Calderón-Larrañaga Sara, Milner Yasmin, Clinch Megan, Greenhalgh Trisha, Finer Sarah
Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
Bromley By Bow Health Partnership, London, UK.
BJGP Open. 2021 Jun 30;5(3). doi: 10.3399/BJGPO.2021.0017. Print 2021 Jun.
Social prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector (VCS). Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice.
To define 'good' practice in SP by identifying context-specific enablers and tensions. To contribute to the development of an evidence-based framework for theorising and evaluating SP within primary care.
DESIGN & SETTING: Realist review of secondary data from primary care-based SP schemes.
Academic articles and grey literature were searched for qualitative and quantitative evidence following the Realist And Meta-narrative Evidence Syntheses - Evolving Standards (RAMESES). Common SP practices were characterised in three settings (general practice, link workers, and community sector) using archetypes that ranged from best to worst practice.
A total of 140 studies were included for analysis. Resources were identified influencing the type and potential impact of SP practices and four dimensions were outlined in which opportunities for good practice arise: 1) individual characteristics (stakeholder's buy-in, vocation, and knowledge); 2) interpersonal relations (trustful, bidirectional, informed, supportive, and transparent and convenient interactions within and across sectors); 3) organisational contingencies (the availability of a predisposed practice culture, leadership, training opportunities, supervision, information governance, resource adequacy, accessibility, and continuity of care within organisations); and 4) policy structures (bottom-up and coherent policymaking, stable funding, and suitable monitoring strategies). Findings were synthesised in a multilevel, dynamic, and usable SP framework.
The realist review and resulting framework revealed that SP is not inherently advantageous. Specific individual, interpersonal, organisational, and policy resources are needed to ensure SP best practice in primary care.
社会处方（SP）涉及将初级保健中的患者与志愿及社区部门（VCS）提供的服务相联系。尽管国民保健服务体系（NHS）初级保健对此兴趣日增，但SP如何以及在何种情况下有助于良好实践仍不明确。
通过识别特定背景下的促进因素和矛盾点来定义SP中的“良好”实践。为在初级保健中对SP进行理论化和评估的循证框架的发展做出贡献。
对基于初级保健的SP计划的二手数据进行实证性综述。
按照实证性与元叙事证据综合——不断发展的标准（RAMESES），检索学术文章和灰色文献以获取定性和定量证据。使用从最佳到最差实践的原型，在三种环境（全科医疗、联络人员和社区部门）中对常见的SP实践进行了特征描述。
共纳入140项研究进行分析。确定了影响SP实践类型和潜在影响的资源，并概述了产生良好实践机会的四个维度：1）个体特征（利益相关者的支持、职业和知识）；2）人际关系（各部门内部及之间信任、双向、信息充分、支持性、透明且便利的互动）；3）组织意外情况（组织内预先存在的实践文化、领导力、培训机会、监督、信息治理、资源充足性、可及性以及护理连续性的可用性）；4）政策结构（自下而上且连贯的政策制定、稳定的资金以及合适的监测策略）。研究结果综合在一个多层次、动态且实用的SP框架中。
实证性综述及由此产生的框架表明，SP并非天生具有优势。需要特定的个体、人际、组织和政策资源来确保初级保健中的SP最佳实践。
