Can primary care-based link workers providing social prescribing improve health outcomes for people with multimorbidity in socially deprived areas? A randomised controlled trial.

Problem

The model of link workers providing social prescribing has been piloted in areas of deprivation, but there remains insufficient evidence to support cost-effectiveness. Multimorbidity is increasing in prevalence and affects those in areas of deprivation at an earlier age, but there are limited evidence-based interventions to improve outcomes. This paper presents the methods and results of a randomised controlled trial that investigated the impact of link workers based in general practices in deprived areas in improving health outcomes for people with multimorbidity.

Approach

Community dwelling adults with multimorbidity (≥two chronic conditions) identified as suitable for referral to the link worker were invited by their GP to participate. Intervention group participants were referred to the link worker and the ‘wait list’ control received usual GP care. The link workers were based in GP practices, met with participants over a one-month period, helped them identify a personalised set of goals and supported them to access community and online resources. The control group met the link worker once after completing follow up data collection and received a list of personalised resources. The link workers also mapped local community resources and reported back to the referring GP.

Primary outcomes were health related quality of life (EQ5D-5L) and mental health (HADS). Data were collected at baseline pre-randomisation and on intervention completion at 1 month using self-completed questionnaires. The link workers recorded details of all meetings including goals set, type of support provided and resources recommended. There are ongoing parallel process and economic analyses.

Findings

240 patients were recruited in 12 GP practices in urban deprived areas of Limerick, Cork, Waterford and Dublin. The trial did not recruit to target as recruitment was particularly challenging potentially due to low health literacy and the ongoing COVID-19 pandemic. The majority of participants were aged less than 65 (59%), female (63%) and were eligible for a GMS card (entitles holders to free primary care based on means testing) (85%).

10 link workers, with a variety of backgrounds in psychology and social care, were recruited and trained. The intervention was adapted to address pandemic public health guidance, with a focus on addressing digital poverty, connecting participants with online supports and coping with the restrictions. 113 of 123 intervention participants met the link worker at least once, with a median of 3 follow up contacts and a median of 3 community resources were recommended. 35% reported achieving their primary goal at one month.

Consequences

The results of the LinkMM trial suggest that the intervention is feasible with the majority of patients engaging with the link workers and identifying community supports. RCT data analysis is ongoing and will be available for presentation.