A systematic review of the effectiveness of link workers providing social prescribing on health outcomes and costs for adults in primary care and community settings

Problem

Social prescribing link workers are being rolled out in many countries often in areas of deprivation. They are recommended for people with mild mental health problems and multimorbidity. Despite widespread use in the UK, evidence for link workers’ effectiveness for the general population and specific subgroups remains limited. Previous reviews looked at U.K. based interventions or included a broad range of studies including those with uncontrolled designs, potentially biasing results. The field has also expanded since previous reviews internationally. This systematic review aimed to examine the effectiveness and costs of link workers in improving health outcomes for people in primary care and community settings with a particular focus on individuals living in deprived areas and with multimorbidity.

Approach

We searched databases of published literature and grey literature from inception to July 2021 for randomised and non-randomised trials examining use of link workers or equivalent for community dwelling adults compared to usual care. We conducted a worldwide search for link worker social prescribing interventions, rather than focusing on a specific geographic location and included equivalent roles across all healthcare systems.

Primary outcomes for the review were health related quality of life (HRQoL) and mental health. Secondary outcomes included healthcare utilisation and costs. Two review authors independently screened abstracts, selected studies, extracted data, evaluated study quality and judged certainty of the evidence. Results were synthesised narratively.

Findings

Seven studies including 3,341 participants were included. Two studies specifically targeted people with multimorbidity and three targeted people living in areas of deprivation. Four studies reported HRQoL outcomes; none reported a positive impact. Four studies included mental health outcomes; three reported no impact. There was no evidence of reductions in primary care usage, but two studies in the US found reduced hospitalisations for people with multimorbidity and an increase in patients reporting high quality care. The intervention was intensive over six months and showed positive results in terms of cost savings, but was trialled in a different health system. No cost effectiveness or cost utility analysis was identified. The certainty of the evidence was low or very low.

Consequences

This is the first systematic review that specifically examined the evidence for social prescribing link workers for people with multimorbidity and in areas of deprivation, which overall was limited. Going forward consideration should be given to interventions that are more intensive for these groups. The widespread policy of rolling out social prescribing projects regardless of the lack of certainty around cost effectiveness makes it challenging for researchers to address the evidence gap, especially in identifying suitable controls. More uncontrolled before after studies will not advance the evidence base and high quality controlled trials of social prescribing link worker interventions are required.