CHALLENGES OF ESTABLISHING SPECIALTY REFERRAL SYSTEM IN IRAN'S HEALTH SECTOR (A QUALITATIVE STUDY)

Abstract

Introduction: The specialty referral process, as an essential part of primary health care, is fundamentally important for the provision of optimal health services. The goal of establishing a functional referral system has yet to be achieved in Iran. This study aimed to explore health expert's viewpoints about challenges of developing and implementing referral system in rural Iran and towns with populations under 20,000. Material and methods: We conducted a qualitative study through five focus group discussions (FGDs), 27 face-to-face, semi-structured interviews at national, provincial, and local levels with family physicians (FPs), clinical specialist physicians, policy-makers, and managers of insurance organizations. Key informants were selected using purposive sampling. Themes were identified using the inductive-deductive framework analysis approach. The barriers and challenges of establishing functional referral system in Iran were identified in a form of six main themes as: service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. Results: Better care for the patients is provided when health care providers and patients work as a team to allow for a smooth patient journey through the health care system. Conclusion: Therefore, a comprehensive reform in FP's roles and positions, health information system, as well as strengthening the health leadership and management infrastructure is recommended.