Original Article

The Challenges and Barriers to the Integration of Laboratory Services in Iran from Laboratory Experts’ Point of View

Abstract

Background: Laboratory services fragmentation creates problems such as non-accountability for costs and quality, not being patient-centered and unsustainability of services in long run. Therefore, health systems consider laboratory services integration an inevitable way. This study aimed to investigate the challenges and barriers to the integration of laboratory services in Iran.

Methods: This qualitative case study was conducted in 2016. Using purposive sampling, semi-structured interviews were conducted with 34 informed participants. Each interview lasted between 30 to 60 min. Acceptability, transferability, reliability, and verifiability were used to assess the validity, accuracy and reliability of qualitative data. Framework approach was used to analyze data.

Results: Lack of economy of scale, unfair access, lack of grading, low quality, development of national strategies to create an integrated network of laboratories, criteria of the laboratories establishment, creation of necessary infrastructure, empowering the private sector and standardization of indicators were considered the most important problems of laboratory services integration in Iran; they were classified into two main themes.

Conclusion: Identified issues are challenges which adversely impact the integration of laboratory services. Therefore, providing infrastructures with increased cooperation between various organizations to increase access to laboratory services in the form of an integrated network is essential.

 

Montenegro H, Holder R, Ramagem C et al (2011). Combating health care fragmenta-tion through integrated health service de-livery networks in the America: lessons learned. Int J Integr Care, 19(5): 5-16.

Stange KC(2009) . The problem of frag-mentation and the need for integrative solutions Ann Fam Med, 7(2): 100-3.

Yip W, Hsiao W (2014). Harnessing the pri-vatization of China's fragmented health-care delivery. The Lancet, 384(9945): 805-18.

Asadi F, Moghaddasi H, Mastaneh Z (2009). Situation analysis of Hematology Infor-mation Systems in educational therapeutic hospital laboratories of Shaheed Beheshti University of Medical Sciences. Health Inf Manag J, 6(1): 21.

Sutherland R (2012). The effect of for-profit laboratories on the accountability, integra-tion, and cost of Canadian health care services. Open Med, 6(4): e166–e170.

Kricka LJ, Savory J (2011). International year of chemistry 2011: a guide to the history of clinical chemistry. Clin Chem, 57(8): 1118-26.

Minkman M (2012). The current state of in-tegrated care: an overview. Int J Integr Care, 20(6): 346–58.

Waddington C, Egger D (2008). Integrated health services—what and why. Geneva, Switzerland: World Health Organization, 1: 1-10.

Hwang W, Chang J, LaClair M, Paz H (2013). Effects of integrated delivery sys-tem on cost and quality. Am J Manag Care, 19(5): e175-84.

Ahgren B, Axelsson R (2005). Evaluating in-tegrated health care: a model for meas-urement. Int J Integr Care, 5(3): 5:e01.

Axelsson R, Axelsson SB (2006). Integration and collaboration in public health: a con-ceptual framework. Int J Health Plann Manage, 21(1): 75-88.

Lawrence PR, Lorsch JW (1967). Organiza-tion and environment: managing differ-entiation and integration. Cambridge (MA): Harvard University Press.

Health Policy Council (2009). I.R. of Iran Health in 5th economical, social and cul-tural development plan. Health Policy Coun-cil, Ministry of Health and Medical Education, Iran.

Robinson JC, Dolan EL (2010). Accounta-ble care organizations in California: les-sons for the national debate on delivery system reform. Oakland, CA: Integrated Healthcare Association.

Robinson JC (2011). Accountable care or-ganization for PPO patients: challenge and opportunity in California. Oakland, CA: Integrated Healthcare Association.

Singer SJ, Burgers J, Friedberg M et al (2011). Defining and measuring integrat-ed patient care: promoting the next fron-tier in health care delivery. Med Care Res Rev, 68(1): 112-27.

Ritchie J, Spencer L, Bryman A, Burgess RG (1994). Qualitative data analysis for ap-plied policy research. Analyzing qualitative data, 173-94.

Mouseli A, Barouni M, Amiresmaili MR, Mirab Samiee S, Vali L (2018). Measuring the net profit of laboratory services: a case study in Iran. Med J IRI, 32(1):62-7.

Terrett N (2011). Ten benefits and six pit-falls to implement integrated clinical la-boratory networks. www.medlabmagazine.com.

