Evidence to support roll out of social prescribing is insufficient

A review of studies published in the BMJ Open journal shows there is inadequate evidence to support the roll out of social prescribing policy internationally. 

The review found no consistent evidence that social prescribing (SP), which links people with complex needs to non-medical support in their community, improves social support, physical function, or reduces the use of primary health services, despite being the most frequently used non-medically qualified link worker model in the UK.

Research also outlined limited evidence that SP improves subjective assessment of personal health or quality of care received. 

Previous reviews of the evidence have mostly focused on UK practice and have included a broad range of studies without comparison groups even though SP is a rapidly evolving field according to researchers. 

In a bid to plug the knowledge gap, experts reviewed the evidence on effectiveness and costs of the link worker model of SP internationally.

They searched 11 research databases for relevant comparative clinical trials, as well as ‘grey literature’, such as government reports and conference proceedings, published up to July 2021.  

Eight studies were analysed for the review, which involved 6,500 people. Five were randomised controlled trials; three were controlled before and after studies and one reported the economic evaluation of an included trial.

Three studies that were analysed came from the US and five were from the UK.

Four studies concluded SP made no difference to health-related quality of life and made no impact with mental health outcomes. 

Of the four studies reporting a measure of physical activity and function, one found an improvement in functional health; two found no evidence of a difference in activities of daily living or physical activity; and one found a reduction in routine activities.

Two US studies found clients rated the quality of their care more highly and that SP reduced hospital admissions for people with several co-existing conditions and who were socially isolated. 

None of the studies included in the review formally analysed cost effectiveness. 

One study found that healthcare costs fell because of fewer referrals, but these savings didn’t offset the costs of the intervention itself, prompting the study authors to conclude that SP was more expensive than usual care. 

Professionals warned the limited number of studies and wide variations in study design, participants and interventions precluded a pooled data analysis of the results, weakening the strength of the review findings.  

Authors of the review said: ‘Policy makers need to be aware that there is insufficient evidence to assess the effectiveness of social prescribing link workers and none on the cost-effectiveness, so the opportunity cost is unknown.

‘Our systematic review suggests that link workers providing social prescribing may have little or no impact on [health related quality of life], mental health or a range of patient-reported outcomes though they may improve self-rated health. 

‘The opportunity costs of investing in social prescribing link workers are unknown and it is essential that high-quality trials determining cost-effectiveness are conducted so that the evidence can catch up with the policy and we avoid wasting valuable time and resources.’

Photo by Elisa Ventur