Using Social Prescribing to Address Health Inequalities in a Haemodialysis Population: A Pilot Study

Background: Social determinants of health have a greater impact on health outcomes than genetics or access to healthcare services. Higher deprivation correlates with greater risk of CKD and worse outcomes. Social prescribing can mitigate the negative impact of wider determinants. Barts Health is a large renal service with 392 patients starting dialysis in 2023. Late presentation is high at 30% and poor health literacy common. We appointed a Healthy Living Advisor (HLA) to support incident haemodialysis patients and address wider determinants influencing poor health outcomes. Methods: All incident haemodialysis patients from 1 September 2023 to 31 August 2024 were screened, assessing self-reported difficulties in housing, finance, and support. A folder of resources and services was compiled. The HLA gave advice, signposted or made referrals. EQ5D score was calculated assessing quality of life at the time of first contact. Follow up calls were made at 3-6 months to repeat EQ5D and evaluate the HLA intervention. The Probability of Superiority (PoS, Buchholz et al, 2015) analysed paired EQ5D scores to assess changes in health status. A score greater than 0.5 suggests more patients improve than deteriorate. Results: 242/307 patients (79%) were assessed by the HLA.142 were referred for non-medical services, with 30% referred to >3 services, highlighting the multifaceted input required. Evaluation at 6 months revealed that 117/142 patients (82%) had input from the relevant service, and 91/142 (64%) felt the outcome was beneficial. 161/242 (67%) completed paired EQ5D questionnaires. There was improvement in scores pre and post intervention (Mean 1.489 ss 1.637, p < 0.0001). The PoS score was 0.57, indicating patients were more likely to experience improved health after the intervention (Figure 2). Conclusion: There is a high financial, housing, social and food insecurity within our population. Improving experience and outcomes includes a need to address these factors . Our HLA intervention demonstrated that it (1) was successful in connecting patients with resources to help address factors influencing their health and wellbeing, (2) resulted in improved health status. Addressing social determinants of health using a focussed intervention to connect incident haemodialysis patients with services improves quality of life, and health outcomes.