Primary care-based link workers providing social prescribing to improve health and social care outcomes for people with multimorbidity in socially deprived areas (the LinkMM trial): Pilot study for a pragmatic randomised controlled trial

Abstract

Introduction: Individuals with multimorbidity in deprived areas experience worse health outcomes and fragmented care. Research suggests that primary care-based link workers providing social prescribing have potential to improve health and well-being. This paper reports the results of a pilot study conducted in preparation for a randomised controlled trial (RCT) that aims to test the effectiveness of primary care-based link workers providing social prescribing in improving health outcomes for people with multimorbidity who attend general practices in deprived areas in Ireland. Methods: An uncontrolled pilot study of an intervention based on the Glasgow Deep End links worker programme, in a single general practice, tested the feasibility and acceptability of planned processes for a RCT. Outcomes were recruitment and retention rates and acceptability of the trial processes and intervention to patients, general practitioners (GPs) and the link worker. Structured interviews were conducted with six patients, the link worker and two GPs within the practice and analysed using descriptive qualitative analysis. Feedback from a Public Patient Involvement group and an Implementation Advisory Group of key stakeholders was incorporated into the evaluation process. Results: Twelve out of 14 patients completed the intervention. Selection and recruitment processes were lengthier than expected. GPs recommended including psychosocial need in the selection process. Interviewed patients, the GPs and the link worker were positive about the intervention. Conclusion: A range of adaptations were identified for the main trial, mainly considering psychosocial need in the selection process to reflect normal referral pathways. This has resulted in a pragmatic RCT design.

Experiences of Non-Pharmaceutical Primary Care Interventions for Common Mental Health Disorders in Socioeconomically Disadvantaged Groups: A Systematic Review of Qualitative Studies

“…The GP/patient relationship also facilitated engagement with the interventions, with several people feeling encouraged to participate in the interventions recommended by a trusted GP [ 46 , 52 ]. Others emphasised the acceptability of the interventions that took place in the setting of a GP surgery.…”

“…Others emphasised the acceptability of the interventions that took place in the setting of a GP surgery. For some, this was due to convenience [ 43 , 56 ], but was more commonly discussed as being due to privacy and the avoidance of the stigma related to mental health difficulties [ 43 , 46 , 47 , 54 ]:…”

“…Poor transport access in rural areas was described as contributing to a “cycle of deprivation” for those who could not travel outside of the area for work, compounding their mental health problems [ 43 ]. Others were put off accessing the suggested interventions that were not affordable or did not offer enough free sessions [ 46 , 52 ].…”

“…[39] Indeed, a couple of service users viewed their relationship with the providers in terms of companionship that was otherwise lacking for them [58,59]. The providers' practical support, such as accompanying service users to activities and appointments, was also widely appreciated [39,42,44,46,49,[51][52][53]58,59].…”

Assessing Sarcopenia, Frailty, and Malnutrition in Community-Dwelling Dependant Older Adults—An Exploratory Home-Based Study of an Underserved Group in Research

“…Previous research examining the delivery of a physical activity program within formal home care services in Ireland reported improvements in physical function, however the high degree of frailty observed among this group required a customised approach [ 51 ]. Psychosocial factors, including social isolation and a lack of informal support, suggest a need for multi-dimensional approaches and support the potential of social prescribing initiatives for this population group [ 52 ].…”