Design and Implementation of a Clinic-Based Food Pharmacy for Food Insecure, Uninsured Patients to Support Chronic Disease Self-Management

A Subsidized Healthy Food Prescription Program for Adults with type 2 Diabetes who are Experiencing Food Insecurity: Protocol for a Randomized Controlled Trial, Modelling and Implementation Studies

“…One approach to better address this problem is to assist patients who are experiencing food insecurity to purchase diabetes-appropriate foods through subsidized healthy food prescription programs. Preliminary evidence suggests that these programs may improve diet quality and self-reported health, while reducing food insecurity, hypertension and BMI, including within Indigenous communities [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. Notably, one $40 fruit and vegetable subsidy delivered to 65 low-income patients with persistent hyperglycemia over 13 weeks led to a 0.71% decline in A1C [56].…”

“…Despite some promising initial ndings, major knowledge gaps remain pertaining to the impact and optimal implementation of subsidized healthy food prescription programs. Most prior studies have been small and uncontrolled, and have examined a small number of self-reported outcomes using brief dietary [44,45,48,60,62] and/or food insecurity screeners [47,[50][51][52][53], and/or short descriptive surveys [44,58,60], rather than objective clinical outcomes. Prior programs have also subsidized the purchase of fruits and vegetables alone, without considering the relevance of entire dietary patterns to blood glucose levels and health outcomes [7,8].…”

An exploration of key barriers to healthcare providers’ use of food prescription (FRx) interventions in the rural South

“…Current healthcare literature generally identifies fruit and vegetable food prescriptions (FRx) as a viable clinical intervention for improving patients' dietary consumption patterns, improving patient health outcomes and aiding in the prevention or management of nutrition-related chronic diseases, such as obesity, diabetes and CVD. While there is no universal protocol or standard of practice specific to FRx, for the purposes of the current study, based on existing interventions and the literature, the authors define FRx as a health focused intervention used by clinical healthcare providers to encourage their patients to improve their dietary consumption patterns by increasing patient access to healthier foods and improving their nutritional literacy (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) . An emphasis on food access for food insecure individuals and disease management are also important provisions in FRx interventions.…”

“…Each of these methods is designed to add money to the household food budget, specifically for fresh fruits and vegetables. Eligibility for these interventions ranges from poor food security status to the presence of a chronic health conditions (obesity, diabetes, pre-diabetes) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) .…”

“…As currently implemented in the USA, FRx interventions rarely recruit through a medical provider but often rely on poor health or presence of a medical condition to determine eligibility (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) . Yet, studies that have evaluated interventions incorporating clinicians indicate that prescriptions supplied by physicians are generally more highly valued by patients because of the symbolic power and patientperceived authority of the recommendation (10) . This presents a particular dilemma for practitionersknowing that clinics are powerful resources in the implementation and effectiveness of FRx interventions, but not understanding the lack of clinic level adoption or involvement.…”