Primary Care and Food Bank Collaboration to Address Food Insecurity: A Pilot Randomized Trial

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Abstract

Food insecurity is common in the United States and linked to poor control of conditions influenced by diet. We conducted a pilot randomized trial to test whether a novel partnership between a primary care practice and a municipal food bank would improve control of type 2 diabetes among patients with food insecurity. Participants received food bank produce delivered twice monthly to the practice site, brief teaching from a food bank dietitian, and home-based education from a community health worker. After 6 months, glycosylated hemoglobin decreased (absolute change) by 3.1% in the intervention group vs 1.7% in the control group ( P = .012). Scores on Starting the Conversation–Diet, a brief dietary measure, improved in the intervention group by 2.47 on a 14-point scale ( P < .001). Body mass indexes (BMIs) were unchanged. In this early-stage study, onsite collaboration between primary care and a regional food bank generated clinically meaningful reductions in HbA _1c and improvements in diet.

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The Intersection between Food Insecurity and Diabetes: A Review

Enza Gucciardi, Mandana Vahabi, Nicole Norris … (2014)

Access to sufficient, safe, and nutritious food not only affects the health of people who experience food insecurity, but also their ability to manage health conditions, such as diabetes. When people find it difficult to access sufficient food, tailoring their food selection to a diabetes regimen is even more difficult. Food insecurity in North America is consistently more prevalent among households with a person living with diabetes, and similarly, diabetes is also more prevalent in food-insecure households. Diabetes management can be stressful due to the many required responsibilities; when compounded with food insecurity, it becomes an even greater challenge. As a result, many food-insecure diabetics find themselves caught between competing priorities such as procuring food, prescribed medications and supplies for diabetes, and managing other living expenses, potentially worsening their condition and overall health. Healthcare providers should be aware and informed about the significant role that food security can play in the prevention and management of diabetes.

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Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals.

Ben Paxton, L A Strycker, A Ammerman … (2010)

For chronic disease prevention and management, brief but valid dietary assessment tools are needed to determine risk, guide counseling, and monitor progress in a variety of settings. Starting The Conversation (STC) is an eight-item simplified food frequency instrument designed for use in primary care and health-promotion settings. This report investigates the feasibility, validity, and sensitivity to change of the STC tool, a simplified screener instrument for assessment and counseling. Data from an ongoing practical efficacy study of type 2 diabetes patients in a diverse population (N=463) were used to document STC validity, robustness, stability, and sensitivity to change from baseline to 4 months. Data were collected from 2008 to 2010, and they were analyzed for this report in 2010. The eight STC items and summary score performed well. STC items and the summary score were moderately intercorrelated (r =0.39-0.59, p<0.05). The STC summary score was significantly correlated with the NCI fat screener at baseline (r =0.39, p<0.05), and change in the STC summary score correlated with reduction in percentage of calories from fat (r =0.22, p<0.05) from baseline to 4 months. The STC was sensitive to the intervention, with intervention participants improving significantly more than controls on the summary score (M=1.16 vs 0.46, p<0.05). The brief STC is a relatively simple, valid, and efficient tool for dietary assessment and intervention in the clinical setting. It is available in English and Spanish and is in the public domain. Researchers and practitioners are encouraged to assess its utility in other settings and with other dietary interventions. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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Effect of improved glycemic control on health care costs and utilization.

N Sandhu, L Grothaus, Andrew McCulloch … (2001)

Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur. To determine whether sustained improvements in hemoglobin A(1c) (HbA(1c)) levels among diabetic patients are followed by reductions in health care utilization and costs. Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State. All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA(1c) measured at least once per year in 1992-1994 (n = 4744). Patients whose HbA(1c) decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n = 732). All others were classified as unimproved (n = 4012). Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997. Diabetic patients whose HbA(1c) measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA(1c) measurements (10.0% vs 7.7%; P /=10%) for these years but appeared to be unaffected by presence of complications at baseline. Beginning in the year following improvement (1994), utilization was consistently lower in the improved cohort, reaching statistical significance for primary care visits in 1994 (P =.001), 1995 (P<.001), 1996 (P =.005), and 1997 (P =.004) and for specialty visits in 1997 (P =.02). Differences in hospitalization rates were not statistically significant in any year. Our data suggest that a sustained reduction in HbA(1c) level among adult diabetic patients is associated with significant cost savings within 1 to 2 years of improvement.

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Author and article information

Journal

Journal ID (nlm-ta): Nutr Metab Insights

Journal ID (iso-abbrev): Nutr Metab Insights

Journal ID (publisher-id): NMI

Journal ID (hwp): spnmi

Title: Nutrition and Metabolic Insights

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Electronic): 1178-6388

Publication date (Electronic): 29 July 2019

Publication date Collection: 2019

Volume: 12

Electronic Location Identifier: 1178638819866434

Affiliations

[1 ]Department of Family and Community Medicine, UT Health San Antonio, San Antonio, TX, USA

[2 ]San Antonio Food Bank, San Antonio, TX, USA

Author notes

[*]Robert L Ferrer, Department of Family and Community Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA. Email: FerrerR@ 123456uthscsa.edu

Author information

Robert L Ferrer https://orcid.org/0000-0002-9377-9329

Article

Publisher ID: 10.1177_1178638819866434

DOI: 10.1177/1178638819866434

PMC ID: 6664622

PubMed ID: 31384130

SO-VID: 0d3a1529-2390-4031-bce8-521c68f29263

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 2 July 2019

Date accepted : 6 July 2019

Funding

Funded by: national center for advancing translational sciences, FundRef https://doi.org/10.13039/100006108;

Custom metadata

cover-date January-December 2019

Keywords: food insecurity,primary health care,diabetes mellitus,type 2,vulnerable populations

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Keywords: food insecurity, primary health care, diabetes mellitus, type 2, vulnerable populations

Primary Care and Food Bank Collaboration to Address Food Insecurity: A Pilot Randomized Trial

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SDG 2: Zero Hunger

Most cited references 13

The Intersection between Food Insecurity and Diabetes: A Review

Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals.

Effect of improved glycemic control on health care costs and utilization.

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