Little evidence to back prescribing art, exercise and gardening

Author: Ingrid Torjesen
Little evidence to back prescribing art, exercise and gardening

Social prescribing, which enables GPs to offer non-medical services, such as exercise, art, gardening and reading, to patients is backed by limited evidence, an editorial* in Drug and Therapeutics Bulletin (DTB) says.

GPs are frequently able to refer patients to a link worker if they think may benefit from access to non-medical services to enable them to take greater control of their health. In England, the reconfiguration of the NHS has created primary care networks which will be funded to employ 1,000 social prescribing link workers, who will be expected to be making upwards of 900,000 referrals by 2023-24 to local services.

These might include exercise, education, books, art, healthy living and green gyms (outdoor exercise), but there are many other activities provided by voluntary organisations that could also be prescribed.

While helping people to access non-medical interventions to better manage their health “seems eminently sensible,” said the author, DTB deputy editor, David Phizackerley, “unfortunately, social prescribing and the individual interventions are still hampered by a lack of robust high-quality evidence of efficacy and effectiveness.”

There’s also a risk that social prescribing “will be expected to provide a low-cost solution to many complex societal problems,” he added.

“For some of the interventions, there are reported benefits in participants’ self-esteem and confidence, sense of control and empowerment, and psychological and mental wellbeing,” Phizackerley said. “However, overall, the evidence on the effectiveness of social prescribing and many of the prescribed interventions is very limited.”

He pointed out that a report by health think tank, The King’s Fund, had concluded that the published research on social prescribing tended to involve small numbers of participants, lack comparison groups, and provide little hard data on outcomes.

“It has also been noted that much of the evidence is based on evaluations of pilot projects and did not allow assessment of success or cost effectiveness,” he said.

Whether social prescribing will curb demand for other primary and community health services is unknown, he emphasised, and there are little or no data on the possible side effects.

He also questions the term itself. “The use of the words ‘prescribing,’ ‘prescription,’ and ‘referral’ reinforces the medical model, suggests that healthcare professionals and social prescribers are also gatekeepers to a menu of interventions, and perhaps perpetuates an expectation that every problem requires a prescription.”

*Phizackerley D. Social prescribing: right idea, wrong name? Drug and Therapeutics Bulletin 2019;57:130.