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Houghtaling B, Short E, Shanks CB, Stotz SA, Yaroch A, Seligman H, Marriott JP, Eastman J, Long CR. Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review. J Gen Intern Med 2024:10.1007/s11606-024-08768-w. [PMID: 38662283 DOI: 10.1007/s11606-024-08768-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.
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Affiliation(s)
- Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA.
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA.
| | - Eliza Short
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | | | - Sarah A Stotz
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Amy Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Hilary Seligman
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Division of General Internal Medicine and Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | | | - Jenna Eastman
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
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Frank HE, Guzman LE, Ayalasomayajula S, Albanese A, Dunklee B, Harvey M, Bouchard K, Vadiveloo M, Yaroch AL, Scott K, Tovar A. Developing and testing a produce prescription implementation blueprint to improve food security in a clinical setting: a pilot study protocol. Pilot Feasibility Stud 2024; 10:51. [PMID: 38521931 PMCID: PMC10960480 DOI: 10.1186/s40814-024-01467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/16/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Food insecurity is common in the United States, especially in Rhode Island, where it affects up to 33% of residents. Food insecurity is associated with adverse health outcomes and disproportionally affects people from minoritized backgrounds. Produce prescription programs, in which healthcare providers write "prescriptions" for free or reduced cost vegetables, have been used to address food insecurity and diet-related chronic disease. Although there is growing evidence for the effectiveness of produce prescription programs in improving food security and diet quality, there have been few efforts to use implementation science methods to improve the adoption of these programs. METHODS This two-phase pilot study will examine determinants and preliminary implementation and effectiveness outcomes for an existing produce prescription program. The existing program is funded by an Accountable Care Organization in Rhode Island and delivered in primary care practices. For the first phase, we conducted a formative evaluation, guided by the Consolidated Framework for Implementation Research 2.0, to assess barriers, facilitators, and existing implementation strategies for the produce prescription program. Responses from the formative evaluation were analyzed using a rapid qualitative analytic approach to yield a summary of existing barriers and facilitators. In the second phase, we presented our formative evaluation findings to a community advisory board consisting of primary care staff, Accountable Care Organization staff, and staff who source and deliver the vegetables. The community advisory board used this information to identify and refine a set of implementation strategies to support the adoption of the program via an implementation blueprint. Guided by the implementation blueprint, we will conduct a single-arm pilot study to assess implementation antecedents (i.e., feasibility, acceptability, appropriateness, implementation climate, implementation readiness), implementation outcomes (i.e., adoption), and preliminary program effectiveness (i.e., food and nutrition security). The first phase is complete, and the second phase is ongoing. DISCUSSION This study will advance the existing literature on produce prescription programs by formally assessing implementation determinants and developing a tailored set of implementation strategies to address identified barriers. Results from this study will inform a future fully powered hybrid type 3 study that will use the tailored implementation strategies and assess implementation and effectiveness outcomes for a produce prescription program. TRIAL REGISTRATION Clinical trials: NCT05941403 , Registered June 9, 2023.
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Affiliation(s)
- Hannah E Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Linda E Guzman
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Shivani Ayalasomayajula
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ariana Albanese
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brady Dunklee
- Integra Community Care Network, Providence, RI, USA
- Care New England Health System, Providence, RI, USA
| | - Matthew Harvey
- Integra Community Care Network, Providence, RI, USA
- Care New England Health System, Providence, RI, USA
| | - Kelly Bouchard
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Maya Vadiveloo
- Department of Nutrition and Food Science, University of Rhode Island, Kingston, RI, USA
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Kelli Scott
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Parikh MA, Selvarajah S, Castora-Binkley M, Angove RSM. Engaging patients and stakeholders to identify a research agenda to support social determinants of health (SDOH) screening and intervention initiatives in community pharmacy. J Am Pharm Assoc (2003) 2024; 64:592-595.e1. [PMID: 38182002 DOI: 10.1016/j.japh.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
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Grega ML, Shalz JT, Rosenfeld RM, Bidwell JH, Bonnet JP, Bowman D, Brown ML, Dwivedi ME, Ezinwa NM, Kelly JH, Mechley AR, Miller LA, Misquitta RK, Parkinson MD, Patel D, Patel PM, Studer KR, Karlsen MC. American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care. Am J Lifestyle Med 2024; 18:269-293. [PMID: 38559790 PMCID: PMC10979727 DOI: 10.1177/15598276231202970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Identify areas of consensus on integrating lifestyle medicine (LM) into primary care to achieve optimal outcomes. METHODS Experts in both LM and primary care followed an a priori protocol for developing consensus statements. Using an iterative, online process, panel members expressed levels of agreement with statements, resulting in classification as consensus, near consensus, or no consensus. RESULTS The panel identified 124 candidate statements addressing: (1) Integration into Primary Care, (2) Delivery Models, (3) Provider Education, (4) Evidence-base for LM, (5) Vital Signs, (6) Treatment, (7) Resource Referral and Reimbursement, (8) Patient, Family, and Community Involvement; Shared Decision-Making, (9) Social Determinants of Health and Health Equity, and (10) Barriers to LM. After three iterations of an online Delphi survey, statement revisions, and removal of duplicative statements, 65 statements met criteria for consensus, 24 for near consensus, and 35 for no consensus. Consensus was reached on key topics that included LM being recognized as an essential component of primary care in patients of all ages, including LM as a foundational element of health professional education. CONCLUSION The practice of LM in primary care can be strengthened by applying these statements to improve quality of care, inform policy, and identify areas for future research.
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Affiliation(s)
- Meagan L. Grega
- St. Luke's University Health Network, Easton, PA, USA; Kellyn Foundation, Tatamy, PA, USA (MLG)
| | - Jennifer T. Shalz
- Lifestyle Medicine Department, St. Luke’s Health System, Boise ID, USA (JTS)
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Science University, Brooklyn, NY, USA (RMR)
| | - Josie H. Bidwell
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MI, USA (JHB)
| | - Jonathan P. Bonnet
- Palo Alto VA Health Care, Palo Alto, CA, USA; Department of Medicine and Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA (JPB)
| | - David Bowman
- Department of Pediatrics, Howard University College of Medicine, Washington, DC, USA; Lifestyle Med Revolution, LLC, Upper Marlboro, MD, USA (DB)
| | - Melanie L. Brown
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA (MLB)
| | - Mollie E. Dwivedi
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University Living Well Center, St. Louis, MO, USA (MED)
| | | | - John H. Kelly
- Loma Linda University, Loma Linda, CA, USA; Lifestyle Health Education Inc., Rocky Mount, VA, USA (JHK)
| | - Amy R. Mechley
- University of Cincinnati College of Medicine, Cincinnati, OH, USA (ARM)
| | - Lawrence A. Miller
- Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA (LAM)
| | - Rajiv K. Misquitta
- Department of Lifestyle Medicine, The Permanente Medical Group, Sacramento, CA, USA (RKM)
| | | | - Dipak Patel
- Community Health Center, Inc., Meriden, CT, USA; Connecticut Lifestyle Medicine, CT, USA (DP)Community Health Center, Inc., Middletown, CT, USA (DP)
| | - Padmaja M. Patel
- Lifestyle Medicine Center, Midland Health, Midland, TX, USA (PMP)
| | - Karen R. Studer
- Preventive Medicine, Loma Linda University Health, Loma Linda, CA, USA (KRS)
| | - Micaela C. Karlsen
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO, USA; Departments of Applied Nutrition and Global Public Health, University of New England, Biddeford, ME, USA (MCK)
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Tariq S, Olstad DL, Beall RF, Spackman E, Lipscombe L, Dunn S, Lashewicz BM, Elliott MJ, Campbell DJ. Exploring the prospective acceptability of a healthy food incentive program from the perspective of people with type 2 diabetes and experiences of household food insecurity in Alberta, Canada. Public Health Nutr 2024; 27:e66. [PMID: 38305101 DOI: 10.1017/s1368980024000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE FoodRx is a 12-month healthy food prescription incentive program for people with type 2 diabetes (T2DM) and experiences of household food insecurity. In this study, we aimed to explore potential users' prospective acceptability (acceptability prior to program use) of the design and delivery of the FoodRx incentive and identify factors influencing prospective acceptability. DESIGN We used a qualitative descriptive approach and purposive sampling to recruit individuals who were interested or uninterested in using the FoodRx incentive. Semi-structured interviews were guided by the theoretical framework of acceptability, and corresponding interview transcripts were analysed using differential qualitative analysis guided by the socioecological model. SETTING Individuals living in Alberta, Canada. PARTICIPANTS In total, fifteen adults with T2DM and experiences of household food insecurity. RESULTS People who were interested in using the FoodRx incentive (n 10) perceived it to be more acceptable than those who were uninterested (n 5). We identified four themes that captured factors that influenced users' prospective acceptability: (i) participants' confidence, views and beliefs of FoodRx design and delivery and its future use (intrapersonal), (ii) the shopping routines and roles of individuals in participants' social networks (interpersonal), (iii) access to and experience with food retail outlets (community), and (iv) income and food access support to cope with the cost of living (policy). CONCLUSION Future healthy food prescription programs should consider how factors at all levels of the socioecological model influence program acceptability and use these data to inform program design and delivery.
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Affiliation(s)
- Saania Tariq
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Reed F Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Lorraine Lipscombe
- Department of Medicine, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Bonnie M Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Meghan J Elliott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - David Jt Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S11-S19. [PMID: 38078573 PMCID: PMC10725798 DOI: 10.2337/dc24-s001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at https://professional.diabetes.org/SOC.
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Drewry MB, Yanguela J, Khanna A, O'Brien S, Phillips E, Bevel MS, McKinley MW, Corbie G, Dave G. A Systematic Review of Electronic Community Resource Referral Systems. Am J Prev Med 2023; 65:1142-1152. [PMID: 37286015 PMCID: PMC10696135 DOI: 10.1016/j.amepre.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Community Resource Referral Systems delivered electronically through healthcare information technology systems (e.g., electronic medical records) have become more common in efforts to address patients' unmet health-related social needs. Community Resource Referral System connects patients with social supports such as food assistance, utility support, transportation, and housing. This systematic review identifies barriers and facilitators that influence the Community Resource Referral System's implementation in the U.S. by identifying and synthesizing peer-reviewed literature over a 15-year period. METHODS This systematic review was conducted following PRISMA guidelines. A search was conducted on five scientific databases to capture the literature published between January 2005 and December 2020. Data analysis was conducted from August 2021 to July 2022. RESULTS This review includes 41 articles of the 2,473 initial search results. Included literature revealed that Community Resource Referral Systems functioned to address a variety of health-related social needs and were delivered in different ways. Integrating the Community Resource Referral Systems into clinic workflows, maintenance of community-based organization inventories, and strong partnerships between clinics and community-based organizations facilitated implementation. The sensitivity of health-related social needs, technical challenges, and associated costs presented as barriers. Overall, electronic medical records-integration and automation of the referral process was reported as advantageous for the stakeholders. DISCUSSION This review provides information and guidance for healthcare administrators, clinicians, and researchers designing or implementing electronic Community Resource Referral Systems in the U.S. Future studies would benefit from stronger implementation science methodological approaches. Sustainable funding mechanisms for community-based organizations, clear stipulations regarding how healthcare funds can be spent on health-related social needs, and innovative governance structures that facilitate collaboration between clinics and community-based organizations are needed to promote the growth and sustainability of Community Resource Referral Systems in the U.S.
