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The impact of patient-held health records on continuity of care among asylum seekers in reception centres: a cluster-randomised stepped wedge trial in Germany
  1. Cornelia Straßner1,
  2. Stefan Noest1,
  3. Stella Preussler2,
  4. Rosa Jahn1,
  5. Sandra Ziegler1,
  6. Katharina Wahedi1,
  7. Kayvan Bozorgmehr1,3
  1. 1 Department of General Practice and Health Services Research, Social Determinants, Equity & Migration Group, University Hospital Heidelberg, Heidelberg, Germany
  2. 2 Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
  3. 3 Department of Population Medicine and Health Services Research, University of Bielefeld, School of Public Health, Bielefeld, Germany
  1. Correspondence to Professor Kayvan Bozorgmehr; kayvan.bozorgmehr{at}


Introduction The aim of this study was to assess the effectiveness of a patient-held health record (PHR) for asylum seekers on the availability of health-related information.

Methods An explorative, cluster-randomised stepped-wedge trial with reception centres as unit of randomisation was conducted. All reception centres (n=6) in two large administrative areas in South Germany with on-site health services were included. All physicians working at these centres were invited to participate in the study. The intervention was the implementation of a PHR. The primary outcome was the prevalence of written health-related information. Secondary outcomes were the physicians’ dissatisfaction with the available written information and the prevalence of missing health-related information. All outcomes were measured at the level of patient–physician contacts by means of a standardised questionnaire, and analysed in logistic multi-level regression models.

Results We obtained data on 2308 patient–physician contacts. The presence of the PHR increased the availability of health-related information (adjusted OR (aOR), 20.3, 95% CI: 12.74 to 32.33), and tended to reduce missing essential information (aOR 0.71, 95% CI: 0.39 to 1.26) and physicians’ dissatisfaction with available information (aOR 0.5, 95% CI: 0.24 to 1.04). The availability of health-related information in the post-intervention period was higher (aOR 4.22, 95% CI: 2.64 to 6.73), missing information (aOR 0.89, 95% CI: 0.42 to 1.88) and dissatisfaction (aOR 0.43, 95% CI: 0.16 to 1.14) tended to be lower compared with the pre-intervention period.

Conclusions Healthcare planners should consider introducing PHRs in reception centres or comparable facilities. Future research should focus on the impact of PHRs on clinical outcomes and on intersectoral care.

Trial registration ISRCTN13212716. Registered 24 November 2016. Retrospectively registered.

  • asylum seekers
  • refugees
  • migration
  • continuity
  • health services
  • health information
  • health record
  • medical record
  • cluster randomisation
  • stepped-wedge trial

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  • Handling editor Dr Eduardo Gómez

  • Contributors Author Contributions: Conceived the study: KB. Study design: KB, SN, CS. Data collection: CS, SZ, RJ, KW. Development of methods and measures: SN, KB, CS. Data analysis: SP, KB. Interpretation: SP, KB, CS. Writing of first and final version of the manuscript: CS, KB. Revision for important intellectual content: CS, SN, SP, RJ, SZ, KW, KB. All authors approved the final version for publication.

  • Funding The study was funded by the Federal Ministry of Education and Research (BMBF) within the scope of the RESPOND project ('Improving Regional Health System Responses to the challenge of forced migration through tailored interventions for asylum seekers and refugees', grant number: FKZ 01GY1611). The funder did not have any role in the study design or in the collection, analysis, interpretation and publication of data.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the ethical committee of the Medical Faculty of the University of Heidelberg (Ethical approval nr: S-438/2016).

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

  • Data availability statement De-identified participant data are available from the last author (Kayvan Bozorgmehr,, ORCID

    0000-0002-1411-1209) upon reasonable request.

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