/PaperFiles/137268_15251298408.pdf
3. Sabet Sarvestani R, Najafi Kalyani M, Alizadeh F, Askari A, Ronaghy H, Bahramali E. Challenges of family physician program in urban areas: A qualitative research. Archives of Iranian Medicine. 2017; 20(7):446-51. [PMID]
4. Kazemian M, Kavian Tellouri F. [Assessment of access to health care in family physician program with a comprehensive health care approach (Persian)]. Health Information Management.  2016; 13(4):304-9. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=529679
5. Bayati A, Ghanbari F, Maleki A, Shamsi M, Jafari M. [Effective factors influencing family medicine programme dyanmics with regard to viewpoints of involved physicians: A qualitative study (Persian)]. Daneshvar Medicine. 2015; 22(117):39-48. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=456758
6. Ebrahimipour H, Hosseini SE, Mahmoudian P, Vafaei Najjar A, Zomordi Niat H, Haghighi H. [Evaluating the performance of family physician in rural health centers, Bardaskan, 2013 (Persian)]. Bayhaq. 2015; 20(2):26-34. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=525583
7. Abedi G, Esmaeili Seraji Z, Mahmoodi G, Jahani M, Abbasi M. Evaluating the implementation of family physician program in urban and rural areas of Mazandaran province with a process approach. Journal of Babol University of Medical Sciences. 2020; 22(1):126-34. http://jbums.org/article-1-8889-en.html
8. Kohpeima Jahromi V, Dehnavieh R, Mehrolhasani M. [Evaluation of urban family physician program in Iran using primary care evaluation tool (Persian)]. Iranian Journal of Epidemiology. 2018; 13:134-44. http://irje.tums.ac.ir/article-1-5983-fa.html
9. de Miranda Chagas SV, Kanaan S, Chung Kang H, Cagy M, de Abreu RE, da Silva LA, et al. Environmental factors, familial aggregation and heritability of total cholesterol, low density lipoprotein-cholesterol and high density lipoprotein-cholesterol in a Brazilian population assisted by the Family Doctor Program. Public Health. 2011; 125(6):329-37. [PMID]
10. Jannati A, Maleki M, Gholizade M, Narimani MR, Vakeli S. [Assessing the strengths & weaknesses of family physician program (Persian)]. Knowledge & Health. 2010; 4(4):39-43.  https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=180274
11. Dehnavieh R, Movahed E, Rahimi H, Zareipour MA, Jadgal KM, Alizadeh S, et al. Evaluation of the referral system in Iran’s rural family physician program; A study of Jiroft University of Medical Sciences. Electronic Physician. 2017; 9(4):4225-30.  [PMID]
12. Fardid M, Jafari M, Moghaddam AV, Ravaghi H. Challenges and strengths of implementing urban family physician program in Fars Province, Iran. Journal of Education and Health Promotion. 2019; 8:36. [PMID]
13. Kersnik J. Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country. Health Policy. 2001; 57(2):155-64. [DOI:10.1016/S0168-8510(01)00118-X]