Social prescribing link workers for people with multimorbidity attending general practice in deprived areas

<p dir="ltr">Multimorbidity, defined as two or more chronic conditions, is increasing in prevalence globally and presents a challenge for patients and healthcare systems. Policy responses focus on personalised care and self-management, but GPs in deprived areas have limited capacity to deliver this. Social prescribing link workers are a potential intervention that could improve outcomes for people with multimorbidity. They support people to connect with non-clinical resources to improve health and wellbeing. The overall aim of this thesis was to investigate the potential impact of practice-based social prescribing link workers for people with multimorbidity attending general practices in socially deprived areas. Specific objectives were to: establish the global evidence base for social prescribing link worker interventions; test the feasibility and acceptability of an evaluation of a practice based, social prescribing link worker intervention for people with multimorbidity; explore the potential impact of the intervention and describe implementation, including the impact of context on, and barriers and facilitators to implementation.</p><p dir="ltr">A systematic review of controlled trials of link worker interventions in primary and community care identified a lack of evidence to support effectiveness. A pilot study, stakeholder engagement and public patient involvement informed a protocol for a randomised controlled trial and economic evaluation of a practice based social prescribing link worker intervention. The trial took place during the COVID-19 pandemic and under-recruited. There were no significant differences in primary or secondary outcomes or any cost effectiveness advantages. If link workers were operating at full capacity, the probability of effectiveness at the €45,000 ICER threshold value for Ireland was 0.787 using the ICECAP-A capability well-being measure. A mixed methods process evaluation showed link worker support was successfully implemented with adaptations due to COVID-19 restrictions, but this did not always translate into connection with community resources, potentially because the one-month intervention was insufficient to support people with complex needs. This was exacerbated by the impact of the COVID-19 pandemic.</p><p dir="ltr">Uncertainty remains about the effectiveness of social prescribing link workers and further evaluations are recommended, potentially considering a longer intervention to establish how best to support people experiencing multimorbidity and social deprivation.</p>