Social prescribing: giving a name to whole-person care
Social prescribing might be a newer term, but it is a core part of the care we already do.
As doctors, we are trained to consider the whole person in patient care. We look for ways to connect patients to non-clinical services and programs in their community to support their social, mental and physical well-being and improve their overall health. The goal of calling this valuable part of clinical care “social prescribing” is to recognize it with a name, make it systematic and build in support for you and your team.
Social prescribing by the numbers
In 2018, the Alliance for Healthier Communities launched a year-long research pilot throughout Ontario called Rx: Community, in which 11 diverse clinical sites provided nearly 3,300 social prescriptions to over 1,100 people. Interventions included programs for food security, social connection, movement, housing or legal support, affordability and more. Nine months into the pilot, 84% of participating health professionals reported improvements in participant health and well-being, and 42% reported a decrease in repeat visits. Rx: Community also found that dedicated navigator support was needed for social prescribing programs to reach their full potential, which can come in the form of a link worker that supports a practice or group of practices.
Natasha Beaudin, social prescribing lead at the alliance, sees a big impact from these small interventions. “Social prescribing is about asking one or two more questions, finding openings and opportunities to help clients work on their own health in a way that’s right for them. This helps to create a relationship of trust.”
Read: Dr. Dominik Nowak: To move Canada’s health system into the future, focus on relationships
Finding the right social prescription
A social prescription can cover a wide range of needs, from helping a person connect to a caregiver support service for an aging parent to sourcing affordable and nutritious food to joining a walking group. Matching a person with the most helpful connection starts with open and transparent conversations.
Tameika Shaw, manager of primary healthcare services at TAIBU Community Health Centre in Scarborough, Ont., advises talking to patients about any barriers impacting their health or preventing them from following our clinical recommendations. She also sees value in training and empowering all staff who come into contact with patients to introduce social prescriptions that could be a good fit.
Shaw tells the story of older adults in her centre and a café in a nearby mall where they used to gather after walks in the morning. One day, the café was shuttered. The social prescribing navigator, Hathor-Ra Phoenix Adwoa, heard their concerns and recommended the centre start an in-house coffee drop-in, where people could gather for conversation and games, and local service providers could join to share information about offerings relevant to their health.
“Building social prescribing into your practice is a journey. Not everyone has the team capacity to support large-scale programs, but even small changes like empowering staff or documenting your social prescriptions to follow-up on barriers help formalize intentional, whole-person care,” Shaw said.
Getting started
To help health professionals get started, the Centre for Effective Practice (CEP) developed a comprehensive social prescribing resource in collaboration with the Alliance for Healthier Communities, the Canadian Institute for Social Prescribing, and St. Michael’s Hospital academic family health team (AFHT).
The CEP resource is designed so that no matter the practice type, location or background with social prescribing, doctors have the necessary guidance to implement social prescribing, find local resources, and make successful referrals. Ideally, practices would be supported by a link worker or systems navigator to whom doctors can refer, but the CEP resource also has approaches for clinicians who do not have these supports or are not in teams.
Especially for those of us in solo or fee-for-service practices, the demands on our time are extraordinary. When I was in a small fee-for-service practice, the key was finding my extended team. In essence, who could I connect this patient with to explore social interventions? The most impactful social prescriptions were versatile. 211, for example, offers services in over 150 languages and can help link people to local supports. Also valuable were connectors like the Ontario Caregiver Organization Caregiver Helpline and nearby Older Adults’ Access Centres.
Patients reclaiming agency
The CEP tool was developed with the guidance of people with lived experience expertise, like Janet Rodriguez, co-lead of Accessibility for All at St. Michael’s AFHT. Rodriguez describes social prescribing as a pathway “to learn to regain some control and manage life issues with the help of my health team.”
When Rodriguez presented with anxiety, insomnia and increased pain, her family doctor kept asking questions and uncovered the reason was financial distress. “It was an eye opener to know that these challenges—that are not medical in nature but made me feel ill—could be alleviated and addressed with other solutions that did not come in a pill form.”
The bottom line on social prescribing
Naming what we are already doing to support whole-person care, making that part of practice systematic, and finding our local allies are keys to social prescribing. By staying pragmatic, social prescribing helps us connect people to resources that address social determinants of health.
Dr. Dominik Nowak is a family physician at Women’s College Hospital in Toronto and clinical lead with the Centre for Effective Practice.