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Affiliation(s)
- Maura B Drewry
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina.
| | - Juan Yanguela
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Anisha Khanna
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Sara O'Brien
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Ethan Phillips
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Malcolm S Bevel
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina; Augusta University, Department of Medicine, Augusta, Georgia
| | - Mary W McKinley
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Giselle Corbie
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Gaurav Dave
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
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van den Berk-Clark C, Schrodt C, Phan C, Garfield T, Samuel S. Provider perspectives on nutrition interventions in primary care: the role of organizational structure and community partnerships. Fam Pract 2023; 40:582-588. [PMID: 37573531 DOI: 10.1093/fampra/cmad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Poor nutrition remains a significant public health concern that is often managed within primary care settings. Meanwhile, to our knowledge, there have been few studies that evaluate the intent of primary care providers to offer nutrition services, nor what type of exchanges they engage in to ensure those programs can be implemented. METHODS Semi-structured interviews were conducted with 16 primary care providers and support staff. Grounded theory analysis was utilized to identify themes and to develop a theoretical model of primary care nutrition program implementation. RESULTS Three themes were identified. Patients approached primary care organizations with complex health beliefs, health severity, and barriers to care (theme 1). Providers and support staff responded by providing services that fit into existing organizational constraints, especially constraints related to workflow/time with patient, space and billing (theme 2). Providers see community as a major cue to action among patients but are unsure of the role of primary care (theme 3). CONCLUSIONS Provider respondents found that implementing nutrition programs in primary care settings is difficult and that effective interventions for nutrition within health settings are limited without community-based partnerships and programming. Additional research is needed to measure existing community ties and how such ties could improve patient nutrition.
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Affiliation(s)
| | | | - Christopher Phan
- Department of Family and Community Medicine, Saint Louis University, St. Louis, MO, USA
| | - Terry Garfield
- Department of Family and Community Medicine, Saint Louis University, St. Louis, MO, USA
| | - Sandra Samuel
- Department of Family and Community Medicine, Saint Louis University, St. Louis, MO, USA
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Konuthula D, Tan MM, Burnet DL. Challenges and Opportunities in Diagnosis and Management of Cardiometabolic Risk in Adolescents. Curr Diab Rep 2023; 23:185-193. [PMID: 37273161 PMCID: PMC10240116 DOI: 10.1007/s11892-023-01513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population. RECENT FINDINGS There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.
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Affiliation(s)
| | - Marcia M Tan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Deborah L Burnet
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
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Lee WC, Lin S, Yang TC, Serag H. Cross-sectional study of food insecurity and medical expenditures by race and ethnicity. ETHNICITY & HEALTH 2023; 28:794-808. [PMID: 36576145 DOI: 10.1080/13557858.2022.2161090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/14/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Food insecurity is a risk factor for morbidity and mortality leading to high medical expenditures, but race/ethnicity was used as adjustments in the literature. The study sought to use race/ethnicity as a key predictor to compare racial differences in associations between food insecurity and expenditures of seven health services among non-institutionalized adults. DESIGN This cross-sectional study used Medical Expenditure Panel Survey that collects information on food insecurity in 2016 (n=24,179) and 2017 (n=22,539). We examined the association between race/ethnicity and food insecurity status and documented the extent to which impacts of food insecurity on medical expenditures varied by race/ethnicity. We fit multivariable models for each racial group, adjusting for states, age, gender, insurance, and education. Adults older than 18 years were included. RESULTS The results show that blacks experienced an inter-racial disparity in food insecurity whereas Hispanics experienced intra-racial disparity. A higher percentage of blacks (28.7%) reported at least one type of food insecurity (11.2% of whites). Around 20% of blacks reported being worried about running out of food and the corresponding number is 8.4% among whites. Hispanics reported more food insecurity issues than whites. Moreover, food insecurity is positively associated with expenditures on emergency room utilization (99% increase for other races vs. 51% increase for whites) but is negatively associated with dental care utilization (43% decrease for blacks and 44% for whites). Except for Hispanics, prescription expenditure has the most positive association with food insecurity, and food insecure blacks are the only group that did not significantly use home health. CONCLUSION The study expanded our understanding of food insecurity by investigating how it affected seven types of medical expenditures for each of four racial populations. An interdisciplinary effort is needed to enhance the food supply for minorities. Policy interventions to address intra-racial disparities among Hispanics and inter-racial disparities among African Americans are imperative to close the gap.
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Affiliation(s)
- Wei-Chen Lee
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sherry Lin
- Department of Health Policy and Management, Texas A&M University, College Station, TX, USA
| | - Tse-Chuan Yang
- Department of Sociology, State University of New York at Albany, Albany, NY, USA
| | - Hani Serag
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Brennan MB, Tan TW, Schechter MC, Fayfman M. Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations. Semin Vasc Surg 2023; 36:19-32. [PMID: 36958894 PMCID: PMC10039286 DOI: 10.1053/j.semvascsurg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Recently, the United States experienced its first resurgence of major amputations in more than 20 years. Compounding this rise is a longstanding history of disparities. Patients identifying as non-Hispanic Black are twice as likely to lose a limb as those identifying as non-Hispanic White. Those identifying as Latino face a 30% increase. Rural patients are also more likely to undergo major amputations, and the rural-urban disparity is widening. We used the National Institute on Minority Health and Health Disparities framework to better understand these disparities and identify common factors contributing to them. Common factors were abundant and included increased prevalence of diabetes, possible lower rates of foot self-care, transportation barriers to medical appointments, living in disadvantaged neighborhoods, and lack of insurance. Solutions within and outside the health care realm are needed. Health care-specific interventions that embed preventative and ambulatory care services within communities may be particularly high yield.
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Affiliation(s)
- Meghan B Brennan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53583.
| | - Tze-Woei Tan
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Marcos C Schechter
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
| | - Maya Fayfman
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA. 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S10-S18. [PMID: 36507639 PMCID: PMC9810463 DOI: 10.2337/dc23-s001] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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13
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Stotz SA, Budd Nugent N, Ridberg R, Byker Shanks C, Her K, Yaroch AL, Seligman H. Produce prescription projects: Challenges, solutions, and emerging best practices – Perspectives from health care providers. Prev Med Rep 2022; 29:101951. [PMID: 36161127 PMCID: PMC9502043 DOI: 10.1016/j.pmedr.2022.101951] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sarah A. Stotz
- University of Colorado, Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
- Corresponding author at: University of Colorado, Anschutz Medical Campus, Colorado School of Public Health, Mail Stop F800, 13055 East 17th Avenue, Aurora, CO 80045.
| | | | | | | | - Ka Her
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Amy L. Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Hilary Seligman
- Division of General Internal Medicine, University of California, San Francisco, CA and Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA
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14
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Cafer A, Rosenthal M, Smith P, McGrew D, Bhattacharya K, Rong Y, Salkar M, Yang J, Nguyen J, Arnold A. Examining the context, logistics, and outcomes of food prescription programs: A scoping review. Res Social Adm Pharm 2022; 19:57-68. [PMID: 36175272 DOI: 10.1016/j.sapharm.2022.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Obesity and associated metabolic conditions are endemic. Finding new strategies to mitigate the impact on wellbeing and healthcare systems is critical. Food prescription programs (FPPs) have been promoted as one route to address this problem in a way that simultaneously addresses the socio-cultural context of obesity. Yet, little is known about the standard practices and logistics of using food prescription programs as an effective intervention. OBJECTIVES To 1) identify the context in which food prescription programs are used; 2) identify implementation logistics of food prescription program; and 3) understand the scope of food prescription program outcomes. METHODS A scoping review was conducted from October 2019 to May 2020 using Google Scholar, EBSCOhost, and AcademicOne Search to identify research articles focused on the implementation of prescription food programs in the US. Updates to articles were made in May of 2021 and May of 2022 to ensure the most up-to-date sample for analysis. There was no publication date restriction for article inclusion. RESULTS A total of 213 articles were identified for abstract review via the search strategy, and 30 articles were included for analysis following article exclusion. Overall, there was little consistency among included articles regarding the target population, participant recruitment, delivery, and evaluation of the food prescription programs implemented. Most food prescription programs studied were associated with farmers markets, lasted less than 6 months, and utilized produce consumption and biometric data as primary outcomes measures. CONCLUSION Significant gaps in the literature concerning the long-term effectiveness, impact on health behaviors, screening of eligible participants, and logistics for implementation were identified. Future research should focus on addressing these shortcomings in the current literature to improve the implementation, sustainability, and scaling of food prescription programs.
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Affiliation(s)
- Anne Cafer
- Department of Sociology and Anthropology, University of Mississippi, United States.
| | - Meagen Rosenthal
- Department of Pharmacy Administration, University of Mississippi, United States.
| | - Parker Smith
- Department of Sociology and Anthropology, University of Mississippi, United States.
| | - Danielle McGrew
- Department of Pharmacy Practice, University of Mississippi, United States.
| | - Kaustuv Bhattacharya
- Department of Pharmacy Administration, University of Mississippi, United States.
| | - Yiran Rong
- Department of Pharmacy Administration, University of Mississippi, United States.
| | - Monika Salkar
- Department of Pharmacy Administration, University of Mississippi, United States.
| | - Johnny Yang
- Department of Biology and Department of Chemistry, University of Mississippi, United States.
| | - Jasmine Nguyen
- Department of Sociology and Anthropology, University of Mississippi, United States.
| | - Austin Arnold
- University of Mississippi School of Pharmacy, Dept of Pharmacy Administration, United States.
