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de Bell S, Alejandre JC, Menzel C, Sousa-Silva R, Straka TM, Berzborn S, Bürck-Gemassmer M, Dallimer M, Dayson C, Fisher JC, Haywood A, Herrmann A, Immich G, Keßler CS, Köhler K, Lynch M, Marx V, Michalsen A, Mudu P, Napierala H, Nawrath M, Pfleger S, Quitmann C, Reeves JP, Rozario K, Straff W, Walter K, Wendelboe-Nelson C, Marselle MR, Oh RRY, Bonn A. Nature-based social prescribing programmes: opportunities, challenges, and facilitators for implementation. ENVIRONMENT INTERNATIONAL 2024; 190:108801. [PMID: 38909402 DOI: 10.1016/j.envint.2024.108801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/26/2024] [Accepted: 06/03/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Evidence on the health benefits of spending time in nature has highlighted the importance of provision of blue and green spaces where people live. The potential for health benefits offered by nature exposure, however, extends beyond health promotion to health treatment. Social prescribing links people with health or social care needs to community-based, non-clinical health and social care interventions to improve health and wellbeing. Nature-based social prescribing (NBSP) is a variant that uses the health-promoting benefits of activities carried out in natural environments, such as gardening and walking. Much current NBSP practice has been developed in the UK, and there is increasing global interest in its implementation. This requires interventions to be adapted for different contexts, considering the needs of populations and the structure of healthcare systems. METHODS This paper presents results from an expert group participatory workshop involving 29 practitioners, researchers, and policymakers from the UK and Germany's health and environmental sectors. Using the UK and Germany, two countries with different healthcare systems and in different developmental stages of NBSP practice, as case studies, we analysed opportunities, challenges, and facilitators for the development and implementation of NBSP. RESULTS We identified five overarching themes for developing, implementing, and evaluating NBSP: Capacity Building; Accessibility and Acceptability; Networks and Collaborations; Standardised Implementation and Evaluation; and Sustainability. We also discuss key strengths, weaknesses, opportunities, and threats for each overarching theme to understand how they could be developed to support NBSP implementation. CONCLUSIONS NBSP could offer significant public health benefits using available blue and green spaces. We offer guidance on how NBSP implementation, from wider policy support to the design and evaluation of individual programmes, could be adapted to different contexts. This research could help inform the development and evaluation of NBSP programmes to support planetary health from local and global scales.
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Affiliation(s)
- Siân de Bell
- Exeter HSDR Evidence Synthesis Centre, University of Exeter, 79 Heavitree Rd, Exeter EX2 4TH, United Kingdom.
| | | | - Claudia Menzel
- Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Landau, Germany
| | - Rita Sousa-Silva
- Young Academy for Sustainability Research, Freiburg Institute for Advanced Studies, University of Freiburg, Albertstraße 19, 79104 Freiburg im Breisgau, Germany; Institute of Environmental Sciences, Department of Environmental Biology, Leiden University, P.O. Box 9518, 2300 RA Leiden, the Netherlands
| | - Tanja M Straka
- Institute of Ecology, Technische Universität Berlin, 12165 Berlin, Germany
| | - Susanne Berzborn
- Black Forest National Park, Schwarzwaldhochstraße 2, 77889 Seebach, Germany
| | - Max Bürck-Gemassmer
- KLUG (German Alliance for Climate Change and Health), Hainbuchenstr. 10a, 13465, Berlin, Germany
| | | | - Chris Dayson
- Centre for Regional Economic and Social Research, Sheffield Hallam University, Sheffield S1 2LX, United Kingdom
| | - Jessica C Fisher
- Durrell Institute of Conservation and Ecology, University of Kent, Canterbury CT2 7NR, United Kingdom
| | - Annette Haywood
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield S1 4DA, United Kingdom
| | - Alina Herrmann
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Institute for General Practice, University Hospital Cologne, Medical Faculty University of Cologne, Cologne, Germany
| | - Gisela Immich
