BMJ Global Health
Volume 4, Issue 4, 2019
The impact of patient-held health records on continuity of care among asylum seekers in reception centres: A cluster-randomised stepped wedge trial in Germany (Article) (Open Access)
Straßner C. ,
Noest S. ,
Preussler S. ,
Jahn R. ,
Ziegler S. ,
Wahedi K. ,
Bozorgmehr K.*
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a
Department of General Practice and Health Services Research, Social Determinants, Equity and Migration Group, University Hospital Heidelberg, Heidelberg, Germany
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b
Department of General Practice and Health Services Research, Social Determinants, Equity and Migration Group, University Hospital Heidelberg, Heidelberg, Germany
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c
Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
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d
Department of General Practice and Health Services Research, Social Determinants, Equity and Migration Group, University Hospital Heidelberg, Heidelberg, Germany
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e
Department of General Practice and Health Services Research, Social Determinants, Equity and Migration Group, University Hospital Heidelberg, Heidelberg, Germany
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f
Department of General Practice and Health Services Research, Social Determinants, Equity and Migration Group, University Hospital Heidelberg, Heidelberg, Germany
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g
Department of General Practice and Health Services Research, Social Determinants, Equity and Migration Group, University Hospital Heidelberg, Heidelberg, Germany, Department of Population Medicine and Health Services Research, University of Bielefeld, School of Public Health, Bielefeld, Germany
Abstract
Introduction: The aim of this study was to assess the effectiveness of a patient-held health record (PHR) for asylum seekers on the availability of health-related information. Methods: An explorative, cluster-randomised stepped-wedge trial with reception centres as unit of randomisation was conducted. All reception centres (n=6) in two large administrative areas in South Germany with on-site health services were included. All physicians working at these centres were invited to participate in the study. The intervention was the implementation of a PHR. The primary outcome was the prevalence of written health-related information. Secondary outcomes were the physicians' dissatisfaction with the available written information and the prevalence of missing health-related information. All outcomes were measured at the level of patient-physician contacts by means of a standardised questionnaire, and analysed in logistic multi-level regression models. Results: We obtained data on 2308 patient-physician contacts. The presence of the PHR increased the availability of health-related information (adjusted OR (aOR), 20.3, 95% CI: 12.74 to 32.33), and tended to reduce missing essential information (aOR 0.71, 95% CI: 0.39 to 1.26) and physicians' dissatisfaction with available information (aOR 0.5, 95% CI: 0.24 to 1.04). The availability of health-related information in the post-intervention period was higher (aOR 4.22, 95% CI: 2.64 to 6.73), missing information (aOR 0.89, 95% CI: 0.42 to 1.88) and dissatisfaction (aOR 0.43, 95% CI: 0.16 to 1.14) tended to be lower compared with the pre-intervention period. Conclusions: Healthcare planners should consider introducing PHRs in reception centres or comparable facilities. Future research should focus on the impact of PHRs on clinical outcomes and on intersectoral care. © 2019 Author(s).
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Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85070201100&doi=10.1136%2fbmjgh-2019-001610&partnerID=40&md5=8e6afee364cf926e106b7e8304a8f255
DOI: 10.1136/bmjgh-2019-001610
ISSN: 20597908
Original Language: English