Children's National Hospital, Washington, DC, USA.
George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241236009. doi: 10.1177/21501319241236009.
INTRODUCTION/OBJECTIVES: In 2022, 1 in 6 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and pediatric clinicians are encouraged to actively screen and intervene in clinical settings. This study aims to evaluate the feasibility and impact of a FI management protocol implemented in 2017 at a pediatric primary care health network serving patients who are Medicaid-eligible in Washington, DC.
In 2019, an 18-item electronic survey was sent to a convenience sample of 42 pediatric clinicians within the health network to understand their knowledge, attitudes, and behaviors surrounding implementation. Both quantitative and qualitative responses were collected and analyzed. We report frequencies of the Likert-type responses, including perceived compliance with protocol components and intervention efficacy. We evaluated the relationship between FI knowledge level and rates of clinician documentation compliance by chi square and Cramer's statistic for effect size. Open-ended responses were reviewed, and common themes were identified and used to provide context for quantitative results.
Out of 42 clinicians invited to complete the survey, 35 completed responses. All respondents reported universal screening for FI (100%) at routine examinations, 80% reported frequently electronically documenting FI in medical records, and 91% of clinicians reported frequently referring families who screened positive for FI to at least one FI resource, with 24% reporting that resources met families' needs. Open-ended responses revealed increased awareness of FI prevalence and of patient experiences in households experiencing FI, increased satisfaction with clinical management of FI, but also concerns around having limited clinical time to do the protocol and the usefulness and accessibility of referred resources. In conclusion, implementing this pilot FI protocol was feasible, but clinicians perceived limited impact of the protocol on alleviating FI and desired more robust intervention options. Further improvements include shifting the burden of performing the protocol away from the clinician, such as by streamlining the protocol or identifying a resource staff member, and establishing more accessible and effective FI interventions such as "Food as Medicine" offerings in partnership with community organizations.
引言/目的：2022 年，美国有六分之一的有孩子的家庭经历了粮食不安全（FI）。FI 对儿童健康的负面影响有充分的记录，鼓励儿科临床医生在临床环境中积极进行筛查和干预。本研究旨在评估 2017 年在一家为华盛顿特区符合医疗补助条件的患者提供服务的儿科初级保健网络中实施的 FI 管理方案的可行性和影响。
2019 年，向该医疗网络的 42 名儿科临床医生发送了一份包含 18 个项目的电子调查，以了解他们在实施方面的知识、态度和行为。收集并分析了定量和定性的回答。我们报告了李克特式回答的频率，包括对协议组成部分和干预效果的遵守程度。我们通过卡方检验和 Cramer's 统计量评估 FI 知识水平与临床医生文档记录合规率之间的关系，以评估效应大小。对开放性回答进行了审查，并确定了常见主题，并用于为定量结果提供背景。
在受邀完成调查的 42 名临床医生中，有 35 人完成了回复。所有受访者均报告在常规检查中对 FI 进行了普遍筛查（100%），80%报告经常在医疗记录中电子记录 FI，91%的临床医生报告经常将筛查阳性的家庭转介到至少一个 FI 资源，其中 24%的临床医生报告资源满足家庭的需求。开放性回答揭示了对 FI 流行率和经历 FI 的家庭中患者的经历的认识增加，对 FI 临床管理的满意度增加，但也对临床时间有限、协议有用性和可及性以及转介资源的有限性表示担忧。总之，实施这个试点 FI 协议是可行的，但临床医生认为该协议对缓解 FI 的影响有限，并希望有更有效的干预措施。进一步的改进包括将执行协议的负担从临床医生身上转移出去，例如简化协议或确定资源人员，并与社区组织合作建立更方便和有效的 FI 干预措施，如“以食物为药物”的服务。