- Chair of Public Health and Health Services Research, Faculty of Medicine, LMU Munich, Germany; Pettenkofer School of Public Health, Munich, Germany
| | - Christian S Keßler
- Institute of Social Medicine, Epidemiology and Health Economy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; Department of Internal Medicine and Nature-based Therapies, Immanuel Hospital Berlin, Berlin, Germany
| | | | - Mary Lynch
- Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Viola Marx
- Dundee City Council, Dundee, United Kingdom
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; Department of Internal Medicine and Nature-based Therapies, Immanuel Hospital Berlin, Berlin, Germany
| | - Pierpaolo Mudu
- WHO Regional Office for Europe, European Centre for Environment and Health, Bonn, Germany
| | - Hendrik Napierala
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximilian Nawrath
- Norwegian Institute for Water Research, Økernveien 94, 0579 Oslo, Norway
| | | | - Claudia Quitmann
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Kevin Rozario
- Friedrich Schiller University Jena, Institute of Biodiversity, Dornburger Straße 159, 07743 Jena, Germany; Helmholtz Centre for Environmental Research - UFZ, Department of Ecosystem Services, Permoserstr. 15, 04318 Leipzig, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Leipzig University, Wilhelm Wundt Institute for Psychology, Neumarkt 9, 04109 Leipzig, Germany
| | - Wolfgang Straff
- Umweltbundesamt (German Environment Agency), Wörlitzer Pl. 1, 0684 Dessau-Roßlau, Germany
| | - Katie Walter
- Ullapool Medical Practice, NHS Highland, Ullapool, United Kingdom
| | | | - Melissa R Marselle
- Environmental Psychology Research Group, School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Rachel Rui Ying Oh
- Helmholtz Centre for Environmental Research - UFZ, Department of Ecosystem Services, Permoserstr. 15, 04318 Leipzig, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany
| | - Aletta Bonn
- Friedrich Schiller University Jena, Institute of Biodiversity, Dornburger Straße 159, 07743 Jena, Germany; Helmholtz Centre for Environmental Research - UFZ, Department of Ecosystem Services, Permoserstr. 15, 04318 Leipzig, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany
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Scarpetti G, Shadowen H, Williams GA, Winkelmann J, Kroneman M, Groenewegen PP, De Jong JD, Fronteira I, Augusto GF, Hsiung S, Slade S, Rojatz D, Kallayova D, Katreniakova Z, Nagyova I, Kylänen M, Vracko P, Jesurasa A, Wallace Z, Wallace C, Costongs C, Barnes AJ, van Ginneken E. A comparison of social prescribing approaches across twelve high-income countries. Health Policy 2024; 142:104992. [PMID: 38368661 DOI: 10.1016/j.healthpol.2024.104992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Social prescribing connects patients with community resources to improve their health and well-being. It is gaining momentum globally due to its potential for addressing non-medical causes of illness while building on existing resources and enhancing overall health at a relatively low cost. The COVID-19 pandemic further underscored the need for policy interventions to address health-related social issues such as loneliness and isolation. AIM This paper presents evidence of the conceptualisation and implementation of social prescribing schemes in twelve countries: Australia, Austria, Canada, England, Finland, Germany, Portugal, the Slovak Republic, Slovenia, the Netherlands, the United States and Wales. METHODS Twelve countries were identified through the Health Systems and Policy Monitor (HSPM) network and the EuroHealthNet Partnership. Information was collected through a twelve open-ended question survey based on a conceptual model inspired by the WHO's Health System Framework. RESULTS We found that social prescribing can take different forms, and the scale of implementation also varies significantly. Robust evidence on impact is scarce and highly context-specific, with some indications of cost-effectiveness and positive impact on well-being. CONCLUSIONS This paper provides insights into social prescribing in various contexts and may guide countries interested in holistically tackling health-related social factors and strengthening community-based care. Policies can support a more seamless integration of social prescribing into existing care, improve collaboration among sectors and training programs for health and social care professionals.
