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Link workers providing social prescribing and health and social care coordination for people with multimorbidity in socially deprived areas (the LinkMM trial): protocol for a pragmatic randomised controlled trial
  1. Bridget Kiely1,
  2. Barbara Clyne1,
  3. Fiona Boland1,
  4. Patrick O'Donnell2,
  5. Deirdre Connolly3,
  6. Eamon O'Shea4,
  7. Susan M Smith1
  1. 1 Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
  2. 2 Primary Healthcare, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  3. 3 Discipline of Occupational Therapy, Trinity College, Dublin, Ireland
  4. 4 School of Business and Economics, National University of Ireland, Galway, Ireland
  1. Correspondence to Dr Bridget Kiely; bridgetkiely{at}


Introduction Link workers are non-health or social care professionals based in primary care who support people to develop and achieve a personalised set of health and social goals by engaging with community resources. Link workers have been piloted in areas of deprivation, but there remains insufficient evidence to support their effectiveness. Multimorbidity is increasing in prevalence, but there are limited evidence-based interventions. This paper presents the protocol for a randomised controlled trial (RCT) that will test the effectiveness of link workers based in general practices in deprived areas in improving health outcomes for people with multimorbidity.

Methods and analysis The protocol presents the proposed pragmatic RCT, involving 10 general practitioner (GP) practices and 600 patients. Eligible participants will be community dwelling adults with multimorbidity (≥two chronic conditions) identified as being suitable for referral to a practice-based link worker. Following baseline data collection, the patients will be randomised into intervention group that will meet the link worker over a1-month period, or a ‘wait list’ control that will receive usual GP care. Primary outcomes are health-related quality of life as assessed by EQ-5D-5L and mental health assessed by Hospital Anxiety and Depression Scale. Secondary outcomes are based on the core outcome set for multimorbidity. Data will be collected at baseline and on intervention completion at 1 month using questionnaires self-completed by participants and GP records. Parallel process and economic analyses will be conducted to explore participants’ experiences and examine cost-effectiveness of the link worker intervention.

Ethics and dissemination Ethical approval has been granted by the Irish College of General Practitioners Ethics Committee. The findings will be published in peer-reviewed journals.

Trial registration number ISRCTN10287737;


  • primary care
  • preventive medicine
  • social medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Twitter @bridgetmkiely, @susanmsmithm

  • Contributors BK is the lead researcher for the pilot project and randomised controlled trial, completed the initial draft, contributed to manuscript drafts, approved the final draft and will act as corresponding author. BC gave advice on methodology for the pilot and main randomised controlled trial, and contributed to manuscript drafts and approved the final draft. FB is the lead statistician for project, gave advice on randomisation methods and planned statistical analysis. She also contributed to manuscript drafts and approved the final draft. PO’D contributed to manuscript drafts and approved the final draft. DC contributed to manuscript drafts and approved the final draft. EO’S is the lead economist and advised on economic methods and analysis plans. SMS conceptualised the original research question and trial methodology. All authors reviewed and approved the final draft.

  • Funding This trial is jointly funded by the Health Research Board Ireland (Grant reference HRB CDA 2018 Reference CDA-2018-003) and the Department of Health Slaintecare Integration Fund (Grant reference PCC-ID24). The funders did not have any role in the design of this study.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details. Fully informed consent will be obtained from all participants. Confidentiality will be maintained by pseudonymisation of data using a unique study ID. Only named members of the research team will have access to individuals personal contact data and will only access it to communicate with participants regarding the trial. All data will be stored in secure password protected files with named access only.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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