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An exploratory randomised trial investigating feasibility, potential impact and cost effectiveness of link workers for people living with multimorbidity attending general practices in deprived urban communities.
- Source :
- BMC Primary Care; 6/28/2024, Vol. 25 Issue 1, p1-15, 15p
- Publication Year :
- 2024
-
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. Registration: This trial is registered on ISRCTN. Title: Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas. Trial ID: ISRCTN10287737. Date registered 10/12/2019. Link: https://www.isrctn.com/ISRCTN10287737 [ABSTRACT FROM AUTHOR]
- Subjects :
- QUALITY-adjusted life years
MEDICAL care use
STATISTICAL models
COST effectiveness
SOCIAL workers
INDEPENDENT living
FAMILY medicine
RESEARCH funding
MENTAL health
SELF-management (Psychology)
HEALTH impact assessment
PRIMARY health care
STATISTICAL sampling
QUESTIONNAIRES
VISUAL analog scale
EVALUATION of medical care
RANDOMIZED controlled trials
DESCRIPTIVE statistics
ANXIETY
METROPOLITAN areas
RESEARCH
QUALITY of life
PSYCHOLOGICAL tests
CONFIDENCE intervals
DATA analysis software
LENGTH of stay in hospitals
COMORBIDITY
SOCIAL classes
COVID-19 pandemic
REGRESSION analysis
MENTAL depression
Subjects
Details
- Language :
- English
- ISSN :
- 27314553
- Volume :
- 25
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Primary Care
- Publication Type :
- Academic Journal
- Accession number :
- 178150986
- Full Text :
- https://doi.org/10.1186/s12875-024-02482-6