Objectives Social prescribing is a way of linking patients in primary care with sources of support within the community to help improve their health and well-being. Social prescribing programmes are being widely promoted and adopted in the UK National Health Service and so we conducted a systematic review to assess the evidence for their effectiveness. Setting/data sources Nine databases were searched from 2000 to January 2016 for studies conducted in the UK. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. All the searches were restricted to English language only. Participants Systematic reviews and any published evaluation of programmes where patient referral was made from a primary care setting to a link worker or facilitator of social prescribing were eligible for inclusion. Risk of bias for included studies was undertaken independently by two reviewers and a narrative synthesis was performed. Primary and secondary outcome measures Primary outcomes of interest were any measures of health and well-being and/or usage of health services. Results We included a total of 15 evaluations of social prescribing programmes. Most were small scale and limited by poor design and reporting. All were rated as a having a high risk of bias. Common design issues included a lack of comparative controls, short follow-up durations, a lack of standardised and validated measuring tools, missing data and a failure to consider potential confounding factors. Despite clear methodological shortcomings, most evaluations presented positive conclusions. Conclusions Social prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money. If social prescribing is to realise its potential, future evaluations must be comparative by design and consider when, by whom, for whom, how well and at what cost. Trial registration number PROSPERO Registration: CRD42015023501.

https://bmjopen.bmj.com/content/bmjopen/7/4/e013384.full.pdf

Social prescribing: less rhetoric and more reality. A systematic review of the evidence

for pharmacists to provide “optimal drug therapy outcomes for Canadians through patient-centred care” has been accepted by all Canadian pharmacy organizations This means a shift from dispensing and technical duties to a particular focus on services that improve patient outcomes However, practice change of this nature has been discussed for many years, and few programs have been fully successful or sustainable over the long term

Are Pharmacists the Ultimate Barrier to Pharmacy Practice Change

Background: The role of technology to facilitate independent living for people with dementia is not fully realized, with initial attempts (e.g. tracking devices) being considered unacceptable from a practical and ethical perspective. The aim of this study is to create acceptable and effective prototype technologies to facilitate independence for people with dementia through a user-centered design process involving them and their carers. Method: The study comprised a three-stage participatory design process: scoping stage (five focus groups, 10 people with dementia and 11 carers); participatory design stage (five workshops, 22 participants) and prototype development stage (four meetings with two people with dementia and one carer). Focus groups and workshops were digitally recorded, fully transcribed and subjected to constant comparative analysis. Results: People with mild to moderate dementia enjoy a variety of activities both on their own and with their families; however, concerns included getting lost, a loss of confidence with curtailment of usual activities, and carer anxiety. Existing technologies (mobile phones) were used intermittently. Participants felt strongly that future devices should be disguised and be integrated easily into their daily routines. Suggested areas for functional improvement included two-way communications, flexibility of function as the illness progresses, and something to "guide" them home when out walking or driving. Attention should also be focused on minimizing the size, weight and visibility of devices to reduce stigmatization. Conclusion: Prototypes for two devices (armband and electronic notepad) were developed. The study showed that involving people with dementia in the process of participatory design is feasible and could lead to devices which are more acceptable and relevant to their needs.

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Keeping In Touch Everyday (KITE) project: developing assistive technologies with people with dementia and their carers to promote independence.

Objectives To understand how the policy of user involvement is interpreted in health service organisations and to identify factors that influence how user involvement is put into practice.

Design Ethnographic study using participant observation, interviews, and collection of documentary evidence.

Setting A multiagency modernisation programme to improve stroke services in two London boroughs.

Participants Service users, National Health Service managers, and clinicians.

Results User involvement in the programme was initiated and led by professionals. Professionals determined the areas of service improvement service users could participate in. A wide range of activities were considered “user involvement,” from patient satisfaction surveys to service users delivering peer support. Involvement tended to be most active in the least technical areas and areas with least input from clinicians. Factors that might explain this included organisational structure, the vagueness of the concept of user involvement, the value attributed to service users’ experiential knowledge, and variations in professional and service user understandings of and commitment to involvement. The gains of involvement were harder to identify in terms of impact on services. More evident were the personal gains for those involved: satisfaction of feeling listened to by professionals, social opportunities of meeting others in a similar situation, and increased knowledge about stroke and services available.

Conclusions User involvement may not automatically lead to improved service quality. Healthcare professionals and service users understand and practise user involvement in different ways according to individual ideologies, circumstances, and needs. Given the resource implications of undertaking user involvement in service development there is a need for critical debate on the purpose of such involvement as well as better evidence of the benefits claimed for it.

https://www.bmj.com/content/bmj/336/7639/313.full.pdf

Assessing the promise of user involvement in health service development: ethnographic study

Chronic disease self-management education programs aim to empower patients through providing information and teaching skills and techniques to improve self-care and doctor-patient interaction, with the ultimate goal of improving quality of life. The recent 2006-07 federal budget allocated an unprecedented $515 million over 5 years for activation of patient self-management activities, commencing this financial year. Previous attempts in other countries to incorporate self-management education activities into the health care sector have faced setbacks because of inadequate integration into primary care. Engagement of health care professionals and their endorsement of self-management activities is critical to success.

Chronic disease self‐management education programs: challenges ahead

In January 2006 the Department of Health published Our health, our care, our say: A new direction for community services. It is the government’s seventh White Paper on health since coming to office in 1997 and, after several years of reform aimed at the acute hospital sector, it represents what Patricia Hewitt, the Secretary of State for Health, calls a ‘fundamental shift’ towards integrated services provided in local communities.

Housing Lin

Papers

Department of Health White Paper - Our health our care our say: a new direction for community services