Pilot Plant-Based Lifestyle Medicine Program in an Urban Public Healthcare System: Evaluating Demand and Implementation

Abstract

Lifestyle interventions that optimize nutrition, physical activity, sleep health, social connections, and stress management, and address substance use, can reduce cardiometabolic risk. Despite substantial evidence that healthful plant-based diets are beneficial for long-term cardiometabolic health and longevity, uncertainty lies in how to implement plant-based lifestyle programs in traditional clinical settings, especially in safety-net contexts with finite resources. In this mixed-methods implementation evaluation of the Plant-Based Lifestyle Medicine Program piloted in a large public healthcare system, we surveyed participants and conducted qualitative interviews and focus groups with stakeholders to assess program demand in the eligible population and feasibility of implementation within the safety-net setting. Program demand was high and exceeded capacity. Participants’ main motivations for joining the program included gaining more control over life, reducing medication, and losing weight. The program team, approach, and resources were successful facilitators. However, the program faced administrative and payor-related challenges within the safety-net setting, and participants reported barriers to access. Stakeholders found the program to be valuable, despite challenges in program delivery and access. Findings provide guidance for replication. Future research should focus on randomized controlled trials to assess clinical outcomes as a result of program participation.

Change in cardiometabolic risk factors in a pilot safety-net plant-based lifestyle medicine program

“…We have previously published findings that the pilot PBLM Program is feasible with high levels of patient satisfaction and interest ( 31 ). In this study, we now demonstrate a significant reduction in key biomarkers of cardiometabolic disease, including HbA1c, body weight, lipids, and diastolic blood pressure.…”

“…A detailed description of the 1-year pilot of the PBLM Program has been published previously ( 31 ). Briefly, the PBLM Program at NYC Health + Hospitals/Bellevue, a large public hospital in New York City, was designed to provide structured, interdisciplinary support for lifestyle changes to improve patients’ cardiometabolic health.…”

“…The program’s goal is to help patients adopt a healthful plant-based eating pattern and other positive behaviors. The evaluation of the pilot program focused primarily on feasibility of implementation and demand for the program ( 31 ). We found demand for the program was high, far exceeding capacity, and patients reported joining the program in order to gain control over their lives, reduce their medication burden, and lose weight.…”

Patient-Reported Outcomes from a Pilot Plant-Based Lifestyle Medicine Program in a Safety-Net Setting

“…The PBLM program was a one-year pilot clinical program implemented in an adult primary care setting in a large urban safety-net healthcare system in New York City. Details of and updates made to the PBLM program have been described in detail elsewhere [ 36 ]. In brief, the program was designed to help patients reduce their cardiometabolic risk through positive lifestyle changes.…”