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15
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Haslam A, Gill J, Taniguchi T, Love C, Jernigan VB. The effect of food prescription programs on chronic disease management in primarily low-income populations: A systematic review and meta-analysis. Nutr Health 2022; 28:389-400. [PMID: 35108144 PMCID: PMC10150796 DOI: 10.1177/02601060211070718] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Having low-income limits one's ability to purchase foods that are high in nutritional value (e.g. vegetables and fruits (V/F)). Higher V/F intake is associated with less diet-related chronic disease. Food pharmacy programs are potential solutions to providing V/F to low-income populations with or at-risk for chronic disease. Aim: This systematic review aimed to determine the effect of food pharmacy programs, including interventions targeting populations at-risk for chronic disease. Methods: We searched Pubmed and Google Scholar databases for studies reporting on food pharmacy interventions and outcomes (hemoglobin A1c, body mass index (BMI), V/F intake, and blood pressure). We calculated pooled mean differences using a random-effects model. Seventeen studies met our inclusion criteria; 13 studies used a pre/post study design, three used a randomized controlled trial, and one was a post-survey only. Results: We found that the pooled mean daily servings of V/F (0.77; 95% CI: 0.30 to 1.24) was higher and BMI (-0.40; 95% CI: -0.50 to -0.31) was lower with food pharmacy interventions We did not find any differences in the pooled mean differences for hemoglobin A1c or systolic blood pressure. Conclusion: Findings posit that food pharmacy programs delivered to primarily low-income individuals with comorbidities may be a promising solution to improving V/F intake and possibly overall diet in these populations.
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Affiliation(s)
- Alyson Haslam
- 8785University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Gill
- 360139Providence Health and Services, Beaverton, OR, USA
| | - Tori Taniguchi
- 33264Oklahoma State University, Center for Health Science, Tulsa, OK, USA
| | - Charlotte Love
- 33264Oklahoma State University, Center for Health Science, Tulsa, OK, USA
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16
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Zimmer R, Strahley A, Weiss J, McNeill S, McBride AS, Best S, Harrison D, Montez K. Exploring Perceptions of a Fresh Food Prescription Program during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10725. [PMID: 36078442 PMCID: PMC9518155 DOI: 10.3390/ijerph191710725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/12/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
This qualitative study aimed to elicit the perspectives of individuals with food insecurity (FI) who were enrolled in a Fresh Food Prescription (FFRx) delivery program through a collaboration between an academic medical center and multiple community partners in the southeastern United States. Semi-structured interviews and open-ended survey responses explored the experiences of participants enrolled in a FFRx delivery program during the COVID-19 pandemic. The interviews probed the shopping habits, food security, experience, and impact of the program on nutrition, health, and well-being; the surveys explored the perceptions of and satisfaction with the program. A coding scheme was developed inductively, and a thematic analysis was conducted on raw narrative data using Atlas.ti 8.4 to sort and manage the data. The themes included that the program promoted healthy dietary habits, improved access to high-quality foods, improved well-being, enhanced financial well-being, and alleviated logistical barriers to accessing food and cooking. Participants provided suggestions for FFRx improvement. Future studies may facilitate improved clinical-community partnerships to address FI.
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Affiliation(s)
- Rachel Zimmer
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA
| | - Ashley Strahley
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA
| | - Jane Weiss
- BestHealth, Atrium Health Wake Forest Baptist, Winston Salem, NC 27157, USA
| | - Sheena McNeill
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA
| | - Allison S. McBride
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA
| | - Scott Best
- H.O.P.E. of Winston Salem, Winston Salem, NC 27106, USA
| | | | - Kimberly Montez
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA
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17
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Zimmer RP, Moore JB, Yang M, Evans J, Best S, McNeill S, Harrison D, Martin H, Montez K. Strategies and Lessons Learned from a Home Delivery Food Prescription Program for Older Adults. J Nutr Gerontol Geriatr 2022; 41:217-234. [PMID: 35694773 DOI: 10.1080/21551197.2022.2084204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Food insecurity (FI) is a growing health problem, worsening during the COVID-19 pandemic. Fresh food prescription programs (FFRx) have been shown to increase healthy eating and decrease FI, but few FFRx are community-informed, or theory based. Our FFRx was a delivery program developed to alleviate FI for older adults. It was implemented in an academic medical center and guided by the Capabilities, Opportunities, Motivations, and Behaviors and Theoretical Domains Framework. We tested impacts of the program on FI, Fruit and Vegetable (FV) intake, depression, and loneliness at six-month intervals. During the FFRx, 31 people completed surveys every six months. FI decreased by an average of 2.03 points (p = <.001) while FV intake increased from a mean of 2.8 servings per day to 2.9 servings per day (p = .53). Depression and loneliness scores stayed stable. Preliminary data from this FFRx program, a partnership between an academic medical center and community partners, had positive impacts on FI.
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Affiliation(s)
- Rachel P Zimmer
- Atrium Health Wake Forest Baptist, Winston Salem, North Carolina, USA.,Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Justin B Moore
- Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Mia Yang
- Atrium Health Wake Forest Baptist, Winston Salem, North Carolina, USA.,Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Joni Evans
- Atrium Health Wake Forest Baptist, Winston Salem, North Carolina, USA
| | - Scott Best
- HOPE of Winston Salem, Winston Salem, North Carolina, USA
| | - Sheena McNeill
- HOPE of Winston Salem, Winston Salem, North Carolina, USA
| | | | - Heather Martin
- Second Harvest Food Bank, Winston Salem, North Carolina, USA
| | - Kimberly Montez
- Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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18
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Olstad DL, Beall R, Spackman E, Dunn S, Lipscombe LL, Williams K, Oster R, Scott S, Zimmermann GL, McBrien KA, Steer KJD, Chan CB, Tyminski S, Berkowitz S, Edwards AL, Saunders-Smith T, Tariq S, Popeski N, White L, Williamson T, L'Abbé M, Raine KD, Nejatinamini S, Naser A, Basualdo-Hammond C, Norris C, O'Connell P, Seidel J, Lewanczuk R, Cabaj J, Campbell DJT. Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies. BMJ Open 2022; 12:e050006. [PMID: 35168964 PMCID: PMC8852661 DOI: 10.1136/bmjopen-2021-050006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The high cost of many healthy foods poses a challenge to maintaining optimal blood glucose levels for adults with type 2 diabetes mellitus who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Healthy food prescription programmes may reduce food insecurity and support patients to improve their diet quality, prevent diabetes complications and avoid acute care use. We will use a type 2 hybrid-effectiveness design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a healthy food prescription incentive programme for adults experiencing food insecurity and persistent hyperglycaemia. A randomised controlled trial (RCT) will investigate programme effectiveness via impact on glycosylated haemoglobin (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term programme effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains to understand determinants of effective implementation and reasons behind programme successes and failures. METHODS AND ANALYSIS 594 adults who are experiencing food insecurity and persistent hyperglycaemia will be randomised to a healthy food prescription incentive (n=297) or a healthy food prescription comparison group (n=297). Both groups will receive a healthy food prescription. The incentive group will additionally receive a weekly incentive (CDN$10.50/household member) to purchase healthy foods in supermarkets for 6 months. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analysed using mixed-effects regression. Longer-term outcomes will be modelled using the UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary and the University of Alberta. Findings will be disseminated through reports, lay summaries, policy briefs, academic publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04725630. PROTOCOL VERSION Version 1.1; February 2022.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Reed Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine L Lipscombe
- 2Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Oster
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sara Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada
| | - Kieran J D Steer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Sheila Tyminski
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Seth Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Gatineau, Quebec, Canada
| | - Alun L Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
| | - Terry Saunders-Smith
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Saania Tariq
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Laura White
- Alberta Region, First Nations and Inuit Health Branch, Indigenous Services Canada, Edmonton, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aruba Naser
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinic Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Petra O'Connell
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Judy Seidel
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Primary Health Care Integration Network, Primary Health Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Calgary, Alberta, Canada
| | - Jason Cabaj
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University Drive NW, Calgary, Alberta, Canada
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19
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An R, Li D, Cole M, Park K, Lyon AR, White NH. Implementation of School Diabetes Care in the United States: A Scoping Review. J Sch Nurs 2022; 38:61-73. [PMID: 34184953 PMCID: PMC9924139 DOI: 10.1177/10598405211026328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diabetes management at school demands close collaboration of multiple stakeholders, including students with diabetes and parents, school nurses, teachers/staff, and local health care providers. This scoping review identified and synthesized evidence concerning factors that contributed to the quality and effectiveness of diabetes care implementation in U.S. K-12 schools. Forty-six studies met the eligibility criteria and were included. Five common factors emerged surrounding training and experiences, communications, parent engagement, resource allocations, and school environment. Complex interactions between multiple stakeholders jointly determined the quality of school diabetes care. A conceptual model was established to elucidate the complex interactions between multiple stakeholders and the relevant facilitators and barriers. Future research should improve sample representativeness, contrast school diabetes care practices to the national guidelines, and assess the impact of the social, economic, and political environment at federal, state, local/district levels on school diabetes care implementation.
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Affiliation(s)
- Ruopeng An
- Brown School, 7548Washington University, St. Louis, MO, USA
| | - Danyi Li
- Brown School, 7548Washington University, St. Louis, MO, USA
| | - Marjorie Cole
- Missouri Department of Health & Senior Services, Jefferson City, MO, USA
| | | | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, 7284University of Washington, Seattle, WA, USA
| | - Neil H White
- School of Medicine, Washington University, St. Louis, MO, USA
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20
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Harris JP, Bett C, McCleary-Jones V. Farmers’ Market Voucher Initiative to Improve Diabetes Control in Older Adults. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Canavan CR, D'cruze T, Kennedy MA, Hatchell KE, Boardman M, Suresh A, Goodman D, Dev A. Missed opportunities to improve food security for pregnant people: a qualitative study of prenatal care settings in Northern New England during the COVID-19 pandemic. BMC Nutr 2022; 8:8. [PMID: 35067225 PMCID: PMC8784232 DOI: 10.1186/s40795-022-00499-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/29/2021] [Indexed: 01/20/2023] Open
Abstract
Background Food insecurity during pregnancy has important implications for maternal and newborn health. There is increasing commitment to screening for social needs within health care settings. However, little is known about current screening processes or the capacity for prenatal care clinics to address food insecurity among their patients. We aimed to assess barriers and facilitators prenatal care clinics face in addressing food insecurity among pregnant people and to identify opportunities to improve food security among this population. Methods We conducted a qualitative study among prenatal care clinics in New Hampshire and Vermont. Staff and clinicians engaged in food security screening and intervention processes at clinics affiliated with the Northern New England Perinatal Quality Improvement Network (NNEPQIN) were recruited to participate in key informant interviews. Thematic analysis was used to identify prominent themes in the interview data. Results Nine staff members or clinicians were enrolled and participated in key informant interviews. Key barriers to food security screening and interventions included lack of protocols and dedicated staff at the clinic as well as community factors such as availability of food distribution services and transportation. Facilitators of screening and intervention included a supportive culture at the clinic, trusting relationships between patients and clinicians, and availability of clinic-based and community resources. Conclusion Prenatal care settings present an important opportunity to identify and address food insecurity among pregnant people, yet most practices lack specific protocols for screening. Our findings indicate that more systematic processes for screening and referrals, dedicated staff, and onsite food programs that address transportation and other access barriers could improve the capacity of prenatal care clinics to improve food security during pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00499-7.