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Affiliation(s)
- Giada Scarpetti
- Technische Universität Berlin, European Observatory on Health Systems and Policies.
| | | | - Gemma A Williams
- European Observatory on Health Systems and Policies, World Health Organization
| | - Juliane Winkelmann
- European Observatory on Health Systems and Policies, World Health Organization
| | - Madelon Kroneman
- Nivel (Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Peter P Groenewegen
- Nivel (Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Judith D De Jong
- Nivel (Netherlands Institute for Health Services Research, Utrecht, Netherlands and Maastricht University
| | - Inês Fronteira
- Global Health and Tropical, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Gonçalo Figueiredo Augusto
- Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
| | - Sonia Hsiung
- Canadian Institute for Social Prescribing, Canadian Red Cross
| | - Siân Slade
- Nossal Institute for Global Health, University of Melbourne, Australia
| | - Daniela Rojatz
- Austrian National Public Health Institute, Vienna, Austria
| | - Daniela Kallayova
- Ministry of Health of the Slovak Republic, Bratislava, Slovak Republic
| | - Zuzana Katreniakova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice and Slovak Public Health Association (SAVEZ), Kosice, Slovak Republic
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice and Slovak Public Health Association (SAVEZ), Kosice, Slovak Republic
| | - Marika Kylänen
- Finnish Best Practice Portal for Health and Wellbeing Promotion, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pia Vracko
- National Institute of Public Health, Ljubljana, Slovenia
| | | | | | - Carolyn Wallace
- University of South Wales, Wales School for Social Prescribing Research (WSSPR), UK
| | | | | | - Ewout van Ginneken
- Technische Universität Berlin, European Observatory on Health Systems and Policies
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Litt JS, Coll-Planas L, Sachs AL, Masó Aguado M, Howarth M. Current Trends and Future Directions in Urban Social Prescribing. Curr Environ Health Rep 2023; 10:383-393. [PMID: 38087048 DOI: 10.1007/s40572-023-00419-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE OF REVIEW Social prescribing (SP) is defined as a non-medical community referral program to support well-being and health. This review explores the current evidence about the effectiveness of SP. RECENT FINDINGS This review examined existing SP models that have been or are being tested to connect people to these opportunities through direct and indirect referral schemes. The review identified a fifth model that facilitates a group-based approach used to mental well-being and resilience. While the development of SP largely originates from the UK, the global interest in SP has increased, with over 31 nations reporting elements of SP. The main goal of SP is to better integrate care between the traditional medical setting and resources available in the community and voluntary sectors. Although this review found widespread optimism around SP, there remain concerns about its effectiveness and demands for high-quality evaluations to strengthen the evidence base for SP.
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Affiliation(s)
- J S Litt
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88 08003, Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
- University of Colorado Boulder, Boulder, CO, USA.
| | - L Coll-Planas
- Research Group On Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Carrer de La Sagrada Família, 7 Vic, 08500, Barcelona, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - A L Sachs
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader, 88 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - M Masó Aguado
- Research Group On Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Carrer de La Sagrada Família, 7 Vic, 08500, Barcelona, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - M Howarth
- Edgehill University, St Helens Road, Ormskirk, L39 4QP, Lancashire, UK
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Wang SY, Larrain N, Groene O. Can peer effects explain prescribing appropriateness? a social network analysis. BMC Med Res Methodol 2023; 23:252. [PMID: 37898770 PMCID: PMC10613382 DOI: 10.1186/s12874-023-02048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/25/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Optimizing prescribing practices is important due to the substantial clinical and financial costs of polypharmacy and an increasingly aging population. Prior research shows the importance of social relationships in driving prescribing behaviour. Using social network analysis, we examine the relationship between a physician practices' connectedness to peers and their prescribing performance in two German regions. METHODS We first mapped physician practice networks using links established between two practices that share 8 or more patients; we calculated network-level (density, average path length) and node-level measures (degree, betweenness, eigenvector). We defined prescribing performance as the total number of inappropriate medications prescribed or appropriate medications not prescribed (PIMs) to senior patients (over the age of 65) during the calendar year 2016. We used FORTA (Fit fOR The Aged) algorithm to classify medication appropriateness. Negative binomial regression models estimate the association between node-level measures and prescribing performance of physician practices controlling for patient comorbidity, provider specialization, percentage of seniors in practice, and region. We conducted two sensitivity analyses to test the robustness of our findings - i) limiting the network mapping to patients younger than 65; ii) limiting the network ties to practices that share more than 25 patients. RESULTS We mapped two patient-sharing networks including 436 and 270 physician practices involving 28,508 and 20,935 patients and consisting of 217,126 and 154,274 claims in the two regions respectively. Regression analyses showed a practice's network connectedness as represented by degree, betweenness, and eigenvector centrality, is significantly negatively associated with prescribing performance (degree-bottom vs. top quartile aRR = 0.04, 95%CI: 0.035,0.045; betweenness-bottom vs. top quartile aRR = 0.063 95%CI: 0.052,0.077; eigenvector-bottom vs. top quartile aRR = 0.039, 95%CI: 0.034,0.044). CONCLUSIONS Our study provides evidence that physician practice prescribing performance is associated with their peer connections and position within their network. We conclude that practices occupying strategic positions at the edge of networks with advantageous access to novel information are associated with better prescribing outcomes, whereas highly connected practices embedded in insulated information environments are associated with poor prescribing performance.
