Financial challenges in the family physician programme in Iran: A systematic review of qualitative research

Introduction

The family physician programme (FPP) was implemented nearly two decades ago as a major health reform. Since the health system and FPP function in a rapidly changing social and economic environment, successful expansion of the programme requires a detailed analysis of its multiple major challenges, including the crucial aspect of its funding system. This systematic review aimed to assess the challenges in the FPP relative to its financing.

Method

All published articles related to the FPP in Iran were included in this study. In particular, original qualitative studies published in English or Persian from 2011 to 2021 were included. In January 2022, international credible scholarly databases and Persian databases were searched. All selected articles were carefully studied, and the data were extracted using the sample, phenomenon of interest, design, evaluation and research type technique. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in preparing the study report.

Results

Among 491 articles retrieved from the search strategy, 50 met the inclusion criteria after their titles and abstracts were screened. Twenty-nine studies were excluded after their full texts were reviewed. A total of 11 eligible empirical studies were finally included. Based on the results, six broad categories (budget and funding, insurance system, tariffs, payments, accountability and injustice) were identified as financial challenges.

Conclusion

This study identified the challenges associated with financing among family physicians, and the results could provide guidance for policy-making in the expansion of the FPP.

Referral System Challenges of the Family Physician Program in Iran: A Systematic Review

Background

Iran has implemented the Family Physician Program (FPP) in 2005 in 4 provinces. This program was supposed to be expanded across the country; however, it faced various challenges. Considering the impact of the referral system on the quality of the FPP implementation, different studies were conducted to evaluate the performance of this system. Therefore, this systematic review of the literature was conducted to investigate the challenges of the referral system of the FPP in Iran.

Methods

All published original articles, reviews, or case studies published in English or Persian related to the challenges in the referral system FPP in Iran from 2011 to September 2022 were included in this study. International credible scholarly databases were searched. The search strategy was defined based on keywords and the search syntax.

Results

Out of 3910 articles identified by the search strategy, considering the inclusion and exclusion criteria and relevance of the study, and accreditation of the studies, 20 studies were included. The referral system suffers from different challenges in the areas associated with policy and planning, management, referral process, and health service recipients.

Conclusion

The inefficient gatekeeping role of family physicians was one of the most important challenges of the referral system. The referral system should be improved by having evidence-based guidelines and policy documents, unified stewardship, integrated insurance schemes, and effective communication between different levels of care.

[Extensor tendon injuries of the hand]

The extensor tendon apparatus is a network consisting of two different systems, an intrinsic and an extrinsic system, which are subdivided into eight different zones. Isolated injuries in zones 1 and 2 can be treated nonoperatively, whereas injuries in zones 3-8 usually require surgical treatment. A decision on the suture technique, suture material and postoperative follow-up care is made depending on the zone of the injury. The concomitant injuries of joints, bones, nerves and vessels must be taken into consideration and treated. The outcome of a tendon injury depends on the location and severity of the injury as well as the surgical technique and follow-up care. Exact knowledge of the anatomy with precise diagnostics, atraumatic, zone-dependent surgical and postoperative treatment, adequate rehabilitation and occupational therapy are essential for high quality management and preservation of fine motor skills and coordination of the whole hand.