Primary Care Uptake Interventions in Taxi, App-Based, and Other For-Hire Vehicle Drivers: The HAILL Cluster Randomized Controlled Trial.

Abstract

Taxi, app-based, and other for-hire vehicle drivers have major health risks and poor healthcare access. Compare workplace interventions to improve driver healthcare access. Taxi Health Access Intervention for Linkages and Lifestyle (HAILL) was a three-arm cluster randomized controlled trial (2015-2022; analyses 2024) with outcomes assessed at 12 months. Randomization was at the cluster (taxi garage) level. We approached 97 taxi garages in New York City (garages with ≥ 100 drivers and app-based driver hubs), 32 were excluded, and 65 enrolled. Drivers attending workplace Health Fairs at the garages were consecutively screened for participation; 735 enrolled. All sites received the Health Fair intervention (health history, screenings [blood pressure, etc.], clinician consult, and 3 months of primary care access facilitation follow-up). Arm 1 received the Health Fair only. Arm 2 received the Health Fair and Navigator case management for up to 12 months. Arm 3 received the Health Fair and up to 12 months of appointment reminder text messages and peer support. Medical Expenditure Panel Survey items measured primary care uptake (primary outcome). A Behavioral Risk Factor Surveillance Survey item measured insurance enrollment (secondary outcome). Two independent-sample t tests compared arm 1 versus 2 and arm 1 versus 3 primary care uptake proportions. Sixty-one garages participated (arm 1, n = 20; arm 2, n = 22; arm 3, n = 19). In the cluster intention-to-treat analyses, primary care uptake was 44% in arm 1 versus 57% in arm 2 (P = .264) and versus 43% in arm 3 (P = .994); health insurance enrollment was 63% in arm 1 versus 58% in arm 2 (P = .627) and versus 50% in arm 3 (P = .197). All interventions increased healthcare access, with a positive trend in primary care uptake between arms 1 and 2. Health Fairs and Navigator case management should be considered by policy makers. ClinicalTrials.gov NCT02508363 ( https://clinicaltrials.gov/study/NCT02508363 ).