A realist evaluation of social prescribing: an exploration into the context and mechanisms underpinning a pathway linking primary care with the voluntary sector
A realist evaluation of social prescribing: an exploration into the context and mechanisms underpinning a pathway linking primary care with the voluntary sector
复制标题
DOI：
10.1017/s1463423617000706
复制
发表时间：
2018-05-01
影响因子：
1.6
通讯作者：
Carnes, Dawn
中科院分区：
文献类型：
--
作者：
Bertotti, Marcello;Frostick, Caroline;Carnes, Dawn
本文采用现实主义的方法来评估社会处方试点地区的哈克尼和城市在伦敦（英国）。它解开的背景因素和机制，影响了这个试点的发展，为全科医生，专员和从业人员的利益，并反映了现实主义的评价方法作为一种工具，用于评价卫生干预措施。初级保健面临着相当大的挑战，包括长期条件的增加，全科医生咨询率，以及日益扩大的健康不平等。由于强调通过社会处方协调员（SPC）将初级保健与非临床社区服务联系起来，一些社会处方模式有助于减轻初级保健的负担，解决健康不平等问题，并鼓励人们更多地使用非临床形式的支持。这一现实主义分析的基础是对用户、专员、全科医生调查、焦点小组和学习活动的定性访谈，以探讨利益攸关方的经验。为了进行详细的分析，我们采用了现实主义的方法，将社会处方途径细分为各个阶段，每个阶段都有背景因素，机制和结果。SPC对于社会处方服务的有效运作至关重要，并负责激活和对用户产生最初的有益影响。虽然社会处方显示出显着的潜力，为患者和初级保健的利益，需要考虑和克服的几个挑战，包括'买在'从一些全科医生，品牌，和资金的第三部门的背景下，社会保健削减严重影响提供医疗保健。现实主义评价方法强调背景和机制，有助于理解如何确定和改进保健干预措施，并更详细地分析不同利益攸关方的贡献。由于SPC是社会处方的核心，需要做更多的工作来理解他们在概念上和实践中的作用。
This article adopts a realist approach to evaluate a social prescribing pilot in the areas of Hackney and City in London (United Kingdom). It unpacks the contextual factors and mechanisms that influenced the development of this pilot for the benefits of GPs, commissioners and practitioners, and reflects on the realist approach to evaluation as a tool for the evaluation of health interventions. Primary care faces considerable challenges including the increase in long-term conditions, GP consultation rates, and widening health inequalities. With its emphasis on linking primary care to non-clinical community services via a social prescribing coordinator (SPC), some models of social prescribing could contribute to reduce the burden on primary care, tackle health inequalities and encourage people to make greater use of non-clinical forms of support. This realist analysis was based on qualitative interviews with users, commissioners, a GP survey, focus groups and learning events to explore stakeholders' experience. To enable a detailed analysis, we adapted the realist approach by subdividing the social prescribing pathway into stages, each with contextual factors, mechanisms and outcomes. SPCs were pivotal to the effective functioning of the social prescribing service and responsible for the activation and initial beneficial impact on users. Although social prescribing shows significant potential for the benefit of patients and primary care, several challenges need to be considered and overcome, including 'buy in' from some GPs, branding, and funding for the third sector in a context where social care cuts are severely affecting the delivery of health care. With its emphasis on context and mechanisms, the realist evaluation approach is useful in understanding how to identify and improve health interventions, and analyse in greater detail the contribution of different stakeholders. As the SPC is central to social prescribing, more needs to be done to understand their role conceptually and practically.