PDF(Pubmed)
Abstract：
BACKGROUND: Social prescribing link workers are non-health or social care professionals who connect people with psychosocial needs to non-clinical community supports. They are being implemented widely, but there is limited evidence for appropriate target populations or cost effectiveness. This study aimed to explore the feasibility, potential impact on health outcomes and cost effectiveness of practice-based link workers for people with multimorbidity living in deprived urban communities.
METHODS: A pragmatic exploratory randomised trial with wait-list usual care control and blinding at analysis was conducted during the COVID 19 pandemic (July 2020 to January 2021). Participants had two or more ongoing health conditions, attended a general practitioner (GP) serving a deprived urban community who felt they may benefit from a one-month practice-based social prescribing link worker intervention.. Feasibility measures were recruitment and retention of participants, practices and link workers, and completion of outcome data. Primary outcomes at one month were health-related quality of life (EQ-5D-5L) and mental health (HADS). Potential cost effectiveness from the health service perspective was evaluated using quality adjusted life years (QALYs), based on conversion of the EQ-5D-5L and ICECAP-A capability index to utility scoring.
RESULTS: From a target of 600, 251 patients were recruited across 13 general practices. Randomisation to intervention (n = 123) and control (n = 117) was after baseline data collection. Participant retention at one month was 80%. All practices and link workers (n = 10) were retained for the trial period. Data completion for primary outcomes was 75%. There were no significant differences identified using mixed effects regression analysis in EQ-5D-5L (MD 0.01, 95% CI -0.07 to 0.09) or HADS (MD 0.05, 95% CI -0.63 to 0.73), and no cost effectiveness advantages. A sensitivity analysis that considered link workers operating at full capacity in a non-pandemic setting, indicated the probability of effectiveness at the €45,000 ICER threshold value for Ireland was 0.787 using the ICECAP-A capability index.
CONCLUSIONS: While the trial under-recruited participants mainly due to COVID-19 restrictions, it demonstrates that robust evaluations and cost utility analyses are possible. Further evaluations are required to establish cost effectiveness and should consider using the ICE-CAP-A wellbeing measure for cost utility analysis.
BACKGROUND: This trial is registered on ISRCTN.
BACKGROUND: Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas.
BACKGROUND: ISRCTN10287737. Date registered 10/12/2019. Link: https://www.isrctn.com/ISRCTN10287737.
METHODS: A pragmatic exploratory randomised trial with wait-list usual care control and blinding at analysis was conducted during the COVID 19 pandemic (July 2020 to January 2021). Participants had two or more ongoing health conditions, attended a general practitioner (GP) serving a deprived urban community who felt they may benefit from a one-month practice-based social prescribing link worker intervention.. Feasibility measures were recruitment and retention of participants, practices and link workers, and completion of outcome data. Primary outcomes at one month were health-related quality of life (EQ-5D-5L) and mental health (HADS). Potential cost effectiveness from the health service perspective was evaluated using quality adjusted life years (QALYs), based on conversion of the EQ-5D-5L and ICECAP-A capability index to utility scoring.
RESULTS: From a target of 600, 251 patients were recruited across 13 general practices. Randomisation to intervention (n = 123) and control (n = 117) was after baseline data collection. Participant retention at one month was 80%. All practices and link workers (n = 10) were retained for the trial period. Data completion for primary outcomes was 75%. There were no significant differences identified using mixed effects regression analysis in EQ-5D-5L (MD 0.01, 95% CI -0.07 to 0.09) or HADS (MD 0.05, 95% CI -0.63 to 0.73), and no cost effectiveness advantages. A sensitivity analysis that considered link workers operating at full capacity in a non-pandemic setting, indicated the probability of effectiveness at the €45,000 ICER threshold value for Ireland was 0.787 using the ICECAP-A capability index.
CONCLUSIONS: While the trial under-recruited participants mainly due to COVID-19 restrictions, it demonstrates that robust evaluations and cost utility analyses are possible. Further evaluations are required to establish cost effectiveness and should consider using the ICE-CAP-A wellbeing measure for cost utility analysis.
BACKGROUND: This trial is registered on ISRCTN.
BACKGROUND: Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas.
BACKGROUND: ISRCTN10287737. Date registered 10/12/2019. Link: https://www.isrctn.com/ISRCTN10287737.
