Co-production of a cardiovascular disease-focused social prescribing pathway in a public heart hospital

Social deprivation and cardiovascular disease occur in overlapping cohorts of patients. Ameliorating the burden of social deprivation may improve both adherence to treatment for cardiovascular disorders and outcomes, but this hypothesis has yet to be proven. The aim of this work is to develop a screening pathway to identify and then provide targeted intervention for patients with concurrent social deprivation and cardiovascular disease at a specialist care public hospital in London, United Kingdom. The primary outcome of this work is to create a social prescribing pathway. A 3- phase approach was taken. The first phase assessed the level of deprivation in a cohort of patients using a digital screening tool. The second phase assessed the feasibility of introducing a digital screening tool with limited support, while also assessing the validity of the tool itself. The third phase built on learning from phase I and II to co-produce a pathway to accurately screen patients and address common needs, and evaluate the effectiveness and impact of social intervention in this group. In phase I, we screened 360 patients on a digital pathway using a screening tool. The questionnaire was circulated to 360 patients of whom 168 (46%) responded. We found that 61/168 (36%) “always”, “often” or “sometimes” had difficulty making ends meet. We used this phase to evaluate the baseline level of deprivation in a population of cardiovascular patients in our area. In phase II, screening was deployed in the setting of a cardiology clinic where adoption of the digital tool was not supported with face-to-face onboarding, the level of digital exclusion became more relevant. Evaluation of the process revealed only 69/150 (46%) patients were able to register for the digital service, but fewer 38/150 (25%) responded to the screening questionnaire. Amongst that group, 16/38 (42%) flagged for a self-reported level of deprivation, the majority of which related to financial instability. No attempt was made to improve uptake of the digital tool in the first and second phases, as the goal of the early work was to determine its effectiveness as a non-supported tool. The final phase of this work, where a patient focus group was provided with this data and asked for feedback, provided a process evaluation of the methods used in the first few phases. We present learning from phased introduction of a screening questionnaire for deprivation in a specialist care hospital. Digital tools exclude some patients so future pathways must employ a multimodality approach to improve engagement. Patients with lived experience reinforced the value of identifying these issues and encouraged sensitivity to barriers to access. Management of expectations is important when providing a new service.