Davari M, Haycox A, Walley T (2012). The Iranian health insurance system; past ex-periences, present challenges and future strategies. Iran J Public Health, 41(9): 1-9.

Nkengasong JN, Nsubuga P, Nwanyanwu O et al (2010). Laboratory systems and services are critical in global health: time to end the neglect. Am J Clin Pathol, 134(3): 368-73.

Grumbach K, Bodenheimer T (2002). A primary care home for Americans: put-ting the house in order. JAMA, 288(7): 889-93.

Sommers LS, Hacker TW, Schneider DM et al (2001). A descriptive study of man-aged-care hassles in 26 practices. West J Med, 174(3): 175-9.

Zhang JQ, Van Leuven KA, Neidlinger SH (2012). System barriers associated with diabetes management in primary care. J Nurse Pract, 8(10): 822-7.

Weeks WB, Gottlieb DJ, Nyweide DE (2010). Higher health care quality and big-ger savings found at large multispecialty medical groups. Health Aff (Millwood), 29(5): 991-7.

Oshiro BT, Henry E, Wilson J et al (2009). Women and newborn clinical integration program. decreasing elective deliveries be-fore 39 weeks of gestation in an integrat-ed health care system. Obstet Gynecol, 113(4): 804-11.

Chen C, Garrido T, Chock D, Okawa G, Liang L (2009). The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care. Health Aff (Millwood), 28(2):323-33.

Ramalho de Oliveira D, Brummel AR, Miller DB (2010). Medication therapy manage-ment: 10 years of experience in a large in-tegrated health care system. J Manag Care Pharm, 16(3):185-95.

Jabbari Beiramy H, Bakhshian F, Jafari GA (2002). The optimal management of re-sources in asadabadi`s comprehensive network laboratories. The first Resources management in hospital conference, Tehran.

Mbah H, Negedu-Momoh OR, Adedokun O et al (2014). Implementing and meas-uring the level of laboratory service inte-gration in a program setting in Nigeria. PLoS ONE, 9(9): e107277.

Bossuyt X. Verweire K. Blanckaert N (2007). Laboratory medicine: challenges and op-portunities. Clin Chem, 53(10): 1730- 3.

Jabari Beirami H, mousazadeh Y, Janati A (2013). Hospitals Downsizing via out-sourcing and integration mechanisms: a qualitative study of the views of experts and managers in Tabriz University of Medical Sciences. J Mil Med, 15(2):133-42.

Eskandari M, Abbaszadeh A, Borhani F (2013). Barriers of Referral System to Health Care Provision in Rural Societies in Iran. J Caring Sci, 2(3): 229–36.

Anand S, Bärnighausen T (2007). Health workers and vaccination coverage in de-veloping countries: an econometric analy-sis. Lancet, 369(9569): 1277-85.

McKenzie JF, Neiger BL, Thackeray R (2012). Planning, implementing, & evalu-ating health promotion programs: A primer: Pearson Higher.

Guzel O, Guner EI (2009). ISO 15189 ac-creditation: requirements for quality and competence of medical laboratories, ex-perience of a laboratory. Clin Biochem, 42(4-5): 274-78.

Clinical Pathology Accreditation (2007). Standards for medical laboratory: accredi-tation for medical laboratories. CPA (UK) Ltd. www.ukas.com/accreditation/cpa

Roointan AR (2002). Management im-provement and use of resources with outsourcing to private sector in Ali-goodarz health care grid. Proceedings of the 1st Nationwide Conference of Resource Manage-ment in Hospitals; Tehran, Iran: 279.

Torani S, Maleki M, Ghodosimoghadam S, Gohari M (2009). Comparing of efficien-cy and effectiveness of Firoozgar hospital pharmacy before and after outsourcing. J Health Manag, 38(12): 59-71.

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IssueVol 47 No 6 (2018) QRcode
SectionOriginal Article(s)
Keywords
Laboratory services Integration Networking Iran

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How to Cite
1.
MOUSELI A, AMIRESMAILI M, BAROUNI M, MIRAB SAMIEE S, VALI L. The Challenges and Barriers to the Integration of Laboratory Services in Iran from Laboratory Experts’ Point of View. Iran J Public Health. 2018;47(6):884-892.