Clinical and psychosocial factors associated with clinician-driven allocation to hybrid versus in-person care in chronic disease management: a Colombian retrospective cohort.
Saldarriaga-Bedoya K, Castrillón-Martínez E, et al. • Primary health care research & development • 2026
Hybrid care allocation was systematically associated with baseline clinical and contextual characteristics (higher HbA1c, inadequate adherence, lower education), and hybrid care was associated with higher three-year therapeutic goal attainment and lower chronic disease-related ED use, though outcome differences should be interpreted cautiously given clinician-driven allocation and baseline differences.
Key Findings
Results
Higher baseline HbA1c was strongly associated with clinician allocation to hybrid care rather than in-person care.
Adjusted odds ratio (aOR) 2.68 per 1% increase in HbA1c; 95% CI 2.17-3.31.
Cohort comprised 638 adults with hypertension, type 2 diabetes, and/or dyslipidemia (319 hybrid; 319 in-person).
Care modality was determined by treating physicians at Alma Mater Hospital of Antioquia, Medellín, Colombia (2019-2025).
Associations were examined with logistic regression and interpreted as associational, not causal.
Results
Inadequate medication adherence at baseline was associated with greater odds of hybrid care allocation.
aOR 1.96; 95% CI 1.17-3.28.
Adherence was among the baseline functional-behavioural characteristics examined.
Results
Higher educational attainment was inversely associated with hybrid care allocation, with a graded effect.
Middle vs low education: aOR 0.43; 95% CI 0.25-0.72.
High vs low education: aOR 0.19; 95% CI 0.10-0.33.
This suggests patients with lower education were more likely to be allocated to hybrid care.
Results
A secondary complexity analysis showed a strong gradient in allocation to hybrid care.
The abstract reports 'a strong gradient was observed in the secondary complexity analysis'.
Specific complexity-analysis estimates are not given in the abstract.
Results
Hybrid care was associated with higher three-year therapeutic goal attainment.
OR 7.34; 95% CI 4.96-10.86.
Allocation was clinician-driven and baseline groups differed, so the authors caution against causal interpretation.
Results
Hybrid care was associated with lower chronic disease-related emergency department utilization.
OR 0.53; 95% CI 0.36-0.79.
Outcomes were assessed over three years of follow-up.
Conclusions
Allocation to hybrid care in routine practice followed systematic patterns tied to baseline clinical and contextual characteristics, and outcome differences should be read cautiously.
Allocation was determined by treating physicians rather than randomization.
The authors state outcome differences should be interpreted cautiously given clinician-driven allocation and baseline differences.
Study design was a retrospective observational cohort.
What This Means
This study looked at how doctors in a Colombian hospital programme decided which patients with high blood pressure, type 2 diabetes, or high cholesterol would receive hybrid care (a mix of in-person and remote care) versus fully in-person care. It reviewed records of 638 adults, split evenly between the two groups, followed for three years.
Patients with higher blood sugar levels (HbA1c), poorer medication adherence, and lower education were more likely to be placed in hybrid care. Hybrid care patients were also more likely to reach their treatment goals after three years and less likely to visit the emergency department for chronic disease problems. A strong pattern was also seen when patients were grouped by complexity of their condition.
Because doctors chose who got which type of care, and the groups differed at the start, these results do not prove hybrid care caused better outcomes. This research suggests that hybrid care is often directed to patients with greater clinical needs and social challenges, and that fair comparisons of hybrid versus in-person care need to account for these differences.
Saldarriaga-Bedoya K, Castrillón-Martínez E, Buskens E, Carvajal Espinosa C, Mesa Valencia J, Ariza-Sosa G, et al.. (2026). Clinical and psychosocial factors associated with clinician-driven allocation to hybrid versus in-person care in chronic disease management: a Colombian retrospective cohort.. Primary health care research & development. https://doi.org/10.1017/S1463423626102035