RESUMO
INTRODUCTION: Food insecurity (FI), defined as "limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways," affects over 12% of US households. Embarrassment persists for patients with FI, and due to the potential consequences of FI, including increased utilization of the health care system, it is important to find causes and potential interventions for FI. The purpose of this project was to better understand FI from the patient perspective, including contributing factors, perceived health effects, and helpful interventions. METHODS: Interviews (N=21) were conducted with suburban community residency clinic patients who screened positive for FI in the last 12 months. Six open-ended questions and a ranking question examined contributors to FI, effects of FI, perceptions of clinic intervention helpfulness, and ideas for novel interventions. RESULTS: Patients identified lack of income (85.7%) as the primary issue they faced. Secondary identified issues were lack of transportation (38.1%), too much debt (33.3%), and food assistance programs not providing for all needs (33.3%). FI effects on patients' health included difficulty adhering to specialized diets and the need to modify eating patterns due to lack of food. Surprisingly, 28.6% perceived no FI related-health effects. Patients felt that the most valuable clinic intervention was provision of urgent need food boxes, followed by FI screening and referrals to community food resources. CONCLUSIONS: Frequent FI screening is in itself useful to patients. Screening paired with community food resource referrals and urgent-need food boxes are the most helpful interventions according to patients.
RESUMO
INTRODUCTION: Food insecurity (FI) is defined as limited or uncertain access to enough nutritious food for all household members to lead an active and healthy life. In 2017, roughly 12% of US households reported FI. FI screening is not standard practice despite FI's association with poor health outcomes. This study compared FI screening strategies in a community-based family medicine residency clinic to determine which strategies identified the largest number of FI patients. METHODS: We conducted this study using a validated two-question screening tool with high sensitivity and specificity for identifying FI. Three implementation strategies of the screening tool were tested: two clinician-initiated and one staff-initiated. Data measured included opportunities to screen, patients actually screened, and the number of positive (disclosure) responses. RESULTS: Clinician-initiated screening rates increased when clinicians followed a standard note template with embedded FI questionnaire vs no template (58.6% vs 7.1%). Despite this improvement, staff-initiated screening returned an even higher screening rate (95.2%). The disclosure of FI determined by staff-initiated screening was also higher (12.2%, similar to previously published data) than clinician-initiated screening (2.3%). CONCLUSIONS: Staff-initiated screening for FI was the best way of identifying FI patients and yielded results consistent with local and national estimates. Clinicians did not screen patients for FI often enough for this approach to be effective, but embedding FI screening into templated notes improved clinician screening rates. Disclosure of FI when staff conducted screening far exceeded disclosure when screening was initiated by clinicians.
