Link workers providing social prescribing and health and social care coordination for people with multimorbidity in socially deprived areas ( The LinkMM trial): A pragmatic randomised controlled trial protocol and pilot.

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

Y.4

Presenter:

Susan M Smith

Twitter:

@susanmsmith

Co-authors:

Mark Murphy, Barbara Clyne, Fiona Boland, Patrick O’Donnell, Deirdre Connolly, Eamon O Shea, Susan M Smith

Author institutions:

Royal College of Surgeons Ireland, Trinity College Dublin, University of Limerick, National University of Ireland, Galway

Problem

Multimorbidity, defined as two or more chronic conditions, is increasing in prevalence and affects 66.2% of patients over 50 attending primary care in Ireland (1). It is associated with increased health care use, fragmented care and poorer health outcomes (2). There is a link between social deprivation and multimorbidity (3). Link workers are non-health or social care professionals based in primary care who support people to develop and achieve a personalised set of health and social goals by engaging with community resources. Link workers have been piloted in areas of deprivation (4), but there remains insufficient evidence to support their effectiveness (5). This study aims to test the effectiveness of link workers based in General Practices in deprived areas in improving health outcomes for people with multimorbidity.

Approach

This will be a randomised controlled trial involving a total of 10 GP practices and 600 patients, serving areas of deprivation in four Irish cities. Eligible participants will be community dwelling adults with multimorbidity suitable for referral to a practice based link worker. Baseline data will be collected, followed by randomisation to intervention or control groups. The intervention group will meet with a link worker based in the GP practice and receive support over three months to develop and achieve a personalised set of health and social goals. The ‘wait list’ control group will receive usual care from their GP during this time. Primary outcomes will be health related quality of life as assessed by EQ5D5L and mental health assessed by HADS. Secondary outcomes will be based on the core outcome for multimorbidity (6) and include a range of patient reported outcome and healthcare utilisation measures.Data will be collected at baseline and on RCT completion at 3 months using questionnaires self-completed by participants. Health care utilisation will be extracted from GP records by researchers. The final protocol was informed by an uncontrolled pilot study in single practice to test feasability and acceptability of the intervention and trial processes.

Findings

The pilot demonstrated that the intervention was received positively. Adjustments were made to the selection process to allow inclusion of GP identification of patients they felt could benefit fron a linkworker intervention. This was felt to reflect real world practice. Additional time was built into the recruitment stages. Recruitment and baseline data for the main trial will be complete by June 2020.

Consequences

This will be the largest trial of link workers with individual randomisation that we are aware of and will provide some of the most robust evidence to date in this area. This will help to inform policy makers in Ireland who are currently actively considering ways to move care into the community and of providing holisitic care for people with multimorbidity.

Submitted by:

Bridget Kiely

Funding acknowledgement:

This trial is jointly funded by the Health Research Board Ireland and the Health Service Executive Slaintecare Integration Fund. The funders did not have any role in the design of this study.