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社会处方对全科医疗工作量和多重用药的影响。

Impact of social prescribing on general practice workload and polypharmacy.

机构信息

Aberfoyle General Practice, Derry, Northern Ireland, UK.

Western Health and Social Care Trust, Gransha Park, Derry, Northern Ireland, UK.

出版信息

Public Health. 2017 Jul;148:96-101. doi: 10.1016/j.puhe.2017.03.010.

Abstract

OBJECTIVES

Social prescribing has emerged as a useful tool for helping patients overcome some of the social and behavioural determinants of poor health. There has been little research on the impact of social prescribing on use of primary healthcare resources. This study sought to determine whether social prescribing activities influenced patient-general practitioner (GP) contacts and polypharmacy.

STUDY DESIGN

Quality-improvement design with social prescribing activity interventions from an urban general practice in Northern Ireland.

METHODS

Patients over 65 years of age with a chronic condition who attended their GP frequently or had multiple medications were offered a social prescribing activity. Participants' contacts with GP and the new repeat prescriptions before and during the social prescribing activity were measured. The total number of repeat prescriptions per patient was compared at the time of referral and 6-12 months later. Indications for referral, primary diagnoses and reasons for declining participation in a social prescribing activity after referral were prospectively recorded.

RESULTS

Sixty-eight patients agreed to participate but only 28 (41%) engaged in a prescribed social activity. There was no statistically significant difference in GP contacts (visits to GP, home visits or telephone calls) or number of new repeat prescriptions between referral and completion of 12 weeks of social prescribing activity. Similarly there was no statistically significant difference in the total number of repeat prescriptions between referral and 6-12 months after social prescribing activity in either intention to treat or per protocol analyses. Social prescribing participants had similar demographic factors. Mental health issues (anxiety and/or depression) were more common among participants than those who were referred but declined participation in a social prescribing activity (P = 0.022).

CONCLUSIONS

While social prescribing may help patients' self-esteem and well-being, it may not decrease GP workload. Further research is required to optimise social prescribing benefits.

摘要

目的

社会处方已成为帮助患者克服健康状况不佳的一些社会和行为决定因素的有用工具。关于社会处方对初级保健资源使用的影响的研究甚少。本研究旨在确定社会处方活动是否会影响患者与全科医生(GP)的接触和多药治疗。

研究设计

北爱尔兰一家城市全科诊所的质量改进设计,采用社会处方活动干预措施。

方法

为经常看医生或服用多种药物的 65 岁以上患有慢性病的患者提供社会处方活动。在社会处方活动之前和期间,测量患者与 GP 的接触情况以及新的重复处方。在转诊时和 6-12 个月后比较每位患者的重复处方总数。前瞻性记录转诊的指征、主要诊断和拒绝参与社会处方活动的原因。

结果

68 名患者同意参与,但只有 28 名(41%)参与了规定的社会活动。在转诊和完成 12 周社会处方活动之间,GP 接触次数(看医生、家访或电话)或新的重复处方数量没有统计学上的显著差异。同样,在意向治疗或按方案分析中,在转诊和社会处方活动后 6-12 个月之间,重复处方的总数也没有统计学上的显著差异。社会处方参与者具有相似的人口统计学因素。与那些被转诊但拒绝参与社会处方活动的患者相比,参与者的心理健康问题(焦虑和/或抑郁)更为常见(P=0.022)。

结论

虽然社会处方可能有助于提高患者的自尊和幸福感,但它可能不会减轻 GP 的工作量。需要进一步研究以优化社会处方的益处。

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