In this Issue:
- What is Social Prescribing?
- Recent research on the benefits and implementation of Social Prescribing
- Components of the Social Prescribing model in team-based primary care
- Key enablers to ensuring program success
- Additional resources
Introduction
Our team-based primary care sector is familiar with the importance of the social determinants of health and their contributions to general health and well-being. A holistic approach to health care requires consideration of social needs and the many local programs that exist in communities across the province. Social prescribing connects patients to the social care services they desire and helps address underlying causes to health and well-being issues. This connection to social supports, shown to improve health and well-being, is a powerful tool for teams and clinicians1. Social prescribing represents a shift from more traditional biomedical approaches to include consideration of social risk factors (loneliness, poverty, etc.) and has the potential to positively impact primary care practice2.
What is Social prescribing
Social prescribing represents a pathway for connecting patients to a variety of non-clinical services through primary care team members. There are many examples of social prescriptions, including visits to the Zoo, museums and art galleries, and student-senior partnerships, to name a few2. The WHO’s recent toolkit on social prescribing notes that each community will offer unique and specific “social prescriptions”, though in general, services typically include supports for social inclusion, mental health, physical activity, self-expression, and financial and housing guidance3. These services are typically delivered by community and volunteer organizations4.
One common model for social prescribing utilizes a prescription navigation position to facilitate referrals and connect patients with community-available social prescriptions3,5. Referrals usually come from a patient’s primary care provider, including family physicians and nurse practitioners4. The navigation role is known by several names, including “navigator”, “link worker”, and “health promotor”. Workers in these roles can help co-design programs with their patients and facilitate regular check-ins with patients to monitor progress. Follow-up with patients is a critical step in assessing the effectiveness of a given social prescription. Figure 1 provides an overview of some of the main social prescribing models, from simple to holistic approaches.
Additional research has proposed an internationally accepted definition and common understanding framework for social prescribing, including the team members who facilitate the social prescribing process6. This includes an “identifier” and a “connector”, both of whom are trusted individuals in clinical and community settings. The identifier is usually a clinical professional and the connector takes the role of the navigator, as described above.
Essential components of a social prescribing model/pathway
Social prescribing has been implemented in primary care settings with good success. Learnings from a 2018 pilot research project7 at the Alliance for Healthier Communities, Rx: Community, include:
- Patients reported general improvements to their mental health and an increased capacity to self-manage their health. They also reported decreased loneliness and an increased sense of connectedness and belonging;
- Social prescribing was found to be useful for improving patient wellbeing and decreasing repeat visits. Healthcare providers also recognized the value of the navigator role, and clinics without this role felt they required more support;
- Integration between clinical care, interprofessional teams, and social support was enhanced. Social prescribing’s co-creation nature also improved the capacity of the community7.
Expanding upon the above findings, patients in this pilot reported a 12% increase in mental health, 49% decrease in loneliness, and 19% increase in social activities. This was coupled with a decrease in repeat patient visits by 5% at three months, and 42% at nine months7. Additional research from other countries has found patients in social prescribing programs to report similar decreases in loneliness and statistically significant increases in measures of well-being4. Overall, mental health is the most commonly reported patient outcome measure8.
The key elements of a social prescribing program in team-based primary care have been outlined by the Alliance for Healthier Communities. These elements are provided below and you can read more via the Alliance’s 2020 resource for Social Prescribing (available here).
A person or client/patient
- As described above, the identifier helps to identify those patients experiencing social and health barriers.
A prescriber
- The prescriber can be anyone on the team who provides patient care. In the model at Windsor FHT, the primary care provider sends referrals to their internal health promoter/link worker.
A navigator
- Receives referrals and works collaboratively with the client
- Connects them to appropriate non-clinical, community-based supports
- As described earlier, this may be a health promoter, link worker, or navigator.
Social prescriptions
- Non-medical and co-created supports in the community
- Examples include referrals to “Life After Fifty” exercise programming (at a reduced cost).
- Support for patients in finding and/or filling out subsidy paperwork.
A data pathway
- Continuous incorporation of meaningful data and lessons learned to ensure quality of delivery and monitor outcomes.
