Systematic review on the use of patient-held health records in low-income and middle-income countries

Research output: Contribution to journalReview articlepeer-review


  • Linju Joseph
  • Dona Boban
  • Claire Humphries
  • Prinu Jose
  • Panniyammakal Jeemon

Colleges, School and Institutes

External organisations

  • Centre for Chronic Disease Control
  • Amrita Institute of Medical Sciences
  • Birmingham City Council
  • Public Health Foundation of India
  • Sree Chitra Tirunal Institute for Medical Sciences and Technology


OBJECTIVE: To review the available evidence on the benefit of patient-held health records (PHRs), other than maternal and child health records, for improving the availability of medical information for handover communication between healthcare providers (HCPs) and/or between HCPs and patients in low-income and middle-income countries (LMICs).

METHODS: The literature searches were conducted in PubMed, EMBASE, CINAHL databases for manuscripts without any restrictions on dates/language. Additionally, articles were located through citation checking using previous systematic reviews and a grey literature search by contacting experts, searching of the WHO website and Google Scholar.

RESULTS: Six observational studies in four LMICs met the inclusion criteria. However, no studies reported on health outcomes after using PHRs. Studies in the review reported patients' experience of carrying the records to HCPs (n=3), quality of information available to HCPs (n=1) and the utility of these records to patients (n=6) and HCPs (n=4). Most patients carry PHRs to healthcare visits. One study assessed the completeness of clinical handover information and found that only 41% (161/395) of PHRs were complete with respect to key information on diagnosis, treatment and follow-up. No protocols or guidelines for HCPs were reported for use of PHRs. The HCPs perceived the use of PHRs improved medical information availability from other HCPs. From the patient perspective, PHRs functioned as documented source of information about their own condition.

CONCLUSION: Limited data on existing PHRs make their benefits for improving health outcomes in LMICs uncertain. This knowledge gap calls for research on understanding the dynamics and outcomes of PHR use by patients and HCPs and in health systems interventions.


Bibliographic note

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.


Original languageEnglish
Article numbere046965
Number of pages11
JournalBMJ open
Issue number9
Publication statusPublished - 2 Sep 2021


  • international health services, public health, quality in health care

ASJC Scopus subject areas