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Affiliation(s)
- Sophie Y Wang
- Hamburg Center for Health Economics, Esplanade 36, 20354, Hamburg, Germany.
- OptiMedis AG, Buchardstraße 17, 20095, Hamburg, Germany.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Nicolas Larrain
- Hamburg Center for Health Economics, Esplanade 36, 20354, Hamburg, Germany
- Employment, Labour and Social Affairs, Health Division, OECD, 2 Rue André Pascal, Cedex 16, 75775, Paris, France
| | - Oliver Groene
- OptiMedis AG, Buchardstraße 17, 20095, Hamburg, Germany
- Faculty of Management, Economics and Society, University of Witten, Alfred-Herrhausen-Straße 50, 58455, HerdeckeWitten, Germany
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5
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Oster C, Skelton C, Leibbrandt R, Hines S, Bonevski B. Models of social prescribing to address non-medical needs in adults: a scoping review. BMC Health Serv Res 2023; 23:642. [PMID: 37316920 DOI: 10.1186/s12913-023-09650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The health and wellbeing consequences of social determinants of health and health behaviours are well established. This has led to a growing interest in social prescribing, which involves linking people to services and supports in the community and voluntary sectors to address non-medical needs. However, there is considerable variability in approaches to social prescribing with little guidance on how social prescribing could be developed to reflect local health systems and needs. The purpose of this scoping review was to describe the types of social prescribing models used to address non-medical needs to inform co-design and decision-making for social prescribing program developers. METHODS We searched Ovid MEDLINE(R), CINAHL, Web of Science, Scopus, National Institute for Health Research Clinical Research Network, Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registry Platform, and ProQuest - Dissertations and Theses for articles and grey literature describing social prescribing programs. Reference lists of literature reviews were also searched. The searches were conducted on 2 August 2021 and yielded 5383 results following removal of duplicates. RESULTS 148 documents describing 159 social prescribing programs were included in the review. We describe the contexts in which the programs were delivered, the program target groups and services/supports to which participants were referred, the staff involved in the programs, program funding, and the use of digital systems. CONCLUSIONS There is significant variability in social prescribing approaches internationally. Social prescribing programs can be summarised as including six planning stages and six program processes. We provide guidance for decision-makers regarding what to consider when designing social prescribing programs.
