JMIR Publications

ABSTRACT

Background:

Social prescription is seen as a tool with the potential to mitigate social determinants of health. Social prescription is not yet well developed in France, where social needs are usually attended by social workers, in a historical context of a deep divide between the health sector and the social sector. On the other side, discharge coordination is gaining attention in France, as a critical tool to improve the quality of care, assessed indirectly using readmission rates.

Objective:

The objective of this study was to combine social prescription and discharge coordination in order to assess the needs for social prescription and its effect on unplanned re-hospitalization rates.

Methods:

We conducted a quasi-experimental study in 2 departments of Medicine of a French University-Hospital, in a disadvantaged suburb of Paris. A discharge coordinator screened patients for social prescribing needs and provided services on the spot, or referred the patient to the appropriate service when needed. Primary outcome was the description of the services delivered by the discharge coordinator and of its process and the characteristics of the patients in terms of social needs. The secondary outcome was the comparison of unplanned re-hospitalization rates.

Results:

223 patients were included in the intervention arm. 44% of the patients seen by the discharge coordinator needed social prescribing, revealing the breadth of patient’s barriers to health care, encompassing language, housing, health literacy and financial issues. No difference was found in readmission rates between patients who benefited from the intervention versus patients who did not (3.1% versus 2.6%; p=1). Ethnic data collection was not legally permitted, but for 81% of the patients, French was not the mother tongue.

Conclusions:

Given the low uptake of social prescribing in France in general, hospital discharge could be used as an opportunity in disadvantaged settings. Other indicators should be devised to evaluate the effect of social prescribing at discharge coordination.