Does a social prescribing 'holistic' link-worker for older people with complex, multimorbidity improve well-being and frailty and reduce health and social care use and costs? A 12-month before-and-after evaluation
Does a social prescribing 'holistic' link-worker for older people with complex, multimorbidity improve well-being and frailty and reduce health and social care use and costs? A 12-month before-and-after evaluation
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DOI：
10.1017/s1463423619000598
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发表时间：
2019-01-01
影响因子：
1.6
通讯作者：
Byng, Richard
中科院分区：
文献类型：
--
作者：
Elston, Julian;Gradinger, Felix;Byng, Richard
目的：评估“整体”联系工作者对服务使用者的福祉、激活和脆弱性的影响，以及他们对卫生和社会护理服务的使用和相关成本。背景：英国的政策是鼓励社会处方（SP）作为一种手段，以提高福祉，自我保健和减少对国民保健制度和社会服务的需求。然而，支持这一政策的证据普遍薄弱，概念化程度较差，特别是在体弱多病、老年人和患者激活方面。托贝和南德文郡NHS基金会信托是一个综合护理组织，委托了一项福祉协调员服务，以支持具有复杂健康需求（>= 2长期条件）的老年人（>= 50岁），作为其服务重新设计的一部分。方法：一项前后研究，测量干预前后12周的健康和社会福祉、活动和虚弱以及干预前后12个月的初级、社区和二级保健服务使用和成本。调查结果：86名参与者中大多数人（85%）实现了目标。在平均健康和幸福方面，患者的激活和虚弱在平均得分上显示出统计学上显著的改善。所有服务的平均活动都增加了（有些变化在统计上是显著的）。44%的参与者看到服务使用减少或没有变化。13个高成本用户（成本变化5000英镑）占总成本增长的59%。这主要是由于发病率和虚弱程度显著迅速上升。协调员发挥了宝贵的关键工作者作用，改善了护理的连续性，减少了隔离，并为护理人员提供了支持。没有入门级参与者特征与幸福感或服务使用的变化相关。需要更大规模、概念化程度更高的对照研究来加强因果关系的主张，并在这一领域制定国家政策。
Aim: To evaluate the impact of 'holistic' link-workers on service users' well-being, activation and frailty, and their use of health and social care services and the associated costs. Background: UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (>= 50 years) with complex health needs (>= 2 long-term conditions), as part of its service redesign. Methods: A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention. Findings: Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>5000 pound change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.