Straßner Cornelia, Noest Stefan, Preussler Stella, Jahn Rosa, Ziegler Sandra, Wahedi Katharina, Bozorgmehr Kayvan
Department of General Practice and Health Services Research, Social Determinants, Equity & Migration Group, University Hospital Heidelberg, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany.
BMJ Glob Health. 2019 Aug 2;4(4):e001610. doi: 10.1136/bmjgh-2019-001610. eCollection 2019.
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.
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.
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.
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.
ISRCTN13212716. Registered 24 November 2016. Retrospectively registered. http://www.isrctn.com/ISRCTN13212716.
本研究旨在评估患者持有的健康记录（PHR）对寻求庇护者获取健康相关信息的有效性。
进行了一项探索性、整群随机阶梯楔形试验，以接待中心作为随机分组单位。纳入了德国南部两个设有现场医疗服务的大行政区内的所有接待中心（n = 6）。邀请了在这些中心工作的所有医生参与研究。干预措施是实施PHR。主要结局是书面健康相关信息的普及率。次要结局是医生对现有书面信息的不满程度以及缺失健康相关信息的普及率。所有结局均通过标准化问卷在患者与医生接触层面进行测量，并在逻辑多水平回归模型中进行分析。
我们获取了2308次患者与医生接触的数据。PHR的存在增加了健康相关信息的可获取性（调整后的比值比（aOR）为20.3，95%置信区间：12.74至32.33），并倾向于减少关键信息的缺失（aOR为0.71，95%置信区间：0.39至1.26）以及医生对现有信息的不满（aOR为0.5，95%置信区间：0.24至1.04）。与干预前相比，干预后期健康相关信息的可获取性更高（aOR为4.22，95%置信区间：2.64至6.73），信息缺失（aOR为0.89，95%置信区间：0.42至1.88）和不满（aOR为0.43，95%置信区间：0.16至1.14）倾向于更低。
医疗保健规划者应考虑在接待中心或类似设施中引入PHR。未来的研究应关注PHR对临床结局和跨部门护理的影响。
ISRCTN13212716。于2016年11月24日注册。追溯注册。http://www.isrctn.com/ISRCTN13212716 。
