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

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.

The child-to-family education program regarding self-medication: A theory-based interventional study.

BACKGROUND AND OBJECTIVE: Self-medication is considered one of the largest social, economic, and health problems in developing communities, including Iran. The present study aimed to determine the effectiveness of a child to family communication approach to self-medication based on the Health Belief Model [HBM]. MATERIAL AND METHODS: This study is a quasi-experimental study that was conducted on 124 students in the fourth grade and their mothers in the intervention and control groups in Isfahan city, Iran. Using multi-stage simple random sampling, two primary schools were selected from each group, and then one class was selected from each primary school. Students in the intervention group attended the educational sessions. Then, the students were required to transfer their education to their families. The impact of education on mothers was evaluated two months after the last session. Data were collected before and after the intervention with a researcher-created questionnaire based on the HBM and were analysed using the SPSS 17 software package, with chi-square, Mann-Whitney U, and Wilcoxon tests. RESULTS: Before training, there was not a significant difference in the mean scores of the HBM constructs in terms of the demographic characteristics between the two groups. After the educational intervention, the mean of knowledge and HBM constructs were increased significantly, and the mean of perceived barriers decreased significantly in the experimental group [P < 0.001]. CONCLUSION: According to the present study, the child-to-family education based on the HBM was effective. It is suggested that educational interventions based on the HBM be designed and implemented to decrease self-medication in Iranian families.

Primary care physician payment mechanisms toward universal health coverage: A study of Iran and selected countries.

BACKGROUND AND AIM: Primary care physician (PCP) payment mechanisms can be important tools for addressing issues of access, quality, and equity in health care. The purpose of the present study is to compare the PCP payment mechanisms of Iran, Canada, Australia, New Zealand, England, Sweden, Norway, Denmark, the Netherlands, Turkey, and Thailand. METHODS: This is a descriptive-comparative study comparing the PCP payment mechanisms of Iran and selected countries in 2020. Data for each country are collected from reliable databases and are tabulated to compare their payment models. Framework analysis is used for data analysis. RESULTS: The results are provided in terms of PCP payment mechanisms, adjusting factor for capitation, reasons for fee-for-service payment, the role of pay-for-performance (PFP) programme, domain and indicators, and reasons for developing PFP in each country. CONCLUSION: The majority of the countries with high UHC service coverage index have applied a mix of PCP payment mechanisms, most of which include capitation and PFP. Moreover, adjusting capitation by factors such as age, sex, and health status will lead to provision of better services to high-risk populations. In recent years, PFP has been paid to Iranian PCPs in addition to salary. Given the various existing models for primary health care in Iran and the increasing burden of chronic diseases, a more appropriate combination of payment mechanisms that create more incentives to provide active and high-quality care should be developed. Also, when developing payment mechanisms, the required infrastructure such as electronic health record should be considered.

Knowledge Translation Improvement Strategies in Universities of Medical Sciences in Iran: A Qualitative Study.

BACKGROUND: Recently, one of the challenges in the health system of the country is the need for research contributing to policy-making. Therefore, it is crucial to develop activities in the field of knowledge Translation (KT). This study aimed to propose KT improvement strategies in universities of medical sciences in Iran. METHODS: In this qualitative study, 18 semi-structured interviews were conducted with key informants from the medical universities in Iran during January-July 2018. The transcribed documents were analyzed using the Gale framework analysis approach. Data organization was carried out using MAXQDA version 10 software. RESULTS: According to framework analysis, six KT improvement strategies were identified including improving the abilities and skills of researchers, improving the processes and quality of knowledge production, revising policies and laws, improving the prerequisites, culture-building, and promoting the use of evidence. CONCLUSION: Given the challenges and strategies outlined in this study, it seems that the mechanism of KT and its effects on improving health plans for policymakers and researchers has not been elucidated yet. Therefore, considerable changes in prerequisites, knowledge production processes, academic procedures, policies and laws are necessary for implementing KT in universities of medical sciences in Iran.

Iranian public hospitals' challenges regarding revenue deficits: A mixed-method study.

Background: The main part of hospitals' funding comes from insurance organizations. In some cases, for different reasons such as not filed services or unpaid health insurance bills, a part of these funding cannot be derived from health insurance companies. This study aims to describe different aspects of the hospitals' revenue deficits in Iranian public hospitals. Methods: This was a mixed-method study consisting of qualitative and quantitative studies. Qualitative data were collected through 17 semi-structured interviews and were analyzed using the analytical framework by MAXQDA.10. Quantitative data were analyzed by the TOPSIS method and Smart TOPSIS Solver.3.2.0. Results: Based on the framework analysis, five sets of the underlying causes of hospital revenue deficits were identified and categorized in 5 themes: bottlenecks, direct causes of revenue deficits, root causes of revenue deficits, revenue deficits management strategies, and challenges and barriers to managing revenue deficits. Through inadequate clinical documentation and failed to provide the insurance organization's requirements, the surgical units, operating rooms, and inpatient units were found as the main sources of revenue deficit. Lack of senior management commitment and inconsistency of insurance organizations for evaluating claims are often listed as the major barriers to effective implementation of corrective interventions. Conclusion: Revenue deficits occurs in most hospital departments and in all stages of converting services into revenue, and a variety of human and organizational factors contribute to them. Therefore, focusing on the main causes of deductions and the participation of all individuals and departments involved in it is critical to reducing deductions.