COMMENTARY

Could It Be as Easy as Prescribing Good Health?

Ranit Mishori, MD, MHS

Disclosures

September 14, 2018

Editorial Collaboration

Medscape &

Hello. My name is Dr Ranit Mishori and I am a professor of family medicine at the Georgetown University School of Medicine.

What I want to talk about today is a relatively new term that you may be reading about in the medical literature, popular media, or hearing about at conferences. The term I want to discuss is called social prescribing.

It comes to us from the United Kingdom and it refers to initiatives that address the social determinants of health. [Social prescribing is intended to respond] to the recognition that social needs and factors like where you live, what you eat, how active you are, your access to healthcare, your income level, your education level, and your social engagement are often as important, if not more important, to health than medical factors such as genetics.

This emerging trend in the United Kingdom focuses on linking patients with nonmedical services to improve their health and well-being. [This can include] food, exercise, and housing. However, importantly, it also emphasizes some softer activities like art, singing, hiking, and participating in social gatherings and groups. As described in the literature, social prescribing is primarily aimed at adults and seniors. It was designed and initiated as a response to the aging of the population and gaps in primary care. But, very importantly, [it is] also [needed] because of an increase in the prevalence of lifestyle-associated conditions and social isolation.

In the UK, social prescribing is sanctioned by the National Health Service. It is embraced by some primary care physicians who send their patients to various community-based activities and organizations.

One recent project was described in BMC Health Services Research. This study looked at [the effect of] deploying what they called well-being coordinators.[1] The coordinators offered support, advice, and linkages to the community.

What were the findings? In many cases, the social prescribing of services had enabled individuals to have a more positive and optimistic view of their life. Data on [the association of this prescribing with] access to care was inconclusive. There were no data about health outcomes. There was some evidence in the study to show that men experienced greater benefits from social prescribing than women.

What about [other] research? This study was one of several in recent years that found some benefits to these interventions, although some of them are more beneficial than others. For example, [there are some better data demonstrating benefits] of prescribing exercise. Evidence is also emerging on the potential benefits of spending time in nature, dancing, singing, social engagement, and the arts.

In general, there are many research gaps and this is certainly an emerging field of study. One issue at this point is that there is not even a consensus on what needs to be studied.

Here are some questions for those of you interested in studying this.

First of all, does the act of prescribing itself—prescribing these activities—make a difference in patients' lives? Are they more likely to act on these recommendations when they come packaged as an official-looking prescription? The evidence on that is a bit problematic. Another paper published in BMC Health Services Research concluded that [the contribution of] social prescribing to [well-being] is still to be determined.[2]

What else do we need to know? We need to know what types of programs work. Are they cost-effective? Which groups of people or subgroups benefit more? What kind of outcomes should be studied in the first place? What is the impact of the utilization of and enrollment in these kinds of programs? What is the effect of attendance and adherence to these programs? Who should be in charge of prescribing: doctors, social workers, well-being navigators? What are some facilitators and barriers to the success of programs like these?

Of course, we need to look at both the patient and provider experience of these initiatives and services. We need to think about funding and policy changes that enable such programs to be identified and supported.

I expect that we will hear more about social prescribing in the near future. It sounds like a term that can be pretty buzzy. Emphasizing and addressing screening for the social determinants of health and social prescribing definitely go hand in hand.

Thank you.

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