Wei, Cuiling, Yan, Vincent Ka Chun, Maringe, Camille, Tian, Wenxin, Chu, Rachel Yui Ki, Liu, Wenlong, Liu, Boyan, Hu, Yuqi, Zhou, Lingyue, Chui, Celine Sze Ling, Li, Xue, Wan, Eric Yuk Fai, Cheung, Ching Lung, Chan, Esther Wai Yin, Wong, William Chi Wai, Wong, Ian Chi Kei and Lai, Francisco Tsz Tsun (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),
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.
Publication DOI: | https://doi.org/10.1136/fmch-2024-002834 |
---|---|
Divisions: | College of Health & Life Sciences > Aston Pharmacy School |
Funding Information: | 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 desi |
Additional Information: | 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. |
Uncontrolled Keywords: | COVID-19,General Practice,Geriatrics,Primary Health Care |
Publication ISSN: | 2009-8774 |
Data Access Statement: | No data are available. The data custodian has not given permission for data sharing |
Last Modified: | 12 Aug 2024 17:48 |
Date Deposited: | 07 Aug 2024 16:00 |
Full Text Link: | |
Related URLs: |
https://fmch.bm ... nt/12/3/e002834
(Publisher URL) http://www.scop ... tnerID=8YFLogxK (Scopus URL) |
PURE Output Type: | Article |
Published Date: | 2024-07 |
Published Online Date: | 2024-07-14 |
Accepted Date: | 2024-07-01 |
Authors: |
Wei, Cuiling
Yan, Vincent Ka Chun Maringe, Camille Tian, Wenxin Chu, Rachel Yui Ki Liu, Wenlong Liu, Boyan Hu, Yuqi Zhou, Lingyue Chui, Celine Sze Ling Li, Xue Wan, Eric Yuk Fai Cheung, Ching Lung Chan, Esther Wai Yin Wong, William Chi Wai Wong, Ian Chi Kei ( ![]() Lai, Francisco Tsz Tsun |