Social prescribing needs more evidence to support its benefits before widespread roll-out – new study


Around one visit to the general practitioner in five are for non-medical issues, such as loneliness or financial difficulties. However, these non-medical issues are known to have a significant impact on the health and well-being of patients. GPs are aware of this and want to take a more holistic approach to care, but often don’t know how to go about it. This has led to the development of “social prescription”, where general practitioners “prescribe” social or support activities for people with the help of a relay worker.

The Liaison Officer is someone who knows a community well, is an excellent listener, and is adept at helping people make change. They meet the people referred for the social prescription, discuss what matters to them and develop a personal project – the “social prescription”.

This may include joining community groups, support to return to work or school, accessing mental health supports, or lifestyle changes, such as getting more exercise. The liaison worker then helps people join groups or just keeps in touch and encourages people to do things on their orders. The duration and type of support for the relays are adapted to each person’s needs.

These social prescribing programs (also called “community support”) are deployed in many countries, including Great Britain, Ireland, Australia and United States. Policymakers hope that social prescribing can not only improve health and well-being, but also reduce health inequalities and save money by diverting people to more appropriate care in the community. My colleagues and I searched to find out what evidence there was for this and found mixed results – although we recognize that it is difficult to prove the effectiveness of these types of programs. Our results are published in BMJ Open.

We searched for all medical studies, websites, and reports from social prescribing projects. We were looking for studies that compared a group of people who met with a social worker in connection with prescribing to a group who did not (known as controlled trials – a high quality clinical trial) and synthesized the evidence in a “systematic review”.

We summarized all studies, particularly to see if they measured quality of life or mental health, and if they included people from disadvantaged areas or with multiple health conditions, as social prescribing programs often focus on these groups.

We found eight studies in total. Three were released in the US and five in the UK.

The length of time people could meet with the liaison worker varied. Most of the studies were quite short (less than six months) and people only met the liaison officer a few times. Because there was so much variation in the studies, it was difficult to find consistent evidence that liaison workers made a difference to quality of life, mental health, social contacts, physical activity, or primary health care utilization of patients.

Three US studies and one Scottish study included people from deprived areas, who also had more than one health problem. Two of the US studies had longer, more intensive programs where liaison workers met with people weekly for six months and worked closely with the health care system. Both of these studies found that people reported better quality care and there were also cost savings due to fewer hospital days.

The third US study found a reduction in emergency department attendance, but an increase in primary care visits. The Scottish study found that people who met with the liaison worker three or more times had improved quality of life, mental health and physical activity.

One in five GP visits is for non-medical issues, such as loneliness or debt problems.
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Overall, this evaluation of social-prescription liaisons seems to show limited benefits, but it only paints a partial picture. The social prescription is designed to be different depending on the needs of the person and the resources of the area, so it is difficult to determine whether or not it works on a larger scale. This assessment approach is also very health-focused and social prescribing is likely to have wider benefits for communities and society.

What our results suggest is that longer, more intense support from liaison workers working closely with healthcare providers likely benefits people with complex needs, such as those living in deprived areas. and with several health problems.

Currently, there are very few liaison workers per capita. In Ireland, for example, a national social prescription system is being put in place. one liaison officer for 50,000 people. To see changes in health inequalities and cost savings, our review suggests a focus on intense support for fewer people or an expansion in the availability of liaison workers. Regardless, it is important to continue learning how social prescribing works best so that the potential benefits can be realized.

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Richard V. Johnson