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格拉斯哥“深度干预”联络人员研究方案:对社会经济高度贫困地区有复杂需求患者的社会处方干预措施的准实验性评估

The Glasgow 'Deep End' Links Worker Study Protocol: a quasi-experimental evaluation of a social prescribing intervention for patients with complex needs in areas of high socioeconomic deprivation.

作者信息

Mercer Stewart W, Fitzpatrick Bridie, Grant Lesley, Chng Nai Rui, O'Donnell Catherine A, Mackenzie Mhairi, McConnachie Alex, Bakhshi Andisheh, Wyke Sally

机构信息

Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK.

出版信息

J Comorb. 2017 Jan 25;7(1):1-10. doi: 10.15256/joc.2017.7.102. eCollection 2017.

Abstract

BACKGROUND

'Social prescribing' can be used to link patients with complex needs to local (non-medical) community resources. The 'Deep End' Links Worker Programme is being tested in general practices serving deprived populations in Glasgow, Scotland.

OBJECTIVES

To assess the implementation and impact of the intervention at patient and practice levels.

METHODS

: Quasi-experimental outcome evaluation with embedded theory-driven process evaluation in 15 practices randomized to receive the intervention or not. : Comprising a practice development fund, a practice-based community links practitioner (CLP), and management support. It aims to link patients to local community organizations and enhance practices' social prescribing capacity. : For intervention practices, staff and adult patients involved in referral to a CLP, and a sample of community organization staff. For comparison practices, all staff and a random sample of adult patients. : 286 intervention and 484 comparator patients. : Primary patient outcome is health-related quality of life (EQ-5D-5L). Secondary patient outcomes include capacity, depression/anxiety, self-esteem, and healthcare utilization. Practice outcome measures include team climate, job satisfaction, morale, and burnout. Outcomes measured at baseline and 9 months. : Barriers and facilitators to implementation of the programme and possible mechanisms through which outcomes are achieved. : For outcome, intention-to-treat analysis with differences between groups tested using mixed-effects regression models. For process, case-study approach with thematic analysis.

DISCUSSION

This evaluation will provide new evidence about the implementation and impact of social prescribing by general practices serving patients with complex needs living in areas of high deprivation.

摘要

背景

“社会处方”可用于将有复杂需求的患者与当地(非医疗)社区资源相联系。“深度介入”联络工作人员计划正在苏格兰格拉斯哥为贫困人群服务的全科诊所进行测试。

目的

在患者和诊所层面评估该干预措施的实施情况及影响。

方法

采用准实验性结果评估,并在15家随机分为接受或不接受干预的诊所中进行基于理论驱动的过程评估。包括一项诊所发展基金、一名驻诊所的社区联络从业者(CLP)以及管理支持。其目的是将患者与当地社区组织相联系,并提高诊所的社会处方能力。对于干预诊所,涉及向CLP转诊的工作人员和成年患者,以及社区组织工作人员样本。对于对照诊所,所有工作人员和成年患者随机样本。286名干预组患者和484名对照组患者。主要患者结局是健康相关生活质量(EQ-5D-5L)。次要患者结局包括能力、抑郁/焦虑、自尊和医疗保健利用情况。诊所结局指标包括团队氛围、工作满意度、士气和职业倦怠。在基线和9个月时测量结局。该计划实施的障碍和促进因素以及实现结局的可能机制。对于结局,采用意向性分析,使用混合效应回归模型检验组间差异。对于过程,采用案例研究方法和主题分析。

讨论

本次评估将为服务于生活在高度贫困地区、有复杂需求患者的全科诊所实施社会处方的情况及影响提供新证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7c5e/5556433/7627bef9b337/joc-07-001-g001.jpg

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