Some key enablers for teams looking to develop their own social prescribing programs can be observed from teams with fully implemented programs. Many of these enablers are outlined in Figure 2 below.
The role of the link worker is essential in ensuring long-term program stability. As observed in Figure 2, the link worker is a key component in several social prescribing enablers. The Canadian Institute for Social Prescribing (CISP) notes that current Canadian social prescribing efforts are grounded in fostering collaboration, providing agility and flexibility, and measuring impact9. Each of these initiatives are linked by the connector/navigator/link worker. Please refer to the CISP’s “Current State of Social Prescribing in Canada” for an excellent social prescribing pathway infographic9.
Additional resources
- The WHO’s recent Social Prescribing Toolkit is a great resource with a summary of work-to-date and examples of pathways for patients3.
- Some examples of patient awareness materials (Information Cards) and social prescribing pathways as developed by Windsor FHT are provided in Appendix A.
- AFHTO has previously reported on social prescribing, and those resources may be found below.
Changes to the eBulletin
AFHTO continually evaluates our communications to ensure we provide high-quality and relevant information to members. This is the first release of our quarterly eBulletin. This shift will allow us to delve deep into the details and provide richer content. Highlighting the breadth and quality of work across our membership and the primary care sector continues to be the driving force behind the eBulletin and we’ll continue to spotlight programs and research aligned with the Quintuple Aim.
References
- Drinkwater, Chris, Josephine Wildman, and Suzanne Moffatt. “Social Prescribing.” BMJ 364 (March 28, 2019): l1285. https://doi.org/10.1136/bmj.l1285.
- Nowak, Dominik Alex, and Kate Mulligan. “Social Prescribing: A Call to Action.” Canadian Family Physician 67, no. 2 (February 1, 2021): 88–91. https://doi.org/10.46747/cfp.670288.
- “A Toolkit on How to Implement Social Prescribing.” Accessed December 1, 2023. https://www.who.int/publications-detail-redirect/9789290619765.
- The King’s Fund. “What Is Social Prescribing?,” November 4, 2020. https://www.kingsfund.org.uk/publications/social-prescribing.
- “Rx: Community – Social Prescribing in Ontario | Alliance for Healthier Communities.” Accessed December 1, 2023. https://www.allianceon.org/Rx-Community-Social-Prescribing-In-Ontario.
- Muhl, Caitlin, Kate Mulligan, Imaan Bayoumi, Rachelle Ashcroft, and Christina Godfrey. “Establishing Internationally Accepted Conceptual and Operational Definitions of Social Prescribing through Expert Consensus: A Delphi Study.” BMJ Open 13, no. 7 (July 1, 2023): e070184. https://doi.org/10.1136/bmjopen-2022-070184.
- Mulligan, Kate, Sara Bhatti, Jennifer Rayner, and Sonia Hsiung. RxCommunity_Final_Report_Mar2020_fullweb.; 2020.
- Sonke, Jill, Nico Manhas, Cassandra Belden, Jane Morgan-Daniel, Seher Akram, Stefany Marjani, Oluwasanmi Oduntan, et al. “Social Prescribing Outcomes: A Mapping Review of the Evidence from 13 Countries to Identify Key Common Outcomes.” Frontiers in Medicine 10 (2023). https://www.frontiersin.org/articles/10.3389/fmed.2023.1266429.
- “Social Prescribing Resources.” Accessed December 1, 2023. https://www.socialprescribing.ca/resources.
- Husk, Kerryn, Kelly Blockley, Rebecca Lovell, Alison Bethel, Iain Lang, Richard Byng, and Ruth Garside. “What Approaches to Social Prescribing Work, for Whom, and in What Circumstances? A Realist Review.” Health & Social Care in the Community 28, no. 2 (2020): 309–24. https://doi.org/10.1111/hsc.12839.
Acknowledgements
AFHTO would like to thank Windsor FHT for their collaboration in developing this eBulletin. The tools and information they have provided will be of great use to others looking to implement this program. More information on Windsor FHT’s program can be found here.
We would also like to thank the Social Prescribing team at the Alliance for Healthier Communities for offering their help and expertise in preparing the content.
Appendix A: sample materials
example of social prescribing infographics
Example of the social prescribing patient pathway
The original document is available here.
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