A Novel Ontological Approach to Track Social Determinants of Health in Primary Care

The associated morbidity and mortality from COVID-19 and the public health response to prevent the spread of the virus has repeatedly demonstrated the significant impact of social determinants of health (SDoH) and social inequities on health outcomes. Social prescriptions are interventions aimed at tackling SDoH. In 2019, NHS-England committed to support the use of social prescribing across England. NHS-England commissioned the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network to monitor the distribution of social prescribing services within English primary care and, within that, monitor the impact of the COVID-19 pandemic response on SDoH. To track incidence of people presenting to primary care with SDoH-related issues, we implemented an ontological approach to curate SDoH indicators in computerised medical records (CMR) using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). These indicators were then extracted from the RCGP-RSC sentinel network database to present weekly incidence rates per 10,000 people to assess the impact of the pandemic on these SDoH. Pre- versus peri-pandemic, we observed an increase in the recording of several of our SDoH indicators;namely issues related to homelessness, unemployment, mental health, harmful substance use and financial difficulties. As far as we are aware, this is the first time that routinely collected primary care CMR data has been utilised for the monitoring and surveillance of SDoH and demonstrates the feasibility of this approach for future surveillance. © 2022, Springer Nature Switzerland AG.

A Novel Ontological Approach to Estimate Inequalities and Underuse of Social Prescriptions for Mental Health in Primary Care in England

Mental health conditions are a significant contributor to morbidity and mortality and cost an estimated £1.6 trillion per year globally. The COVID-19 pandemic and its associated lockdowns have contributed to increases in common mental health problems (CMHP) like depression. Bodies in the UK recommend the use of non-medical interventions like social prescriptions to support individuals suffering from CMHP. In 2019, NHS-England committed to support the use of social prescribing across England. Despite this commitment, the proportion of eligible individuals with a CMHP that actually receive a social prescription remains unknown. To overcome this knowledge gap, a novel ontological approach was used to estimate the proportion of individuals with a CMHP that received a social prescription, disaggregated by different attributes (region, ethnicity, socio-economic status, sex, age) across a four-year period from 2017–2020. We discovered two general trends. First, there was a 1.4-fold increase in the presentation of individuals, across all attributes, to primary care with a CMHP across the four-year period analysed. There was also marked variation in the presentation to primary care with a CMHP based on different attributes (2020 variation figures - regions: 2.8-fold;ethnicity: 1.8-fold;socio-economic status: 1.4-fold;sex: 1.7-fold;age: 3.9-fold). Second, despite an increase in the use of social prescribing for mental health, there was still substantial underuse of it across all attributes in England (the highest percentage seen across all attributes in 2020 was 14%). The general trends revealed through our analyses provide valuable insights that can help to inform both policy and practice to address variation, health inequalities as well as to proactively design and implement appropriate services. © 2022, Springer Nature Switzerland AG.