Managing conflict of interests in Iran's family medicine program: A scoping review

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.

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.

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.

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.