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Affiliation(s)
- Chelsey R Canavan
- Department of Population Health, Dartmouth-Hitchcock Medical Center, Medical Center Drive, Lebanon, NH, 03766, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Tiffany D'cruze
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Meaghan A Kennedy
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kayla E Hatchell
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Maureen Boardman
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Arvind Suresh
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Daisy Goodman
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Alka Dev
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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22
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Shroba J, Das R, Bilaver L, Vincent E, Brown E, Polk B, Ramos A, Russell AF, Bird JA, Ciaccio CE, Lanser BJ, Mudd K, Sood A, Vickery BP, Gupta R. Food Insecurity in the Food Allergic Population: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:81-90. [PMID: 34862158 DOI: 10.1016/j.jaip.2021.10.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022]
Abstract
Food allergies affect 32 million Americans. Restricted diets due to food allergies can be difficult to maintain especially when the household is food insecure. Food insecurity is defined as the inability to acquire food for household members due to insufficient money or resources for food. The COVID-19 pandemic has caused many people to face food insecurity for the first time with Latinx, Native American, and Black communities disproportionately affected. Because of the increase in food insecurity, this work group developed a survey regarding food insecurity screening. This survey was sent out to a random sample of American Academy of Allergy Asthma & Immunology members to assess food insecurity knowledge and practices. The majority of survey participants did not routinely screen their patients for food insecurity. The biggest barrier identified to screening was lack of knowledge of how to perform a screen and resources available when a patient screened positive. This work group report provides guidance on how to implement and perform a food insecurity screen, including federal resources and assistance programs.
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Affiliation(s)
- Jodi Shroba
- Division of Allergy and Immunology, Children's Mercy Hospital, Kansas City, Mo.
| | - Rajeshree Das
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Lucy Bilaver
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Eileen Vincent
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | - Brooke Polk
- Division of Allergy, Imunology and Pulmonary Medicine, Washington University, St Louis, Mo
| | - Ashley Ramos
- Division of Allergy and Immunology, Children's National Health System, Washington, DC
| | - Anne F Russell
- Spring Arbor University School of Nursing and Health Sciences Spring Arbor, Mich
| | - J Andrew Bird
- Southwestern Medical Center, University of Texas, Dallas, Texas
| | | | - Bruce J Lanser
- National Jewish Health Division of Pediatric Allergy and Clinical Immunology, Denver, Colo
| | - Kim Mudd
- Division of Pediatric Allergy and Immunology, Johns Hopkins, Baltimore, Md
| | - Amika Sood
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Brian P Vickery
- Emory University and Children's Healthcare of Atlanta, Atlanta, Ga
| | - Ruchi Gupta
- Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Ill
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23
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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24
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Hong YR, Turner K, Nguyen OT, Alishahi Tabriz A, Revere L. Social Determinants of Health and After-Hours Electronic Health Record Documentation: A National Survey of US Physicians. Popul Health Manag 2021; 25:362-366. [PMID: 34637635 DOI: 10.1089/pop.2021.0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Identifying patients' social determinants of health (SDoH) can improve patient outcomes but may increase clinicians' documentation time. However, there is limited evidence of how many physicians document SDoH and the associated burden. To address this gap, this study examines documentation of SDoH and after-hours electronic health record (EHR) work among a nationally representative sample of US office-based physicians. This was a cross-sectional analysis of the 2018-2019 National Electronic Health Records Survey. A survey design-adjusted bivariate analysis was used to estimate the prevalence of SDoH documentation and compare this activity between physicians' and practices' characteristics. A modified multivariable Poisson model was used to estimate prevalence ratios of SDoH documentation and after-hours work. The study sample included a weighted sample of 303,389 US physicians (31.5%, female; 72.5%, aged ≥50 years; 48.8% primary care specialty). Of those, 84.3% reported documenting patients' SDoH information. Physicians documenting patients' SDoH tend to be younger (<50 years). Prevalence estimates of after-hours EHR documentation were comparable between physicians recording patients' SDoH and those not (33.7% vs. 33.0%) and this difference did not reach statistical significance in adjusted analysis (adjusted prevalence ratio, 0.94, 95% confidence interval, 0.64-1.39). Thus, documenting patients' SDoH appears to be common among US physicians, and this activity is not associated with after-hours EHR documentation. Future studies should examine how patients' SDoH information is used and its association with patient health outcomes.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Oliver T Nguyen
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Lee Revere
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
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Draper CL, Morrissey E, Younginer N. Health Clinic Readiness to Implement Nutrition Supports in Partnership With SNAP-Ed. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:843-850. [PMID: 34030974 DOI: 10.1016/j.jneb.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the readiness of health clinics to implement nutrition support strategies in partnership with the Supplemental Nutrition Assistance Program Education (SNAP-Ed) program. DESIGN Qualitative study using semistructured interviews. SETTING South Carolina. PARTICIPANTS A convenience sample of key informants (n = 26) from health clinics (n = 15) interested in partnering with the SNAP-Ed program. PHENOMENON OF INTEREST Health clinic readiness to implement nutrition supports, including motivation, current capacities, and capacity-building needs. ANALYSIS Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed descriptively and thematically. RESULTS Clinics were most interested in implementing food insecurity screenings and making referrals to resources for accessing nutritious foods and produce prescription programs. Motivation was largely driven by a commitment to prevent chronic disease and on the basis of past success implementing a healthy eating strategy. A wide range of current capacities and capacity-building needs to implement strategies of interest were identified. CONCLUSIONS AND IMPLICATIONS Findings suggest the readiness of some clinics to partner with SNAP-Ed to implement nutrition support strategies and identifies early insights on areas practitioners might need to engage clinics in for capacity-building. Some implementers might need further training before having their own capacity to support clinics in the wide range of nutrition support strategies included, which could be explored in future studies.
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Affiliation(s)
- Carrie L Draper
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - Erin Morrissey
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Nicholas Younginer
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
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26
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Bhat S, Coyle DH, Trieu K, Neal B, Mozaffarian D, Marklund M, Wu JHY. Healthy Food Prescription Programs and their Impact on Dietary Behavior and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12:1944-1956. [PMID: 33999108 PMCID: PMC8483962 DOI: 10.1093/advances/nmab039] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
The enormous burden of diet-related chronic diseases has prompted interest in healthy food prescription programs. Yet, the impact of such programs remains unclear. The aim of this study was to conduct a systematic review of healthy food prescription programs and evaluate their impact on dietary behavior and cardiometabolic parameters by meta-analysis. A systematic search was carried out in Medline, Embase, Scopus, and Cochrane Central Register of Controlled Trials databases since their inception to 3 January, 2020 without language restriction. A systematic search of interventional studies investigating the effect of healthy food prescription on diet quality and/or cardiometabolic risk factors including BMI, systolic (SBP) and diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), or blood lipids was carried out. Thirteen studies were identified for inclusion, most of which were quasi-experimental (pre/post) interventions without a control group (n = 9). Pooled estimates revealed a 22% (95% CI: 12, 32; n = 5 studies, n = 1039 participants; I2 = 97%) increase in fruit and vegetable consumption, corresponding to 0.8 higher daily servings (95% CI: 0.2, 1.4; I2 = 96%). BMI decreased by 0.6 kg/m2 (95% CI: 0.2, 1.1; I2 = 6.4%) and HbA1c by 0.8% (95% CI: 0.1, 1.6; I2 = 92%). No significant change was observed in other cardiometabolic parameters. These findings should be interpreted with caution in light of considerable heterogeneity, methodological limitations of the included studies, and moderate to very low certainty of evidence. Our results support the need for well-designed, large, randomized controlled trials in various settings to further establish the efficacy of healthy food prescription programs on diet quality and cardiometabolic health.
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Affiliation(s)
- Saiuj Bhat
- School of Medicine, The University of Western Australia, Crawley, Australia
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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27
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Heasley C, Clayton B, Muileboom J, Schwanke A, Rathnayake S, Richter A, Little M. "I was eating more fruits and veggies than I have in years": a mixed methods evaluation of a fresh food prescription intervention. ACTA ACUST UNITED AC 2021; 79:135. [PMID: 34301335 PMCID: PMC8298943 DOI: 10.1186/s13690-021-00657-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 07/10/2021] [Indexed: 11/10/2022]
Abstract
Background Food insecurity is associated with poor nutritional health outcomes. Prescribing fresh fruits and vegetables in healthcare settings may be an opportunity to link patients with community supports to promote healthy diets and improve food security. This mixed methods study evaluated the impacts of a fresh food prescription pilot program. Methods The study took place at two Community Health Centre locations in Guelph, Ontario, Canada. Sixty food insecure patients with ≥1 cardio-metabolic condition or micronutrient deficiency participated in the intervention. Participants were prescribed 12 weekly vouchers to Community Food Markets. We conducted a one-group pre-post mixed-methods evaluation to assess changes in fruit and vegetable intake, self-reported health, food security, and perceived food environments. Surveys were conducted at baseline and follow-up and semi-structured interviews with participants were conducted following the intervention. Results Food security and fruit and vegetable consumption improved following the intervention. Food security scores increased by 1.6 points, on average (p < 0.001). Consumption of fruits and 'other' vegetables (cucumber, celery, cabbage, cauliflower, squashes, and vegetable juice) increased from baseline to follow-up (p < 0.05). No changes in self-reported physical or mental health were observed. Qualitative data suggested that the intervention benefited the availability, accessibility, affordability, acceptability, and accommodation of healthy foods for participating households. Conclusions Fresh food prescription programs may be a useful model for healthcare providers to improve patients' food environments, healthy food consumption, and food security.
