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Social Prescribing in the U.S. and England: Emerging Interventions to Address Patients’ Social Needs

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Introduction

There is growing interest in the role of healthcare systems in addressing patients’ social needs. This is no surprise; evidence on the impact of social factors on population health is well established. People’s education, income, housing, and other social issues have a major impact on their health—a bigger impact, by most estimates, than health care.1 These social factors, in turn, shape people’s health behaviors, such as diet and physical activity, acting as the causes of the causes of disease.2, 3 Yet, despite a substantial body of evidence documenting the impact of the social determinants of health, far less is known about what healthcare systems can best do to address them.

One approach being developed in diverse national contexts is social prescribing—a term used in England to describe the process of connecting patients with non-medical services to improve their health and well-being. Though the U.S. and England have very different healthcare systems and levels of social services spending, both countries are increasingly experimenting with social prescribing as a way to address patients’ social needs in clinical settings. Approaches vary, but the process usually involves screening for social needs (such as social isolation or access to food), referring to community-based services (such as welfare advice or housing support), and supporting people to access relevant services (often using a care coordinator or link worker). A variety of policy initiatives in both countries, such as accountable care organizations and other value-based payment models, have created new opportunities for these kinds of approaches to be developed within the healthcare system. Models that reward outcomes of care rather than just provision of services offer greater incentives for providers to respond to the social factors that impact health.

Section snippets

Social Prescribing in Practice

One of the best-known examples of social prescribing in England can be found in Tower Hamlets in London, an urban area with high levels of socioeconomic deprivation. Family doctors identify patients in their clinics who could benefit from non-medical services and make referrals to a social prescribing coordinator using a standardized form in their electronic medical record. Coordinators contact patients by phone or meet them in person to discuss social issues and identify appropriate services,

Some Promising Evidence, Yet More Gaps In Knowledge

These examples demonstrate that social prescribing is feasible, but evidence of its effectiveness is currently lacking. Two systematic reviews recently examined the evidence on interventions to address patients’ social needs in clinical settings in the U.S.5 and England6 (with each review looking at the evidence in their own countries). Some promising approaches were identified, primarily in the U.S. Observational data from the U.S. show positive impacts of integrating legal services into

Filling Evidence Gaps

These evidence gaps provide a major challenge for health policy and practice—particularly as the prevalence of social prescribing grows. Although the potential benefits from closer integration between health care and social services are significant, realizing this relies on the ability to learn quickly from social prescribing interventions and share evidence about what works in different contexts. This is easier said than done. Interventions to address social needs are complex, involve many

A Road To (No)Where?

Ultimately, however, social prescribing can only work if effective services are available in the community to address patients’ social needs. Once clinicians have identified unmet needs and referred patients to community-based resources, what happens if existing services are unable to meet those needs? This is not an abstract question. A recent study in Philadelphia, for example, tested food insecurity screening in pediatric care combined with referrals to a community-based partner to help

Social Prescribing Meets Payment Reform

To overcome some of these challenges, healthcare systems in both countries are experimenting with ways to better align healthcare and social services spending—sometimes blurring the boundaries between traditionally siloed budgets. In England, some social prescribing programs allow funding to “follow the patient” to community-based organizations providing a range of social supports. Personal health budgets offer patients with complex needs the freedom to purchase non-medical services (typically

Conclusions

Current interest among healthcare leaders in addressing patients’ social needs is a welcome recognition of the limitations of medical care in improving population health. Growing experimentation with social prescribing suggests that clinicians see these limitations in their own clinics and communities, too—even in healthcare systems as diverse in values and coverage as the U.S. and England. The challenge now lies in learning from this experimentation and guiding these efforts towards

Acknowledgments

Support for HA’s research that contributed to this article was provided by The Commonwealth Fund. The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff. NA, LG and CF's work on this project was supported by Kaiser Permanente.

No financial disclosures were reported by the authors of this paper.

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