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Affiliation(s)
- Candice Oster
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Claire Skelton
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Richard Leibbrandt
- College of Science & Engineering, Flinders University, Adelaide, SA, Australia
| | - Sonia Hines
- College of Medicine & Public Health, Flinders Rural and Remote Health, Flinders University, Alice Springs, Northern Territory, Australia
| | - Billie Bonevski
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
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Groene OR, Huelmann T, Hampe W, Emami P. German Physicians and Medical Students Do Not Represent the Population They Serve. Healthcare (Basel) 2023; 11:1662. [PMID: 37372780 DOI: 10.3390/healthcare11121662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Medical professionals who represent the communities they serve are in a better position to understand patients' social circumstances and communicate in a more patient-centered way. International studies show limited diversity and underrepresentation of certain social groups in the population of physicians and medical students. We designed an observational study to investigate the cultural and socio-economic diversity of physicians and medical applicants in comparison to the general population in Germany. We invited 15,195 physicians in Hamburg and 11,287 medical applicants in Germany to participate in an online survey between June and August 2022. The lower three quintiles of objective socio-economic background (SEB) were vastly underrepresented in all subsamples of the study and in particular amongst applicants and students admitted in Hamburg: 57.9% of physicians and 73.8% of medical students in Hamburg originate from the top quintile of SEB. The Turkish and Polish communities were particularly underrepresented in the group of physicians from Hamburg and medical applicants and students in Germany (p = 0.02; p < 0.001). In line with existing evidence, the vast majority of physicians and medical students come from the most affluent households when entering medical school. Widening participation strategies are needed to facilitate fairer access to the study of medicine in Germany.
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Affiliation(s)
- Oana R Groene
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thorben Huelmann
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Wolfgang Hampe
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Pedram Emami
- Hamburg Chamber of Physicians, 22083 Hamburg, Germany
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Wildman J, Wildman JM. Impact of a link worker social prescribing intervention on non-elective admitted patient care costs: A quasi-experimental study. Soc Sci Med 2023; 317:115598. [PMID: 36527893 DOI: 10.1016/j.socscimed.2022.115598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Healthcare systems in many countries are enthusiastically adopting link worker social prescribing interventions that aim to tackle the social determinants of health by linking patients to voluntary and community sector activities and sources of support to address their social needs and improve condition management. Social prescribing interventions aim to improve health and reduce healthcare spending. However, despite the diversion of healthcare budgets to fund social prescribing, we still lack robust evidence for its effectiveness. In this study we evaluate whether participation in a social prescribing intervention reduced non-elective admitted patient care use and costs for 8283 patients aged between 40 and 74 years, with a diagnosis of type 2 diabetes and living in an area of high socioeconomic deprivation in north-east England. Patients were followed for a total of 6 years: 2 years pre-intervention and 4 years post intervention. Exploiting a natural experiment, we used a two-part difference-in-differences regression model to estimate costs conditional on healthcare use. We also estimated intervention effects across several intervention and control groups and sample subgroups. Participation in the intervention resulted in reductions of up to -£77.57 [95% CI: -152.30, -2.84] (for high engagement patients) per patient, per year, in non-elective care costs. Reductions were greater for patients with higher levels of engagement with the intervention. Sub-group analyses showed greater cost reductions for non-White patients, older patients, and patients without additional co-morbidities. Our findings suggest that engagement with a link worker social prescribing intervention may reduce non-elective healthcare spending, perhaps through enabling better condition management that results in fewer avoidable health crises.
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Affiliation(s)
- John Wildman
- Economics, Newcastle University Business School, Newcastle University, UK.
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Kloppe T, Tetzlaff B, Mews C, Zimmermann T, Scherer M. Interprofessional collaboration to support patients with social problems in general practice-a qualitative focus group study. BMC PRIMARY CARE 2022; 23:169. [PMID: 35788186 PMCID: PMC9251943 DOI: 10.1186/s12875-022-01782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Social problems of patients such as family or work-related conflicts as well as financial difficulties affect the individual health situation and the treatment of diseases in general practice. General practitioners (GPs) would like to have direct access to professionals in social care services. In Germany, there are many different social care facilities for people with a wide range of social problems. As the social and health care systems hardly interact collaborations between social professionals (SPs) and GPs are rare exceptions. This study explored perspectives of GPs regarding their patients with social problems in combination with the perspectives of SPs. Aim of this study was to explore how a systematic interprofessional collaboration between GPs and SPs could be realised. METHODS We carried out a participatory sequential qualitative study design consisting of two focus groups with GPs, two with SPs and two mixed-professional focus groups with GPs and SPs. The focus groups were conducted with semi-structured moderating guidelines and analysed with a qualitative content analysis approach using inductive and deductive categories. RESULTS GPs view themselves as the first point of contact for their patients' social problems. For persistent social problems, they expressed a desire for support and SPs were willing to provide this. We developed a stepped care implementation model for a systematic cooperation consisting of nine collaboration strategies. These strategies included: index or website of social care services, referrals to the social care system, using flyers and posters of social care services, direct contact/hotline to local social care services, participation in meetings of social care facilities, involving physician assistants, external social care advice service in GP rooms, implementation in education and training and access to volunteers. CONCLUSIONS Our stepped care implementation model for a systematic cooperation of GPs and SPs could be a feasible need- and resource-oriented approach for the collaborative care of patients with social problems to improve their medical treatment in most western healthcare systems. GPs and SPs are ready to generate the necessary evidence for policy makers in high quality RCTs.
