Myra Rzepa and the people at her crafting workshop are not just making Christmas ornaments. They are part of a new program across Ontario to test the effectiveness of social prescriptions: a non-medical approach that links patients with activities and services in a bid to reduce the need for drugs and visits to the doctor.
Ms. Rzepa found leading the workshop benefited her, too. “It’s very therapeutic for me to help people, and also to do what I love,” says Ms. Rzepa, 30, an avid painter and craftsperson, who has borderline personality disorder and depression and has struggled with addiction to opiates.
The participants at the workshop earlier this month in Thunder Bay, Ont., might not have attended had their health-care providers not suggested it to help them with issues such as social anxiety and loneliness. And as someone who has social anxiety herself, Ms. Rzepa said working with her hands makes her feel better. “It’s very soothing and relaxing, and then it’s rewarding because you made something in the end. You’re proud of it.”
Thunder Bay’s NorWest Community Health Centre is one of 11 facilities across the province offering social prescriptions for activities ranging from support groups and yoga to free museum visits and knitting circles. The pilot project, launched earlier this fall by the Alliance for Healthier Communities, which represents community health centres throughout Ontario, aims to connect patients to programs and services that address some of the broader determinants of health, such as exercise, community involvement and diet, but fall beyond the scope of medical practice.
If patients receive support to become more physically and socially active and adopt healthier lifestyle habits, the thinking goes, they are likely to need fewer medications, doctors’ appointments and hospital visits.
Social prescribing has taken off in Britain amid belt-tightening in health care and a shortage of general practitioners, and it is gaining momentum internationally. Reports of its successes are many. However, one expert cautions against adopting the program without the proper tracking and assessment of the outcome.
“You’ve got a great opportunity to do what we haven’t done [in Britain], and that’s look before you leap,” says Paul Wilson, a senior research fellow at the University of Manchester’s Alliance Manchester Business School, who co-authored a 2016 study in the BMJ Open titled Social prescribing: less rhetoric and more reality. A systematic review of the evidence.
The way social prescribing typically works is doctors or nurses refer patients to someone called a link worker, who connects them with community services and programs that match their needs. For example, a patient with financial trouble may be referred to a debt-counselling program.
Mr. Wilson and his team examined 15 studies on social-prescribing programs in Britain published between 2000 and 2016. Most had positive outcomes, such as improvements in patients’ self-reported feelings of loneliness and isolation. But Mr. Wilson says these studies were generally small, with poor research design and reporting, so it is impossible to conclude just how effective social prescribing actually is.
“Social prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money,” he and colleagues wrote.
Mr. Wilson explains it can be hard to determine, for instance, whether reported reductions in hospital admissions are due to social prescriptions or to other care that patients may receive beforehand, such as additional attention in the form of medication reviews or goal-setting sessions with their doctors and nurses.
That is not to say social prescribing does not work, he says, but rather, the current evidence does not show that it does.
Tara Case, chief executive of Ways to Wellness, a service that offers social prescribing in Newcastle upon Tyne, says her work gives her a front-row view of how it improves lives and makes economic sense. Patients who use social prescribing report increases in their activity, improved sleep and diet, as well as improvements in their mental health and overall positive feelings. Moreover, she says, the patients use hospital services less than those who do not use the social-prescribing service.
But proving its value can be challenging because the effects of social prescribing may not come for years, Ms. Case says.
“[For] someone who is socially isolated or really sitting at home and not getting any exercise and not eating well, it takes some time for [prescribed activities and programs] to end up impacting how they use hospital services and reducing the progression of their disease,” she says.
In Ontario, Kate Mulligan, director of policy and communications at the Alliance for Healthier Communities, says her organization will track patients over 10 months to assess their health and self-reported sense of well-being during the pilot project.
A large portion of the costs of the project will go toward this evaluation process, Dr. Mulligan says, noting the project is funded by a $600,000-grant from the Ministry of Health and Long-term Care.
Gathering the evidence to show that programs and services such as community kitchens or crafting workshops are beneficial for health “is one of the most exciting parts” of the endeavour, she says. “We’ll finally be able to show that.”
Meanwhile, Mr. Wilson suggests Canada can answer important questions about social prescribing, including which patients would benefit, in what circumstances, and whether it is effective, before implementing it on a large scale.
“Those are all questions we’ve not been able to answer because we’ve leapt in,” he says.