Food Rx: Mobilizing Outpatient Clinics to Prescribe Healthy Food for Underserved Patients

Anna P. Goddu
1 MSc ,

Tonya S. Roberson DT

1 BA ,

Katie E. Raffel BS

2 MS4 ,

Marshall H. Chin MD
2 Pritzker

1 MPH ,

Monica E. Peek MD

1 MPH

1 Section

of General Internal Medicine, Department of Medicine, University of Chicago.

School of Medicine, University of Chicago.

Statement of Problem
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

Description of Program
Food Rx leverages a novel platformthe providers prescriptionto 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

Findings to Date
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

Objectives of Program
1. Develop and pilot a program that integrates community nutrition resources into diabetes care Use a providers 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

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

Figure 3: Behavioral prescription with coupon on back

Figure 4: Nutrition education handout

Figure 1: Participating local farmers market

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

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).