Purpose and Objectives We conducted a mixed-methods process and outcome evaluation for a statewide fruit and vegetable prescription program. The process evaluation assessed program implementation, identified opportunities for quality improvement, and provided recommendations for future programmatic activities. The outcome evaluation measured how the program affected purchases of fruits and vegetables among low-income patients and patient satisfaction with the program. Intervention Approach The Washington State Department of Health (WA DOH) partnered with public and private health care systems, public health agencies, a community-based organization, and a supermarket chain to launch a fruit and vegetable prescription program in 2016. The prescription was a $10 voucher redeemable for fruits and vegetables at any one of 169 participating supermarkets. Prescriptions were distributed to eligible low-income patients in clinics and community settings. Evaluation Methods WA DOH reviewed quarterly reports, meeting minutes and notes, telephone call logs, and email logs to solicit feedback on program implementation processes. We calculated overall prescription redemption rates on the basis of the number of prescriptions distributed by implementing partners and the number of prescriptions redeemed at participating supermarkets. We assessed patient satisfaction through a web-based survey. The study period was July 1, 2016, through June 30, 2018. Results Best practices for implementation included using the prescription to improve patient engagement and retention and connect patients to additional services, and working in the community to enhance program support and uptake. Overall, $154,810 in fruit and vegetable prescriptions were redeemed during the study period (54.4% redemption rate). Most survey respondents (88.2%) reported eating more fruits and vegetables than previously as a result of the prescription. Implications for Public Health Fruit and vegetable prescriptions are an effective way to increase affordability of healthy foods for low-income patients. These programs are scalable and translatable across various types of patient–provider encounters.

No abstract

People with low incomes suffer disproportionately from diet-related chronic diseases and may have fewer resources to manage their diseases. The “food as medicine” movement encourages healthcare systems to address these inequities while controlling escalating healthcare costs by integrating interventions such as produce prescriptions, in which healthcare providers distribute benefits for fruit and vegetable purchases. The purpose of this study was to identify perceived facilitators and barriers for designing and implementing produce prescriptions within the healthcare system. Nineteen semi-structured in-depth interviews were conducted with experts, and interviews were analyzed using thematic analysis. Overall, interviewees perceived that produce prescriptions could impact patients’ diets, food security, disease management, and engagement with the healthcare system, while reducing healthcare costs. Making produce prescriptions convenient to use for patients, while providing resources to program implementers and balancing the priorities of payers, will facilitate program implementation. Integrating produce prescriptions into the healthcare system is feasible but requires program administrators to address implementation barriers such as cost and align complex technology systems (i.e., electronic medical records and benefit/payment processing). Engaging patients, clinics, retailers, and payers in the design phase can improve patient experience with a produce-prescription program; enhance clinic and retail processes enrolling patients and redeeming benefits; and ensure payers can measure outcomes of interest.

Improvements to correctional facilities’ food environment can provide healthier food and beverage options for incarcerated individuals, a population disproportionately affected by chronic disease. This article describes efforts to increase healthy options in the commissary program at Washington State correctional facilities from 2017 to 2019, and the role of a multidisciplinary collaboration between the state’s Department of Corrections, Department of Health, and Statewide Family Council. Through the development, implementation, and promotion of nutrition standards, the nutritional quality of foods and beverages in the commissary program improved.