Precision public-health intervention for care coordination: a real-world study

Abstract

Background: Health emergencies disproportionally affect vulnerable populations. Digital tools can help primary care providers find, and reach, the right patients.

Aim: To evaluate whether digital interventions delivered directly to GPs' clinical software were more effective at promoting primary care appointments during the COVID-19 pandemic than interventions delivered by post.

Design and setting: Real-world, non-randomised, interventional study involving GP practices in all Australian states.

Method: Intervention material was developed to promote care coordination for vulnerable older veterans during the COVID-19 pandemic, and sent to GPs either digitally to the clinical practice software system or in the post. The intervention material included patient-specific information sent to GPs to support care coordination, and education material sent via post to veterans identified in the administrative claims database. To evaluate the impact of intervention delivery modalities on outcomes, the time to first appointment with the primary GP was measured; a Cox proportional hazards model was used, adjusting for differences and accounting for pre-intervention appointment numbers.

Results: The intervention took place in April 2020, during the first weeks of COVID-19 social distancing restrictions in Australia. GPs received digital messaging for 51 052 veterans and postal messaging for 26 859 veterans. The digital group was associated with earlier appointments (adjusted hazard ratio 1.38 [1.34 to 1.41]).

Conclusion: Data-driven digital solutions can promote care coordination at scale during national emergencies, opening up new perspectives for precision public-health initiatives.

Keywords: audit and feedback; care coordination; digital health; general practice; intervention study; precision public health; veterans.

Figure 1.

Schematic representation of the digital intervention delivery.

Figure 2.

Sample of the electronic document sent to GPs as part of the intervention.

Figure 3.

GP appointments during the first months of the COVID-19 pandemic, by appointment type.

Figure 4.

Kaplan–Meier curve depicting the chance of GP appointment in the first 3 months post-intervention, by group.