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首页> 美国卫生研究院文献>Primary Health Care Research Development >A realist evaluation of social prescribing: an exploration into the context and mechanisms underpinning a pathway linking primary care with the voluntary sector
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A realist evaluation of social prescribing: an exploration into the context and mechanisms underpinning a pathway linking primary care with the voluntary sector

机译：对社会处方的现实主义评估：探索背景和机制的基础这些机制和机制将初级保健与志愿部门联系起来

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This article adopts a realist approach to evaluate a social prescribing pilot in the areas of Hackney and City in London (United Kingdom). It unpacks the contextual factors and mechanisms that influenced the development of this pilot for the benefits of GPs, commissioners and practitioners, and reflects on the realist approach to evaluation as a tool for the evaluation of health interventions. Primary care faces considerable challenges including the increase in long-term conditions, GP consultation rates, and widening health inequalities. With its emphasis on linking primary care to non-clinical community services via a social prescribing coordinator (SPC), some models of social prescribing could contribute to reduce the burden on primary care, tackle health inequalities and encourage people to make greater use of non-clinical forms of support. This realist analysis was based on qualitative interviews with users, commissioners, a GP survey, focus groups and learning events to explore stakeholders’ experience. To enable a detailed analysis, we adapted the realist approach by subdividing the social prescribing pathway into stages, each with contextual factors, mechanisms and outcomes. SPCs were pivotal to the effective functioning of the social prescribing service and responsible for the activation and initial beneficial impact on users. Although social prescribing shows significant potential for the benefit of patients and primary care, several challenges need to be considered and overcome, including ‘buy in’ from some GPs, branding, and funding for the third sector in a context where social care cuts are severely affecting the delivery of health care. With its emphasis on context and mechanisms, the realist evaluation approach is useful in understanding how to identify and improve health interventions, and analyse in greater detail the contribution of different stakeholders. As the SPC is central to social prescribing, more needs to be done to understand their role conceptually and practically.
机译：本文采用现实主义的方法来评估伦敦（英国）哈克尼和城市地区的社会处方飞行员。它为全科医生，专员和从业者带来了影响该试点项目发展的背景因素和机制，并反思了作为卫生干预措施评估工具的现实主义评估方法。初级保健面临着巨大的挑战，包括长期病情的增加，全科医生的咨询率以及健康不平等的扩大。由于强调通过社会处方协调员（SPC）将基本医疗服务与非临床社区服务联系起来，一些社会处方模型可以有助于减轻基本医疗服务的负担，解决健康不平等现象，并鼓励人们更多地使用非医疗服务。临床形式的支持。这种现实主义的分析基于对用户，专员，GP调查，焦点小组和学习活动的定性访谈，以探索利益相关者的经验。为了进行详细的分析，我们通过将社会处方途径细分为各个阶段，每个阶段都有上下文因素，机制和结果，从而采用了现实主义方法。 SPC对社交处方服务的有效运行至关重要，并负责激活和最初对用户产生有益的影响。尽管社交处方显示出使患者和初级保健受益的巨大潜力，但仍需考虑并克服一些挑战，包括在严重削减社会保健的情况下，从某些全科医生那里“买进”，品牌化以及为第三部门提供资金影响卫生保健的提供。通过强调环境和机制，现实主义评估方法有助于理解如何识别和改善健康干预措施，并更详细地分析不同利益相关者的贡献。由于SPC在社会处方中至关重要，因此需要做更多的工作来从概念上和实践上理解他们的作用。

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