Analysis of electronic referral system agenda setting based on kingdon multiple streams framework

33 Abstract Objective (s): One of the important factors for the implementation of primary health care is the referral system. The aim of this study was to analyze of electronic referral system agenda setting based on Kingdon's multiple streams framework in Golestan province. Methods : A qualitative study was conducted in 2020 based on Kingdan (2003) model in Golestan province. Data were collected using two methods of document review and in-depth individual interviews with 26 individual interviews. Purposeful sampling and analysis of documents were performed by content analysis and interviews were analyzed by framework analysis. Results : The Problem stream was the weakening of the general practitioner and the non-referral of patients, the increase in the payment of people and insurance organizations, and the absence of some specialist physicians. The Policy stream included the obligation to implement the family physician program and referral system in upstream laws and documents, the implementation of the rural family physician program and referral system in 2005, and the urban family physician program in Fars and Mazandaran provinces. The Politic stream included launching a lean system at Golestan University of Medical Sciences, passing a law allocating one percent of value-added resources to the prevention and treatment of villagers within the referral system, and charismatic policymakers and committed executives. Conclusion: Despite the problems caused by the non-implementation of the referral system and the enforcement of laws due to conflicts of interest and insufficient funding for policy implementation in this area, the intersection of three currents of problem, policy, and political determination led to the opening of the window of e-referral policy and system in Golestan Kingdon model, Policy