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

doi:10.1136/fmch-2024-002834

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

University of Hong Kong
London School Of Hygiene and Tropical Medicine
Laboratory of Data Discovery for Health
Advanced Data Analytics for Medical Science (ADAMS) Limited

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

8 Downloads (Pure)

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 language	English
Article number	e002834
Number of pages	11
Journal	Family Medicine and Community Health
Volume	12
Issue number	3
Early online date	14 Jul 2024
DOIs	https://doi.org/10.1136/fmch-2024-002834
Publication status	Published - 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

Funding

This work was funded by a research grant from the Health Bureau of the Government of the Hong Kong Special Administrative Region, through the Health and Medical Research Fund Research on COVID-19 (COVID19F01). The funder was not involved in the study design, data collection, data analysis, data interpretation, and writing of the report. Francisco Tsz Tsun Lai and Ian Chi Kei Wong are partially supported by the Laboratory of Data Discovery for Health, funded by the AIR@InnoHK and administered by the Innovation and Technology Commission.

Funders	Funder number
Health Bureau of the Government
Innovation and Technology Commission
Health and Medical Research Fund Research on COVID-19	COVID19F01

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

COVID-19
General Practice
Geriatrics
Primary Health Care

Access to Document

10.1136/fmch-2024-002834Licence: CC BY-NC 4.0

C Wei et al_Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients w multimorbidity_territory-wide target trial emulation
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.
Final published version, 870 KBLicence: CC BY-NC 4.0

Cite this

Wei, C., Yan, V. K. C., Maringe, C., Tian, W., Chu, R. Y. K., Liu, W., Liu, B., Hu, Y., Zhou, L., Chui, C. S. L., Li, X., Wan, E. Y. F., Cheung, C. L., Chan, E. W. Y., Wong, W. C. W., Wong, I. C. K., & Lai, F. T. T. (2024). Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: A territory-wide target trial emulation. Family Medicine and Community Health, 12(3), Article e002834. https://doi.org/10.1136/fmch-2024-002834

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

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.",

keywords = "COVID-19, General Practice, Geriatrics, Primary Health Care",

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

note = "Copyright {\textcopyright} 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.",

year = "2024",

month = jul,

doi = "10.1136/fmch-2024-002834",

language = "English",

volume = "12",

journal = "Family Medicine and Community Health",

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number = "3",

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Wei, C, Yan, VKC, Maringe, C, Tian, W, Chu, RYK, Liu, W, Liu, B, Hu, Y, Zhou, L, Chui, CSL, Li, X, Wan, EYF, Cheung, CL, Chan, EWY, Wong, WCW, Wong, ICK & Lai, FTT 2024, 'Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: A territory-wide target trial emulation', Family Medicine and Community Health, vol. 12, no. 3, e002834. https://doi.org/10.1136/fmch-2024-002834

TY - JOUR

T1 - Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: A territory-wide target trial emulation

AU - Wei, Cuiling

AU - Yan, Vincent Ka Chun

AU - Maringe, Camille

AU - Tian, Wenxin

AU - Chu, Rachel Yui Ki

AU - Liu, Wenlong

AU - Liu, Boyan

AU - Hu, Yuqi

AU - Zhou, Lingyue

AU - Chui, Celine Sze Ling

AU - Li, Xue

AU - Wan, Eric Yuk Fai

AU - Cheung, Ching Lung

AU - Chan, Esther Wai Yin

AU - Wong, William Chi Wai

AU - Wong, Ian Chi Kei

AU - Lai, Francisco Tsz Tsun

PY - 2024/7

Y1 - 2024/7

N2 - 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.

AB - 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.

KW - COVID-19

KW - General Practice

KW - Geriatrics

KW - Primary Health Care

UR - https://fmch.bmj.com/content/12/3/e002834

UR - https://www.scopus.com/pages/publications/85198721800

U2 - 10.1136/fmch-2024-002834

DO - 10.1136/fmch-2024-002834

M3 - Article

C2 - 38902080

AN - SCOPUS:85198721800

SN - 2305-6983

VL - 12

JO - Family Medicine and Community Health

JF - Family Medicine and Community Health

IS - 3

M1 - e002834

ER -

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

Abstract

Bibliographical note

Data Access Statement

Funding

UN SDGs

Keywords

Access to Document

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Cite this