A Randomized Controlled Trial of Social Prescribing: Comparing a Comprehensive Navigation Model With Signposting.

Abstract (English)

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.