Volume 26, Issue 1 (3-2023)                   jha 2023, 26(1): 67-89 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Mosadeghrad A M, Ranjbar Hamghavandi M H, Mohsenian A, Metanat S, Bordbar S. Managing conflict of interests in Iran's family medicine program: A scoping review. jha 2023; 26 (1) :67-89
URL: http://jha.iums.ac.ir/article-1-4249-en.html
1- Professor, School of Public Health, Tehran University of Medical Sciences, Tehran
2- MD. Student, School of Medicine, Tehran University of Medical Sciences, Tehran
3- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
4- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
5- MD. Student, School of Medicine, Tehran University of Medical Sciences, Tehran , sanazbrd1381@gmail.com
Abstract:   (665 Views)
Introduction: Family medicine is a program in which the family physician and his team members are responsible for providing comprehensive, coordinated, continuous, and individual and family-based health services to promote, restore, or maintain health in a community. Iran's urban family medicine program was initiated in 2011 and conflict of interest (COI) is a challenge to its effective implementation. This research aimed to identify the types and examples of COI in family medicine programs and to present solutions to control it.
Methods: This study was carried out using the scoping review method. All articles and documents published in six databases (i.e., Pubmed, Web of Science, Scopus, SID, Magiran, and Noormags) and Google Scholar search engine in the field of COI in family medicine program between January 1980 and July 2022 were searched. Finally, 31 related documents were selected and analyzed using the framework analysis method.
Results: Overall, 18 examples of COI were identified in the family medicine program, which were divided into two categories: direct and indirect COI. Receiving money, gifts, samples, and grants from pharmaceutical and medical equipment companies has been cited more in the literature. Furthermore, 28 solutions for managing conflict of interests were identified and categorized into four levels: Meta (government and the Ministry of Health), macro (medical universities, health insurance companies and pharmaceutical and medical equipment companies), meso (health organizations) and micro (health services provider and receiver). Developing rules and regulations, using performance-based payment methods, monitoring and controlling the performance of family doctors, clarifying the financial relations of family doctors with industries, using an evidence-based educational system, and enhancing family doctors’ knowledge and skills were cited in the literature.
Conclusion: Conflict of interest is a serious challenge in primary health care and family medicine program which may lead to corruption. Conflict of interest strategies should be implemented at the individual, organizational, and national levels to be effective. A system must be created to increase the cost of COI to individuals.
Full-Text [PDF 796 kb]   (438 Downloads)    
Type of Study: Review | Subject: Health Services Management
Received: 2022/12/12 | Accepted: 2023/03/18 | Published: 2023/07/26