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Affiliation(s)
- Cole Heasley
- Department of Population Medicine, University of Guelph, Guelph, ON Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, BC Canada
| | | | - Jade Muileboom
- Arrell Food Institute, University of Guelph, Guelph, ON Canada
| | - Anna Schwanke
- Food From Thought, University of Guelph, Guelph, ON Canada
| | | | - Abby Richter
- Guelph Community Health Centre, Guelph, ON Canada
| | - Matthew Little
- School of Public Health and Social Policy, University of Victoria, Victoria, BC Canada
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The impact of a produce prescription programme on healthy food purchasing and diabetes-related health outcomes. Public Health Nutr 2021; 24:3945-3955. [PMID: 33902771 PMCID: PMC8369461 DOI: 10.1017/s1368980021001828] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: To evaluate a Produce Prescription Programme’s utilisation and its effects on healthy food purchasing and diabetes control among participants with type 2 diabetes. Design: Prospective cohort study using participants’ electronic health records and food transaction data. Participants were categorised as ‘Frequent Spenders’ and ‘Sometimes Spenders’ based on utilisation frequency. Multivariate regressions assessed utilisation predictors and programme effects on fruit/vegetable purchasing (spending, expenditure share and variety) and on diabetes-related outcomes (HbA1c, BMI and blood pressure). Setting: Patients enrolled by clinics in Durham, North Carolina, USA. Participants received $40 monthly for fruits and vegetables at a grocery store chain. Participants: A total of 699 food-insecure participants (353 with diabetes). Results: Being female and older was associated with higher programme utilisation; hospitalisations were negatively associated with programme utilisation. Frequent Spender status was associated with $8·77 more in fruit/vegetable spending (P < 0·001), 3·3 % increase in expenditure share (P = 0·007) and variety increase of 2·52 fruits and vegetables (P < 0·001). For $10 of Produce Prescription Dollars spent, there was an $8·00 increase in fruit/vegetable spending (P < 0·001), 4·1 % increase in expenditure share and variety increase of 2·3 fruits/vegetables (P < 0·001). For the 353 participants with diabetes, there were no statistically significant relationships between programme utilisation and diabetes control. Conclusions: Programme utilisation was associated with healthier food purchasing, but the relatively short study period and modest intervention prevent making conclusions about health outcomes. Produce Prescription Programmes can increase healthy food purchasing among food-insecure people, which may improve chronic disease care.
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29
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Yang WE, Shah LM, Spaulding EM, Wang J, Xun H, Weng D, Shan R, Wongvibulsin S, Marvel FA, Martin SS. The role of a clinician amid the rise of mobile health technology. J Am Med Inform Assoc 2021; 26:1385-1388. [PMID: 31373364 DOI: 10.1093/jamia/ocz131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/05/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022] Open
Abstract
Mobile health (mHealth) interventions have demonstrated promise in improving outcomes by motivating patients to adopt and maintain healthy lifestyle changes as well as improve adherence to guideline-directed medical therapy. Early results combining behavioral economic strategies with mHealth delivery have demonstrated mixed results. In reviewing these studies, we propose that the success of a mHealth intervention links more strongly with how well it connects patients back to routine clinical care, rather than its behavior modification technique in isolation. This underscores the critical role of clinician-patient partnerships in the design and delivery of such interventions, while also raising important questions regarding long-term sustainability and scalability. Further exploration of our hypothesis may increase opportunities for multidisciplinary clinical teams to connect with and engage patients using mHealth technologies in unprecedented ways.
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Affiliation(s)
- William E Yang
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lochan M Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Jane Wang
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Helen Xun
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rongzi Shan
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Francoise A Marvel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seth S Martin
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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30
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An exploration of key barriers to healthcare providers' use of food prescription (FRx) interventions in the rural South. Public Health Nutr 2021; 24:1095-1103. [PMID: 33423706 DOI: 10.1017/s1368980020005376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this exploratory study was to examine the attitude towards food prescriptions (FRx) interventions among clinicians and identify potential barriers to their use in clinical practice. DESIGN The current study employed an exploratory research design using in-depth semi-structured interviews. Research participants were selected from primary care facilities, family practice offices and obesity clinics located in Mississippi and Louisiana. SETTING Providers selected for participation in the current study serve predominantly rural, low-income communities in the US South. PARTICIPANTS From an original population of fifty healthcare providers that included physicians, registered dieticians and nurse practitioners, from Oxford, Tupelo, Batesville, Jackson, and Charleston, MS and New Orleans, LA. Fifteen healthcare providers agreed to participate, including three physicians, four registered dieticians, three nurses and three nurse practitioners. RESULTS The current study found that while healthcare providers expressed a desire to use FRx interventions, there was a universal lack of understanding by healthcare providers of what FRx interventions were, how they were implemented and what outcomes they were likely to influence. CONCLUSIONS The current study identified key bottlenecks in the use of FRx interventions at the clinic level and data provided evidence for two key recommendations: (1) development and validation of a screening tool to be used by clinicians for enrolling patients in such interventions and (2) implementation of nutrition education in primary professional training, as well as in continuing education.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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32
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Peek ME, Vela MB, Chin MH. Practical Lessons for Teaching About Race and Racism: Successfully Leading Free, Frank, and Fearless Discussions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S139-S144. [PMID: 32889939 DOI: 10.1097/acm.0000000000003710] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Successfully teaching about race and racism requires a careful balance of emotional safety and honest truth-telling. Creating such environments where all learners can thrive and grow together is a challenge, but a consistently doable one. This article describes 12 lessons learned within 4 main themes: ground rules; language and communication; concepts of social constructs, intersectionality, and bidirectional biases; and structural racism, solutions, and advocacy. The authors' recommendations for how to successfully teach health professions students about race and racism come from their collective experience of over 60 years of instruction, research, and practice. Proficiency in discussing race and addressing racism will become increasingly relevant as health care institutions strive to address the social needs of patients (e.g., food insecurity, housing instability) that contribute to poor health and are largely driven by structural inequities. Having interprofessional team-based care, with teams better able to understand and counteract their own biases, will be critical to addressing the social and structural determinants of health for marginalized patients. Recognizing that implicit biases about race impact both patients and health professions students from underrepresented racial/ethnic backgrounds is a critical step toward building robust curricula about race and health equity that will improve the learning environment for trainees and reduce health disparities.
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Affiliation(s)
- Monica E Peek
- M.E. Peek is associate professor of medicine, Section of General Internal Medicine, member, Center for the Study of Race, Politics and Culture, and associate director, Chicago Center for Diabetes Translation Research, The University of Chicago, Chicago, Illinois
| | - Monica B Vela
- M.B. Vela is professor of medicine, Section of General Internal Medicine, member, Center for the Study of Race, Politics and Culture, and associate dean, Multicultural Affairs, The University of Chicago, Chicago, Illinois
| | - Marshall H Chin
- M.H. Chin is Richard Parrillo Family Professor of Healthcare Ethics, Department of Medicine, and director, Chicago Center for Diabetes Translation Research, The University of Chicago, Chicago, Illinois
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33
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Veldheer S, Scartozzi C, Knehans A, Oser T, Sood N, George DR, Smith A, Cohen A, Winkels RM. A Systematic Scoping Review of How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations. J Nutr 2020; 150:2859-2873. [PMID: 32856074 DOI: 10.1093/jn/nxaa209] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/18/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is compelling evidence on the impact of diet as preventative medicine, and with rising health care costs healthcare organizations are attempting to identify interventions to improve patient health outcomes. OBJECTIVES The purpose of this systematic scoping review was to characterize existing healthcare organization-based interventions to improve access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact of identified interventions on dietary intake and health outcomes. METHODS Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from 1 January 1990 to 31 December 2019. To be selected for inclusion, original studies must have included a healthcare organization and have had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Practice Project tool was used to assess study quality in 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts). RESULTS A total of 8876 abstracts were screened, yielding 44 manuscripts or abstracts from 27 programs. Six program models were identified: 1) a cash-back rebate program, 2) F&V voucher programs, 3) garden-based programs, 4) subsidized food box programs, 5) home-delivery meal programs, and 6) collaborative food pantry-clinical programs. Only 6 of 27 studies included a control group. The overall quality of the studies was weak due to participant selection bias and incomplete reporting on data collection tools, confounders, and dropouts. Given the heterogeneity of outcomes measured and weak study quality, conclusions regarding dietary and health-related outcomes were limited. CONCLUSIONS Healthcare-based initiatives to improve patient access to F&V are novel and have promise. However, future studies will need rigorous study designs and validated data collection tools, particularly related to dietary intake, to better determine the effect of these interventions on health-related outcomes.
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Affiliation(s)
- Susan Veldheer
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Christina Scartozzi
- Penn State Health, St. Joseph's Family and Community Medicine Residency Program, Hershey, PA, USA
| | - Amy Knehans
- Penn State College of Medicine, Harrell Library, Hershey, PA, USA
| | - Tamara Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Family Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Natasha Sood
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R George
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | | | - Alicia Cohen
- Departments of Family Medicine and Health Services, Policy, and Practice, Providence VA Medical Center and Brown University, Providence, RI, USA
| | - Renate M Winkels
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Wageningen University, Division of Human Nutrition and Health, Wageningen, Netherlands
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Bagchi AD. A Structural Competency Curriculum for Primary Care Providers to Address the Opioid Use Disorder, HIV, and Hepatitis C Syndemic. Front Public Health 2020; 8:210. [PMID: 32582612 PMCID: PMC7289946 DOI: 10.3389/fpubh.2020.00210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/07/2020] [Indexed: 12/26/2022] Open
Abstract
The interrelated epidemics of opioid use disorder (OUD) and HIV and hepatitis C virus (HCV) infection have been identified as one of the most pressing syndemics facing the United States today. Research studies and interventions have begun to address the structural factors that promote the inter-relations between these conditions and a number of training programs to improve structural awareness have targeted physician trainees (e.g., residents and medical students). However, a significant limitation in these programs is the failure to include practicing primary care providers (PCPs). Over the past 5 years, there have been increasing calls for PCPs to develop structural competency as a way to provide a more integrated and patient-centered approach to prevention and care in the syndemic. This paper applies Metzel and Hansen's (1) framework for improved structural competency to describe an educational curriculum that can be delivered to practicing PCPs. Skill 1 involves reviewing the historical precedents (particularly stigma) that created the siloed systems of care for OUD, HIV, and HCV and examines how recent biomedical advances allow for greater care integration. To help clinicians develop a more multidisciplinary understanding of structure (Skill 2), trainees will discuss ways to assess structural vulnerability. Next, providers will review case studies to better understand how structural foundations are usually seen as cultural representations (Skill 3). Developing structural interventions (Skill 4) involves identifying ways to create a more integrated system of care that can overcome clinical inertia. Finally, the training will emphasize cultural humility (Skill 5) through empathetic and non-judgmental patient interactions. Demonstrating understanding of the structural barriers that patients face is expected to enhance patient trust and increase retention in care. The immediate objective is to pilot test the feasibility of the curriculum in a small sample of primary care sites and develop metrics for future evaluation. While the short-term goal is to test the model among practicing PCPs, the long-term goal is to implement the training practice-wide to ensure structural competence throughout the clinical setting.
