Department of Nutrition, University of California, Davis, Davis, California.
OCHIN Inc., Portland, Oregon; Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
Am J Prev Med. 2023 Sep;65(3):467-475. doi: 10.1016/j.amepre.2023.03.014. Epub 2023 Mar 23.
Screening for food insecurity in clinical settings is recommended, but implementation varies widely. This study evaluated the prevalence of screening for food insecurity and other social risks in telehealth versus in-person encounters during the COVID-19 pandemic and changes in screening before versus after widespread COVID-19 vaccine availability.
These cross-sectional analyses used electronic health record and ancillary clinic data from a national network of 400+ community health centers with a shared electronic health record. Food insecurity screening was characterized in 2022 in a sample of 275,465 first encounters for routine primary care at any network clinic during March 11, 2020-December 31, 2021. An adjusted multivariate multilevel probit model estimated screening prevalence on the basis of encounter mode (in-person versus telehealth) and time period (initial pandemic versus after vaccine availability) in a random subsample of 11,000 encounters.
Encounter mode was related to food insecurity screening (p<0.0001), with an estimated 9.2% screening rate during in-person encounters, compared with 5.1% at telehealth encounters. There was an interaction between time period and encounter mode (p<0.0001), with higher screening prevalence at in-person versus telehealth encounters after COVID-19 vaccines were available (11.7% vs 4.9%) than before vaccines were available (7.8% vs 5.2%).
Food insecurity screening in first primary care encounters is low overall, with lower rates during telehealth visits and the earlier phase of the COVID-19 pandemic. Future research should explore the methods for enhancing social risk screening in telehealth encounters.
建议在临床环境中筛查食物不安全状况，但实施情况差异很大。本研究评估了在 COVID-19 大流行期间远程医疗与面对面接触中食物不安全和其他社会风险筛查的流行率，以及广泛提供 COVID-19 疫苗前后筛查的变化。
这些横断面分析使用了来自拥有共享电子病历的 400 多家社区卫生中心的国家网络的电子病历和辅助诊所数据。在 2022 年，根据 2020 年 3 月 11 日至 2021 年 12 月 31 日期间任何网络诊所的常规初级保健的 275465 例首次就诊的随机样本，对食物不安全筛查进行了描述。在 11000 次就诊的随机子样本中，基于接触模式（面对面与远程医疗）和时间段（大流行初期与疫苗供应后），使用调整后的多变量多级概率模型估计了筛查的流行率。
接触模式与食物不安全筛查有关（p<0.0001），面对面接触时的估计筛查率为 9.2%，而远程医疗接触时为 5.1%。时间段和接触模式之间存在交互作用（p<0.0001），在 COVID-19 疫苗可用后，面对面接触比远程医疗接触的筛查率更高（11.7%比 4.9%），而在疫苗可用前，面对面接触比远程医疗接触的筛查率更高（7.8%比 5.2%）。
总体而言，首次初级保健接触中的食物不安全筛查率较低，远程医疗就诊和 COVID-19 大流行早期阶段的筛查率较低。未来的研究应该探索在远程医疗接触中加强社会风险筛查的方法。
