By Melinda Young
The food pharmacy model is growing in popularity. Hospital Case Management offers this snapshot of several food pharmacy programs that have produced positive results for their target populations.
• Virtua Mount Holly Hospital’s Food Farmacy program. Virtua Health opened its first Food Farmacy in 2018. It expanded to a second location at its Camden campus in 2019.
“At first, we called it a food pantry, but we adjusted the name because we see food as a form of medicine,” explains April Schetler, MS, RD, FAND, an assistant vice president of community health engagement at Virtua Health, headquartered in Marlton, NJ.
An estimated 15% of Camden County, NJ, residents do not know where their next meal will come from, according to Feeding America’s 2020 projected food insecurity data.1 “Many of these people are children,” Schetler adds. “There are few things as rewarding as watching a group of school-age children shopping at our Mobile Farmers Market. They deliberate over whether they want apples or oranges, and they can identify things like chard and squash.”
This experience helps build healthy habits in children and will hopefully lead to a multigenerational improvement. “We can help entire families enjoy a heightened quality of life through the power of a healthy diet,” Schetler says.
The program also focuses on patients with chronic illnesses who can alleviate symptoms by improving their diet and nutrition. “The Food Farmacy provides free, healthy foods to patients with diet-related chronic diseases and food insecurity,” Schetler says. “Patients participate in a structured, comprehensive six-month program led by a registered dietitian.”
The program includes nutrition education specific to each patient’s diet-related condition. The dietitian offers recipes and meal preparation advice. The Food Farmacy team can offer support for patients’ other social needs.
“Thinking more long-term, we are also building relationships,” Schetler says. “Virtua Health is deeply embedded in the neighborhoods we serve; we have relationships with many wonderful not-for-profits.” The Food Farmacy serves as an entry point for connecting people to additional resources and services they may not have known existed, she adds.
Virtua Health’s Food Farmacy program also is one piece of the organization’s Eat Well programs, which are designed to address food insecurity.
“We have two vehicles that support food access by bringing healthy, affordable foods to the communities, where such things are not plentiful,” Schetler explains. “These are communities in which fast food restaurants and corner stores are more prevalent than comprehensive markets.”
The Eat Well Mobile Farmers Market and Eat Well Mobile Grocery Store sell foods at rates well below market prices. “In addition to addressing cost, we address the common problem of transportation,” Schetler says. “For those who do not have an easy or reliable way to get to a market, we bring the market to them.”
• Hurley Medical Center’s Food FARMacy. There are high rates of obesity and food insecurity in Genesee County, MI. There also is an 18% poverty rate. More than one-third of the population does not have access to a large grocery store, according to data on the county from FeedingAmerica.org.
The Food FARMacy has been a hit with case managers because it gives them a reliable place to refer patients who need help with nutrition and affording food, says Brittany Damerow, RDN, SNS, a coordinator and dietitian for the Food FARMacy at Hurley Medical Center in Flint, MI.
“A lot of times, there are not enough reliable resources for people. This is a great resource for our healthcare system and patients,” Damerow says. “Anybody can make a referral — nurses, case managers, social workers, and doctors — and they can refer patients to the program at any point in their care within the healthcare system.”
Patients visit the Food FARMacy and are assessed for their diagnoses and needed resources. “We take the time to screen for other barriers they might have, and we can help people access those resources in the community,” Damerow explains. “The Food FARMacy is a shorter-term program for people.”
With rising food costs and the extra Food Assistance Program ending, there will be a greater overall need for programs that help with budgeting, education, and supplemental foods. “In the past few months, we have been serving an average of 651 patients per month, and we are expecting this number to go up,” Damerow adds.
Patients receive 12 visits, with one visit each month. They receive a seven-day supply of healthy food, enough for their entire household. The program also offers nutritional education about patients’ disease states, and it focuses on the person’s overall health. They shop with a dietitian who can answer questions about their chronic disease.
“They’re given the opportunity and dignity to choose their own foods and what they would like for their household,” Damerow says. “We go around and shop with the patient and go over health and food choices.”
