Evaluation of a COVID-influenced Curriculum to Address Food Insecurity in a Detroit Family Medicine Residency Clinic

Abstract

To date, numerous projects have demonstrated that an ongoing limited access to nutritionally dense food (i.e., "food insecurity") plays a key role in the overall health and wellbeing of lower income at-risk populations. METHODSFor this 2019-2020 pilot project, the resident physician authors first created and administered a simple five-item questionnaire screening process to systematically identify food insecure patients in their metropolitan Detroit residency clinic. A sample of patients who had been identified as food insecure and pre-diabetic were then provided improved access to healthy foods, supplemented by a six-week program of nutritional education classes using a nationally recognized "Cooking Matters'' six-week long curriculum with a licensed chef and nutrition educator RESULTSAfter institutional review board approval, the authors enrolled a sample of 10 adults. The authors successfully measured both pre-and post-program Hemoglobin A1c (HbA1C) levels for all participants who completed the required course and subsequent clinic follow up visits. Using a series of initial non-parametric Wilcoxon Signed Rank matched pair tests, post-program follow-up at three months revealed statistically significant reductions in documented HbA1c levels from baseline for six enrolled patients (W=1, Z = -2.226, p = 0.026) and six-month follow up (i.e., more than four months after completion of the program) (W = 1, Z = -2.060, p = 0.039). In post-program surveys, each respondent indicated that they found the class content to be generally beneficial to increase their nutritional knowledge. CONCLUSIONSIn the authors' setting, this food insecurity program has subsequently led to a more formal screening process to evaluate and identify food insecure patients. The authors discuss the scheduling difficulties they experienced from the COVID-19 pandemic for their sample patients. However, these pilot results suggest that prolonged benefits may require ongoing "virtual" teaching sessions with pre-diabetic patients to address the complex factors influencing food insecurity levels identified in similar inner-city settings.Ghouse A, Gunther W, Sebastian M. Evaluation of a COVID-influenced Curriculum to Address Food Insecurity in a Detroit Family Medicine Residency Clinic. SMRJ. 2020;5(2).

Healthcare-based food assistance programmes in the United States: a scoping review and typology

“…Eighteen ( 12 , 15 , 18 , 19 , 23 , 34 , 35 , 38 , 43 , 45 , 47 , 50 , 53 , 55 , 58 , 59 , 60 , 62 , 63 , 66 , 69 ) of the thirty-five programmes discussed screening for food insecurity. Of these, six programmes ( 23 , 38 , 43 , 45 , 55 , 62 , 70 ) used the USDA Household Food Security Survey, with number of items ranging from two to eighteen.…”

“…One programme ( 54 ) was created explicitly for pregnant women, four ( 35 , 44 , 50 , 57 ) for children, and one ( 49 ) for families with either pregnant women or children under age seven. Fourteen ( 12 , 15 , 18 , 34 , 35 , 45 – 47 , 50 , 53 , 55 , 58 – 60 , 63 , 69 ) programmes required patients to screen positive for food insecurity in order to be enrolled. One programme ( 23 , 43 ) required patients to be eligible for the Supplemental Nutrition Assistance Programme (SNAP) or to screen positive for food insecurity.…”

“…Fourteen programmes ( 15 , 18 , 32 , 33 , 35 , 45 , 46 , 48 , 52 , 53 , 55 , 62 – 64 , 68 ) provided food directly to patients. Of these, eight ( 12 , 15 , 18 , 45 , 46 , 48 , 53 , 68 ) provided both produce and non-perishable foods, three ( 32 , 33 , 52 , 64 ) provided only produce, one [40] provided only non-perishable foods, and one ( 35 ) provided baby formula.…”

“…( 46 , 53 ) One programme ( 52 ) utilised an on-site community garden. Two programmes ( 12 , 46 ) that provided food directly to patients offered a choice of food, while ten programmes ( 15 , 18 , 32 , 33 , 45 , 48 , 52 , 53 , 63 , 64 , 68 ) provided participants with a pre-packed bag. Three programmes ( 12 , 18 , 46 ) provided medically-tailored foods, that is, foods that met the nutritional requirements of the patient based on their medical status, as designated by their physician or registered dietitian.…”

“…Ongoing All pediatric patients of practice [all receive Rx regardless of need] Schlosser, 2019a (58) ; Schlosser, 2019b (59) ; & Joshi, 2019 (60) Cuyahoga County, OH Continued children, and one (49) for families with either pregnant women or children under age seven. Fourteen (12,15,18,34,35,(45)(46)(47)50,53,55,(58)(59)(60)63,69) programmes required patients to screen positive for food insecurity in order to be enrolled. One programme (23,43) required patients to be eligible for the Supplemental Nutrition Assistance Programme (SNAP) or to screen positive for food insecurity.…”