title: Continuity of care in the cross-border context: insights from a survey of German patients treated abroad.
abstract: BACKGROUND
  Continuity of care is important for outcomes and patient satisfaction and includes additional considerations in the context of cross-border health care. Although this has been discussed in research and was picked up in the recently transposed Directive on patients' rights (2011/24/EU), there is limited evidence about related issues actually encountered by patients crossing borders.
  
  
  METHODS
  An anonymous postal survey was carried out by the Techniker Krankenkasse, one of the largest sickness funds in Germany. The questionnaire was sent to 45 189 individuals who had received treatment in EU/EEA countries and included items on relational, management and informational continuity.
  
  
  RESULTS
  The survey had a response rate of 41% (n = 17 543). Of those respondents who had travelled for care (n = 3307), ∼19% (n = 570) did so due to a relationship of trust with a given provider. Only 8% of all respondents required emergency follow-up services due to complications, the majority of which was obtained back in Germany. Twelve percentage of those who were prescribed medication abroad (n = 4208) reported problems, spanning unknown products, dispensation and reimbursement. Information exchange between providers across borders was rare and largely carried out by the patients themselves.
  
  
  CONCLUSIONS
  Although relational continuity may be important to specific groups of patients travelling for care, it is primarily informational continuity and its interrelation with management continuity that need to be addressed in the cross-border context. Information exchange should be endorsed at European level. Additional focus is required on informing patients about documentation rights and requirements and providing health records that are comprehensive and comprehensible.
authors: 1 Department of Health Care Management, Berlin University of Technology, Berlin, Germany dimitra.panteli@tu-berlin.de.
authors: Dimitra
authors: D
authors: Panteli
authors: 2 Scientific Institute of Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG) Hamburg, Germany.
authors: Caroline
authors: C
authors: Wagner
authors: 2 Scientific Institute of Techniker Krankenkasse for Benefit and Efficiency in Health Care (WINEG) Hamburg, Germany.
authors: Frank
authors: F
authors: Verheyen
authors: 1 Department of Health Care Management, Berlin University of Technology, Berlin, Germany.
authors: Reinhard
authors: R
authors: Busse
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D005858:Germany; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D057193:Medical Tourism / Q000706:statistics & numerical data*; D008875:Middle Aged; D017060:Patient Satisfaction; D055553:Prescription Drugs; D011369:Professional-Patient Relations
chemical_list: D055553:Prescription Drugs