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: This study evaluated whether digital interventions delivered directly to general practitioners’ (GPs) clinical software are more effective than postal delivery interventions in promoting primary care appointments during the COVID-19 pandemic. Design and setting: Real world, non-randomised, interventional study involving outpatient clinics in all Australian states. Methods: We developed intervention material to promote care coordination for vulnerable older veterans during COVID-19 which was delivered to GPs either digitally via direct delivery to the clinical practice software system or via postal delivery. The intervention material delivered included patient specific information to general practitioners to support care coordination, and education material was also delivered via post to the 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 using a Cox proportional hazards model adjusting for differences prior to the intervention in the health contact rates between the digital and postal health care providers. Results: The intervention took place in April 2020, during the first weeks of COVID-19 social distancing rules in Australia. GPs received digital messaging for 51,052 veterans and postal messaging for 26,859 veterans. Being in the digital group was associated with earlier appointments (Adjusted hazard ratio: 1.38 (1.35, 1.4)). Conclusion: Data-driven digital solutions can promote care coordination at scale during national emergencies, opening up new perspectives for precision public health initiatives.