Goddu Anna - Food Rx Study - SGIM FINAL
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Transcript of Goddu Anna - Food Rx Study - SGIM FINAL
Food Rx: Mobilizing Outpatient Clinics to Prescribe Healthy Food for Underserved Patients
Patients with diabetes in underserved communities face significant challenges to eating healthy, including:
• limited nutrition education • little accessible and affordable healthy foods
To address these barriers, it may be feasible for clinics to integrate community nutrition resources into diabetes care
Statement of Problem
1. Develop and pilot a program that integrates community nutrition resources into diabetes care
Use a provider’s prescription as a channel for:• providing nutrition education• raising awareness of local food resources• offering financial incentives for healthy food
Collaborate with: • six local clinics• a local farmers market (Figure 1)
• a national retail pharmacy expanded to sell healthy food (Figure 2)
2. Assess the feasibility of this collaborative program
3. Assess the impact of program on utilization of community resources for healthy food on the South Side of Chicago, a region with food deserts
Objectives of Program
Food Rx leverages a novel platform—the provider’s prescription—to link clinics with nutrition resources on the South Side of Chicago
Food Rx was collaboratively and iteratively developed by the clinics, community partners, and research team
Providers prescribe Food Rx to diabetes patients at six practices:
• 4 federally-qualified health centers• 1 academic primary care center• 1 academic endocrinology clinic
Food Rx includes:• Behavioral prescription (Figure 3)
• Nutrition education handout (Figure 4)
• Coupon for healthy food redeemable at local farmers market and 9 participating Walgreens stores (Figure 3)
• Map of local food partners
Description of Program
Anecdotal evidence suggests that Food Rx may be a powerful tool to promote healthy food as part of diabetes treatment:
• Providers report Food Rx is “empowering”• Patients report that the educational handout and
coupon are helpful
Dissemination of Rx may be impacted by provider factors:• Commitment to incorporating Food Rx into routine
diabetes management plan• Time to introduce Rx and counsel patients• Competing clinical priorities for chronic disease
management in this patient population• Familiarity with the community needs and resources
Participating locations are likely strong determinant of use• Familiarity with Walgreens or farmers market sites• Existing store preferences
Amount and structure of financial incentives affect redemption• Value of voucher or coupon • Minimum purchase requirement
Key Lessons
Food Rx shows promise as a model for integrating community resources into clinical care of underserved patients and can be implemented in diverse clinical settings
The collaborative process of designing Food Rx enabled program to meet the demands of each stakeholder to:
• Maintain clinic workflow• Ensure integrity of research methodology• Uphold partners’ organizational priorities
Promising plans for further development include:
1. Incorporating non-physician staff in Rx dissemination (e.g. nutritionists/medical assistants)
2. Offering store and market tours to increase familiarity with resources and bolster nutrition education
3. Providing multiple coupons redeemable over time to increase incentive to adopt new shopping habits
Findings to Date
Anna P. Goddu MSc1, Tonya S. Roberson DT BA1, Katie E. Raffel BS MS42, Marshall H. Chin MD MPH1, Monica E. Peek MD MPH1 1 Section of General Internal Medicine, Department of Medicine, University of Chicago. 2 Pritzker School of Medicine, University of Chicago.
Acknowledgments: The authors would like to thank Denise Scarpelli and Danny Burke for their help acquiring data. This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (Grant No. R18DK083946), the Chicago Center for Diabetes Translation Research (Grant No. P30 DK092949), the Diabetes Research and Training Center (Grant No. P60 DK20595), and the Alliance to Reduce Disparities in Diabetes of the Merck Foundation. Marshall Chin is supported by an NIDDK Midcareer Investigator Award in Patient-Oriented Research (Grant No. K24 DK071933).
Measures of Success
Regular check-ins with stakeholders with documentation of all anecdotal feedback
Identification of purchasing trends through collection of coupon redemption data
Qualitative exploration of barriers/facilitators to Rx utilization via in-depth interviews
Figure 2: Walgreens site expanded to sell healthy foods
Figure 1: Participating local farmers market
Figure 3: Behavioral prescription with coupon on back Figure 4: Nutrition education handout