Clinical and psychosocial factors associated with clinician-driven allocation to hybrid versus in-person care in chronic disease management: a Colombian retrospective cohort
Kevin Saldarriaga-Bedoya, Esteban Castrillón-Martínez, Erik Buskens, Carolina Carvajal Espinosa, Juan Fernando Mesa Valencia, Gladys Rocío Ariza-Sosa, Maarten LahrAbstract
Rationale:
Hybrid care is increasingly used for chronic disease management, yet how patients are allocated to these modalities in routine practice remains poorly understood.
Aims and objectives:
To characterize baseline factors associated with physician-driven allocation to hybrid versus in-person care and examine three-year clinical outcomes.
Methods:
This retrospective observational cohort included adults with hypertension, type 2 diabetes, and/or dyslipidemia enrolled in a programme in Alma Mater Hospital of Antioquia, Medellín, Colombia (2019–2025). Care modality was determined by treating physicians. Associations between baseline clinical, functional–behavioural, and psychosocial characteristics, care allocation, and follow-up outcomes were examined using logistic regression and interpreted as associational rather than causal.
Results:
Among 638 participants (319 hybrid; 319 in-person), higher baseline glycated haemoglobin (HbA1c) (adjusted odds ratio [aOR] 2.68 per 1% increase; 95% CI 2.17–3.31) and inadequate medication adherence (aOR 1.96; 95% CI 1.17–3.28) were associated with hybrid care allocation, whereas higher educational attainment was inversely associated (middle vs low: aOR 0.43; 95% CI 0.25–0.72; high vs low: aOR 0.19; 95% CI 0.10–0.33). A strong gradient was observed in the secondary complexity analysis. Hybrid care was associated with higher three-year therapeutic goal attainment (OR 7.34; 95% CI 4.96–10.86) and lower chronic disease-related emergency department utilization (OR 0.53; 95% CI 0.36–0.79).
Conclusion:
Hybrid care allocation was systematically associated with baseline clinical and contextual characteristics. Outcome differences should be interpreted cautiously given clinician-driven allocation and baseline differences.