Searching for Real-World Effectiveness of Health Care Innovations: Scoping Study of Social Prescribing for Diabetes

Abstract

BackgroundSocial prescribing is a process whereby primary care patients are linked or referred to nonmedical sources of support in the community and voluntary sector. It is a concept that has arisen in practice and implemented widely in the United Kingdom and has been evaluated by various organizations.ObjectiveThe aim of our study was to characterize, collate, and analyze the evidence from evaluation of social prescribing for type 2 diabetes in the United Kingdom and Ireland, comparing information available on publicly available websites with the published literature.MethodsWe used a broad, pragmatic definition of social prescribing and conducted Web-based searches for websites of organizations providing potentially relevant services. We also explored linked information. In parallel, we searched Medline, PubMed, Cochrane Library, Google Scholar, and reference lists for relevant studies published in peer-reviewed journals. We extracted the data systematically on the characteristics, any reported evaluation, outcomes measured and results, and terminology used to describe each service.ResultsWe identified 40 UK- or Ireland-based projects that referred people with type 2 diabetes and prediabetes to nonmedical interventions or services provided in the community. We located evaluations of 24 projects; 11 as published papers, 12 as Web-based reports, and 1 as both a paper and a Web-based report. The interventions and services identified included structured group educational programs, exercise referral schemes, and individualized advice and support with signposting of health-related activities in the community. Although specific interventions such as community-based group educational programs and exercise referral have been evaluated in randomized controlled trials, evaluation of individualized social prescribing services involving people with type 2 diabetes has, in most cases, used pre-post and mixed methods approaches. These evaluations report generic improvement in a broad range of outcomes and provide an insight into the criteria for the success of social prescribing services.ConclusionsOur study revealed the varied models of social prescribing and nonmedical, community-based services available to people with type 2 diabetes and the extent of evaluation of these, which would not have been achieved by searching databases alone. The findings of this scoping study do not prove that social prescribing is an effective measure for people with type 2 diabetes in the United Kingdom, but can be used to inform future evaluation and contribute to the development of the evidence base for social prescribing. Accessing Web-based information provides a potential method for investigating how specific innovative health concepts, such as social prescribing, have been translated, implemented, and evaluated in practice. Several challenges were encountered including defining the concept, focusing on process plus intervention, and searching diverse, evolving Web-based sources. Further exploration of this approach will inform future rese...

What approaches to social prescribing work, for whom, and in what circumstances? A realist review

“…Although our study was unique in its focus only on the process of social prescribing, our findings are in line with Pilkington et al () scoping study, where the team found limited evidence owing to information not being published and activities not being labelled as ‘social prescribing’.…”

“…Although this may reduce GP burden (Chatterjee et al, ), it adds complexity in defining and identifying initiatives. Our review and recent literature are agreed that the link worker model and personalisation of the support, regardless of the original referral, is one of the more important features in effective social prescribing initiatives (Chatterjee et al, ; Moffatt, Steer, Lawson, Penn, & O'Brien, ; Pilkington et al, ).…”

“…The prescribing of non‐medical, community or social activities is becoming more common in England as an option to help people manage and prevent illness and improve their health and well‐being (Loftus, McCauley, & McCarron, ; Pilkington, Loef, & Polley, ). These approaches, often labelled ‘social prescribing’, can range from financial advice to walking groups and enable healthcare providers to respond to a broad range of patient needs, as well as potentially reducing GP and emergency department service demand (Polley, Bertotti, Kimberlee, Pilkington, & Refsum, ).…”

“…Despite this proliferation the evidence base is patchy (Wilson & Booth, ), limited in quality and extent (Polley et al, ), with little consensus around appropriate outcome measures (Rempel, Wilson, Durrant, & Barnett, ). Previous studies highlight evidence gaps regarding effectiveness of programmes (Bickerdike, Booth, Wilson, Farley, & Wright, ; Chatterjee, Camic, Lockyer, & Thomson, ; Pescheny, Pappas, & Randhawa, ), the process of referral and delivery (Bickerdike et al, ), the suitability of the process for different health conditions (Pilkington et al, ), cost‐effectiveness (Bickerdike et al, ; Polley et al, ) or impact on GP workload (Loftus et al, ).…”

Determinants of Well-Being and Their Implications for Health Care

“…One recent positive development in clinical practice has been the growing use of “social prescribing,” whereby clinicians and associated nonmedical staff direct patients to community resources and tactics that are likely to improve the social context within which people live [32-37]. Given the primary importance of positive social connections for happiness, increased use of social prescribing is almost sure to be part of a happiness-based clinician’s tool kit.…”