Requirements and Incentives for Implementation of Pharmaceutical Strategic Purchasing in Iranian Health System: A Qualitative Study

PURPOSE: According to the importance of strategic purchasing as a prerequisite for overall access and universal health coverage, this study was conducted to explore requirements and incentives for implementation of pharmaceutical strategic purchasing in the Iranian health system.METHODS: This was a qualitative study conducted through content analysis with an inductive approach applying a five-stage framework analysis. Data analysis was started right after transcribing each interview applying MAXQDA10. Data was saturated after 32 semi-structured interviews with experts. These key informants were selected purposefully and through snowball sampling.RESULTS: The findings are categorized under three main themes: “Payment Mechanisms to Service Providers”, “Insurance Reimbursement Mechanisms” and “Rules and Regulations”, and eight related subthemes.CONCLUSIONS: According to the importance of incentive interventions in pharmaceutical strategic purchasing, it is necessary to pay close attention to pharmaceutical price, realistic and fair premiums and appropriate contracts with suppliers, along with estimation a reasonable profit margin for pharmaceutical suppliers and the appropriate reimbursement mechanisms as the most significant incentives for increasing access to pharmaceuticals and implementing strategic purchasing.

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

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v31i1.15 ◽

2021 ◽

Vol 31 (1) ◽

Author(s):

Sogand Tourani ◽

Narges Rafiei ◽

Shahnaz Rimaz ◽

Seyed Kazem Malakouti ◽

Alireza Heidari

Keyword(s):

Qualitative Study ◽

Knowledge Translation ◽

Knowledge Production ◽

Data Organization ◽

Health Plans ◽

Medical Sciences ◽

Structured Interviews ◽

Framework Analysis ◽

Improvement Strategies

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, mproving 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.

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Future Challenges of Nursing in Health System of Iran

Frontiers in Public Health ◽

10.3389/fpubh.2021.676160 ◽

2021 ◽

Vol 9 ◽

Author(s):

Salman Barasteh ◽

Maryam Rassouli ◽

Mohammad Reza Karimirad ◽

Abbas Ebadi

Keyword(s):

Professional Development ◽

Nursing Education ◽

Health System ◽

Universal Health Coverage ◽

Health Coverage ◽

Structured Interviews ◽

Framework Analysis ◽

The Future ◽

Future Challenges ◽

Universal Health

Purpose: Nursing development is considered as one of the most important ways to achieve the universal health coverage and sustainable development goals in different countries. Nursing in Iran has the potential to provide services at all levels of universal health coverage. Therefore, planning for nursing in Iran needs to recognize the future challenges. This study aims to explore the future challenges of nursing in the health system of Iran from the perspective of nursing experts.Methods: In this qualitative study, 11 semi-structured interviews were conducted with nursing experts by purposive sampling in 2017–2018. Interviews were recorded and transcribed and framework analysis method was used to analysis the data.Results: The results showed that a favorable future requires planning in three areas of nursing “governance challenges” including centralized nursing stewardship, policy-making and legislation, monitoring and evaluation, and cooperation and communication with other institutions, “inadequacy of professional development with social demands” including community-based nursing, nursing upgrades with disease patterns, expanding home care, expanding care centers, and use of technology, “human resource challenges “including nursing education tailored to the needs of the community, empowering nursing managers, recruiting and retaining nurses, and specialized nursing.Conclusions: A favorable future requires a coherent nursing government, professional development of nursing based on social demands, and enhancing human resources in line with the emerging needs of the future.

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What makes an optimal delivery for PrEP against HIV: A qualitative study in MSM

International Journal of STD & AIDS ◽

10.1177/09564624211060824 ◽

2022 ◽

pp. 095646242110608

Author(s):

Janice Y. C. Lau ◽

Ngai-Sze Wong ◽

Krystal C. K. Lee ◽

Tsz-Ho Kwan ◽

Grace C. Y. Lui ◽

...

