LAUSR

Social prescribing (SP) is an act of connection. Although Savage et al note that the evidence continues to emerge for the role of supported and co-designed clinical referral (the novel element of SP), there is a strong body of evidence for the prevalence of loneliness and social isolation among older adults and its associated negative health impacts. There is also a strong body of evidence for health benefits of the types of activities typically prescribed under SP (eg, physical activity, group-based educational loneliness intervention, and arts-based activities). Given the existing evidence and demonstrated need, it is imperative we undertake action research, quality improvement, and innovation to meet the immediate needs of people and communities living with social and medical complexities. This action research around what works, for whom, and under what circumstances will help people, communities, and providers grow and refine SP programs and offerings over time. We thank Savage et al for pointing out the importance of assessing whether improvements in a patient’s health and well-being are clinically significant. SP values patientreported outcome and experience measures as important clinical indicators, and the preliminary evidence is promising. Participants in our pilot report reduced social isolation, increased sense of community belonging, a renewed sense of confidence and purpose, and an improved sense of control in management of their own health. Electronic medical record (EMR) tracking and planned linkages with population health data sets will help us determine other measures of clinical significance over time. Savage et al also take an important interest in understanding the procedural elements of SP, such as tracking referral patterns, understanding the reasons for referral, identifying the types of resources and supports being referred to, and measuring changes in healthcare usage and costs. By design, the Rx: Community pilot helps identify and track these through a common EMR and business information reporting tool, supporting the development of a high-fidelity SP model that can be adapted in diverse contexts. Additional interviews with key players involved in the SP pathway (providers, link workers, staff implementing programs, and community partners) help to identify the facilitators and barriers to successful implementation. SP in Canada is being led initially by community health centers, experts in health equity and community development. These interdisciplinary health and social care centers operate under a model of health and well-being that ensures the capacity to meet the needs of clients. This model allows for the repurposing of existing resources and provides a bulwark against unintended consequences, such as building the unsupported referrals that Savage et al term “roads to nowhere.” Implementation and research advisory committees; deep and long-standing community governance, engagement, and partnerships in community health centers; and communities of practice among implementing staff across centers help identify andmitigate challenges throughout the process. For those hoping to implement SP outside of this supportive context, the cautions of Savage et al are critical: SP depends on a holistic understanding of health and wellbeing; a person-centered, individualized, and co-designed approach; a supportive clinical and resource architecture; and well-resourced social and community services.