A Randomized Controlled Trial of Social Prescribing: Comparing a Comprehensive Navigation Model With Signposting
Ontario, Canada
This article explores how shared decision-making and motivational interviewing can support patient-centered care. It explains how clinicians can combine these approaches to help patients make informed choices, address behavior change, and ensure that care reflects both medical evidence and individual patient preferences.
DOI: https://doi.org/10.1370/afm.250265
Posted byAnandita Gupta
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Abstract/Description
PURPOSE Social prescribing is a promising strategy to address unmet health and social needs and reduce health disparities. We compared 2 social prescribing approaches that differed with respect to their level of navigation support.
METHODS We conducted a randomized controlled trial among patients with health and/or social needs in primary care practices in 2 regions of Ontario, Canada. Patients were randomized to an Access to Resources in the Community (ARC) intervention arm or a 211-Ontario control arm. ARC patients were offered comprehensive, longitudinal navigation services that included informational, instrumental, and emotional support. 211-Ontario patients were signposted (directed to) inbound navigation services providing mainly informational support. We compared the arms on the primary outcome of self-reported access to at least 1 needed health or social resource, and also on equity for the Francophone minority population. Data were collected with a survey at baseline and at end of the study 3 months later.
RESULTS A total of 326 patients were randomized, of whom 237 (73%) completed the end-of-study survey. Among all patients randomized, the ARC arm had a significantly higher rate of self-reported access to needed resources at study end when compared with the 211-Ontario arm (50.3% vs 35.8%; absolute difference, = 14.5%; 95% CI, 3.9%-25.2%). The ARC advantage was maintained after adjusting for patient factors among all patients randomized (adjusted odds ratio = 1.82; 95% CI, 1.13-2.94) and among the subset completing the study (adjusted odds ratio = 1.82; 95% CI, 1.23-2.94). Patients in the ARC arm also reported significantly better experience and greater ability to engage in their care. Francophones had significantly higher access to language-concordant services in the ARC arm. Exploratory analyses pointed to differences in access across populations within arms, for different types of needs, and for different types of patient–ARC navigator encounters.
CONCLUSIONS The ARC model achieved better overall outcomes and reduced inequities with respect to language-concordant services. Further research is required to understand the importance of in-person visits and the patient population for whom it should be prioritized.
METHODS We conducted a randomized controlled trial among patients with health and/or social needs in primary care practices in 2 regions of Ontario, Canada. Patients were randomized to an Access to Resources in the Community (ARC) intervention arm or a 211-Ontario control arm. ARC patients were offered comprehensive, longitudinal navigation services that included informational, instrumental, and emotional support. 211-Ontario patients were signposted (directed to) inbound navigation services providing mainly informational support. We compared the arms on the primary outcome of self-reported access to at least 1 needed health or social resource, and also on equity for the Francophone minority population. Data were collected with a survey at baseline and at end of the study 3 months later.
RESULTS A total of 326 patients were randomized, of whom 237 (73%) completed the end-of-study survey. Among all patients randomized, the ARC arm had a significantly higher rate of self-reported access to needed resources at study end when compared with the 211-Ontario arm (50.3% vs 35.8%; absolute difference, = 14.5%; 95% CI, 3.9%-25.2%). The ARC advantage was maintained after adjusting for patient factors among all patients randomized (adjusted odds ratio = 1.82; 95% CI, 1.13-2.94) and among the subset completing the study (adjusted odds ratio = 1.82; 95% CI, 1.23-2.94). Patients in the ARC arm also reported significantly better experience and greater ability to engage in their care. Francophones had significantly higher access to language-concordant services in the ARC arm. Exploratory analyses pointed to differences in access across populations within arms, for different types of needs, and for different types of patient–ARC navigator encounters.
CONCLUSIONS The ARC model achieved better overall outcomes and reduced inequities with respect to language-concordant services. Further research is required to understand the importance of in-person visits and the patient population for whom it should be prioritized.