An evaluation of Mongolia’s universal patient-held health booklets as a tool for continuity of care in chronic disease patients: a cross-sectional study: Can universal patient-held booklets promote continuity of care and patient-centred care in low resource countries? The case of Mongolia

TY - JOUR

T1 - An evaluation of Mongolia’s universal patient-held health booklets as a tool for continuity of care in chronic disease patients: a cross-sectional study

T2 - Can universal patient-held booklets promote continuity of care and patient-centred care in low resource countries? The case of Mongolia

AU - Ibrahim, Hussein

AU - Munkhbayar, Uyanga

AU - Humphries, Claire

AU - Ochir, Chimedsuren

AU - Toivgoo, Aira

AU - Narula, Indermohan

AU - Lilford, Richard

AU - Manaseki-Holland, Semira

PY - 2019/9

Y1 - 2019/9

N2 - Objective: To describe a nationwide Patient-held Health Booklet system and investigate its use and completeness for clinical information transfer during chronic non-communicable disease (NCD) outpatient visits in Mongolia. Design: Cross-sectional survey and document review.Setting: Two large government secondary-care hospital outpatient departments (OPD) in Ulaanbaatar.Participants: 395 adult outpatients attending for NCDs. Outcome measure: Numbers of patient-held records brought and used by OPD doctors; Completeness of records on arrival and leaving OPD.Results: 96% (379) brought handover documentation from previous provider/s: 94% had patient-held health Booklets, 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, 93% were provided with written clinical information in the Booklet and 39% were also given other documents. 84% recalled being given verbal information. Only 40.8% of the records of the OPD consultation with written information included all three key handover information items (diagnosis, management/treatment and follow-up). The Booklets 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, 0.61) decreased the likelihood of receiving written management/treatment information; living >1 hour away (OR=0.48; 95%CI 0.27, 0.87), comorbidity (OR=0.55; 95%CI 0.35, 0.87), and returning to secondary-care for follow-up (OR=0.52; 95%CI 0.33, 0.80) all independently decreased the likelihood of receiving written follow-up information. A Ministry order mandates the use of the patient-held health Booklet, but there were no other policies, guidelines or clinician training relating to their use. Conclusions: The universal Patient-Held Health Booklets were well-accepted, well-utilised and the best completed handover documentation. The Booklets provided a successful handover option for chronic NCD patients in Mongolia but their completeness needs improving. There is potential for their application globally.

AB - Objective: To describe a nationwide Patient-held Health Booklet system and investigate its use and completeness for clinical information transfer during chronic non-communicable disease (NCD) outpatient visits in Mongolia. Design: Cross-sectional survey and document review.Setting: Two large government secondary-care hospital outpatient departments (OPD) in Ulaanbaatar.Participants: 395 adult outpatients attending for NCDs. Outcome measure: Numbers of patient-held records brought and used by OPD doctors; Completeness of records on arrival and leaving OPD.Results: 96% (379) brought handover documentation from previous provider/s: 94% had patient-held health Booklets, 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, 93% were provided with written clinical information in the Booklet and 39% were also given other documents. 84% recalled being given verbal information. Only 40.8% of the records of the OPD consultation with written information included all three key handover information items (diagnosis, management/treatment and follow-up). The Booklets 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, 0.61) decreased the likelihood of receiving written management/treatment information; living >1 hour away (OR=0.48; 95%CI 0.27, 0.87), comorbidity (OR=0.55; 95%CI 0.35, 0.87), and returning to secondary-care for follow-up (OR=0.52; 95%CI 0.33, 0.80) all independently decreased the likelihood of receiving written follow-up information. A Ministry order mandates the use of the patient-held health Booklet, but there were no other policies, guidelines or clinician training relating to their use. Conclusions: The universal Patient-Held Health Booklets were well-accepted, well-utilised and the best completed handover documentation. The Booklets provided a successful handover option for chronic NCD patients in Mongolia but their completeness needs improving. There is potential for their application globally.

KW - Clinical handover

KW - Health systems

KW - Patient safety

KW - Quality improvement

KW - Non-communicable diseases

KW - Mongolia

M3 - Article

VL - 28

SP - 729

EP - 740

JO - BMJ Quality & Safety

JF - BMJ Quality & Safety

SN - 2044-5415

IS - 9

ER -