Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
J Nutr. 2020 Nov 19;150(11):2859-2873. doi: 10.1093/jn/nxaa209.
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.
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.
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).
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.
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.
饮食作为预防医学具有重要影响，随着医疗保健成本的不断上升，医疗机构正在试图寻找干预措施以改善患者的健康结果。
本系统范围综述的目的是描述现有的基于医疗机构的干预措施，以改善患者人群获得水果和蔬菜（F&V）的机会。此外，我们旨在回顾已确定的干预措施对饮食摄入和健康结果的影响。
从 1990 年 1 月 1 日至 2019 年 12 月 31 日，在 PubMed®（MEDLINE®）、Embase®、CINAHL®和 Cochrane Library®中搜索标题和摘要。为了入选，原始研究必须包含医疗机构，并具有以增加门诊自然环境中患者获得或提供新鲜 F&V 为重点的方案。使用有效公共卫生实践项目工具（Effective Public Health Practice Project tool）评估 6 个领域（选择偏倚、研究设计、混杂因素、盲法、数据收集方法以及退出和辍学）的研究质量。
共筛选了 8876 篇摘要，从 27 个方案中获得了 44 篇论文或摘要。确定了 6 种方案模型：1）现金返还回扣方案，2）F&V 代金券方案，3）以花园为基础的方案，4）补贴食品箱方案，5）家庭送餐方案，6）合作食品储藏室-临床方案。27 项研究中仅有 6 项包括对照组。由于参与者选择偏倚以及数据收集工具、混杂因素和辍学情况的报告不完整，研究的总体质量较差。鉴于所测量的结果存在异质性和研究质量较弱，关于饮食和健康相关结果的结论受到限制。
改善患者获得 F&V 的机会的基于医疗机构的举措是新颖的，具有前景。然而，未来的研究将需要严格的研究设计和经过验证的数据收集工具，特别是与饮食摄入相关的工具，以更好地确定这些干预措施对健康结果的影响。
