Policy options to reduce patient visits in specialized service centers: A case study in speciality and subspeciality clinics in Iran

• Published date: 01 June 2023
• Author: Leila Doshmangir,Parinaz Doshmangir,Hossein Jabbari Beyrami,Gisoo Alizadeh,Vladimir Sergeevich Gordeev
• Date: 01 June 2023
• DOI: http://doi.org/10.1002/wmh3.541

Received: 22 November 2021

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Revised: 2 May 2022

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Accepted: 9 June 2022

DOI: 10.1002/wmh3.541

ORIGINAL ARTICLE

Policy options to reduce patient visits in

specialized service centers: A case study in

speciality and subspeciality clinics in Iran

Leila Doshmangir

1,2

|Parinaz Doshmangir

3

|

Hossein Jabbari Beyrami

4

|Gisoo Alizadeh

1

|

Vladimir Sergeevich Gordeev

5

1

Department of Health Policy & Management,

Tabriz Health Services Management

Research Center, School of Management &

Medical Informatics, Tabriz University of

Medical Sciences, Tabriz, Iran

2

Social Determinants of Health Research

Center, Tabriz University of Medical

Sciences, Tabriz, Iran

3

Public Health Network, Tabriz University of

Medical Sciences, Tabriz, Iran

4

Tabriz Health Services Management

Research Center, Health Management and

Safety Promotion Research Institute, Tabriz

University of Medical Sciences, Tabriz, Iran

5

Department of Infectious Disease

Epidemiology, London School of Hygiene &

Tropical Medicine, London, UK

Correspondence

Gisoo Alizadeh, Department of Health Policy

& Management, Tabriz Health Services

Management Reserch Center, School of

Management & Medical Information, Tabriz

University of Medical Sciences, Tabriz, Iran.

Email: G.alizadeh.1369@gmail.com

Abstract

Hospital congestion, delayed discharge, and bypassing

primary care facilities are challenges facing the Iranian

health‐care sector. We conducted a case study at the

Sheikh al‐Rais Specialty Clinic, Tabriz, Iran, to find

plausible, practical policy options for designing and

implementing a referral system to reduce and regulate

referral volumes to this clinic. We first reviewed the

evidence on existing options of hospital congestion and

unnecessary referral reduction by conducting a scoping

literature review and then supplemented the findings

with 18 semistructured interviews. We examined the

perspectives of service users and experts in the field. Six

practical policy options were identified: institutionaliza-

tion of the referral system and family physician program,

reinforcing gatekeeping system, use of telemedicine,

utilization of educational algorithms, implementation of

electronic health records, and establishing specialized

clinics in different city areas. Local context adaptation,

ensuring the availability of resources, political support,

and feasibility are critical factors for successful policy

implementation.

KEYWORDS

family physician, health policy and systems research, hospital

queueing, Iran, policy option, referral system

Key points

•Improving documentation using electronic health

records, integrating electronic health records with refer-

ral systems, controlling and reducing the demand for

unnecessary referrals through screening mechanisms,

World Medical & Health Policy. 2023;15:108–122.wileyonlinelibrary.com/journal/wmh3108

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© 2022 Policy Studies Organization.