Ostrobothnia Digital Clinic Experiment

The Wellbeing Services County of Ostrobothnia, a mid-sized administrative region in Western Finland, will launch its digital clinic platform, a website and app for its digital services, on April 15, 2025. Over time, the digital clinic platform will include several different chat channels for various services. The main channel, the digital clinic, will be a chat channel to contact primary care professionals. The initial contact will be with a nurse, after which the nurse has the opportunity to consult with a physician. Primary care patients with new health issues who choose to contact the digital clinic are expected to log in with strong identification for a care needs assessment and treatment. At the time of writing, the plan is to keep the digital clinic open from 8 AM to 3 PM Monday through Thursday and from 8 AM to 2 PM on Fridays. Other chat channels that Ostrobothnia plans to launch using the platform, such as a chat for social services, a chat for rehabilitation, and a chat for customer service, do not require strong identification, and are not intended to serve as a substitute for the digital clinic.

Our intervention is to randomize access to the digital clinic for a nine-month period, starting on April 15. The randomization assigns households to two groups that either have access (the treatment group) or do not have access (the control group) to the newly launched digital clinic. Individuals in the treatment group will have access to the digital clinic immediately after its opening. The entire population residing in the region will have access to the digital clinic after the nine-month trial period. The trial does not affect access to other available alternatives for contacting primary care, such as traditional public primary care, occupational healthcare, or private clinics.

The intervention (access to the digital clinic) is accompanied by an information campaign targeting all households in the treatment group. The primary communication channel with the treatment group is through mailed letters. These letters will inform recipients about their option to use the digital clinic during the trial period and provide instructions on what the digital clinic is, and how to use it, as well as the rationale for granting access initially only to a randomly-selected subgroup of the population. We will send these information letters to all households belonging to the treatment group. We will send one letter per household and randomize the recipient within the household so that all household members over the age of eighteen have the same probability of receiving the letter. In a small sample of households consisting only of minors, all individuals aged 15 to 18 have an equal probability of receiving the letter. There will be no information letters addressed to individuals under the age of fifteen. The letters will be mailed shortly before the launch of the digital clinic.

For more information on the intervention, see Section 3 of our Analysis Plan (PAP).

2025-04-15

2026-01-14

The number of in-person visits in public primary care (Y1.1).

The number of public digital clinic contacts (D.1).

Y1.1: This outcome includes in-person visits to nurses and physicians in traditional public primary care clinics.

D.1: This outcome includes care needs assessments, remote appointments to nurses and physicians (via chat and video), and professional-to-professional interactions between nurses and physicians in digital public primary care clinics.

Secondary:
The number of other contacts with traditional public primary care (Y1.2).

Tertiary:
The total number of public primary care contacts (Y1.3)
An indicator for having any public digital clinic contact during the follow-up (D.2).

Y1.2: This outcome includes care needs assessments, remote appointments to nurses and physicians, and professional-to-professional interactions between nurses and physicians in traditional public primary care clinics.

Y1.3: This outcome includes in-person visits to nurses and physicians, care needs assessments, remote appointments to nurses and physicians, and professional-to-professional interactions between nurses and physicians in digital and traditional public primary care clinics.

D.2: This outcome includes care needs assessments, remote appointments to nurses and physicians (via chat and video), and professional-to-professional interactions between nurses and physicians in digital public primary care clinics.

Our intervention is to randomize access to the digital clinic for a nine-month period, starting on April 15. The randomization assigns households to two groups that either have access (the treatment group) or do not have access (the control group) to the newly launched digital clinic. Individuals in the treatment group will have access to the digital clinic immediately after its opening. The entire population residing in the region will have access to the digital clinic after the nine-month trial period. The trial does not affect access to other available alternatives for contacting primary care, such as traditional public primary care, occupational healthcare, or private clinics.

We randomized treatment at the household level based on permanent addresses, ensuring that all members of a household were assigned to the same treatment group. Households were stratified by size to maintain balance across different household compositions. Within each stratum, we randomly assigned 50% of the households to the treatment group (a 1:1 ratio). Specifically, for each household ID cluster, we generated a random floating-point number and sorted the clusters by this value within each household size group. Households in the top 50% of these sorted values were assigned to the treatment group.

Moreover, we randomized one recipient of the information letter (see Section 3.2 of the pre-analysis plan) per treated household as follows: All household members over the age of eighteen had the same probability of receiving the letter. In a small sample of households consisting only of minors, all individuals aged 15 to 18 had an equal probability of receiving the letter. The randomization code, like all other code written for this PAP, is available in the Github repository of this project.

Not available

Randomization done in office by a computer. The replication codes are available here: https://github.com/tapiohaa/SoteDataLab/tree/main/ostrobothnia_digital_clinic_experiment/01_randomization

Household, defined by permanent address.

Yes

81,564 households in the randomization sample.

Note that the analysis sample will be smaller: we restrict to individuals aged 0 to 70, and we include only those individuals of the randomization population for whom we can link randomization data and socioeconomic covariates.

At the time of writing, we cannot report the exact sample sizes of the analysis data, only the sample sizes of the randomization data. This is mainly because the exact sample sizes of the final research paper will be observed only after merging Statistics Finland full population data (FOLK) of 2024 with the treatment indicator data. At the time of writing, the latest statistical year fully available is 2022.

170,306 individuals in the randomization sample. Note that the analysis sample will be smaller: we restrict to individuals aged 0 to 70, and we include only those individuals of the randomization population for whom we can link randomization data and socioeconomic covariates. At the time of writing, we cannot report the exact sample sizes of the analysis data, only the sample sizes of the randomization data. This is mainly because the exact sample sizes of the final research paper will be observed only after merging Statistics Finland full population data (FOLK) of 2024 with the treatment indicator data. At the time of writing, the latest statistical year fully available is 2022.

40,782 households (with 85,145 individuals) in the treatment.
40,782 households (with 85,161 individuals) in the control.

Note that the analysis sample will be smaller: we restrict to individuals aged 0 to 70, and we include only those individuals of the randomization population for whom we can link randomization data and socioeconomic covariates.

At the time of writing, we cannot report the exact sample sizes of the analysis data, only the sample sizes of the randomization data. This is mainly because the exact sample sizes of the final research paper will be observed only after merging Statistics Finland full population data (FOLK) of 2024 with the treatment indicator data. At the time of writing, the latest statistical year fully available is 2022.

See our extensive power analyses in Appendix B of our pre-analysis plan (PAP).

Pre-analysis plan (March 28, 2025)