title: The influence of health care reforms on work-related attitudes and anxieties of primary care physicians.
abstract: OBJECTIVE
  Reforming primary healthcare services has been the core agenda of health policies of the developing countries in accordance with the recommendations of the World Health Organization. In Turkey, the Transformation in Health Project brings along many changes in all aspects of primary health care services, such as organization and financing of services and employment of healthcare workers. The aim of this study was to determine the effects of health care reforms on primary care physicians working in Izmir.
  
  
  METHODS
  A questionnaire and an anxiety scale were applied to a sample of primary care physicians in Izmir in 2007 and 2009. The questionnaire consisted of questions about demographic characteristics and expressions regarding the effect of reforms on physicians organized on a 7-point Likert scale. The State-Trait Anxiety Inventory was used as an anxiety scale.
  
  
  RESULTS
  The mean scores given by physicians working in family health centers were significantly higher than those of physicians working in public institutions. The score for "My responsibilities are well defined" statement given by physicians working in family health centers decreased significantly in the second survey. The necessity of reforms in the health care system and primary care health services was more significantly favored by physicians working in family health centers. Persistent anxiety of physicians working in community health centers was significantly higher in both surveys.
  
  
  CONCLUSIONS
  Our study showed that health reforms had a substantial impact on work-related attitudes and anxieties of primary care physicians, and this effect was maintained over time.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Dokuz Eylul University, 35340 Inciralti-Izmir, Turkey. tolga.gunvar@deu.edu.tr
authors.forename: Tolga
authors.initials: T
authors.lastname: Günvar
authors.forename: Mehtap
authors.initials: M
authors.lastname: Kartal
authors.forename: Aynur
authors.initials: A
authors.lastname: Toksun
authors.forename: Beyazıt
authors.initials: B
authors.lastname: Yemez
authors.forename: Dilek
authors.initials: D
authors.lastname: Güldal
mesh_terms: D000328:Adult; D000367:Age Factors; D001007:Anxiety / Q000523:psychology*; D001291:Attitude of Health Personnel; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000523:psychology*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014421:Turkey