The challenges of the family physician policy in Iran: a systematic review and meta-synthesis of qualitative researches

Behzadifar, Masoud; Behzadifar, Meysam; Heidarvand, Sanaz; Gorji, Hasan Abolghasem; Aryankhesal, Aidin; Moghadam, Sharare Taheri; Mohammadibakhsh, Roghayeh; Bragazzi, Nicola Luigi

doi:10.1093/fampra/cmy035

Cited by 14 publications

(22 citation statements)

References 51 publications

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“…This policy challenge has also been highlighted in other studies 40,41 . In addition, unstable political and economic conditions, particularly sanctions, pose significant threats to this programme and its expansion in low‐income and developing countries such as Iran 42,43 …”

Section: Discussionmentioning

confidence: 87%

“…40,41 In addition, unstable political and economic conditions, particularly sanctions, pose significant threats to this programme and its expansion in low-income and developing countries such as Iran. 42,43 There were also sociocultural challenges in the implementation of the e-referral system. Similarly, Hooshmand et al identified the cultural domain as the biggest challenge of the referral system.…”

Section: Discussionmentioning

confidence: 99%

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

Kabir

Heidari

Honarvar

et al. 2022

Health Planning & Management

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Referral chain reduces patient costs and results in more efficient use of workforce and equipment. Despite the implementation of the Family Physician Programme in Iran, the referral system does not function as intended. Therefore, this study was conducted to explain the challenges in the implementation of an electronic referral system in Iran. This qualitative study was performed in Golestan province in northern Iran. The participants were 46 family physicians, specialist physicians, healthcare managers, experts, and patients who were selected through purposive sampling. Data were collected using in‐depth individual interviews and were analysed using content analysis. Implementation of the electronic referral system faces management challenges (planning, organisation, motivation, control), administrative challenges (scheduling, patient load and waiting time, visit and diagnosis, feedback), and educational, policy, sociocultural, technological, and economic challenges. Policymakers can adopt appropriate strategies to improve the quantity and quality of their electronic referral system according to the challenges identified herein.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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

Kabir

Heidari

Honarvar

et al. 2022

Health Planning & Management

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“…[ 78 ] Therefore, one can say that in countries such as the US and Iran where there is a large income gap between family physicians and specialist, the likelihood of conflict of interest and the resulting problems will be exacerbated by implementing the family physician program with the gatekeeper role and the compulsory referral system. [ 14 79 ] In countries such as the United Kingdom, conflict of interest has been managed in different ways such as reforming the payment system and launching of a transparent information system[ 28 ]…”

Section: Discussionmentioning

confidence: 99%

Family physician model in the health system of selected countries: A comparative study summary

Mohammadibakhsh

Aryankhesal

Jafari

et al. 2020

J Edu Health Promot

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BACKGROUND: In the 21 st century, with the epidemiological and demographic transition and the changing nature of diseases and the increase in the burden of chronic diseases, the need to strengthen primary health care and the development of the family medical program as a strategy is felt significantly. AIM: The purpose of this study is to compare the model of implementation of family physician program (FPP) in the United States, England, Germany, Singapore, Turkey, Egypt, and Iran. MATERIALS AND METHODS: This is a comparative study that examines the model of family physician implementation in selected countries. Data for each country were gathered from the valid databases, were compared according to the comparative table, and analyzed by a framework approach. In order to assure the validity of data, the researchers referred to the websites of the selected nations' Ministry of Health and also cross-checked the findings with reports published by the World Health Organization. RESULTS: In this study, we used the Control Knobs framework to compare countries' FPPs because the framework can demonstrate all necessary features of national health system programs. This framework includes governance and organization, regulation, financing, payment, and behavior in each country. The results of this study show that although the principles of FPP in the selected countries are almost common, they use different methods in FPP implementation. CONCLUSIONS: As the success of any policy depends on the political, economic, social, and cultural context of each country, considering these factors and reinforcing each of the control knobs are critical to the success of the family physician's policy implementation.

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“…The implementation of this program has resulted in improvements in some of the most important health indicators, including child and maternal mortality rates, life expectancy, and infection disease control [23]. Based on Iran's fth development program in the health sector and considering the positive effects of rural FP, urban family physician program (UFPP) was implemented as a pilot in two provinces, Fars and Mazandaran, along with referral system instructions to determine the pros and cons of implementing UFPP [24].…”

Section: Introductionmentioning

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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The challenges of the family physician policy in Iran: a systematic review and meta-synthesis of qualitative researches

Cited by 14 publications

References 51 publications

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

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

Family physician model in the health system of selected countries: A comparative study summary

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

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