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Six-month outcomes after a GP phone call during the first French COVID-19 lockdown (COVIQuest): a cluster randomised
Ambre Sauvage1,2, Emeline Laurent3,4, Bruno Giraudeau2,5
1Epidemiology Unit for Clinical Data in Centre-Val de Loire (EpiDcliC), CHRU de Tours, Tours, Centre-Val de Loire, France asauvage.isp@gmail.com.
Insights
A general practitioner phone call intervention for chronic disease patients during COVID-19 lockdown was linked to increased hospitalizations for cardiovascular disease (CVD) and mental health disorders (MHD) at six months. Outpatient care showed no significant changes.
Area of Science:
- Public Health
- Healthcare Management
- Clinical Research
Background:
- COVID-19 lockdowns raised concerns about primary care access for chronic disease patients.
- The COVIQuest trial investigated general practitioner (GP) phone calls to patients with cardiovascular disease (CVD) or mental health disorders (MHD).
- Previous 1-month follow-up showed no effect on hospitalizations for CVD and a potential increase for MHD.
Purpose of the Study:
- To assess 6-month hospitalization and specialized consultation rates in chronic patients receiving GP phone calls during the COVID-19 lockdown.
- To compare these rates with the same period in 2019.
- To evaluate the utility of medico-administrative databases in clinical research.
Main Methods:
- Cluster randomized controlled trial involving 149 GPs across eight French regions.
- Included patients aged 70+ with CVD or 18+ with MHD.
- Assessed hospitalizations and specialized consultations using the French national health data system (Système National des Données de Santé).
Main Results:
- Patients receiving the GP phone intervention had higher hospitalization rates at 6 months: 17.3% (CVD) and 14.4% (MHD), versus 14.9% and 10.7% in controls.
- No significant difference in specialized consultation rates was observed between intervention and control groups for either CVD or MHD.
- Hospitalization rates during the same period in 2019 were comparable to the intervention group, suggesting a potential artifact.
Conclusions:
- The GP phone call intervention was associated with increased 6-month hospitalizations for patients with CVD or MHD.
- No impact on outpatient care was detected.
- Results may be influenced by public health campaigns during lockdown; medico-administrative databases are valuable for long-term outcome research.
Objectives:
The first COVID-19 lockdown raised concerns about reduced access to primary care, especially for people with chronic diseases particularly at risk in the absence of follow-up. However, the COVIQuest trial, evaluating the impact of a general practitioner (GP) phone call (intervention) to chronic patients with cardiovascular disease (CVD) or mental health disorder (MHD) concluded that the intervention had no effect at 1 month on the rate of self-reported hospitalisations in the CVD subtrial, whereas the intervention group in MHD subtrial might have a higher rate. This second part of the study aimed to describe the 6 month hospitalisation and specialised consultation rates, using the French health data system (Système National des Données de Santé). The secondary objective was to describe these rates during the same period in 2019.
Design:
A cluster randomised controlled trial, with clusters being GPs.
Setting:
Primary care, 149 GPs from eight French regions.
Participants:
Patients ≥70 years old with chronic CVD or ≥18 years old with MHD.
Interventions:
A standardised GP-initiated phone call aiming to evaluate patient's need for urgent care (vs usual care for control groups).
Primary And Secondary Outcome Measures:
The occurrence of at least one hospitalisation at end point 31 October 2020 (randomisation 30 April 2020), excluding those starting on 30 April 2020, was measured as planned. Another main outcome was the occurrence of at least one specialised consultation during the same period. These 6 month effects were studied, using a logistic regression model within a generalised estimating equation framework, for each subtrial.
Results:
4640 patients were included: 3274 cardiovascular (mean age 79.9±7.0 years; 57.8% male) and 1366 psychiatric (53.2±7.0; 36.5%). For both subtrials, the intervention patients were significantly more hospitalised than the control patients, respectively, 17.3% versus 14.9% of CVD patients (OR=1.26 (1.05 to 1.52)); 14.4% versus 10.7% of MHD patients (OR=1.40 (1.00 to 1.96)). During the same period in 2019, the hospitalisation rates were, respectively, 16.3%, 18.2%, 15.8% and 14.8%. The proportions of patients with at least one specialised consultation were not different between the intervention and control groups, respectively, 24.6% versus 24.3% for CVD patients (OR=1.06 (0.85 to 1.32)); 26.5% versus 24.4% for MHD patients (OR=1.15 (0.84 to 1.57)). During the same period in 2019, these rates were, respectively, 22.7%, 24.6%, 28.0% and 25.5%.
Conclusions:
The intervention was associated with higher rates of hospitalisation at 6 months in patients with MHD or CVD. No intervention impact was found in outpatient care. These results are difficult to interpret because of a potential artefact induced by national campaigns promoting medical use during lockdown, overlapping the study inclusion period. This study showed that medico-administrative databases could represent a complementary cost-effective tool to clinical research for long-term and healthcare consumption outcomes.
Trial Registration Number:
NCT04359875.
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