BackgroundSocial prescribing assists patients to engage insocial activities and connect to community supports as part of a holistic approach to primary care. Rx: Community was a social prescribing project, implemented within 11 community health centres situated across Ontario, Canada.AimsTo explore how social prescribing as a process facilitates positive outcomes for patients.Design and settingWe used qualitative methods, conducting 18 focus groups involving 88 patients and 8 additional in-depth interviews.MethodsInterviews and focus groups were transcribed verbatim and analyzed thematically using a theoretical framework based onself-determination theory.ResultsParticipants who had received social prescriptions described social prescribing as an empathetic process that respects their needs and interests. Social prescribing facilitated the patient’s voice in their care, helped patient’s develop skills in addressing needs important to them, and fostered trusting relationships with staff and other participants. Patients reported their social support networks were expanded, and they had improved mental health and ability in self-management of chronic conditions. Patients who became involved in social prescribing as voluntary “health champions” reported this was a positive experience and they gained a sense of purpose by giving back to their communities in ways that felt meaningful for them.ConclusionSocial prescribing produced positive outcomes for patients, and fit well within the community health centre model of primarycare. Future research should examine the impact on health outcomes and examine the return on investment of developing and implementing social prescribing programs.

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See the response from https://doi.org/10.1111/jgs.16253 et al.

BackgroundThere has been a large-scale adoption of virtual delivery of primary care as a result of the COVID-19 pandemic.AimIn this descriptive study, an equity lens is used to explore the impact of transitioning to greater use of virtual care in community health centres (CHCs) across Ontario, Canada.Design & settingA cross-sectional survey was administered and electronic medical record (EMR) data were extracted from 36 CHCs.MethodThe survey captured CHCs‘ experiences with the increased adoption of virtual care. A longitudinal analysis of the EMR data was conducted to evaluate changes in health service delivery. EMR data were extracted monthly for a period of time before the pandemic (April 2019–February 2020) and during (April 2020–February 2021).ResultsIn comparison with the pre-pandemic period, CHCs experienced a moderate decline in visits made (11%), patients seen (9%), issues addressed (9%), and services provided (15%). During the pandemic period, an average of 54% of visits were conducted virtually, with telephone as the leading virtual modality (96%). Drops in service types ranged from 28%–82%. The distribution of virtual modalities varied according to the provider type. Access to in-person and virtual care did not vary across patient characteristics.ConclusionThe results demonstrate a large shift towards virtual delivery while maintaining in-person care. No meaningful differences were found in virtual versus in-person care related to patient characteristics or rurality of centres. Future studies are needed to explore how to best select the appropriate modality for patients and service types.

Introduction The Alliance for Healthier Communities represents community‐governed healthcare organizations in Ontario, Canada including Community Health Centres, which provide primary care to more disadvantaged populations. Methods In this experience report, we describe the Alliance's journey towards becoming a learning health system using examples for organizational culture, data and analytics, people and partnerships, client engagement, ethics and oversight, evaluation and dissemination, resources, identification and prioritization, and deliverables and impact. Results Many of the foundational elements for a learning health system were already in place at the Alliance including an integrated and accessible data platform. Leadership championed and embraced the movement towards a learning health system, which led to restructuring of the organization. This included role changes for data support personnel, better communication, and dissemination plans, strategies to engage clinicians and other front‐line staff, restructuring of committees for more collaborative planning and prioritization of quality improvement and research initiatives, and the development of a new Practice‐Based Learning Network for more opportunities to use the data for research and evaluation. Conclusions Next steps will focus on continued clinical engagement and partnerships as well as ongoing reflection on the transition and success of the learning health system work.

Background: The onset of the COVID-19 pandemic and introduction of various restrictions resulted in drastic changes to "traditional" primary healthcare service delivery modalities. Aim: To understand the impact of virtual care on healthcare system performance within the context of Ontario Community Health Centres.Design and Setting: Thematic analysis of qualitative interviews with thirty-six providers and thirty-one patients.Methods: Semi-structured phone interviews were conducted in the fall of 2020. Interviews were recorded, transcribed verbatim and analyzed thematically using the quadruple aim framework.Results: Virtual care had removed certain barriers to care. Patients and providers, found that phone visits impacted quality of care due to the inability to read body language and relying solely on patient descriptions. Video visits allowed for a similar experience to in-person visits but technical issues constrained this. Depending on the service provided, some providers felt they were not providing the same quality of care. Providers reported reductions in no-show rates and highlighted the efficiency of virtual appointments. Providers also found they were able to collaborate at a similar level prior to the pandemic and saw improvements in work-life balance. Overall, patients and providers alike preferred virtual visits with those known to them and for less-complex/transactional aspects of care. Conclusion: Our study described positive and negative impacts on patient care, population health, health system costs and provider experience. These results will be useful for primary care organizations in post-pandemic planning, however future research is needed for a deeper exploration of the impact on quality of care specifically for more complex health concerns.

This is a response to the article by Savage et al.S ocial prescribing (SP) is an act of connection. Although Savage et al note that the evidence continues to emerge for the role of supported and co-designed clinical referral 1 (the novel element of SP), there is a strong body of evidence for the prevalence of loneliness and social isolation among older adults and its associated negative health impacts. 2 There is also a strong body of evidence for health benefits of the types of activities typically prescribed under SP (eg, physical activity, 3 group-based educational loneliness intervention, 3 and arts-based activities 4 ). Given the existing evidence and demonstrated need, it is imperative we undertake action research, quality improvement, and innovation to meet the immediate needs of people and communities living with social and medical complexities. This action research around what works, for whom, and under what circumstances will help people, communities, and providers grow and refine SP programs and offerings over time.We thank Savage et al for pointing out the importance of assessing whether improvements in a patient's health and well-being are clinically significant. 1 SP values patientreported outcome and experience measures as important clinical indicators, and the preliminary evidence is promising. Participants in our pilot report reduced social isolation, increased sense of community belonging, a renewed sense of confidence and purpose, and an improved sense of control in management of their own health. 5 Electronic medical record (EMR) tracking and planned linkages with population health data sets will help us determine other measures of clinical significance over time.Savage et al also take an important interest in understanding the procedural elements of SP, such as tracking referral patterns, understanding the reasons for referral, identifying the types of resources and supports being referred to, and measuring changes in healthcare usage and costs. 1 By design, the Rx: Community pilot helps identify and track these through a common EMR and business information reporting tool, supporting the development of a high-fidelity SP model that can be adapted in diverse contexts. 5 Additional interviews with key players involved in the SP pathway (providers, link workers, staff implementing programs, and community partners) help to identify the facilitators and barriers to successful implementation. SP in Canada is being led initially by community health centers, experts in health equity and community development. These interdisciplinary health and social care centers operate under a model of health and well-being that ensures the capacity to meet the needs of clients. 5 This model allows for the repurposing of existing resources and provides a bulwark against unintended consequences, such as building the unsupported referrals that Savage et al term "roads to nowhere." 1 Implementation and research advisory committees; deep and long-standing community governance, engagement, and partnerships in community ...

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