Behzad Damari, Abbas Vosough Moghaddam, Narges Rostami Gooran, Mohammad Javad Kabir,
Volume 14, Issue 2 (9-2016)
Abstract
Background and Aim: The most important healthcare reform in Iran during the last decade has been implementation of the family physician and referral system in rural areas and small towns with a population of less than 20000. The program was expanded (as a pilot project), with small modifications, to rural areas of 2 provinces, namely, Fars and Mazandaran. This study was initiated to assess the achievements, challenges and weak points of the pilot project before deciding to expand it to other provinces.
Materials and Methods: This qualitative study was conducted in winter 2013. Data were collected using document desk reviews, semi-structured interviews with key informants, and focus-group discussions. Relevant family health policy makers, managers and service providers in the two provinces were invited to the meetings. The data were analyzed and categorized based on the content analysis method.
Results: The data showed that the family physician program is faced with several challenges regarding objectives; stewardship; service providing; and human, financial and information resources. It is to be noted, however, that the program has had achievements such as increased access to services, increased coordination among insurance organizations and medical universities, and organizing and managing health files.
Conclusion: The program should not be expanded to other provinces before redesigning in order to assure that it is more complete and comprehensive and create commitment and adequate guarantee among stakeholders. It is essential that all the stakeholders agree on general and specific objectives of a 5-year program and prepare an operational plan for each specific objective.
Mohammad Javad Kabir, Alireza Haydari, Mohammad Reza Honarvar, Zahra Khatirnameni, Abbas Badakhshan, Narges Rafiei, Sakine Beygom Kazemi, Seyed Mehdi Sedaghat, Mehrdad Kamangari, Masoumeh Gholami, Maryam Eri, Mansoureh Lotfi,
Volume 19, Issue 2 (9-2021)
Abstract
Background and Aim: The World Health Organization considers the implementation of the referral system to be a key step in improving the quality of services in health care systems. The purpose of this study was to explain the executive challenges of the electronic referral system in Golestan Province, Iran.
Materials and Methods: A qualitative study was conducted in Golestan Province, Iran in 2019 with a content analysis approach. The participants were family physicians, specialists, university staff managers, responsible health officers in the Offices of Deputy Ministers of Health, the General Directorate of Health Insurance, Department of Information Technology, Rural Health Network managers, health network managers and patients selected purposefully. Data were collected through semi-structured interviews and analyzed using the content analysis method.
Results: The main challenges of giving appointments to patients included the lack of time of family physicians, the irregular presence of specialists, difficulty in getting an appointment, and reverse referrals. As regards referrals and waiting times, the main challenges were found to be the lack of sufficient admissions following cancellation of the health insurance contract with the private sector, the delay of physicians in attending the health centers, long waiting times to be visited, and writing the feedback by the physicians. In addition, the main challenges of the visits and diagnosis included the short visiting times, the higher quality of the specialists' visits in the private sector, and the lack of clear guidelines. Finally, the main challenges as regards giving feedback were the reluctance and noncommitment of some specialists to provide feedback, as well as the low quality and lack of usability of the feedbacks given.
Conclusion: Based on the findings of this study, the following actions and measures may help improve the current situation as regards the current referral systems: allocating sustainable resources; allocating financial credits; designing and implementing a reward and punishment system; reforming the queuing system; empowering medical students; and equipping specialists with electronic pens for giving written feedback.
Mohammad Javad Kabir, Alireza Heidari, Nahid Jafari, Zahra Khatirnamani, Mohammad Reza Honarvar, Naser Behnampour,
Volume 19, Issue 4 (3-2022)
Abstract
Background and Aim: Using a proper method to prioritize and develop a basic health services package is a serious challenge. This study was conducted to design a process for developing and revising a basic health services package in Iran.
Materials and Methods: A combined study of quantitative and qualitative methods was used in this study. The qualitative part was conducted through holding 25 in-depth individual interviews and two focus group discussions with experts from the Ministry of Health and Medical Education, Program and Budget Organization and insurance organizations, while the quantitative part was a descriptive cross-sectional study including 277 experts using a valid and reliable questionnaire. Data analysis of the qualitative and quantitative parts was done using a content analysis and the SPSS-23 software, respectively.
Results: The process of developing a basic health services package includes 4 steps, namely, explaining the list of services in the basic health services package, extracting the criteria for including services in the service package, prioritizing the criteria for including services in the package, and comparing services with priority criteria. In the prioritization stage, disease burden criteria, target groups and community needs were found to have the highest means and recognized as the most important criteria.
Conclusion: The process designed in this study for developing and revising a basic health services package provides policymakers with the required scientific evidence by emphasizing the introduction and continuity of services that have higher priorities and the elimination of services that have lower priorities.
