More Research Needed to Evaluate Healthcare-Based Interventions Addressing Food Insecurity

The healthcare system has shown a growing interest in addressing social determinants of health, including food insecurity. However, despite recent research into interventions to address food insecurity, there are only a small number of low-quality studies in the area, which indicates more rigorous research is needed on the effectiveness of these interventions, according to a review published in Annals of Family Medicine.

Previous research has shown that young adults who are food insecure are more likely to be diagnosed with migraine and food insecurity linked with cancer death rates. Humana’s Bold Goal initiative is an ambitious effort to address chronic conditions and overall health, and nutrition and food insecurity are among the factors the program is looking to address. The program has shown that not having enough food can case a Medicare Advantage member to have a monthly average of 26.6 Unhealthy Days, which is a measure of a person’s self-reported mental and physical well-being. Each Unhealthy Day translates into 10 hospital admissions per 1000 people, or $15.64 per member per month in additional costs.

In the new review, the authors analyzed peer-reviewed literature published between January 2000 and September 2018. They included studies that described healthcare-based food insecurity interventions. A total of 23 studies were included and 74% were rated as low or very low in quality based on their study design and sample size. Lower quality studies either had no comparison group or they compared outcomes to a control group that was significantly different from the intervention group. There were 2 randomized controlled trials (RCTs), 1 cluster RCT, 2 quasi-experimental studies, 3 matched cohort studies, 8 single-group pre—post studies, and the rest had descriptive, mixed methods, or qualitative designs.

Despite the wide variety of study designs, the interventions they analyzed fell into 2 categories: a description of education and/or referral interventions (n = 12) or an examination of interventions that provided food or food vouchers with or without resource referrals (n = 11). The outcomes examined included process outcomes, such as the number of patients referred; food security status, health, health behaviors and self-efficacy; healthcare utilization and/or cost; and patient/caregiver perception of intervention acceptability.

The majority of the studies exclusively described process measures. Only 2 studies indirectly reported on patients' food security status after the intervention, but neither used a validated screening tool to assess food insecurity, the authors noted. In the 4 studies examining changes in fruit and vegetable intake, there was no seen intervention effect, although caregivers reported an increased in fruits/vegetables consumption among pediatric patients who participated in a food or voucher program.

Only 5 studies reported on patient health outcomes, each with different metrics, but most showed small or no improvements and none of the studies examined food insecurity outcomes, so it was unclear “whether changes in food security mediated changes in health outcomes,” the authors wrote. Only 1 study reported on caregiver acceptability of a food/voucher intervention and showed caregivers of pediatric patients appreciated the program and preferred vouchers over pre-prepared food bags.

Finally, only 2 studies reported on healthcare utilization. One study showed small but statistically significant changes in emergency department utilization and receipt of preventive care services/visits among infants in a nutrition support program versus infants not in the program. The other study also examined healthcare costs and found patients who received meal deliveries had fewer visits to the emergency department and used less emergency transportation. These patients also had lower medical spending than a control group.

“Though many health care settings are actively exploring ways to reduce patient [food insecurity] to improve patient health and well-being, there is currently little rigorously conducted research in this area,” the authors concluded. “Early evidence suggests that these programs may help patients better connect with food resources, but more research is needed to better explore impacts on health, health care utilization, and cost.”

References

De Marchis EH, Torres JM, Benesch T, et al. Interventions addressing food insecurity in health care settings: a systematic review. Ann Fam Med. 2019;17(5):436-447. doi: 10.1370/afm.2412.