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Affiliation(s)
- Ann D Bagchi
- Rutgers School of Nursing, The State University of New Jersey, Newark, NJ, United States
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35
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Cohen DJ, Wyte-Lake T, Dorr DA, Gold R, Holden RJ, Koopman RJ, Colasurdo J, Warren N. Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs. J Am Med Inform Assoc 2020; 27:690-699. [PMID: 32134456 PMCID: PMC7647291 DOI: 10.1093/jamia/ocaa010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/06/2020] [Accepted: 01/16/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To identify the unmet information needs of clinical teams delivering care to patients with complex medical, social, and economic needs; and to propose principles for redesigning electronic health records (EHR) to address these needs. MATERIALS AND METHODS In this observational study, we interviewed and observed care teams in 9 community health centers in Oregon and Washington to understand their use of the EHR when caring for patients with complex medical and socioeconomic needs. Data were analyzed using a comparative approach to identify EHR users' information needs, which were then used to produce EHR design principles. RESULTS Analyses of > 300 hours of observations and 51 interviews identified 4 major categories of information needs related to: consistency of social determinants of health (SDH) documentation; SDH information prioritization and changes to this prioritization; initiation and follow-up of community resource referrals; and timely communication of SDH information. Within these categories were 10 unmet information needs to be addressed by EHR designers. We propose the following EHR design principles to address these needs: enhance the flexibility of EHR documentation workflows; expand the ability to exchange information within teams and between systems; balance innovation and standardization of health information technology systems; organize and simplify information displays; and prioritize and reduce information. CONCLUSION Developing EHR tools that are simple, accessible, easy to use, and able to be updated by a range of professionals is critical. The identified information needs and design principles should inform developers and implementers working in community health centers and other settings where complex patients receive care.
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Affiliation(s)
- Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA
| | - Tamar Wyte-Lake
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente, Portland, Oregon, USA
- Department of Research, OCHIN Inc, Portland, Oregon, USA
| | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Joshua Colasurdo
- Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA
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Aiyer JN, Raber M, Bello RS, Brewster A, Caballero E, Chennisi C, Durand C, Galindez M, Oestman K, Saifuddin M, Tektiridis J, Young R, Sharma SV. A pilot food prescription program promotes produce intake and decreases food insecurity. Transl Behav Med 2020; 9:922-930. [PMID: 31570927 DOI: 10.1093/tbm/ibz112] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Food insecurity is associated with limited food resources that may lead to poor nutritional intake and diet-related chronic disease. Food prescription programs offer an avenue for facilitating access to fresh and healthy nonperishable food while reducing food insecurity. The purpose of this pilot study is to examine the feasibility, perceptions, and impact of a collaborative food prescription program in an area with a high rate of food insecurity. The study was a single group pre-post evaluation design. Participants were recruited from two school-based clinics and one Federally Qualified Health Center in north Pasadena, an area with a high rate of food insecurity in Harris County, TX. Adult, food insecure participants were screened at health clinics for eligibility. Participants received nutrition education materials and 30 pounds of a variety of fresh produce plus four healthy, nonperishable food items every 2 weeks for up to 12 visits at a local food pantry. Surveys and tracking tools monitored food insecurity, program dosage, reach, fidelity, acceptability, and program costs. Surveys and key informant interviews assessed perceptions of health care providers, implementation staff, and participants. Participants (n = 172) in the program reported a 94.1% decrease in the prevalence of food insecurity (p < .01) at the end of the program. An average of 29.2 pounds of fruits and vegetables were distributed per family per distribution, and 99% of participants reported eating "all" or "most" of the food provided. Program costs were $12.20 per participant per redemption. Interviews revealed that providers and participants felt the program was well received and highly needed. This pilot study demonstrates the framework and feasibility of a collaborative clinic-based food prescription program to address food insecurity. Future research should examine the sustained impact of such programs on behavioral and health outcomes.
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Affiliation(s)
- Jennifer N Aiyer
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center in Houston (UTHealth) School of Public Health, Houston, USA
| | - Margaret Raber
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center in Houston (UTHealth) School of Public Health, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Rosalind S Bello
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Anna Brewster
- Cancer Prevention & Control Platform, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Elizabeth Caballero
- Cancer Prevention & Control Platform, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Catherine Chennisi
- Office of Policy and Planning, Harris County Public Health, Houston, USA
| | - Casey Durand
- Health Promotion & Behavioral Sciences, The University of Texas Health Science Center in Houston (UTHealth) School of Public Health, USA
| | - Marcita Galindez
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Katherine Oestman
- Cancer Prevention & Control Platform, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Jennifer Tektiridis
- Research Planning and Development, Duncan Family Institute for Cancer Prevention and Risk Assessment, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Shreela V Sharma
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center in Houston (UTHealth) School of Public Health, Houston, USA
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Schlosser AV, Joshi K, Smith S, Thornton A, Bolen SD, Trapl ES. "The coupons and stuff just made it possible": economic constraints and patient experiences of a produce prescription program. Transl Behav Med 2020; 9:875-883. [PMID: 31570919 DOI: 10.1093/tbm/ibz086] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although produce prescription (PRx) programs have been shown to improve fruit and vegetable (FV) consumption, few studies have examined how economic constraints influence participant experience. We conducted a qualitative study of patient experience of a 3-month PRx program for hypertension (PRxHTN) including 3 safety-net clinics and 20 farmers' markets (FMs). We interviewed 23 PRxHTN participants using semistructured guides to understand their program experiences. Interviews were audio-taped, transcribed, and analyzed to identify a priori and emergent themes. PRxHTN participants completing qualitative interviews were mostly middle-aged (mean: 62 years) African American (100%) women (78%). Economic hardship as a barrier to maximum program participation and sustainability was a main theme identified, with three subthemes: (i) transportation issues shaped shopping and eating patterns and limited participant ability to access FMs to utilize PRxHTN vouchers; (ii) limited and unstable income shaped participant shopping and eating behavior before, during, and after PRxHTN; and (iii) participants emphasized individual-level influences like personal or perceived motivations for program participation, despite significant structural constraints, such as economic hardship, shaping their program engagement. Future PRx programs should bolster economic and institutional supports beyond FM vouchers such as transportation assistance, partnering with local food banks and expansion to local grocery stores offering year-round FV access to support sustained behavior change. Additionally, structural competency tools for providers may be warranted to reorient focus on structural influences on program engagement and away from potentially stigmatizing individual-level explanations for program success. These efforts have potential to enhance the translation of PRx programs to the needs of economically vulnerable patients who struggle to manage chronic illness and access basic nutrition.
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Affiliation(s)
- Allison V Schlosser
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | - Kakul Joshi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Anna Thornton
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Shari D Bolen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Better Health Partnership, Cleveland, OH, USA.,Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.,Center for Health Care Research and Policy, Case Western Reserve University at the MetroHealth System, Cleveland, OH, USA
| | - Erika S Trapl
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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Thornton PL, Kumanyika SK, Gregg EW, Araneta MR, Baskin ML, Chin MH, Crespo CJ, de Groot M, Garcia DO, Haire-Joshu D, Heisler M, Hill-Briggs F, Ladapo JA, Lindberg NM, Manson SM, Marrero DG, Peek ME, Shields AE, Tate DF, Mangione CM. New research directions on disparities in obesity and type 2 diabetes. Ann N Y Acad Sci 2019; 1461:5-24. [PMID: 31793006 DOI: 10.1111/nyas.14270] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.
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Affiliation(s)
- Pamela L Thornton
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland
| | - Shiriki K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Edward W Gregg
- Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Maria R Araneta
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Monica L Baskin
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Carlos J Crespo
- Oregon Health and Science University and Portland State University Joint School of Public Health, Portland, Oregon
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, Indiana
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Debra Haire-Joshu
- Washington University in St. Louis, School of Medicine and the Brown School, St. Louis, Missouri
| | | | - Felicia Hill-Briggs
- Johns Hopkins School of Medicine and Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland
| | - Joseph A Ladapo
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, and UCLA Fielding School of Public Health, Los Angeles, Los Angeles, California
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Schlosser AV, Smith S, Joshi K, Thornton A, Trapl ES, Bolen S. "You Guys Really Care About Me…": a Qualitative Exploration of a Produce Prescription Program in Safety Net Clinics. J Gen Intern Med 2019; 34:2567-2574. [PMID: 31512182 PMCID: PMC6848686 DOI: 10.1007/s11606-019-05326-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/27/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although research shows produce prescription (PRx) programs increase fruit and vegetable (FV) consumption, little is known about how participants experience them. OBJECTIVE To better understand how participants experience a PRx program for hypertensive adults at 3 safety net clinics partnered with 20 farmers' markets (FMs) in Cleveland, OH. DESIGN We conducted semi-structured interviews with 5 program providers, 23 patient participants, and 2 FM managers. PARTICIPANTS Patients interviewed were mainly middle-aged (mean age 62 years), African American (100%), and women (78%). Providers were mainly middle-aged men and women of diverse races/ethnicities. INTERVENTION Healthcare providers enrolled adult patients who were food insecure and diagnosed with hypertension. Participating patients attended monthly clinic visits for 3 months. Each visit included a blood pressure (BP) check, dietary counseling for BP control, a produce prescription, and produce vouchers redeemable at local FMs. APPROACH Patient interviews focused on (1) beliefs about food, healthy eating, and FMs; (2) clinic-based program experiences; and (3) FM experiences. Provider and market manager interviews focused on program provision. All interviews were audio-taped, transcribed, and analyzed thematically. KEY RESULTS We identified four central themes. First, providers and patients reported positive interactions during program activities, but providers struggled to integrate the program into their workflow. Second, patients reported greater FV intake and FM shopping during the program. Third, social interactions enhanced program experience. Fourth, economic hardships influenced patient shopping and eating patterns, yet these hardships were minimized in some participants' views of patient deservingness for program inclusion. CONCLUSIONS Our findings highlight promises and challenges of PRx programs for economically disadvantaged patients with a chronic condition. Patient participants reported improved interactions with providers, increased FV consumption, and incorporation of healthy eating into their social networks due to the program. Future efforts should focus on efficiently integrating PRx into clinic workflows, leveraging patient social networks, and including economic supports for maintenance of behavior change.
