Department of Pediatrics,
Center for Pediatric Clinical Effectiveness and PolicyLab, and.
Pediatrics. 2017 Jul;140(1). doi: 10.1542/peds.2017-0319. Epub 2017 Jun 20.
National organizations recommend pediatricians screen for food insecurity (FI). Although there has been growing research in urban practices, little research has addressed FI screening in suburban practices. We evaluated the feasibility, acceptability, and impact of screening in suburban practices.
We conducted a mixed methods study that implemented FI screening in 6 suburban pediatric primary care practices. We included all children presenting for either a 2-, 15-, or 36-month well-child visit ( = 5645). Families who screened positive were eligible to be referred to our community partner that worked to connect families to the Supplemental Nutrition Assistance Program. We conducted focus groups with clinicians to determine their perceptions of screening and suggestions for improvement.
Of the 5645 children eligible, 4371 (77.4%) were screened, of which 122 (2.8%) screened positive for FI (range: 0.9%-5.9% across practices). Of the 122 food-insecure families, only 1 received new Supplemental Nutrition Assistance Program benefits. In focus groups, 3 themes emerged: (1) Time and workflow were not barriers to screening, but concerns about embarrassing families and being unable to provide adequate resources were; (2) Clinicians reported that parents felt the screening showed caring, which reinforced clinicians' continued screening; (3) Clinicians suggested implementing screening before the visit.
We found it is feasible and acceptable for clinicians to screen for FI in suburban practices, but the referral method used in this study was ineffective in assisting families in obtaining benefits. Better approaches to connect families to local resources may be needed to maximize the effectiveness of screening in suburban settings.
国家组织建议儿科医生对粮食不安全（FI）进行筛查。尽管在城市实践中已经有越来越多的研究，但很少有研究涉及郊区实践中的 FI 筛查。我们评估了在郊区实践中进行筛查的可行性、可接受性和影响。
我们进行了一项混合方法研究，在 6 家郊区儿科初级保健实践中实施了 FI 筛查。我们纳入了所有因 2、15 或 36 个月的定期儿童健康检查前来就诊的儿童（=5645 名）。筛查呈阳性的家庭有资格被转介给我们的社区合作伙伴，以帮助家庭获得补充营养援助计划。我们与临床医生进行了焦点小组讨论，以了解他们对筛查的看法和改进建议。
在 5645 名符合条件的儿童中，有 4371 名（77.4%）接受了筛查，其中 122 名（2.8%）筛查出粮食不安全（各实践中的范围为 0.9%-5.9%）。在 122 个粮食不安全的家庭中，只有 1 个家庭获得了新的补充营养援助计划福利。在焦点小组讨论中，出现了 3 个主题：（1）时间和工作流程不是筛查的障碍，但担心使家庭尴尬和无法提供足够的资源是障碍；（2）临床医生报告说，父母认为筛查表明了关怀，这加强了临床医生继续进行筛查的意愿；（3）临床医生建议在就诊前实施筛查。
我们发现，临床医生在郊区实践中筛查 FI 是可行且可接受的，但本研究中使用的转介方法在帮助家庭获得福利方面效果不佳。可能需要更好的方法将家庭与当地资源联系起来，以最大限度地提高筛查在郊区环境中的效果。
