Challenges in the implementation of an electronic referral system: A qualitative study in the Iranian context

Kabir, Mohammad Javad; Heidari, Alireza; Honarvar, Mohammad Reza; Khatirnamani, Zahra; Rafiei, Narges

doi:10.1002/hpm.3563

Cited by 3 publications

(7 citation statements)

References 32 publications

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“…The results showed that the percentage of feedback reached from level 2 to level 1 has increased signi cantly after covid-19 and is still in an unfavorable situation. A prior study showed that the lack of feedback or its unfavorable is one of the common and basic problems in the referral system from the beginning of the establishment of healthcare networks in the country (29). According to the principle of using appropriate technology from the four principles of the network system, in the current situation and with the growth and development of electronic health records and electronic referral technology, providing feedback can facilitate health and treatment affairs, time management for service recipients and service providers, and save on heavy expenses (16).…”

Section: Discussionmentioning

confidence: 99%

“…It is determined electronically and integrated at the rst level in the comprehensive health service center. In a study, lack of necessary infrastructure, weakness in cultivating and informing the society about the bene ts of the electronic referral system, the absence of the possibility of electronic appointments from o ces and referral centers, and the lack of regular presence of physicians in comprehensive urban and rural health service centers were stated as the causes of low performance of electronic referral (29). Managers are responsible for providing all the necessary infrastructure and emphasizing and supporting everyone on the implementation of laws.…”

Section: Discussionmentioning

confidence: 99%

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Performance trend of the family physician referral system before and after the Covid-19 pandemic: A study in northern Iran

Soltani,

Fallah,

Marvi

et al. 2023

Preprint

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Background: Considering the challenges of the referral system in the family physician program and the impact of Covid-19 pandemic on the performance of the relevant ministry's programs, it is necessary to assess the performance of the referral system. This study was conducted with the aim of investigating the performance of the family physician referral system before and after Covid-19 in Golestan province. Objective: The present descriptive-analytical study was conducted on secondary data (including information on physicians' and midwives' visits, percentage of prescriptions and other information) in Golestan province from 2017 to 2022 in a census and retrospective manner. Data were collected using the reference ratio checklist and analyzed with SPSS 23 software at a significance level of less than 0.05. Results: The highest and lowest percentages of referrals by family physicians were belonged to the surgical and infectious specialists before Covid-19, and internal medicine and urology specialists after Covid-19, respectively. Referral due to physician's diagnosis and target group increased compared to before Covid-19 and care and reverse referral decreased compared to before Covid-19. The amount of changes in the population covered by rural insurance, the amount of referrals to midwives, the percentage of electronic appointments after Covid-19 were significant compared to before it (P-Value<0.05). Conclusion: The present study showed that the Covid-19 pandemic had a significant impact on family physician referral indicators, such as the process of referral to specialists, drug prescriptions, insurance coverage, one-time service population, and patient care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Performance trend of the family physician referral system before and after the Covid-19 pandemic: A study in northern Iran

Soltani,

Fallah,

Marvi

et al. 2023

Preprint

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“…However, with the passing of several years under such a law, the health care referral system in Iran is facing serious challenges that have greatly affected the UFPP. Various factors have led to the emergence of such a situation, including easy access to specialized services, a lack of an accurate information system, a lack of awareness about UFPP goals, cultural problems, etc [21,44,72]. Nonetheless, evidence suggests that family physicians acting as gatekeepers can reduce costs and improve care quality [60,73].…”

Section: Organizationmentioning

confidence: 99%

The challenges of urban family physician program over the past decade in Iran: A scoping review and qualitative study with policy-makers

Lankarani

Honarvar

Shahabi

et al. 2023

Preprint

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Introduction: Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges. Methods This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (Organization, financing, payment, regulation, and behavior). Results The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms. Conclusion Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran.

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“…As prediabetes is characterized by elevated blood glucose levels that do not yet meet the diagnostic criteria for diabetes, the therapeutic management of diabetes and prediabetes is similar [ 4 , 5 ]. In both cases, a comprehensive approach is required to better control glycemia levels [ 6 , 7 ]. Many factors are involved in preventing the disease and achieving better disease control, such as changing lifestyles through education, supporting self-management, and preventing the development and progression of complications [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…They are thus paving the way for innovations and represent a real benefit in the face of new health care challenges, such as the aging population, rising health care costs, and the unprecedented challenges posed by pandemics such as the COVID-19 pandemic [ 6 ]. Particularly in Canada, the public health care system faces challenges often associated with overcrowded clinics, long wait times, and limited resources [ 7 ]. Through remote consultations and continuous monitoring, telehealth has the potential to relieve pressure on health care facilities, improving resource allocation and optimizing patient flow management in the public health care system.…”

Section: Introductionmentioning

confidence: 99%

The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review

Mannoubi,

Kairy,

Menezes

et al. 2024

JMIR Med Inform

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Background Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. Objective This scoping review’s primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. Methods A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data. Results The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports. Conclusions This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional’s advice and interaction results in more effective interventions and outcomes.

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Challenges in the implementation of an electronic referral system: A qualitative study in the Iranian context

Cited by 3 publications

References 32 publications

Performance trend of the family physician referral system before and after the Covid-19 pandemic: A study in northern Iran

Performance trend of the family physician referral system before and after the Covid-19 pandemic: A study in northern Iran

The challenges of urban family physician program over the past decade in Iran: A scoping review and qualitative study with policy-makers

The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review

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