摘要：
背景：社会处方链接工作者是非健康或社会护理专业人员，他们将有心理社会需求的人与非临床社区支持联系起来。它们正在广泛实施，但对于适当的目标人群或成本效益的证据有限.本研究旨在探讨其可行性,对于生活在贫困城市社区的多病患者，基于实践的链接工人对健康结果和成本效益的潜在影响。
方法：在COVID19大流行期间（2020年7月至2021年1月）进行了一项务实的探索性随机试验，包括等待列表常规护理控制和盲点分析。参与者有两种或两种以上持续的健康状况，参加了为贫困城市社区提供服务的全科医生（GP），他们认为他们可以从为期一个月的基于实践的社会处方链接工人干预中受益。.可行性措施是招募和留住参与者，实践和联系工人，并完成结果数据。1个月时的主要结果是健康相关的生活质量（EQ-5D-5L）和心理健康（HADS）。使用质量调整生命年(QALYs)评估了卫生服务角度的潜在成本效益，基于EQ-5D-5L和ICACAP-A能力指数转换为效用评分。
结果：从600的目标中，在13个一般实践中招募了251名患者。基线数据收集后随机分为干预（n=123）和对照组（n=117）。参与者在一个月时的保留率为80%。所有实践和链接工人（n=10）都保留了试用期。主要结局的数据完成率为75%。在EQ-5D-5L（MD0.01，95％CI-0.07至0.09）或HADS（MD0.05，95％CI-0.63至0.73）中，使用混合效应回归分析没有显着差异，没有成本效益优势。敏感性分析，考虑了在非大流行环境下满负荷工作的联系工人，表明，使用ICACAP-A能力指数，爱尔兰在45,000欧元ICER阈值下的有效性概率为0.787。
结论：虽然试验招募不足的参与者主要是由于COVID-19的限制，这表明稳健的评估和成本效用分析是可能的。需要进一步评估以确定成本效益，并应考虑使用ICE-CAP-A福利措施进行成本效用分析。
背景：该试验已在ISRCTN上注册。
背景：在社会贫困地区，使用链接工人为患有复杂多重性疾病的人提供社会处方以及健康和社会护理协调。
背景：ISRCTN10287737。注册日期2019年10月12日。链接：https://www.isrctn.com/ISRCTN10287737.
方法：在COVID19大流行期间（2020年7月至2021年1月）进行了一项务实的探索性随机试验，包括等待列表常规护理控制和盲点分析。参与者有两种或两种以上持续的健康状况，参加了为贫困城市社区提供服务的全科医生（GP），他们认为他们可以从为期一个月的基于实践的社会处方链接工人干预中受益。.可行性措施是招募和留住参与者，实践和联系工人，并完成结果数据。1个月时的主要结果是健康相关的生活质量（EQ-5D-5L）和心理健康（HADS）。使用质量调整生命年(QALYs)评估了卫生服务角度的潜在成本效益，基于EQ-5D-5L和ICACAP-A能力指数转换为效用评分。
结果：从600的目标中，在13个一般实践中招募了251名患者。基线数据收集后随机分为干预（n=123）和对照组（n=117）。参与者在一个月时的保留率为80%。所有实践和链接工人（n=10）都保留了试用期。主要结局的数据完成率为75%。在EQ-5D-5L（MD0.01，95％CI-0.07至0.09）或HADS（MD0.05，95％CI-0.63至0.73）中，使用混合效应回归分析没有显着差异，没有成本效益优势。敏感性分析，考虑了在非大流行环境下满负荷工作的联系工人，表明，使用ICACAP-A能力指数，爱尔兰在45,000欧元ICER阈值下的有效性概率为0.787。
结论：虽然试验招募不足的参与者主要是由于COVID-19的限制，这表明稳健的评估和成本效用分析是可能的。需要进一步评估以确定成本效益，并应考虑使用ICE-CAP-A福利措施进行成本效用分析。
背景：该试验已在ISRCTN上注册。
背景：在社会贫困地区，使用链接工人为患有复杂多重性疾病的人提供社会处方以及健康和社会护理协调。
背景：ISRCTN10287737。注册日期2019年10月12日。链接：https://www.isrctn.com/ISRCTN10287737.
