The Glasgow ‘Deep End’ Links Worker Study Protocol: A Quasi-Experimental Evaluation of a Social Prescribing Intervention for Patients with Complex Needs in Areas of High Socioeconomic Deprivation

Abstract

Background‘Social prescribing’ can be used to link patients with complex needs to local (non-medical) community resources. The ‘Deep End’ Links Worker Programme is being tested in general practices serving deprived populations in Glasgow, Scotland.ObjectivesTo assess the implementation and impact of the intervention at patient and practice levels.MethodsStudy design: Quasi-experimental outcome evaluation with embedded theory-driven process evaluation in 15 practices randomized to receive the intervention or not. Complex intervention: Comprising a practice development fund, a practice-based community links practitioner (CLP), and management support. It aims to link patients to local community organizations and enhance practices’ social prescribing capacity. Study population: For intervention practices, staff and adult patients involved in referral to a CLP, and a sample of community organization staff. For comparison practices, all staff and a random sample of adult patients. Sample size: 286 intervention and 484 comparator patients. Outcomes: Primary patient outcome is health-related quality of life (EQ-5D-5L). Secondary patient outcomes include capacity, depression/anxiety, self-esteem, and healthcare utilization. Practice outcome measures include team climate, job satisfaction, morale, and burnout. Outcomes measured at baseline and 9 months. Processes: Barriers and facilitators to implementation of the programme and possible mechanisms through which outcomes are achieved. Analysis plan: For outcome, intention-to-treat analysis with differences between groups tested using mixed-effects regression models. For process, case-study approach with thematic analysis.DiscussionThis evaluation will provide new evidence about the implementation and impact of social prescribing by general practices serving patients with complex needs living in areas of high deprivation.

Link workers’ perspectives on factors enabling and preventing client engagement with social prescribing

“…Our findings confirm the importance of primary‐care practitioners’ engagement with social prescribing (White, Kinsella, & South, )(Whitelaw et al., ). In common with other studies (Bertotti et al., ; Brandling & House, ; Mercer et al., ), we find that link workers’ experiences of primary‐care engagement with social prescribing indicate that practitioners can be both slow to identify patients who may benefit from social prescribing and to refer. We identify as an additional issue the referral of patients with severe and complex social problems who may be unable to engage with social prescribing.…”

“…Without holistic and intensive link worker support, clients could not engage effectively with the intervention. Moreover, the rationale behind the link worker role is that identifying, navigating and accessing community services can be extremely challenging, especially for patients in socioeconomically disadvantaged areas (Mercer et al., ). Primary‐care professionals are unlikely to have knowledge of the full range of community‐based resources and this study confirms that effective linkage requires link workers’ comprehensive community knowledge.…”

Effectiveness of Community-Links Practitioners in Areas of High Socioeconomic Deprivation

“…We conducted a quasi-experimental clusterrandomized controlled trial (RCT) of the Glasgow Deep End LWP. 11 Practices were eligible for the program if they were located in Glasgow and in the 100 practices in Scotland (which has approximately 1,000 practices) serving the most-deprived patients (based on the percentage of registered patients in practices living in the 15% most-deprived postcodes in Scotland). Fifteen general practices serving patients living in very deprived areas (out of 76 eligible practices in Glasgow) took part.…”

“…The study was approved by the University of Glasgow College of Medical Veterinary and Life Sciences Ethics Committee (200140077) and registered prospectively with International Standard Randomized Controlled Trials (ISRCTN80842457), and the protocol was published. 11…”

“…Full details of the recruitment procedure have been published. 11 In brief, the health care clinicians-general practitioners (GPs) and practice nurses (PNs)-were briefed to give adult patients (aged 18 years or older) the study information and to seek permission to pass on their contact details to the research team at the time of referral to a CLP. When this permission was received, a member of the research team contacted patients to explain the study and, if patients expressed interest in taking part, mailed them the study consent form and baseline questionnaire to complete and return to the study office.…”