Tapio Haaga, Alex Kivimäki, What is Kortelainen, Oskari Nokso-Koivisto, Tanja Saxell, Meeri Seppä, Lauri Sääksvuori

Summary:

We used a large-scale randomized controlled trial (RCT) to study the effects of a publicly offered digital clinic. Digiklinikka provides primary health care services through digital channels. The research intervention gave access to a public digital clinic that provides chat-based primary care receptions via a mobile application and website. The service includes assessments of the need for treatment, diagnoses, prescriptions and recommendations for further treatment. The digital clinic was designed to complement traditional primary public health care services, such as attendance and telephone consultations. The experiment was carried out in Ostrobothnia, a health care area serving a population of 179,000. We randomised access to the digital clinic at household level so that 50 per cent of households had access to the service.

This Supplementary Statistical Analysis Plan (SAP) reports the results of our pre-registered analyses with minor changes in relation to our Preliminary Analysis Plan (PAP) and Statistical Analysis Plan (SAP). Using administrative data at the individual level, we find that the impact of the use of a digital clinic on the number of attendances in primary public health care did not deviate statistically significantly from zero. The score estimate is negative, suggesting that only five attendances per 100 digital clinic contacts were avoided (95 %Confidence interval of : −23 to +13). Instead, the digital clinic reduced the number of other traditional primary public healthcare contacts, including telemedicine, consultations between professionals and assessments of the need for care: 37 other contacts in traditional primary public health care were avoided per 100 digital clinic contacts (95 %Confidence interval of : −60–14). The results suggest that other traditional primary public health services are closer substitutes for digital services than attendance. Overall, access to the digital clinic increased the total number of contacts in primary public health care by 2.4 per cent (95 %Confidence interval of : +0,4 % – +4,4 %). We do not see any statistically significant effects on the use of specialised medical care provided in hospitals, nor do we see evidence that the use of private or occupational health care has been replaced by public sector services.

Read the research blog: Results of the Ostrobothnian digital clinic experiment: Chat receptions in medical care improved availability, but attendances did not significantly decrease