Disrupted specialist outpatient services and alternative modes of service for patients with diabetes mellitus: A population-based, retrospective cohort study in Hong Kong

Abstract

Introduction: Reduced specialist outpatient clinic (SOPC) services during COVID-19 waves may have increased the risk of mortality and complications in patients with diabetes mellitus (DM). Evidence on whether alternative modes of service have mitigated these risks is lacking. Methods: In this population-based, retrospective cohort study in Hong Kong, we included patients with DM between 2010 and 2019 and had internal medicine SOPC visits in 2019. We identified modes of care (SOPC, primary care clinics and drug-refill service) of these patients in 2020 and followed them from January 2021 to June 2024. Cox proportional hazards models were used to estimate risks of all-cause mortality and complications. Results: Among 96 372 patients, SOPC follow-up disruptions in 2020 were associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.20, 95% CI 1.12–1.29) and cardiovascular diseases (CVD) incidence (HR 1.12, 95% CI 1.05–1.20). Among those affected by SOPC follow-up disruptions in 2020, patients who had attended primary care clinics in 2020 had a lower risk of all-cause mortality (HR 0.72, 95% CI 0.60–0.87) and CVD (HR 0.84, 95% CI 0.72–0.99) than those without any primary care clinic attendance visits. Conclusion: SOPC service disruption was associated with increased risk of mortality and CVD among patients with DM. Primary care clinic service could be a beneficial alternative mode of service to attenuate the excessive risk. These findings support a policy that follow-up at primary care clinics should be provided for patients with DM when SOPC service is disrupted in future public health crises.