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Affiliation(s)
- Thomas Kloppe
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Britta Tetzlaff
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Claudia Mews
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Thomas Zimmermann
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Morse DF, Sandhu S, Mulligan K, Tierney S, Polley M, Chiva Giurca B, Slade S, Dias S, Mahtani KR, Wells L, Wang H, Zhao B, De Figueiredo CEM, Meijs JJ, Nam HK, Lee KH, Wallace C, Elliott M, Mendive JM, Robinson D, Palo M, Herrmann W, Østergaard Nielsen R, Husk K. Global developments in social prescribing. BMJ Glob Health 2022; 7:e008524. [PMID: 35577392 PMCID: PMC9115027 DOI: 10.1136/bmjgh-2022-008524] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/02/2022] [Indexed: 11/09/2022] Open
Abstract
Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the 'Beyond the Building Blocks' framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs.
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Affiliation(s)
| | - Sahil Sandhu
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Stephanie Tierney
- Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | | | | | - Siân Slade
- University of Melbourne, Melbourne, Victoria, Australia
| | - Sónia Dias
- Universidade Nova de Lisboa Escola Nacional de Saúde Pública, Lisbon, Portugal
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Leanne Wells
- Consumers Health Forum of Australia, Deakin, Victoria, Australia
| | - Huali Wang
- Peking University Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders, Beijing, China
| | - Bo Zhao
- Health Administration, Yonsei University-Wonju Campus, Wonju, Gangwon-do, Republic of Korea
| | | | | | - Hae Kweun Nam
- Department of Preventive Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | | | | | | | | | - David Robinson
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Miia Palo
- Lapland Hospital District, Rovaniemi, Finland
| | | | - Rasmus Østergaard Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Aarhus, Denmark
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Patients' and clinicians' perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe. BJGP Open 2022; 6:BJGPO.2021.0172. [PMID: 35031559 PMCID: PMC9447319 DOI: 10.3399/bjgpo.2021.0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background The impact of the COVID-19 pandemic on patients’ and clinicians’ perceptions of healthcare-seeking behaviour and delivery of care is unclear. The pandemic accelerated the use of remote care, and understanding its benefits and drawbacks may inform its implementation during current and future healthcare emergencies. Aim To explore patients’ and primary care professionals’ (PCPs) experiences of primary care delivery in the first wave of the pandemic. Design & setting Qualitative study using semi-structured interviews in primary care in eight European countries (England, Ireland, Belgium, the Netherlands, Greece, Poland, Sweden, and Germany). Method A total of 146 interviews were conducted with 80 PCPs and 66 patients consulting for respiratory tract infection (RTI) symptoms, in eight European countries. Data were collected between April and July 2020, and analysed using thematic analysis. Results It was found that patients accepted telemedicine when PCPs spent time to understand and address their concerns, but a minority preferred in-person consultations. PCPs felt that remote consultations created emotional distance between themselves and patients, and they reported having to manage diverse COVID-19-related medical and social concerns. Conclusion Remote consultations for RTI symptoms may be acceptable long term if both groups are happy to use this format, but it is important that PCPs take time to address patients’ concerns and provide safety-netting advice.
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