一项探索性随机试验，研究为贫困城市社区中接受常规医疗服务的多病共存患者提供联络工作者的可行性、潜在影响和成本效益。

An exploratory randomised trial investigating feasibility, potential impact and cost effectiveness of link workers for people living with multimorbidity attending general practices in deprived urban communities.

机构信息

Department of General Practice, Clinical Research Fellow, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, 123 St Stephens Green, Dublin 2, Dublin, Ireland.

Centre for Research in Medical Devices (CÚRAM, RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, SFI 13, Galway, Ireland.

出版信息

BMC Prim Care. 2024 Jun 28;25(1):233. doi: 10.1186/s12875-024-02482-6.

DOI:10.1186/s12875-024-02482-6

PMID:38943076

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11212363/

Abstract

BACKGROUND

Social prescribing link workers are non-health or social care professionals who connect people with psychosocial needs to non-clinical community supports. They are being implemented widely, but there is limited evidence for appropriate target populations or cost effectiveness. This study aimed to explore the feasibility, potential impact on health outcomes and cost effectiveness of practice-based link workers for people with multimorbidity living in deprived urban communities.

METHODS

A pragmatic exploratory randomised trial with wait-list usual care control and blinding at analysis was conducted during the COVID 19 pandemic (July 2020 to January 2021). Participants had two or more ongoing health conditions, attended a general practitioner (GP) serving a deprived urban community who felt they may benefit from a one-month practice-based social prescribing link worker intervention.. Feasibility measures were recruitment and retention of participants, practices and link workers, and completion of outcome data. Primary outcomes at one month were health-related quality of life (EQ-5D-5L) and mental health (HADS). Potential cost effectiveness from the health service perspective was evaluated using quality adjusted life years (QALYs), based on conversion of the EQ-5D-5L and ICECAP-A capability index to utility scoring.

RESULTS

From a target of 600, 251 patients were recruited across 13 general practices. Randomisation to intervention (n = 123) and control (n = 117) was after baseline data collection. Participant retention at one month was 80%. All practices and link workers (n = 10) were retained for the trial period. Data completion for primary outcomes was 75%. There were no significant differences identified using mixed effects regression analysis in EQ-5D-5L (MD 0.01, 95% CI -0.07 to 0.09) or HADS (MD 0.05, 95% CI -0.63 to 0.73), and no cost effectiveness advantages. A sensitivity analysis that considered link workers operating at full capacity in a non-pandemic setting, indicated the probability of effectiveness at the €45,000 ICER threshold value for Ireland was 0.787 using the ICECAP-A capability index.

CONCLUSIONS

While the trial under-recruited participants mainly due to COVID-19 restrictions, it demonstrates that robust evaluations and cost utility analyses are possible. Further evaluations are required to establish cost effectiveness and should consider using the ICE-CAP-A wellbeing measure for cost utility analysis.

REGISTRATION

This trial is registered on ISRCTN.

TITLE

Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas.

TRIAL ID

ISRCTN10287737. Date registered 10/12/2019. Link: https://www.isrctn.com/ISRCTN10287737.

摘要

背景

社会处方联系工作者是非卫生或社会保健专业人员，他们将有心理社会需求的人与非临床社区支持联系起来。他们正在广泛实施，但针对合适的目标人群或成本效益的证据有限。本研究旨在探索针对生活在贫困城市社区的多病共存人群的基于实践的联系工作者在可行性、对健康结果的潜在影响和成本效益方面的效果。

方法

这是一项在 COVID-19 大流行期间（2020 年 7 月至 2021 年 1 月）进行的实用探索性随机试验，采用等待名单常规护理对照和分析时的盲法。参与者有两种或两种以上持续存在的健康状况，在服务贫困城市社区的全科医生就诊，全科医生认为他们可能受益于一个月的基于实践的社会处方联系工作者干预。可行性措施包括参与者、实践和联系工作者的招募和保留，以及完成结果数据。一个月时的主要结果是健康相关的生活质量（EQ-5D-5L）和心理健康（HADS）。从卫生服务角度评估潜在的成本效益，使用质量调整生命年（QALYs），根据 EQ-5D-5L 和 ICECAP-A 能力指数转换为效用评分。

结果

从 600 名目标人群中，在 13 家全科医生诊所招募了 251 名患者。在基线数据收集后，对干预组（n=123）和对照组（n=117）进行了随机分组。一个月时的参与者保留率为 80%。所有实践和联系工作者（n=10）都在试验期间保留。主要结局数据的完成率为 75%。使用混合效应回归分析，在 EQ-5D-5L（MD 0.01，95%CI-0.07 至 0.09）或 HADS（MD 0.05，95%CI-0.63 至 0.73）方面均未发现显著差异，也没有成本效益优势。敏感性分析考虑了在非大流行环境下联系工作者满负荷运作的情况，使用 ICECAP-A 能力指数表明，在爱尔兰 45000 欧元的 ICER 阈值下，具有成本效益的概率为 0.787。