Effectiveness of primary-care based community-links practitioners in areas of high socioeconomic deprivation

S. Wyke, B. Fitzpatrick, L. Grant, N.R. Chng, A. McConachie, A. Bakhshi, G. James-Rae, C. O'Donnell, S. Mercer

Research output: Contribution to journalMeeting Abstract

Abstract

Background
A common policy response to health inequalities is the introduction of social prescribing programmes. Social prescribing aims to link patients to non-medical sources of support within a community, expanding options and resources beyond those traditionally provided in primary healthcare. Providing access to community-based services is expected to, for example, help reduce social isolation, provide access to initiatives supporting behaviour change (such as walking groups) and mitigate some of the effects of poverty by access to welfare advice or employment opportunities. Although widespread, the evidence-base for the effectiveness of social prescribing is extremely limited. We aimed to assess the effect of a form of social prescribing, the primary care-based community links practitioner (CLP) programme, on patients’ quality of life and wellbeing.

Methods
Quasi-experimental cluster randomised controlled trial in socioeconomically deprived areas of Glasgow, Scotland. Adult patients (≥18 years) referred to CLPs in seven intervention practices were compared with a random sample of adult patients from eight comparison practices at baseline and 9 months. Primary outcome; health-related quality of life (EQ-5D-5L). Secondary outcomes; wellbeing (ICE-CAP A), depression (HADS-D) anxiety (HADS-A), and self-reported exercise. Multilevel, multi-regression analyses adjusted for baseline differences. Patients were not blind to the intervention, but outcome analysis was masked.

Result
Data were collected on 288 and 214 (72.4%) patients in the intervention practices at baseline and follow-up, and on 612 and 561 (92%) patients in the comparison practices. Intention to treat analysis found no differences between the two groups for any outcome. In sub-group analysis, patients who saw the CLP on three or more occasions (45% of those referred) had significant improvements in EQ-5D-5L, HADS-D, HADS-A and exercise levels. There was a high positive correlation between CLP consultation rates and patient uptake of suggested community resources

Conclusion
We were unable to prove the effectiveness of referral to CLPs based in primary care in deprived areas on improving patient outcomes. Future efforts to boost uptake and engagement might improve overall outcomes, although the apparent improvements in those who regularly saw the CLPs may be due to reverse causality. Further research is required before wide-scale deployment of this approach.
Original languageEnglish
Article numberOP72
Pages (from-to)A35-A36
Number of pages2
JournalJournal of Epidemiology and Community Health
Volume73
Issue numberSupplement 1
DOIs
Publication statusPublished - 3 Sep 2019
Externally publishedYes

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