Mayfield Carlene A, Robinson-Taylor Tanya, Rifkin Danielle, Harris Mamie-Eleanor
Department of Community Health (Dr Mayfield and Ms Rifkin) and Social Strategy & Impact (Ms Robinson-Taylor), Atrium Health, Charlotte, North Carolina; and Office of Policy and Prevention, Mecklenburg County Public Health, Charlotte, North Carolina (Ms Harris).
J Public Health Manag Pract. 2024;30(1):133-139. doi: 10.1097/PHH.0000000000001821. Epub 2023 Aug 30.
Socioeconomic risk factors have the greatest impact on overall health trajectory. Patients with Medicaid insurance are more likely to experience food insecurity, in addition to poor health and increased health care utilization. Targeted food and produce prescription programs can reduce food insecurity, but sustainable implementation is challenging and evidence demonstrating the impact on clinical utilization outcomes is lacking.
In 2021, a cross-sector collaboration between Mecklenburg County Public Health, Reinvestment Partners, and Atrium Health initiated a food prescription program in urban North Carolina. A low-cost mass text message campaign was used to identify and enroll Medicaid-insured patients with a history of emergency department (ED) utilization.
A nonrandomized before/after evaluation design was used with a 12-month data collection window (6 months before/after program enrollment) for 711 patients enrolled between June 2021 and 2022. Changes in the odds of nonadmission ED utilization were modeled using logistic regression, adjusting for race/ethnicity, gender, age, comorbidity, and dose, along with interaction by comorbidity.
A majority of the sample was non-Hispanic Black (61%; n = 436), female (90%; n = 643), with "none to mild" chronic disease comorbidity (81%; n = 573). The unadjusted and adjusted odds of nonadmission ED utilization significantly reduced between time periods, along with significant interaction by comorbidity. Among the subsamples, patients with "none to mild" comorbidity showed 34% reduction in odds of nonadmission ED utilization (OR = 0.64; 95% CI, 0.47-0.86).
Food prescription programming targeting Medicaid-insured patients may reduce ED utilization, particularly among those without severe comorbidity. Retrospective data collection and sample homogeneity reduced the quality of evidence, but results offer a pragmatic example that can be replicated for further study. Additional research is needed to strengthen the body of evidence and support cross-sector investment in food and produce prescription programming.
社会经济风险因素对整体健康轨迹影响最大。除了健康状况不佳和医疗保健利用率增加外，参加医疗补助保险的患者更有可能面临粮食不安全问题。有针对性的食品和农产品处方计划可以减少粮食不安全，但可持续实施具有挑战性，且缺乏证明其对临床使用结果影响的证据。
2021年，梅克伦堡县公共卫生部门、再投资伙伴公司和中庭健康公司之间的跨部门合作在北卡罗来纳州城市地区启动了一项食品处方计划。一项低成本的群发短信活动被用于识别并招募有急诊科就诊史的医疗补助保险患者。
采用非随机前后评估设计，对2021年6月至2022年期间登记的711名患者进行为期12个月的数据收集（项目登记前后各6个月）。使用逻辑回归模型对未入院急诊科就诊几率的变化进行建模，并对种族/民族、性别、年龄、合并症和剂量进行调整，同时考虑合并症的交互作用。
大多数样本为非西班牙裔黑人（61%；n = 436），女性（90%；n = 643），患有“无至轻度”慢性病合并症（81%；n = 573）。在不同时间段内，未入院急诊科就诊的未调整和调整后几率显著降低，合并症的交互作用也很显著。在子样本中，患有“无至轻度”合并症的患者未入院急诊科就诊几率降低了34%（OR = 0.64；95% CI，0.47 - 0.86）。
针对医疗补助保险患者的食品处方计划可能会降低急诊科的利用率，特别是在那些没有严重合并症的患者中。回顾性数据收集和样本同质性降低了证据质量，但结果提供了一个可复制用于进一步研究的实用示例。需要更多研究来加强证据体系，并支持对食品和农产品处方计划的跨部门投资。
