Preparing the prescription: a review of the aim and measurement of social referral programmes

Abstract

Objective: Our aim is to review, and qualitatively evaluate, the aims and measures of social referral programmes. Our first objective is to identify the aims of social referral initiatives. Our second objective is to identify the measures used to evaluate whether the aims of social referral were met.

Design: Literature review.

Background: Social referral programmes, also called social prescribing and emergency case referral, link primary and secondary healthcare with community services, often under the guise of decreasing health system costs.

Method: Following the PRISMA guidelines, we undertook a literature review to address that aim. We searched in five academic online databases and in one online non-academic search engine, including both academic and grey literature, for articles referring to 'social prescribing' or 'community referral'.

Results: We identified 41 relevant articles and reports. After extracting the aims, measures and type of study, we found that most social referral programmes aimed to address a wide variety of system and individual health problems. This included cost savings, resource reallocation and improved mental, physical and social well-being. Across the 41 studies and reports, there were 154 different kinds of measures or methods of evaluation identified. Of these, the most commonly used individual measure was the Warwick-Edinburgh Mental Well-being Scale, used in nine studies and reports.

Conclusions: These inconsistencies in aims and measures used pose serious problems when social prescribing and other referral programmes are often advertised as a solution to health services-budgeting constraints, as well as a range of chronic mental and physical health conditions. We recommend researchers and local community organisers alike to critically evaluate for whom, where and why their social referral programmes 'work'.

Keywords: Health Services Research; Literature Review; Social Medicine; Social Prescribing; Social Referral.

Figure 1

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for the literature search strategy for social referral programmes. The main criterion for inclusion was an empirical assessment of a programme that contained a patient referral out of the healthcare system and into the community or voluntary system. Six hundred and forty-five articles and reports were initially identified and assessed for duplication and relevance. Forty-one articles and reports were then assessed for full-text eligibility. Eighteen articles or reports were identified. The citations and reference lists for the academic articles were searched for additional literature, alongside other non-eligible review papers, as well as the reference lists of the non-academic reports. This resulted in 23 articles further identified as relevant. Finally, 41 studies were included in the qualitative synthesis. NICE refers to the National Institue for Health and Care Excellence.

Figure 2

A summary of the social referral process identified in the literature search. All programmes’ participants were identified by various indicators of need, for example, low-level mental health conditions within the healthcare sector. The participants were then provided with either a facilitated or non-facilitated referral to a community or voluntary activity. Patient identification and referral represent the ‘process’ while the activity represents the ‘treatment’ of social referral programmes. Finally, the proposed outcomes included either improved individual well-being, for example, mental well-being, and/or system-level improvement, for example, reallocated healthcare resources.