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Can universal patient-held health booklets promote continuity of care and patient-centred care in low-resource countries? The case of Mongolia
  1. Hussein Ibrahim1,
  2. Uyanga Munkhbayar2,
  3. Aira Toivgoo3,
  4. Claire Humphries1,
  5. Chimedsuren Ochir4,
  6. Indermohan S Narula3,
  7. Richard Lilford5,6,
  8. Semira Manaseki-Holland1
  1. 1Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  2. 2School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
  3. 3Wellspring NGO, Ulaanbaatar, Mongolia
  4. 4Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
  5. 5Warwick Medical School, University of Warwick, Coventry, UK
  6. 6Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, West Midlands, UK
  1. Correspondence to Dr Semira Manaseki-Holland, College of Medical and Dental Sciences, University of Birmingham, Institute of Applied Health Research, Birmingham B15 2TT, UK; s.manasekiholland{at}bham.ac.uk

Abstract

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.

  • clinical handover
  • health systems
  • patient safety
  • quality improvement
  • non-communicable diseases
  • mongolia
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Footnotes

  • Contributors HI: substantial contributions to conception and study design, acquisition of data, analysis and interpretation of data, drafting the article, revising it critically, and final approval of the version to be published. UB: substantial contributions to study design, acquisition of data, analysis and interpretation of data, and final approval of the version to be published. CH: contributions to analysis and interpretation of data, revising it critically, and final approval of the version to be published. AT, CO, IN, RL: substantial contributions to conception and design and contribution to the drafts of the manuscript. SMH: conception of the study question, substantial contributions to study design, drafting the article, revising it critically and final approval of the version to be published.

  • Funding The School of Population Sciences and Humanities, University of Birmingham, UK, BMedSc Research Budget helped cover some of the costs of this study. Otherwise this research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The sponsor had no role in the study design, collection, analysis, interpretation of the data or any other contribution. RL is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The research was conducted in accordance with a protocol reviewed and approved by Research Ethics Comittees at both the University of Birmingham in England and the Mongolian National University of Medical Sciences in Mongolia. All patients gave informed consent before taking part.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data and tools are available upon request from the corresponding author.

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