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Food Rx: Mobilizing Outpatient Clinics to Prescribe Healthy Food for Underserved Patients Patients with diabetes in underserved communities face significant challenges to eating healthy, including: • limited nutrition education • little accessible and affordable healthy foods To address these barriers, it may be feasible for clinics to integrate community nutrition resources into diabetes care Statement of Problem 1. Develop and pilot a program that integrates community nutrition resources into diabetes care Use a provider’s prescription as a channel for: • providing nutrition education • raising awareness of local food resources • offering financial incentives for healthy food Collaborate with: • six local clinics • a local farmers market (Figure 1) • a national retail pharmacy expanded to sell healthy food (Figure 2) 2. Assess the feasibility of this collaborative program 3. Assess the impact of program on utilization of community resources for healthy food on the South Side of Chicago, a region with food deserts Objectives of Program Food Rx leverages a novel platform—the provider’s prescription—to link clinics with nutrition resources on the South Side of Chicago Food Rx was collaboratively and iteratively developed by the clinics, community partners, and research team Providers prescribe Food Rx to diabetes patients at six practices: • 4 federally-qualified health centers • 1 academic primary care center • 1 academic endocrinology clinic Food Rx includes: • Behavioral prescription (Figure 3) • Nutrition education handout (Figure 4) • Coupon for healthy food redeemable at local farmers market and 9 participating Walgreens stores (Figure 3) • Map of local food partners Description of Program Anecdotal evidence suggests that Food Rx may be a powerful tool to promote healthy food as part of diabetes treatment: • Providers report Food Rx is “empowering” • Patients report that the educational handout and coupon are helpful Dissemination of Rx may be impacted by provider factors: • Commitment to incorporating Food Rx into routine diabetes management plan • Time to introduce Rx and counsel patients • Competing clinical priorities for chronic disease management in this patient population • Familiarity with the community needs and resources Participating locations are likely strong determinant of use • Familiarity with Walgreens or farmers market sites • Existing store preferences Amount and structure of financial incentives affect redemption • Value of voucher or coupon • Minimum purchase requirement Key Lessons Food Rx shows promise as a model for integrating community resources into clinical care of underserved patients and can be implemented in diverse clinical settings The collaborative process of designing Food Rx enabled program to meet the demands of each stakeholder to: • Maintain clinic workflow • Ensure integrity of research methodology • Uphold partners’ organizational priorities Promising plans for further development include: 1. Incorporating non-physician staff in Rx dissemination (e.g. nutritionists/medical assistants) 2. Offering store and market tours to increase familiarity with resources and bolster nutrition education 3. Providing multiple coupons redeemable over time to increase incentive to adopt new shopping habits Findings to Date Anna P. Goddu MSc 1 , Tonya S. Roberson DT BA 1 , Katie E. Raffel BS MS4 2 , Marshall H. Chin MD MPH 1 , Monica E. Peek MD MPH 1 1 Section of General Internal Medicine, Department of Medicine, University of Chicago. 2 Pritzker School of Medicine, University of Chicago. Acknowledgments: The authors would like to thank Denise Scarpelli and Danny Burke for their help acquiring data. This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (Grant No. R18DK083946), the Chicago Center for Diabetes Translation Research (Grant No. P30 DK092949), the Diabetes Research and Training Center (Grant No. P60 DK20595), and the Alliance to Reduce Disparities in Diabetes of the Merck Foundation. Marshall Chin is supported by an NIDDK Midcareer Investigator Award in Patient-Oriented Research (Grant No. K24 DK071933). Measures of Success Regular check-ins with stakeholders with documentation of all anecdotal feedback Identification of purchasing trends through collection of coupon redemption data Qualitative exploration of barriers/facilitators to Rx utilization via in-depth interviews Figure 2: Walgreens site expanded to sell healthy foods Figure 1: Participating local farmers market Figure 3: Behavioral prescription with coupon on back Figure 4: Nutrition education handout
