Shifts in primary care utilization patterns following digital health implementation: an operational evaluation of the...

Early identification of care-seeking patterns and clinical triage optimization are critical challenges in mass gathering medicine. Genetic and structural clinical protocols are designed to manage surges, but the combined impact of digital triage networks on physical healthcare-seeking behaviors remains to be characterized. We evaluated the integration of a 'Digital-First' healthcare model during the 2023-2024 Hajj mass gatherings, tracking shifts in primary care utilization patterns alongside extreme environmental thermal pressures.

This prospective-observational cohort study utilized de-identified operational health registry data from the Saudi Ministry of Health (MOH) spanning the 2023 and 2024 Hajj seasons. High-fidelity clinical registry metrics from physical primary health care (PHC) clinics, emergency departments (ED), and specialized holy site hospitals were standardized as rates per 10,000 registered pilgrims. Digital care-seeking volumes were extracted from the unified Sehhaty virtual portal. A Sequential Explanatory Expert Forum comprising 15 senior critical care and public health specialists resolved operational recommendations.

The total registered pilgrim population was 1,845,223 in 2023 and 1,833,164 in 2024, representing a baseline density decrease of 0.65%. The implementation of the first digital model in 2024 was associated with the absorption of 516,585 virtual consultations, establishing a virtual-to-physical primary utilization ratio of 3.24:1. This digital deployment co-occurred with an 18.65 % decline in physical PHC visits (from 195,974 in 2023 to 159,425 in 2024), representing a standardized rate reduction from 1,062.1 to 869.7 visits per 10,000 pilgrims. Conversely, acute care strain rose sharply; holy site ED visits increased by 42.45% (from 212.0 to 304.0 per 10,000 pilgrims), while documented heat stroke cases rose by 73.36 % (from 6.1 to 10.6 per 10,000 pilgrims) and heat exhaustion rose by 42.10 % (57.2 to 81.8 per 10,000 pilgrims).

The transition to a digital-first operational model co-occurred with a substantial shift in primary healthcare utilization, successfully redirecting low-acuity demand to virtual platforms during a mass gathering. However, this digital absorption did not decouple health system strain in acute care categories, where a documented environmental climate anomaly drove severe emergency and thermal illness surges. These findings suggest that virtual platforms function as critical clinical buffers rather than system-wide protectors during extreme climate events.