Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: A territory-wide target trial emulation

Cuiling Wei, Vincent Ka Chun Yan, Camille Maringe, Wenxin Tian, Rachel Yui Ki Chu, Wenlong Liu, Boyan Liu, Yuqi Hu, Lingyue Zhou, Celine Sze Ling Chui, Xue Li, Eric Yuk Fai Wan, Ching Lung Cheung, Esther Wai Yin Chan, William Chi Wai Wong, Ian Chi Kei Wong*, Francisco Tsz Tsun Lai*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: 

Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19. Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been examined. This study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with multimorbidity. 

Design:

Retrospective cohort study emulating a randomised target trial using electronic health records. Setting We used data from the Hospital Authority and the Department of Health in Hong Kong, which provided comprehensive electronic health records, COVID-19 confirmed case data, population-based vaccination records and other individual characteristics for the study. 

Participants:

Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022. Interventions Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure, compared to no outpatient visit. Main outcome measures Primary outcome was all-cause mortality within one year. Secondary outcomes included mortality from respiratory, cardiovascular and cancer causes. 

Results:

A total of 6183 eligible COVID-19 survivors were included in the analysis. The all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group (17.1 deaths per 100 person-year) compared with non-visit group (42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95% CI 8.1% to 14.4%). We also observed significantly better survival from respiratory diseases in the general outpatient visit group (difference in 1-year survival: 6.3%, 95% CI 3.5% to 8.9%). In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a general outpatient visit after COVID-19 discharge, the better the survival. 

Conclusions:

Timely primary care consultations after COVID-19 hospitalisation may improve survival following COVID-19 hospitalisation among older adults aged 85 or above with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population's recovery and well-being.

Original languageEnglish
Article numbere002834
Number of pages11
JournalFamily Medicine and Community Health
Volume12
Issue number3
Early online date14 Jul 2024
DOIs
Publication statusPublished - Jul 2024

Bibliographical note

Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ.

Data Access Statement

No data are available. The data custodian has not given permission for data sharing

Keywords

  • COVID-19
  • General Practice
  • Geriatrics
  • Primary Health Care

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