Can universal patient-held health booklets promote continuity of care and patient-centred care in low-resource countries? The case of Mongolia
Can universal patient-held health booklets promote continuity of care and patient-centred care in low-resource countries? The case of Mongolia
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DOI：
10.1136/bmjqs-2018-008941
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发表时间：
2019-09-01
影响因子：
5.4
通讯作者：
Manaseki-Holland, Semira
中科院分区：
文献类型：
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作者：
Ibrahim, Hussein;Munkhbayar, Uyanga;Manaseki-Holland, Semira
背景患者及其主治医护人员均可访问的临床记录系统促进了护理的连续性和以患者为中心的护理，从而改善了临床结果。随着需要持续护理的慢性非传染性疾病患者比例的增加，对这一系统的需求也越来越大。在低收入和中等收入国家，这些疾病的负担是最大的，这是特别真实的。目的描述一个全国范围内的病人持有的健康手册（PHHB）系统，并调查其使用和完整性的临床信息传输慢性非传染性疾病门诊就诊在乌兰巴托，Mongolia.Methods定性和定量的方法，在这个混合方法研究。采用结构化访谈对在两家大型公立二级保健医院门诊部就诊的慢性非传染性疾病成年患者进行了抽样研究;采用人工审查来分析与其临床护理有关的书面文件的内容;结果96%（379/395）的患者接受了培训。从以前的供应商那里带来了移交文件：94%有PHHB，27%有其他额外的文件，4%没有。67%是从初级保健转介，44%转介回随访。在离开门诊部时，无论是否需要电脑输入数据，93%的病人的医生都在公共卫生和健康手册中提供了书面临床信息。84%的患者回忆起被给予口头信息。然而，只有41%的书面信息咨询包括所有三个关键的移交信息项目（诊断，管理/治疗和随访）。PHHB是最完整的文件类型，有证据表明患者（80%），公共（95%）和私人（77%）提供者咨询过这些文件。生活>1小时路程（OR=0.28; 95% CI 0.13 - 0.61）降低了接受书面管理/治疗信息的可能性;居住距离>1小时（OR=0.48; 95% CI 0.27 - 0.87），合并症（OR=0.55; 95% CI 0.35 - 0.87）和返回二级护理（OR=0.52; 95% CI 0.33 - 0.80）均独立降低了接受书面随访信息的可能性。一个部命令授权使用的小册子，但没有其他相关的政策，指导方针或临床医生training.Conclusion普遍PHHB被广泛接受，使用良好，最好的完成移交文件。PHHB为蒙古的慢性非传染性疾病患者提供了一个成功的移交选择，但其完整性需要改进。具有全球应用的潜力。
Background A system of clinical records accessible by both patients and their attending healthcare professionals facilitates continuity of care and patient-centred care, thereby improving clinical outcomes. The need for such a system has become greater as the proportion of patients with chronic non-communicable diseases (NCDs) requiring ongoing care increases. This is particularly true in low-income and middle-income countries where the burden of these diseases is greatest.Objective To describe a nationwide patient-held health booklet (PHHB) system and investigate its use and completeness for clinical information transfer during chronic NCD outpatient visits in Ulaanbaatar, Mongolia.Methods Qualitative and quantitative methodologies were employed in this mixed-methods study. Structured interviews were used to study a sample of adult patients with chronic NCDs attending the outpatient departments (OPDs) of two large, public secondary care hospitals; artefact reviews were used to analyse the content of the written documents relating to their clinical care; and snowball methodology was used to identify policy and training documents.Results 96% (379/395) brought handover documentation from previous provider/s: 94% had PHHBs, 27% other additional documents and 4% had nothing. 67% were referred from primary care and 44% referred back for follow-up. On leaving the OPD, irrespective of requirements for computer data entry, doctors provided written clinical information in the PHHB for 93% of patients. 84% of patients recalled being given verbal information. However, only 41% of the consultation with written information included all three key handover information items (diagnosis, management/treatment and follow-up). The PHHBs were the best completed type of document, with evidence that they were consulted by patients (80%), public (95%) and private (77%) providers. Living >1 hour away (OR=0.28; 95% CI 0.13 to 0.61) decreased the likelihood of receiving written management/treatment information; living >1 hour away (OR=0.48; 95% CI 0.27 to 0.87), comorbidity (OR=0.55; 95% CI 0.35 to 0.87) and returning to secondary care (OR=0.52; 95% CI 0.33 to 0.80) all independently decreased the likelihood of receiving written follow-up information. A Ministry order mandates the use of the booklet, but there were no other related policies, guidelines or clinician training.Conclusion The universal PHHBs were well accepted, well used and the best completed handover documentation. The PHHBs provided a successful handover option for patients with chronic NCDs in Mongolia, but their completeness needs improving. There is potential for global application.