Keyword(s):

Qualitative Study ◽

Service Providers ◽

Effective Means ◽

Qualitative Assessment ◽

Theory Approach ◽

Service Model ◽

Structured Interviews ◽

Sexually Transmitted ◽

Ethnic Chinese ◽

Sex With Men

Background Pre-exposure prophylaxis (PrEP) is an effective means of HIV prevention for men who have sex with men (MSM), a key population whose engagement is crucial for achieving effective public health outcomes. An optimal service model would be important in planning the implementation of PrEP in places where such service has not been established. Methods A qualitative study was conducted to delineate the attributes of an optimal PrEP service model for MSM in Hong Kong, a city where no formal PrEP programs existed. Twenty purposively sampled MSM who were enrollees of two pilot PrEP projects participated in the semi-structured interviews promoting story-telling. The coded data were thematically analyzed following Grounded Theory approach, focusing on uncovering a typology of the essential attributes of an optimal PrEP service model, and the reasons for such preferences. Results Participating MSM were all ethnic Chinese and aged 26 to 52 years. All had received PrEP from pilot projects in conjunction with periodic screening of sexually transmitted infections (STI), HIV antibody, and plasma creatinine. Four major themes emerged as regards the attributes of a preferred PrEP service: (i) comprehensiveness of HIV/STI and safety monitoring; (ii) convenient unitary service; (iii) stigma-free PrEP access and protecting confidentiality; and (iv) affordable price. Whereas regular provision of PrEP was acceptable to MSM, unaffordability and related stigma were the anticipated challenges for potential service providers. Conclusions The qualitative assessment of MSM’s preference for PrEP service delivery has yielded important information on the many facets of a desirable service model.

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Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services: a qualitative study exploring patient perspectives on treatment experience

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465820000594 ◽

2020 ◽

pp. 1-15

Author(s):

Gary Lamph ◽

John Baker ◽

Tommy Dickinson ◽

Karina Lovell

Keyword(s):

Mental Health ◽

Primary Care ◽

Personality Disorder ◽

Qualitative Study ◽

Patient Group ◽

Stepped Care ◽

Research Approach ◽

Structured Interviews ◽

Framework Analysis ◽

Co Morbidity

Abstract Background: High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England. Aims: This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care-based IAPT treatment. Method: A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach. Results: Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important. Conclusions: For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach.

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The anticipated and the lived experience of home and in-centre haemodialysis: Is there a disconnect?

Journal of Health Psychology ◽

10.1177/1359105316630135 ◽

2016 ◽

Vol 22 (12) ◽

pp. 1524-1533 ◽

Cited By ~ 3

Author(s):

Rabiya Majeed-Ariss ◽

A Jayanti ◽

T Schulz ◽

A Wearden ◽

S Mitra

Keyword(s):

Qualitative Study ◽

Lived Experience ◽

Barriers And Facilitators ◽

Structured Interviews ◽

Framework Analysis ◽

Patient Factors ◽

Home Haemodialysis ◽

Advantages And Disadvantages ◽

Patients Experience

This qualitative study aimed to explore home haemodialysis and in-centre haemodialysis patients’ experience, to illuminate barriers and facilitators in the uptake and maintenance of home haemodialysis. Thirty-two semi-structured interviews with patients receiving home haemodialysis or in-centre haemodialysis were analysed using framework analysis. Four themes emerged: ‘perceptions of self’; ‘impact of haemodialysis on family’; ‘perceived advantages and disadvantages of home haemodialysis and in-centre haemodialysis’ and ‘practical issues and negotiating haemodialysis’. The lived experience of home haemodialysis was in contrast to the lived experience of in-centre haemodialysis and to the anticipated experience of home haemodialysis, highlighting patient factors that contributed to under-usage of home haemodialysis.

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Policy Making Challenges in the scope of Oral Health in Developing Countries A Qualitative Study of the Islamic Republic of Iran

10.21203/rs.2.16823/v1 ◽

2019 ◽

Author(s):

Mohammad Mohammadpour ◽

Peivand Bastani ◽

Arash Ghanbarzadegan ◽

Jamshid Bahmai

Keyword(s):