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Affiliation(s)
- Allison V Schlosser
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Samantha Smith
- Epidemiology, Surveillance, & Informatics, Cuyahoga County Board of Health, Parma, OH, USA
| | - Kakul Joshi
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Anna Thornton
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Erika S Trapl
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Shari Bolen
- Better Health Partnership, Cleveland, OH, USA
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- Center for Health Care Research and Policy, Case Western Reserve University at the MetroHealth System, Cleveland, OH, USA
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Fraze TK, Brewster AL, Lewis VA, Beidler LB, Murray GF, Colla CH. Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals. JAMA Netw Open 2019; 2:e1911514. [PMID: 31532515 PMCID: PMC6752088 DOI: 10.1001/jamanetworkopen.2019.11514] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/30/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Social needs, including food, housing, utilities, transportation, and experience with interpersonal violence, are linked to health outcomes. Identifying patients with unmet social needs is a necessary first step to addressing these needs, yet little is known about the prevalence of screening. Objective To characterize screening for social needs by physician practices and hospitals. Design, Setting, and Participants Cross-sectional survey analyses of responses by physician practices and hospitals to the 2017-2018 National Survey of Healthcare Organizations and Systems. Responses were collected from survey participants from June 16, 2017, to August 17, 2018. Exposures Organizational characteristics, including participation in delivery and payment reform. Main Outcomes and Measures Self-report of screening patients for food insecurity, housing instability, utility needs, transportation needs, and experience with interpersonal violence. Results Among 4976 physician practices, 2333 responded, a response rate of 46.9%. Among hospitals, 757 of 1628 (46.5%) responded. After eliminating responses because of ineligibility, 2190 physician practices and 739 hospitals remained. Screening for all 5 social needs was reported by 24.4% (95% CI, 20.0%-28.7%) of hospitals and 15.6% (95% CI, 13.4%-17.9%) of practices, whereas 33.3% (95% CI, 30.5%-36.2%) of practices and 8.0% (95% CI, 5.8%-11.0%) of hospitals reported no screening. Screening for interpersonal violence was most common (practices: 56.4%; 95% CI, 53.3%-2 59.4%; hospitals: 75.0%; 95% CI, 70.1%-79.3%), and screening for utility needs was least common (practices: 23.1%; 95% CI, 20.6%-26.0%; hospitals: 35.5%; 95% CI, 30.0%-41.0%) among both hospitals and practices. Among practices, federally qualified health centers (yes: 29.7%; 95% CI, 21.5%-37.8% vs no: 9.4%; 95% CI, 7.2%-11.6%; P < .001), bundled payment participants (yes: 21.4%; 95% CI, 17.1%-25.8% vs no: 10.7%; 95% CI, 7.9%-13.4%; P < .001), primary care improvement models (yes: 19.6%; 95% CI, 16.5%-22.6% vs no: 9.6%; 95% CI, 6.0%-13.1%; P < .001), and Medicaid accountable care organizations (yes: 21.8%; 95% CI, 17.4%-26.2% vs no: 11.2%; 95% CI, 8.6%-13.7%; P < .001) had higher rates of screening for all needs. Practices in Medicaid expansion states (yes: 17.7%; 95% CI, 14.8%-20.7% vs no: 11.4%; 95% CI, 8.1%-14.6%; P = .007) and those with more Medicaid revenue (highest tertile: 17.1%; 95% CI, 11.4%-22.7% vs lowest tertile: 9.0%; 95% CI, 6.1%-11.8%; P = .02) were more likely to screen. Academic medical centers were more likely than other hospitals to screen (49.5%; 95% CI, 34.6%-64.4% vs 23.0%; 95% CI, 18.5%-27.5%; P < .001). Conclusions and Relevance This study's findings suggest that few US physician practices and hospitals screen patients for all 5 key social needs associated with health outcomes. Practices that serve disadvantaged patients report higher screening rates. The role of physicians and hospitals in meeting patients' social needs is likely to increase as more take on accountability for cost under payment reform. Physicians and hospitals may need additional resources to screen for or address patients' social needs.
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Affiliation(s)
- Taressa K. Fraze
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Amanda L. Brewster
- School of Public Health, Division of Health Policy and Management, University of California, Berkeley
| | - Valerie A. Lewis
- Gilling School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill
| | - Laura B. Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Genevra F. Murray
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Carrie H. Colla
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
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Harris J, Haltbakk J, Dunning T, Austrheim G, Kirkevold M, Johnson M, Graue M. How patient and community involvement in diabetes research influences health outcomes: A realist review. Health Expect 2019; 22:907-920. [PMID: 31286639 PMCID: PMC6803418 DOI: 10.1111/hex.12935] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022] Open
Abstract
Background Patient and public involvement in diabetes research is an international requirement, but little is known about the relationship between the process of involvement and health outcomes. Objective This realist review identifies who benefits from different types of involvement across different contexts and circumstances. Search strategies Medline, CINAHL and EMBASE were searched to identify interventions using targeted, embedded or collaborative involvement to reduce risk and promote self‐management of diabetes. People at risk/with diabetes, providers and community organizations with an interest in addressing diabetes were included. There were no limitations on date, language or study type. Data extraction and synthesis Data were extracted from 29 projects using elements from involvement frameworks. A conceptual analysis of involvement types was used to complete the synthesis. Main results Projects used targeted (4), embedded (8) and collaborative (17) involvement. Productive interaction facilitated over a sufficient period of time enabled people to set priorities for research. Partnerships that committed to collaboration increased awareness of diabetes risk and mobilized people to co‐design and co‐deliver diabetes interventions. Cultural adaptation increased relevance and acceptance of the intervention because they trusted local delivery approaches. Local implementation produced high levels of recruitment and retention, which project teams associated with achieving diabetes health outcomes. Discussion and Conclusions Achieving understanding of community context, developing trusting relationships across sectors and developing productive partnerships were prerequisites for designing research that was feasible and locally relevant. The proportion of diabetes studies incorporating these elements is surprisingly low. Barriers to resourcing partnerships need to be systematically addressed.
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Affiliation(s)
- Janet Harris
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Johannes Haltbakk
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research, Deakin University and Barwon Health Partnership, Geelong, Victoria, Australia
| | - Gunhild Austrheim
- Library, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marit Kirkevold
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marit Graue
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Trapl ES, Smith S, Joshi K, Osborne A, Benko M, Matos AT, Bolen S. Dietary Impact of Produce Prescriptions for Patients With Hypertension. Prev Chronic Dis 2018; 15:E138. [PMID: 30447106 PMCID: PMC6266424 DOI: 10.5888/pcd15.180301] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Little is known regarding the impact of produce prescriptions within the context of hypertension visits at safety net clinics. We evaluated intervention effectiveness on patient usage of farmers markets and dietary change related to fruit and vegetable consumption. METHODS Health Improvement Partnership - Cuyahoga worked with 3 clinics to integrate, implement, and evaluated a produce prescription for hypertension (PRxHTN) program. PRxHTN involves 3 monthly, nonphysician provider visits, comprising blood pressure measurement, nutrition counseling, and four $10 farmers market produce vouchers, for hypertensive adult patients screening positive for food insecurity. Dietary measures were collected at visits 1 and 3. Voucher use was tracked via farmers market redemption logs. RESULTS Of the 224 participants from 3 clinics, most were middle-aged (mean age, 62 y), female (72%), and African American (97%) and had a high school education or less (62%). Eighty-six percent visited a farmers market to use their produce vouchers, with one-third reporting it was their first farmers market visit ever. Median number of farmers market visits was 2 (range: 0-6), and median number of vouchers redeemed was 8 (range: 0-12). Among the subsample with follow-up survey data (n = 137), significant improvement in fruit and vegetable consumption was observed as well as a decline in fast food consumption. CONCLUSION PRxHTN participants visited at least 1 farmers market, reported increases in provider communication related to diet, and exhibited significant changes in dietary behavior. PRxHTN can serve as a strong model for linking safety net clinics with farmers markets to promote community resource use and improve fruit and vegetable consumption among food-insecure patients with hypertension.
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Affiliation(s)
- Erika S Trapl
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
- Prevention Research Center for Healthy Neighborhoods, BioEnterprise Bldg, Room 445, 11000 Cedar Ave, Cleveland, OH 44106-7069.
| | | | - Kakul Joshi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Anna Thornton Matos
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Shari Bolen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
- Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
- Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio
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Tung EL, Gunter KE, Bergeron NQ, Lindau ST, Chin MH, Peek ME. Cross-Sector Collaboration in the High-Poverty Setting: Qualitative Results from a Community-Based Diabetes Intervention. Health Serv Res 2018; 53:3416-3436. [PMID: 29355934 PMCID: PMC6153162 DOI: 10.1111/1475-6773.12824] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To characterize the motivations of stakeholders from diverse sectors who engaged in cross-sector collaboration with an academic medical center. DATA SOURCE Primary qualitative data (2014-2015) were collected from 22 organizations involved in a cross-sector diabetes intervention on the South Side of Chicago. STUDY DESIGN In-depth, semistructured interviews; participants included leaders from all stakeholder organization types (e.g., businesses, community development, faith-based) involved in the intervention. DATA COLLECTION METHODS Data were transcribed verbatim from audio and video recordings. Analysis was conducted using the constant comparison method, derived from grounded theory. PRINCIPAL FINDINGS All stakeholders described collaboration as an opportunity to promote community health in vulnerable populations. Among diverse motivations across organization types, stakeholders described collaboration as an opportunity for: financial support, brand enhancement, access to specialized skills or knowledge, professional networking, and health care system involvement in community-based efforts. Based on our findings, we propose a framework for implementing a working knowledge of stakeholder motivations to facilitate effective cross-sector collaboration. CONCLUSIONS We identified several factors that motivated collaboration across diverse sectors with health care systems to promote health in a high-poverty, urban setting. Understanding these motivations will be foundational to optimizing meaningful cross-sector collaboration and improving diabetes outcomes in the nation's most vulnerable communities.
