Bu Feifei, Hayes Daniel, Burton Alexandra, Fancourt Daisy
Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK.
Br J Psychiatry. 2024 Oct 28:1-9. doi: 10.1192/bjp.2024.141.
Social prescribing is growing rapidly globally as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear.
To gain a comprehensive picture of social prescribing in the UK, from referral routes, reasons, to contacts with link workers and prescribed interventions.
This study undertook the first analyses of a large database of administrative data from over 160 000 individuals referred to social prescribing across the UK. Data were analysed using descriptive analyses and regression modelling, including logistic regression for binary outcomes and negative binomial regression for count variables.
Mental health was the most common referral reason and mental health interventions were the most common interventions prescribed. Between 72% and 85% of social prescribing referrals were from medical routes (primary or secondary healthcare). Although these referrals demonstrated equality in reaching across sociodemographic groups, individuals from more deprived areas, younger adults, men, and ethnic minority groups were reached more equitably via non-medical routes (e.g. self-referral, school, charity). Despite 90% of referrals leading to contact with a link worker, only 38% resulted in any intervention being received. A shortage of provision of community activities - especially ones relevant to mental health, practical support and social relationships - was evident. There was also substantial heterogeneity in how social prescribing is implemented across UK nations.
Mental health is the leading reason for social prescribing referrals, demonstrating its relevance to psychiatrists. But there are inequalities in referrals. Non-medical referral routes could play an important role in addressing inequality in accessing social prescribing and therefore should be prioritised. Additionally, more financial and infrastructural resource and strategic planning are needed to address low intervention rates. Further investment into large-scale data platforms and staff training are needed to continue monitoring the development and distribution of social prescribing.
社会处方作为一种应对健康的社会决定因素的方式，在全球范围内迅速发展。然而，它覆盖了哪些人群以及实施的效果如何仍不明确。
全面了解英国的社会处方情况，包括转诊途径、原因、与联络人员的接触以及所开具的干预措施。
本研究首次对来自英国各地超过16万人的社会处方行政数据大数据库进行了分析。使用描述性分析和回归模型对数据进行分析，包括二元结果的逻辑回归和计数变量的负二项回归。
心理健康是最常见的转诊原因，心理健康干预是最常见的开具干预措施。72%至85%的社会处方转诊来自医疗途径（初级或二级医疗保健）。尽管这些转诊在不同社会人口群体中的覆盖情况显示出平等性，但来自更贫困地区、年轻人、男性和少数族裔群体的人通过非医疗途径（如自我转诊、学校、慈善机构）能更公平地被覆盖。尽管90%的转诊导致与联络人员取得联系，但只有38%的转诊最终接受了任何干预措施。社区活动的提供明显不足，尤其是与心理健康、实际支持和社会关系相关的活动。英国不同地区在社会处方的实施方式上也存在很大差异。
心理健康是社会处方转诊的主要原因，表明其与精神科医生的相关性。但转诊存在不平等现象。非医疗转诊途径在解决获得社会处方方面的不平等问题上可以发挥重要作用，因此应予以优先考虑。此外，需要更多的财政和基础设施资源以及战略规划来解决干预率低的问题。需要进一步投资于大规模数据平台和员工培训，以持续监测社会处方的发展和分布情况。
