Produce prescription programs aim to improve food insecurity (FI) and nutrition but their effectiveness is unclear. We conducted a pilot study to demonstrate the feasibility and explore the potential impact of a family-based, home-delivery produce prescription and nutrition education program. We measured enrollment, satisfaction, participation, and retention as measure of feasibility. Adult participants answered pre-post self-report questionnaires assessing FI, child and adult fruit and vegetable intake, and culinary literacy and self-efficacy. To understand participants’ lived experiences, qualitative interviews were conducted at the 6-month time point. Twenty-five families were enrolled. Feasibility measures indicate participants were generally satisfied with the program but there were important barriers to participation. Qualitative data revealed themes around reduced food hardship, healthy eating, budget flexibility, and family bonding. Fruit and vegetable consumption increased in a small subgroup of children, but post-intervention intake remained below recommended levels, particularly for vegetables. FI scores were not significantly different post-intervention, but qualitative findings indicated improved access and reliability of food. This is the first intervention of its kind to be evaluated for feasibility and our results suggest the intervention is well-received and supportive. However, further study, with a larger sample size, is needed to understand factors influencing participation and assess effectiveness.
Objectives: To estimate the cost-effectiveness of alternative
risk-dictated strategies utilizing prophylactic tranexamic acid (TXA)
for the prevention of postpartum hemorrhage. Design: Cost-utility
analysis using a Markov decision-analytic model. Setting: All US labor
and delivery units. Population: A cohort of 3.8 million women delivering
in the US. Methods: We constructed a microsimulation-based Markov
decision-analytic model estimating the lifetime costs and benefits of
three alternative risk-dictated strategies for TXA prophylaxis versus
the status quo (no TXA). Each strategy differentially modified
risk-specific hemorrhage probabilities by preliminary estimates of TXA’s
prophylactic efficacy. Costs and benefits were considered from the
healthcare system and societal perspectives. Main outcome measures:
Incremental costs, quality-adjusted life-years (QALYs), and adverse
maternal outcomes averted. Results: All TXA strategies were dominant
versus the status quo, implying that they were more effective while also
being cost-saving. Providing TXA to all delivering women irrespective of
hemorrhage risk assignment produced the most favorable results overall,
with estimated cost savings greater than $670 million and approximately
149,505 hemorrhage cases, 2,933 hysterectomies, and 70 maternal deaths
averted, per annual cohort. Threshold analysis suggested that TXA is
likely to be cost-saving for health systems at costs below $184 per
gram. Conclusions: Our findings suggest that routine prophylaxis with
TXA would likely result in substantial cost-savings and reductions in
adverse maternal outcomes in this context. The integrity of this
conclusion is maintained across all risk-dictated strategies, even when
the cost of TXA is significantly higher than what is supported in the
literature.
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