Does a social prescribing ‘holistic’ link-worker for older people with complex, multimorbidity improve well-being and frailty and reduce health and social care use and costs? A 12-month before-and-after evaluation

Abstract

Aim: To evaluate the impact of ‘holistic’ link-workers on service users’ well-being, activation and frailty, and their use of health and social care services and the associated costs. Background: UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (≥50 years) with complex health needs (≥2 long-term conditions), as part of its service redesign. Methods: A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention. Findings: Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>£5000 change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.

Using self-determination theory to understand the social prescribing process: a qualitative study

“…Multiple studies indicate that these prescriptions improve social inclusion [2][3][4][5] , mental well-being, 6 physical activity levels, 7 and selfmanagement of health. 8,9 However, beyond identifying the impact of these prescriptions, it is equally important to understand how SP as a process facilitates these outcomes. As such, this paper builds on the work done by Hanlon et al, 10 Kellezi et al 3 and Payne et al 11 in trying to understand the "how" of SP.…”

Social prescribing for individuals with mental health problems: a qualitative study of barriers and enablers experienced by general practitioners

“…However, most evidence on social prescribing to date is from the perspective of the patient and their outcomes. Various studies have shown the benefits of the link worker role to patients, and some are also starting to evaluate social prescribing from the perspective of link workers [21,22]. But the role of the GP in social prescribing is less well understood.…”

“…Studies have identified that the success of social prescribing seems to rest on the GP's ability to identify social issues and root cause [23]. It also appears to rely on GP "buy-in" to validate the service among other professionals and patients, and requires GPs to believe in the link worker's ability and in the benefits of social prescribing [22]. Further, a few studies have included interviews with GPs, but these have tended to involve a very small number of GP interviews, or focused solely on 1 practice or locale [24,25].…”

Green Health Partnerships in Scotland; Pathways for Social Prescribing and Physical Activity Referral

“…Social prescribing schemes provide a pathway for referring patients from primary care services to non-clinical services in the community, often provided by third sector organisations [ 15 ]. Evidence for social prescribing is generally weak [ 16 , 17 ] and studies are required to better understand implementation. Physical activity referral schemes (PARS) are an internationally recognised pathway for referring patients from primary and secondary care to supervised PA opportunities [ 18 , 19 ].…”