Oral Health ◽

Qualitative Study ◽

Developing Country ◽

Policy Making ◽

Middle Eastern ◽

Developed Countries ◽

Health Improvement ◽

Snowball Sampling ◽

Structured Interviews ◽

Framework Analysis

Abstract Background As the strategies proposed for oral health improvement in developed countries do not adapt for the setting of the developing ones, this study is to identify the challenges of oral health policy making in developing countries.Methods It was a qualitative study conducted in 2019 in Iran as a middle-eastern developing country. The study population included all the experts who have enough experience in the scope and have the eagerness to participate. Snowball sampling was used to include the participants and after 12 semi-structured interviews saturation was achieved. Guba and Lincoln criteria containing acceptability, validity, reliability, and transferability were used to assure the study reliability and finally five-stage framework analysis method was used to analyze the data.Results The analysis of the results of the interviews resulted in the identification of 7 main themes and 20 sub-themes as the main challenges of achieving oral health in a developing country. The main themes identified were: policy making, implementing, educational, stewardship, prevention, insurance, and resource allocating. Conclusion: According to the present results, it seems that national coverage of oral health and the integration of these services in prevention ones and serious attention to the private sector can be considered as the most important strategies for achieving improved oral health.

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Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

10.21203/rs.3.rs-26636/v3 ◽

2020 ◽

Author(s):

Sarah C Masefield ◽

Alan Msosa ◽

Jean Grugel

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Health System ◽

National Health ◽

Low Income ◽

Service Providers ◽

Health Sector ◽

National Health System ◽

Low Income Countries ◽

Health Coverage

Abstract BackgroundAll countries face challenging decisions about healthcare coverage. Malawi has committed to achieving Universal Health Coverage (UHC) by 2030, the timeframe set out by the Sustainable Development Goals (SDGs). As in other low income countries, scarce resources stand in the way of more equitable health access and quality in Malawi. Its health sector is highly dependent on donor contributions, and recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve more effective cooperation with stakeholders. This study explores health sector stakeholders’ perceptions of the challenges to improving governance in Malawi’s national health system within the post-2017 context of government attempts to articulate a way forward.MethodsA qualitative study design was used. Interviews were conducted with 22 representatives of major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. Content relating to healthcare governance was identified in the transcripts and field notes and analysed using inductive content analysis.ResultsStakeholders view governance challenges as a significant barrier to achieving a more effective and equitable health system. Three categories were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).ConclusionsHealth sector stakeholders see serious political, structural, and financial challenges to improving governance in the national health system in Malawi which will impact the government’s goal of achieving UHC by 2030. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the policy documents, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC. The difficulties stakeholders perceive in relation to building equitable and effective healthcare governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

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Challenges of the Relative Value Unit Experience in Iran: A Qualitative Study

10.53350/pjmhs211551249 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1249-1255

Author(s):

S. Forootan ◽

S. Hajebrahimi ◽

B. Najafi ◽

A. Janati

Keyword(s):

Qualitative Study ◽

Service Providers ◽

Health Sector ◽

Active Role ◽

Structured Interviews ◽

Group Discussions ◽

Provider Behavior ◽

Income Disparities ◽

Relative Value ◽

Data Content

Background: The Relative Value Unit (RVU) is a value scale and plays a key role in the physician reimbursement system. The health sector has faced challenges such as providers’ dissatisfaction, income disparities, and reduced service quality which is said to be due to improper RVUs. Always there are debates about it. This study aims to identify the challenges of the RVU experience in Iran from the perspective of the service providers, payers and, policymakers. Methods: This qualitative study was conducted in 2020. Data were collected from November 2019 to February 2020. Thirty experts participated in the study and were categorized into four groups: insurance organizations’ managers, surgeons, health economists, and health policymakers. Focus Group Discussions and semi-structured interviews were held to collect data. Content analysis was conducted to analyze data. Results: According to the expert, the challenges of RVU in Iran are classified into five scopes. Financial, payment, macro-organization, regulation, and persuasion scope. Each scope’s result was categorized into main themes and relevant sub-themes. Conclusions: The RVU has an important impact on the health system, provider behavior, and even patients. Paying attention to required infrastructures, decision- makers’ conflict of interests, decrease the Ministry of Health and Medical Education’s authority, and expanding the active role of involved organizations to increase their commitment to the successful implantation of RVU is necessary. Keywords: Relative Value Unit, Challenge, Expert opinion, Qualitative study, Iran.

