Evaluation of a community health worker social prescribing program among UK patients with type 2 diabetes

Importance  Despite lacking robust evidence of effectiveness, health care systems in developed countries are funding holistic community health worker (CHW) social prescribing programs that address social needs and health behaviors as adjuncts to clinical care.

Objective  To determine whether a UK National Health Service (NHS) CHW social prescribing program was associated with improved hemoglobin A1c (HbA1c) levels among patients with type 2 diabetes.

Design, Setting, and Participants  This cohort study with difference-in-differences analysis was conducted among 8086 patients (4752 in the referral program, 3334 in the control group) in 24 NHS primary care practices in a city in North East England. Patients aged 40 to 74 years with a diagnosis of type 2 diabetes were observed for 8 years, from 2011 through 2019. The statistical analysis was conducted between June 1, 2019, and January 31, 2021.

Interventions  A social prescribing program, launched in April 2015, enabling primary care staff to refer patients to CHW support to identify condition management and social needs goals and access voluntary and community sector support to address these goals. Intervention referral was only available in primary care practices in the city’s west. The control group included patients in the city’s east where referral was unavailable.

Main Outcomes and Measures  HbA1c level, a marker of glycemic control.

Results  A total of 8086 patients were included in the analysis (mean [SD] age, 57.8 [8.78] years; 3477 women [43%]; 6631 White patients [82%]). Mean (SD) baseline HbA1c levels were 7.56% (1.47%) in the referral program group and 7.44% (1.43%) in the control group. Following introduction of the social prescribing referral program, the referral group experienced an HbA1c reduction of −0.10 percentage points (95% CI, −0.17 to −0.03 percentage points) compared with the control group. The association increased over time: after 3 years the estimated association was −0.14 percentage points (95% CI, −0.24 to −0.03 percentage points). The association was stronger for White patients compared with non-White patients (−0.15 percentage points [95% CI, −0.26 to −0.04 percentage points] after 3 years), those with fewer additional comorbidities (−0.16 percentage points [95% CI, −0.29 to −0.04 percentage points] after 3 years), and those living in the most socioeconomically deprived areas (−0.19 percentage points [95% CI, −0.32 to −0.07 percentage points] after 3 years).

Conclusions and Relevance  In this study of UK adults with type 2 diabetes, a social prescribing program with referral to CHWs targeting patients’ social needs and health behaviors was associated with improved HbA1c levels, suggesting that holistic CHW interventions may help to reduce the public health burden of type 2 diabetes.