RT Journal Article
SR Electronic
T1 Effectiveness of Community-Links Practitioners in Areas of High Socioeconomic Deprivation
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 518
OP 525
DO 10.1370/afm.2429
VO 17
IS 6
A1 Stewart W. Mercer
A1 Bridie Fitzpatrick
A1 Lesley Grant
A1 Nai Rui Chng
A1 Alex McConnachie
A1 Andisheh Bakhshi
A1 Greg James-Rae
A1 Catherine A. O’Donnell
A1 Sally Wyke
YR 2019
UL http://www.annfammed.org/content/17/6/518.abstract
AB PURPOSE To assess the effect of a primary care–based community-links practitioner (CLP) intervention on patients’ quality of life and well-being.METHODS Quasi-experimental cluster-randomized controlled trial in socioeconomically deprived areas of Glasgow, Scotland. Adult patients (aged 18 years or older) referred to CLPs in 7 intervention practices were compared with a random sample of adult patients from 8 comparison practices at baseline and 9 months. Primary outcome: health-related quality of life (EQ-5D-5L, a standardized measure of self-reported health-related quality of life that assesses 5 dimensions at 5 levels of severity). Secondary outcomes: well-being (Investigating Choice Experiments for the Preferences of Older People Capability Measure for Adults [ICECAP-A]), depression (Hospital Anxiety and Depression Scale, Depression [HADS-D]), anxiety (Hospital Anxiety and Depression Scale, Anxiety [HADS-A]), and self-reported exercise. Multilevel, multiregression analyses adjusted for baseline differences. Patients were not blinded to the intervention, but outcome analysis was masked.RESULTS Data were collected on 288 and 214 (74.3%) patients in the intervention practices at baseline and follow-up, respectively, and on 612 and 561 (92%) patients in the comparison practices. Intention-to-treat analysis found no differences between the 2 groups for any outcome. In subgroup analyses, patients who saw the CLP on 3 or more occasions (45% of those referred) had significant improvements in EQ-5D-5L, HADS-D, HADS-A, and exercise levels. There was a high positive correlation between CLP consultation rates and patient uptake of suggested community resources.CONCLUSIONS We were unable to prove the effectiveness of referral to CLPs based in primary care in deprived areas for improving patient outcomes. Future efforts to boost uptake and engagement could improve overall outcomes, although the apparent improvements in those who regularly saw the CLPs may be due to reverse causality. Further research is needed before wide-scale deployment of this approach.