METHOD: This study developed a conceptual framework based on the "Future Triangle" (FT) and the "Health Systems Governance" (HSG) models. This framework delineates the characteristics associated with the 'pulls on the future' for desired and intelligent PHC, as identified by a panel of experts. Additionally, the 'weights of the past'-referring to the challenges faced by Iran's PHC system in utilizing AI-, and the 'push of the present'-which captures the impacts of AI implementation in global primary care settings-were extracted through a review of relevant literature. The integration and analysis of the collected evidence facilitated the formulation of a range of potential future scenarios, including both optimistic and pessimistic scenarios.

FINDINGS: The interaction between the three elements of the FT will shape the future states of Iran's PHC, whether optimistic or pessimistic. Building an optimistic scenario for an AI-driven PHC system necessitates addressing past challenges, including deficiencies in the referral and family doctor systems, the absence of evidence-based decision-making, neglect of essential community health needs, fragmented service delivery, high provider workload, and inadequate follow-up on the health status of service recipients. Consideration must also be given to the current impacts of AI in primary care, including comprehensive, coordinated, and need-based service delivery with systematic and integrated monitoring, quality improvement, early disease prevention, precise diagnosis, and effective treatment. Furthermore, fostering a shared vision among stakeholders by defining and advocating for a future system characterized by foresight, resilience, agility, adaptability, and collaboration is essential.