Abstract
BackgroundThe 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.MethodsEarly 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.ResultsHealthcare 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.ConclusionA 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.
Highlights
The provision of high-quality medical care to asylum seekers represents a key challenge in many countries of the European Union
Our results underline the need to improve the availability of health-related information for patients in reception centers and suggest that a patient-held personal health records (PHR) can be a viable solution if three essential requirements are met: First, consistent PHR use by all health personnel involved in the delivery of care to asylum seekers in reception centers must be achieved
Our study shows that the degree of fragmentation in service delivery design and health information systems, consistent use of the PHR by internal and external physicians, sufficient workforce capacity to cope with the additional workload, clear implementation guidelines, electronic health records well integrated with the patient-held PHR and legible handwritings are essential elements for the successful implementation of a patient-held PHR for asylum seekers in reception centers
Summary
The provision of high-quality medical care to asylum seekers represents a key challenge in many countries of the European Union. One of the key challenges has been the continuity of medical care, namely establishing communication and networks between health care providers treating refugees and asylum seekers as their trajectory continues to move them within and across different European countries [2, 3]. In Germany, initial provision and organization of medical care to asylum seekers falls under the responsibilities of state-level reception centers. These centers accommodate asylum seekers upon their entry into Germany for six months before they are transferred to peripheral reception centers in other federal states, or districts and communities. The study concluded that, in the absence of national guidelines and unified electronic health records, a standardized, patient-held Personal Health Record (PHR) represents the only viable means to transmit health-related information between providers and across sectors [6]
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