1. World Health Organization. Declaration of alma-ata. Regional Office for Europe: Denmark, Copenhagen; 1978. p. 4.
2. Mosadeghrad A, Aarabi M, Abbasi M. Family practice: A conceptual review. Hakim. 2021;24(2):172-91. [In Persian]
3. Mobasheri F, Jafarzadeh S, Bahramali E. The level of satisfaction of family physician program in urban population of Fasa from 2014 to 2015. J Fasa Univ Med Sci. 2017;7(2):190-8. [In Persian]
4. Kabir MJ, Ashrafian Amiri H, Rabiee M, Keshavarzi A, Hoseini S, Nasrollahpour Shirvani D. Health care providers, satisfaction in the urban family physician program of Iran. Nursing And Midwifery Journal. 2018;16(2):92-100. [in Persian]
5. Damari B, Vosough Moghaddam A, Rostami Gooran N, Kabir MJ. Evaluation of the urban family physician and referral system program in Fars and Mazandran provinces: History, achievements, challenges and solutions. J Sch Publ Health Inst Publ Health Res. 2016;14(2):17-38. [In Persian]
6. Behzadifar M, Behzadifar M, Heidarvand S, Gorji HA, Aryankhesal A, Taheri Moghadam Sh, et al. The challenges of the family physician policy in Iran: A systematic review and meta-synthesis of qualitative researches. Fam Pract. 2018 ;35(6): 652-60. [DOI:10.1093/fampra/cmy035]
7. Fardid M, Jafari M, Vosoogh Moghaddam A, Ravaghi H. Challenges and strengths of implementing urban family physician program in Fars province. J Educ Health Promot. 2019;8:1-8.
8. Mosadeghrad AM. Managing conflict of interest in health sector: A letter to the editor. Tehran University Medical Journal. 2022;80(10):847-8. [In Persian]
9. Field MJ, Lo B, editors. Conflict of interest in medical research, education and practice. Washington, DC: The National Academies Press; 2009.
10. Mosadeghrad AM, Ferlie E. Total quality management in healthcare. In: Ortenblad A, Abrahamson Lofstrom C, Sheaff R, editors. Management innovations for healthcare organizations: adopt, abandon or adapt? New York: Routledge; 2016. p. 378-96.
11. Mosadeghrad AM. Comments on Iran hospital accreditation system. Iran J Public Health. 2016; 45(6):837-9.
12. Campbell EG, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D. A national survey of physician-industry relationships. N Engl J Med. 2007;356(17):1742-50. [DOI:10.1056/NEJMsa064508]
13. Kaiser Family Foundation. National survey of physicians part II: Doctors and prescription drugs. Menlo Park, CA: KFF; 2002. 9 p.
14. Morgan MA, Dana J, Loewenstein G, Zinberg S, Schulkin J. Interactions of doctors with the pharmaceutical industry. J Med Ethics. 2006;32(10):559-63. [DOI:10.1136/jme.2005.014480]
15. Neyazi N, Mosadeghrad AM, Afshari M, Isfahani P, Safi N. Strategies to tackle non-communicable diseases in Afghanistan: A scoping review. Front Public Health. 2023;11:1-15. [DOI:10.3389/fpubh.2023.982416]
16. Arksey H, O'Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. [DOI:10.1080/1364557032000119616]
17. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess B, editors. Analyzing qualitative data. London: Routledge; 1994. p. 187-208.
18. Guyatt G, Akl EA, Hirsh J, Kearon C, Crowther M, Gutterman D, et al. The vexing problem of guidelines and conflict of interest: A potential solution. Ann Intern Med. 2010;152(11):738-41. [DOI:10.7326/0003-4819-152-11-201006010-00254]
19. Hensley S, Martinez B. To sell their drugs, companies increasingly rely on doctors. Wall St J (East Ed). 2005.
20. Rosenthal E. Drug makers' push leads to vaccines' fast rise. New York Times. 2008:A1.
21. Wazana A. Physicians and the pharmaceutical industry: Is a gift ever just a gift? JAMA. 2000;283(3):373-80. [DOI:10.1001/jama.283.3.373]
22. Sandberg WS, Carlos R, Sandberg EH, Roizen MF. The effect of educational gifts from pharmaceutical firms on medical students' recall of company names or products. Acad Med. 1997;72(10):916-8. [DOI:10.1097/00001888-199710000-00024]
23. Alper PR. Primary care in transition. JAMA. 1994;272(19):1523-7. [DOI:10.1001/jama.1994.03520190069037]
24. Ghiasipour M, Mosadeghrad AM, Arab M, Jaafaripooyan E. Leadership challenges in health care organizations: The case of Iranian hospitals. Med J Islam Repub Iran. 2017;31:1-8. [DOI:10.14196/mjiri.31.96]
25. Esfahani P, Mosadeghrad AM, Akbarisari A. The success of strategic planning in health care organizations of Iran. Int J Health Care Qual Assur. 2018;31(6):563-74. [DOI:10.1108/IJHCQA-08-2017-0145]
26. Chimonas S, Rothman DJ. New federal guidelines for physician-pharmaceutical industry relations: The politics of policy formation. Health Aff (Millwood). 2005;24(4):949-60. [DOI:10.1377/hlthaff.24.4.949]
27. Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: Why it matters. Ann Intern Med. 2007;146(4):301-6. [DOI:10.7326/0003-4819-146-4-200702200-00011]
28. Mosadeghrad AM, Isfahani P. Strategies for reducing induced demand in the health system: A scoping review. Journal of Health Administration. 2023;25(4):45-68.
29. National Health Service England. Managing conflicts of interest in the NHS. 2017. [DOI:10.1136/bmj.j1590]
30. Fischer MA, Keough ME, Baril JL, Saccoccio L, Mazor KM, Ladd E, et al. Prescribers and pharmaceutical representatives: Why are we still meeting? J Gen Intern Med. 2009;24(7):795-801. [DOI:10.1007/s11606-009-0989-6]

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Journal of Health Administration

Designed & Developed by : Yektaweb