A Systematic Scoping Review of How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations

Abstract

Background There is compelling evidence on the impact of diet as preventative medicine, and with rising health care costs healthcare organizations are attempting to identify interventions to improve patient health outcomes. Objectives The purpose of this systematic scoping review was to characterize existing healthcare organization–based interventions to improve access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact of identified interventions on dietary intake and health outcomes. Methods Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from 1 January 1990 to 31 December 2019. To be selected for inclusion, original studies must have included a healthcare organization and have had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Practice Project tool was used to assess study quality in 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts). Results A total of 8876 abstracts were screened, yielding 44 manuscripts or abstracts from 27 programs. Six program models were identified: 1) a cash-back rebate program, 2) F&V voucher programs, 3) garden-based programs, 4) subsidized food box programs, 5) home-delivery meal programs, and 6) collaborative food pantry–clinical programs. Only 6 of 27 studies included a control group. The overall quality of the studies was weak due to participant selection bias and incomplete reporting on data collection tools, confounders, and dropouts. Given the heterogeneity of outcomes measured and weak study quality, conclusions regarding dietary and health-related outcomes were limited. Conclusions Healthcare-based initiatives to improve patient access to F&V are novel and have promise. However, future studies will need rigorous study designs and validated data collection tools, particularly related to dietary intake, to better determine the effect of these interventions on health-related outcomes.

Feasibility of a Home-Delivery Produce Prescription Program to Address Food Insecurity and Diet Quality in Adults and Children

“…Produce prescription programs have been implemented in primary care settings to address FI and diet quality and many targeting adults have been evaluated for feasibility and impact [ 25 , 26 ]. Few programs specifically addressing families with young children have been evaluated and all, except one [ 27 ], have used a client-choice, external-to-the-home model of providing supplemental produce resources (e.g., farmer’s market or food pantry vouchers) [ 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

The Promise and Uncertainty of Fruit and Vegetable Prescriptions in Health Care

“…Current challenges include infrequent screening in health care systems or the electronic health record for food security or especially diet quality, no broad coverage for Food Is Medicine interventions in Medicare and Medicaid, and a dearth of standardized toolkits to provide health care executives and clinicians with pragmatic implementation frameworks. Conversely, the concept of Food Is Medicine is gaining public visibility; is founded on compelling evidence for health benefits of phytonutrientrich, minimally processed foods; fits into Affordable Care Act requirements for Community Health Needs Assessments by nonprofit hospitals; and is foundational to addressing social determinants in health care (2). Growing shifts toward valuebased accountable care and risk-sharing payments should accentuate this interest.…”

“…Growing shifts toward valuebased accountable care and risk-sharing payments should accentuate this interest. Robust evaluation of ongoing and future interventions is essential to assess dietary, health, and utilization impacts, hopefully accelerating our understanding of the many research gaps identified by Veldheer et al (2).…”

A Case for Using Electronic Health Record Data in the Evaluation of Produce Prescription Programs

“… 2 Strategies to help reduce food insecurity among patients include supporting enrollment in federal food assistance programs, providing information and access to on-site food pantries, referring patients to local community resources (eg, food banks), and increasingly, offering referrals for direct financial incentives or subsidies for fruits and vegetables. 3 , 4 The last 5 years have seen tremendous growth in the prevalence and evaluation of such programs, often referred to as produce prescriptions, though it is difficult to quantify since so many operate within health systems or local community groups. A recent landscape analysis reported more than 100 programs launched between 2010 and 2020.…”