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Affiliation(s)
- Elizabeth L. Tung
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchUniversity of ChicagoChicagoIL
| | - Kathryn E. Gunter
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchUniversity of ChicagoChicagoIL
| | - Nyahne Q. Bergeron
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchUniversity of ChicagoChicagoIL
| | - Stacy Tessler Lindau
- Department of Obstetrics and GynecologyDepartment of Medicine‐GeriatricsChicago Center for Diabetes Translation Researchthe MacLean Center for Clinical Medical Ethics, and the Comprehensive Cancer CenterUniversity of ChicagoChicagoIL
| | - Marshall H. Chin
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchMacLean Center for Clinical Medical EthicsUniversity of ChicagoChicagoIL
| | - Monica E. Peek
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchMacLean Center for Clinical Medical EthicsUniversity of ChicagoChicagoIL
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Gans KM, Risica PM, Keita AD, Dionne L, Mello J, Stowers KC, Papandonatos G, Whittaker S, Gorham G. Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial. Int J Behav Nutr Phys Act 2018; 15:80. [PMID: 30126463 PMCID: PMC6102886 DOI: 10.1186/s12966-018-0704-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 07/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fruit and vegetable (F&V) intake can reduce risks for chronic disease, but is much lower than recommended amounts in most Western populations, especially for those with low income levels. Rigorous research is needed on practical, cost-effective interventions that address environmental as well as personal determinants of F&V intake. This paper presents the results of a cluster randomized controlled trial evaluating the efficacy of 'Live Well, Viva Bien' (LWVB), a multicomponent intervention that included discount, mobile fresh F&V markets in conjunction with nutrition education. METHODS Fifteen subsidized housing sites in Providence County, Rhode Island (8 intervention and 7 control sites) were randomized using a random number generator. Of these, nine housed elderly and/or disabled residents and six housed families. A total of 1597 adult housing site residents (treatment n = 837; control n = 760) were enrolled (73% women, 54% Hispanic, 17% black, Mean age 54 years). A year-long multicomponent intervention including mobile F&V markets plus nutrition education (e.g. campaigns, DVDs, newsletters, recipes, and chef demonstrations) was implemented at intervention sites. Physical activity and stress interventions were implemented at control sites. Follow-up occurred at 6 and 12 months. The main outcome measure was F&V consumption measured by National Cancer Institute's 'Eating at America's Table All Day Screener'. RESULTS From baseline to 12 months, the intervention group increased total F&V intake by 0.44 cups with the control group decreasing intake by 0.08 cups (p < .02). Results also showed an increased frequency of F&V eating behaviors compared to the control group (p < .01). There was a clear dose response effect of the F&V markets with participants who reported attending all or most of the markets increasing F&V intake by 2.1 cups and 0.86 cups, respectively compared with less than half cup increases for lower levels of market attendance (p < .05). Use of the DVDs, recipes and taste-testings was also associated with greater increases in F&V intake; however, use of other educational components was not. CONCLUSIONS LWVB is the first cluster, randomized controlled trial to demonstrate the efficacy of year-round F&V markets on improving F&V intake for low-income adults, which provides an evidence-base to bolster the mission of mobile produce markets. Further, the results more broadly support investment in environmental changes to alleviate disparities in F&V consumption and diet-related health inequities. TRIAL REGISTRATION NUMBER Clinicatrials.gov registration number: NCT02669472.
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Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Akilah Dulin Keita
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Kristen Cooksey Stowers
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- University of Connecticut Rudd Center for Food Policy and Obesity, Hartford, USA
| | - George Papandonatos
- Department of Statistical Scieces, Brown University School of Public Health, Providence, USA
| | | | - Gemma Gorham
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
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Berkowitz SA, Karter AJ, Corbie-Smith G, Seligman HK, Ackroyd SA, Barnard LS, Atlas SJ, Wexler DJ. Food Insecurity, Food "Deserts," and Glycemic Control in Patients With Diabetes: A Longitudinal Analysis. Diabetes Care 2018; 41:1188-1195. [PMID: 29555650 PMCID: PMC5961388 DOI: 10.2337/dc17-1981] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/27/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Both food insecurity (limited food access owing to cost) and living in areas with low physical access to nutritious foods are public health concerns, but their relative contribution to diabetes management is poorly understood. RESEARCH DESIGN AND METHODS This was a prospective cohort study. A random sample of patients with diabetes in a primary care network completed food insecurity assessment in 2013. Low physical food access at the census tract level was defined as no supermarket within 1 mile in urban areas and 10 miles in rural areas. HbA1c measurements were obtained from electronic health records through November 2016. The relationship among food insecurity, low physical food access, and glycemic control (as defined by HbA1c) was analyzed using hierarchical linear mixed models. RESULTS Three hundred and ninety-one participants were followed for a mean of 37 months. Twenty percent of respondents reported food insecurity, and 31% resided in an area of low physical food access. In adjusted models, food insecurity was associated with higher HbA1c (difference of 0.6% [6.6 mmol/mol], 95% CI 0.4-0.8 [4.4-8.7], P < 0.0001), which did not improve over time (P = 0.50). Living in an area with low physical food access was not associated with a difference in HbA1c (difference 0.2% [2.2 mmol/mol], 95% CI -0.2 to 0.5 [-2.2 to 5.6], P = 0.33) or with change over time (P = 0.07). CONCLUSIONS Food insecurity is associated with higher HbA1c, but living in an area with low physical food access is not. Food insecurity screening and interventions may help improve glycemic control for vulnerable patients.
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Affiliation(s)
- Seth A Berkowitz
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA .,Diabetes Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Andrew J Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Giselle Corbie-Smith
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.,Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Hilary K Seligman
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA.,Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Sarah A Ackroyd
- Department of Obstetrics, Gynecology & Reproductive Sciences, Temple University Hospital, Philadelphia, PA
| | - Lily S Barnard
- University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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47
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Zibelli A. The Hungry Cancer Patient: A Case of Money Ill Spent. Popul Health Manag 2018; 21:433-434. [PMID: 29393804 DOI: 10.1089/pop.2017.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Allison Zibelli
- Division of Regional Cancer Care, Sidney Kimmel Cancer Center, Thomas Jefferson University , Philadelphia, Pennsylvania
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48
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Joshi K, Smith S, Bolen SD, Osborne A, Benko M, Trapl ES. Implementing a Produce Prescription Program for Hypertensive Patients in Safety Net Clinics. Health Promot Pract 2018; 20:94-104. [DOI: 10.1177/1524839917754090] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction. Although community–clinical linkages can improve chronic disease management, little is known regarding strategies for program implementation. We describe implementation of a unique produce prescription program for patients with hypertension (PRxHTN) involving 3 safety net clinics and 20 farmers’ markets (FMs). Strategy. Safety net clinics were invited to participate, and provider-leads received assistance in (1) developing a process flow to screen for food insecurity among hypertensive adults for program referral, (2) integrating the program into their electronic health record for scheduling, and (3) counseling patients on PRxHTN/FM use. Research staff met with clinics twice monthly. FM managers were trained on maintaining PRxHTN voucher redemption logs. Discussion. A total of 7 diverse providers screened 266 patients over 3 months; 224 were enrolled. Twelve FM, including one newly established at a clinic through provider–FM manager collaboration, redeemed over $14,500 of the $10 PRxHTN vouchers. We describe several strategies that can be used to prepare for and overcome implementation challenges including organizational and staff selection, facilitative administration, and clinical training and consultation. Conclusion. The PRxHTN program offers a flexible implementation process allowing clinics to successfully adapt their workflow to suit their staffing and resources.
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Affiliation(s)
- Kakul Joshi
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Shari D. Bolen
- The Center for Health Care Research and Policy at MetroHealth/Case Western Reserve, Cleveland, OH, USA
- Better Health Partnership, Cleveland, OH, USA
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49
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van Ommen B, Wopereis S, van Empelen P, van Keulen HM, Otten W, Kasteleyn M, Molema JJW, de Hoogh IM, Chavannes NH, Numans ME, Evers AWM, Pijl H. From Diabetes Care to Diabetes Cure-The Integration of Systems Biology, eHealth, and Behavioral Change. Front Endocrinol (Lausanne) 2018; 8:381. [PMID: 29403436 PMCID: PMC5786854 DOI: 10.3389/fendo.2017.00381] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/26/2017] [Indexed: 12/23/2022] Open
Abstract
From a biological view, most of the processes involved in insulin resistance, which drives the pathobiology of type 2 diabetes, are reversible. This theoretically makes the disease reversible and curable by changing dietary habits and physical activity, particularly when adopted early in the disease process. Yet, this is not fully implemented and exploited in health care due to numerous obstacles. This article reviews the state of the art in all areas involved in a diabetes cure-focused therapy and discusses the scientific and technological advancements that need to be integrated into a systems approach sustainable lifestyle-based healthcare system and economy. The implementation of lifestyle as cure necessitates personalized and sustained lifestyle adaptations, which can only be established by a systems approach, including all relevant aspects (personalized diagnosis and diet, physical activity and stress management, self-empowerment, motivation, participation and health literacy, all facilitated by blended care and ehealth). Introduction of such a systems approach in type 2 diabetes therapy not only requires a concerted action of many stakeholders but also a change in healthcare economy, with new winners and losers. A "call for action" is put forward to actually initiate this transition. The solution provided for type 2 diabetes is translatable to other lifestyle-related disorders.
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Affiliation(s)
- Ben van Ommen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Suzan Wopereis
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Pepijn van Empelen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Hilde M. van Keulen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Wilma Otten
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Marise Kasteleyn
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Johanna J. W. Molema
- Netherlands Organization for Applied Scientific Research (TNO), Department of Work Health Technology, Leiden, Netherlands
| | - Iris M. de Hoogh
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Niels H. Chavannes
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Mattijs E. Numans
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Andrea W. M. Evers
- Department of Health, Medical and Neuropsychology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Hanno Pijl
- Leiden University Medical Center (LUMC), Department of Internal Medicine, Leiden, Netherlands
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50
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Pooler JA, Hoffman VA, Karva FJ. Primary Care Providers' Perspectives on Screening Older Adult Patients for Food Insecurity. J Aging Soc Policy 2017; 30:1-23. [PMID: 28768107 DOI: 10.1080/08959420.2017.1363577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Food insecurity has been associated with poor health and health outcomes among older adults, yet food assistance resources are available and underutilized. Routine screening and referral for food insecurity in primary care is one avenue to connect food-insecure older adults with available resources. This qualitative study aims to better understand the beliefs of primary care providers (PCPs) about food security screening and referrals in a primary care setting and perceived barriers to implementation. PCPs (n = 16) who have older adult patients but do not routinely screen for food insecurity were interviewed by phone. PCPs recognize the importance of food security for older patients and discuss nutrition and food access with patients under certain circumstances. Concerns emerged with regard to implementing a systematic screening and referral process: limited time to meet with patients, a lack of resources for addressing food insecurity, and prioritizing food insecurity at both the health system and the patient levels. Despite perceived challenges, PCPs are receptive to the idea of systematically screening and referring patients to external resources for food assistance and support. Barriers could be addressed by health systems prioritizing food insecurity as a health concern and public and private payers providing reimbursement for screening.
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Affiliation(s)
- Jennifer A Pooler
- a Senior Research Associate, Advanced Analytics Division, IMPAQ International, LLC , Windham , Maine , USA
| | - Vanessa A Hoffman
- b Senior Research Analyst, Labor and Human Services Division , IMPAQ International, LLC , Washington , DC , USA
| | - Fata J Karva
- c Research Analyst, Education Division , IMPAQ International, LLC , Washington , DC , USA
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