Options include canned food that is low in sodium, fresh produce, lean meat, and whole grains. The food is stored in an outpatient clinic with the diabetes center, a space separate from the hospital. Patients can select food from various aisles, much as they would in a grocery store.
“We even have a grocery cart and can put groceries in it, and we have reusable bags with our logo on them,” Damerow says. “We also offer meal kits. Every month, we create a new recipe for patients to try.”
The recipes can be vegetarian or focused on a theme, such as heart-healthy foods for National Heart Month. The recipes provide high fiber, lean protein, low sodium, and are diabetes friendly.
“We also offer seasonings, which can be very expensive for patients,” Damerow says. “We want to create an educational opportunity for patients to season their food without added salt.”
The Food FARMacy’s initial funding included a combination of grants and health system funds. The health system also pays for ongoing costs, including rent, overhead, and salaries.
Although the food assistance is short-term, the goal is to provide long-term education. “It creates the opportunity to speak with patients and meet them where they are,” Damerow says.
Food insecurity among these patients could be ongoing. The program’s solution is to give people a list of community resources, including local food banks. They also receive information about Meals on Wheels, budget coaching from the local United Way, and how to sign up for state food assistance. Those resources could help people obtain healthy foods on the weeks when do not visit the Food FARMacy and after their 12 visits are up.
“The feedback we’ve had is people having opened their eyes to health and their diseases,” Damerow says. “One patient said, ‘Wow, I didn’t realize how bad I felt until I started this program.’”
Other patients said they drink more water now and are getting more exercise. “It’s a great program to bridge the gap between healthcare and nutrition,” Damerow says.
• Geisinger’s Fresh Food Farmacy. The health system started the Fresh Food Farmacy program in 2017 to address two disturbing trends: the increasing rate of type 2 diabetes in its population, and increased rates of food insecurity, says Allison Hess, MBA, vice president of health services at Geisinger in Danville, PA.
Geisinger offered diabetes programs and education for patients, but the rates continued to rise. More action was needed.
“There started to be more of a prevalence in healthcare about the impact of social needs on health outcomes,” Hess explains. “We looked at literature and recognized the correlation between food insecurity and unmanaged type 2 diabetes, and we decided to do a test pilot.” The idea was to provide food as medicine for type 2 diabetes patients and see if this would lead to more positive health outcomes.
The outcomes have been positive. Patients recorded an average 2-2.4 reduction in A1c levels, fewer ED visits, fewer hospital readmissions, lower blood pressure, and overall better engagement of care among patients with diabetes.
“Our model is a little different because we actually built food banks with one on the hospital campus, where we repurposed an administrative building,” Hess explains. “Another one is in a food desert, and the third is in partnership with a federally qualified health center. We did the three models as a pilot program.”
The Fresh Food Farmacy offers items approved by a registered dietitian, and they meet nutritional guidelines. Patients can select from a variety of items, including frozen food options and whole grains.
“They can get up to 10 meals a week for themselves and [each member of] their entire household,” Hess says. “We have recipes that match the food in the food pantry. We have over 200 recipes for them now.” They also offer group classes and an evidence-based diabetes self-management class.
The only criterion for visiting the Food Farmacy is a diagnosis of type 2 diabetes with an A1c level of greater than 8. Patients must also report struggles with providing healthy food options.
“The program is intensive for three to six months, and from there it’s just food distribution,” Hess explains. “Because the food is funded through partnerships with Feeding America and local food bank distribution centers, we can provide food as long as they need it and are actively participating.”
The next model for the Fresh Food Farmacy is for the health system to partner with food banks to help them provide healthier and more nutritious options for people with chronic conditions. Partnerships and outreach are needed because even with three Fresh Food Farmacy locations, some people remain without ready access.
The challenge is expanding the program without building additional brick-and-mortar locations. “Instead, we can leverage existing community organizations and help them bring in better nutrition to have a broader outreach,” Hess explains. “The concept is more of a lifestyle management focus, which is a good model for anybody with a diet-responsive chronic condition.”
REFERENCE
- Hunger in New Jersey. Feeding America. 2023.
The food pharmacy model is growing in popularity. Hospital Case Management offers this snapshot of several food pharmacy programs that have produced positive results for their target populations.
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