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Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain)

International Journal for Equity in Health ◽

10.1186/s12939-021-01409-2 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Andrés Cernadas ◽

Ángela Fernández

Keyword(s):

Qualitative Study ◽

Health Services ◽

Healthcare Workers ◽

Service Providers ◽

Universal Access ◽

Healthcare Services ◽

Medical Professional ◽

Homeless Population ◽

Public Health Services ◽

Structured Interviews

Abstract Background In Spain, homeless individuals have lower perceived quality of health than the rest of the population and their life expectancy is 30 years lower than the national average. While the Spanish health system provides universal access and coverage, homeless individuals do not access or use public care enough to maintain their health. The objective of this study is to determine if homeless individuals can access public health services in conditions of equality with the rest of the population, as established in healthcare legislation, and to better understand the causes of observed inequalities or inequities of access. Methods A detailed qualitative study was carried out in the city of Barcelona (Spain) from October 2019 to February 2020. A total of nine open and in-depth interviews were done with homeless individuals along with seven semi-structured interviews with key informants and two focus groups. One group was composed of eight individuals who were living on the street at the time and the other consisted of eight individuals working in healthcare and social assistance. Results The participants indicated that homeless individuals tend to only access healthcare services when they are seriously ill or have suffered some kind of injury. Once there, they tend to encounter significant barriers that might be 1) administrative; 2) personal, based on belief that that will be poorly attended, discriminated against, or unable to afford treatment; or 3) medical-professional, when health professionals, who understand the lifestyle of this population and their low follow-through with treatments, tend towards minimalist interventions that lack the dedication they would apply to other groups of patients. Conclusions The conclusions derived from this study convey the infrequent use of health services by homeless individuals for reasons attributable to the population itself, to healthcare workers and to the entire healthcare system. Accordingly, to reduce inequities of access to these services, recommendations to healthcare service providers include adapting facilities to provide more adequate care for this population; increasing sensitivity/awareness among healthcare workers; developing in situ care systems in places where the homeless population is most concentrated; and establishing healthcare collaboration agreements with entities that work with this population.

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Sexual assault: women’s voices on the health impacts of not being believed by police

BMC Women s Health ◽

10.1186/s12905-021-01358-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Karen McQueen ◽

Jodie Murphy-Oikonen ◽

Ainsley Miller ◽

Lori Chambers

Keyword(s):

Sexual Assault ◽

Social Impact ◽

Service Providers ◽

Well Being ◽

Analysis Data ◽

Health Impacts ◽

Structured Interviews ◽

Secondary Victimization ◽

Sexually Assaulted ◽

The Impact

Abstract Background Sexual assault is a prevalent crime against women globally with known negative effects on health. Recent media reports in Canada indicate that many sexual assault reports are not believed by police. Negative reporting experiences of sexual assault have been associated with secondary victimization and trauma among survivors. However, little is known about the impact that being sexually assaulted and not believed by police has on a survivor’s health and well-being. The purpose of this study was to explore women’s experiences of not being believed by police after sexual assault and their perceived impact on health. Methods We conducted open-ended and semi-structured interviews with 23 sexual assault survivors who were sexually assaulted and not believed by police. The interviews explored the self-reported health impacts of not being believed by police and were conducted from April to July, 2019. All interviews were audio-recorded, transcribed, and entered into NVIVO for analysis. Data were analyzed using Colaizzi’s analytic method. Results Analysis revealed three salient themes regarding the health and social impact of not being believed by police on survivors of sexual assault: (1) Broken Expectations which resulted in loss of trust and secondary victimization, (2) Loss of Self, and (3) Cumulative Health and Social Effects. The findings showed that not being believed by police resulted in additional mental and social burdens beyond that of the sexual assault. Many survivors felt further victimized by police at a time when they needed support, leading to the use taking of alcohol and/or drugs as a coping strategy. Conclusion Reporting a sexual assault and not being believed by police has negative health outcomes for survivors. Improving the disclosure experience is needed to mitigate the negative health and social impacts and promote healing. This is important for police, health, and social service providers who receive sexual assault disclosures and may be able to positively influence the reporting experience and overall health effects.

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