Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
Global Health. 2018 Jul 20;14(1):71. doi: 10.1186/s12992-018-0394-1.
BACKGROUND: The provision of high-quality medical care to asylum seekers represents a key challenge in many countries of the European Union. Especially continuity of care has been difficult to achieve as the migrant trajectory moves asylum seekers across and within European countries. Patient-held personal health records (PHR) have been proposed to facilitate the transfer of medical history between health sectors and providers, but so far there is no data to support its use in the migrant setting. The present paper addresses this knowledge gap by exploring the experiences and practices of healthcare providers in reception centers for asylum seekers using a patient-held PHR as well as the perceived associated benefits and shortcomings. METHODS: Early evaluation by means of a multi-sited qualitative study in six asylum seeker reception centers in five cities in the German state of Baden-Wuerttemberg, conducted between November 2016 and January 2017. The PHR evaluated in this study was implemented in five of these reception centers between February and October 2016; the remaining one only receiving patients with the PHR through transfer from the other facilities. 17 interviews were conducted with physicians and nurses working at these reception centers exploring their experiences, routines, and perspectives regarding the patient-held PHR. The interviews were recorded, transcribed and analyzed following the approach of thematic analysis. RESULTS: Healthcare providers recognise the potential of a patient-held PHR to improve access to medical history. They use the PHR to document their medical consultations and to collect other medical reports. However, physician adherence to the patient-held PHR was described as unsatisfactory, in particular among external doctors, thus limiting its immediate benefit. Reasons given for this low adherence included lack of information before implementation, demanding working conditions with little support, low perceived benefits depending on the degree of fragmentation of settings, parallel existence of other documentation platforms and strained patient relationships. CONCLUSION: A patient-held PHR could improve the availability of health-related information in reception centers if a context-sensitive implementation process achieves high adherence to the PHR among physicians as well as high patient compliance and includes guidelines regarding its adequate integration into local routines.
背景:向寻求庇护者提供高质量的医疗保健是许多欧盟国家面临的一项重大挑战。特别是,随着移民轨迹将寻求庇护者在欧洲国家之间转移,医疗服务的连续性难以实现。患者持有的个人健康记录(PHR)被提议用于促进卫生部门和提供者之间的医疗史转移,但迄今为止,没有数据支持其在移民环境中的使用。本研究通过探索难民接待中心的医疗服务提供者使用患者持有的 PHR 的经验和做法,以及他们认为的相关优缺点,填补了这一知识空白。
方法:通过在德国巴登-符腾堡州五个城市的六个难民接待中心进行的多地点定性研究进行早期评估,该研究于 2016 年 11 月至 2017 年 1 月进行。本研究评估的 PHR 于 2016 年 2 月至 10 月在其中五个接待中心实施;其余一个只通过从其他设施转移来接收持有 PHR 的患者。对在这些接待中心工作的医生和护士进行了 17 次访谈,探讨他们对患者持有的 PHR 的经验、常规和看法。访谈以主题分析的方式进行记录、转录和分析。
结果:医疗服务提供者认识到患者持有的 PHR 改善获取病史的潜力。他们使用 PHR 记录他们的医疗咨询并收集其他医疗报告。然而,医生对患者持有的 PHR 的遵守情况被描述为不尽如人意,尤其是外部医生,从而限制了其直接效益。导致这种低遵守率的原因包括实施前缺乏信息、工作条件艰苦、支持不足、根据设置碎片化程度感知收益低、同时存在其他记录平台以及紧张的医患关系。
结论:如果一个敏感的实施过程能够使医生高度遵守 PHR,并且患者高度遵守并包括关于将其适当整合到当地常规的指南,那么患者持有的 PHR 可以改善接待中心的健康相关信息的可用性。
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