Referral system in rural Iran: improvement proposals

Abstract

Because of insufficient communication between primary health care providers and specialists, which leads to inefficiencies and ineffectiveness in rural population health outcomes, to implement a well-functioning referral system is one of the most important tasks for some countries. Using purposive and snowballing sampling methods, we included health experts, policy-makers, family physicians, clinical specialists, and experts from health insurance organizations in this study according to pre-determined criteria. We recorded all interviews, transcribed and analyzed their content using qualitative methods. We extracted 1,522 individual codes initially. We also collected supplementary data through document review. From reviews and summarizations, four main themes, ten subthemes, and 24 issues emerged from the data. The solutions developed were: care system reform, education system reform, payment system reform, and improves in culture-building and public education. Given the executive experience, the full familiarity, the occupational and geographical diversity of participants, the solutions proposed in this study could positively affect the implementation and improvement of the referral system in Iran. The suggested solutions are complementary to each other and have less interchangeability.

Effectiveness of telephone-based screening and triage during COVID-19 outbreak in the promoted primary healthcare system: a case study in Ardabil province, Iran

“…In this health system, all services are leveled and healthcare providers and health workers as first-level forces do services at the first level. At the second level, the physicians are considered as second-level forces in comprehensive health service centers; this has prevented unnecessary referrals of patients and clients to hospital (Naseriasl et al 2018;Ministry of Health and Medical Education 2009). In confronting a health crisis, the use of a referral system is a key and effective measure (WHO 1999;Pringle et al 2018).…”

Family physician and referral system adherence in Iranian primary healthcare system

“…Considering the unwelcome consequences of self-referral, designing and implementing interventions to improve the situation is essential. In this regard, interventions in the healthcare system, medical education system, and payment system -alongside culture-building and public education -are required in Iran, as concluded by Naseriasl et al Accordingly, establishing a health information system between the different levels of the healthcare system, developing referral guidelines, establishing specialty courses for FPs, and applying mixed payment systems are the most important interventions [46]. Also, considering that both patients and FPs need accurate and quick access to healthcare information in order to make appropriate decisions, establishing an electronic health record is recommended.…”

The impact of National Health Insurance online referral system on the access and quality of health services in Gianyar District, Bali, Indonesia

“…10,23, 24 Patients with specific health service requirements and special conditions such as haemodialysis, thalassemia, haemophilia, psychiatric disorders, leprosy, MDR-TB, chemotherapy, radiotherapy, HIV-PLHIV are able to be more easily acquire appropriate treatment according to the their medical condition. 20,25 Improved communication between services on the online referral system also facilitates the transfer of information (knowledge sharing) between health professionals. 21,26, 27 Another positive impact is the ease of administration arrangements for patients and service providers.…”