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Monday Nov 14, 2016

Community Finds Right Prescription to Fight Hunger

"Life in the real world keeps getting in the way, Doc," sighed yet another frustrated patient.

I had recently diagnosed her with diabetes, and she was trying to lose weight so she could avoid having to take medication. She felt as though she didn't know what to eat or how to cook. In short, she felt as though she was failing and wanted to give up.

Photo courtesy Heidi Davis

Patients and caregivers learn to make healthy and affordable meals in a teaching kitchen. Providence Milwaukie Hospital in Milwaukie, Ore., opened the facility on its campus last year.

I also was frustrated, trying to fix a complicated problem in a 20-minute office visit.

Sound familiar?

For so many of my patients, "life in the real world" makes it hard to take care of their health. My patients often feel they're not in control when it comes to factors that affect their health, such as stress and financial and time constraints.

It's no surprise that nutrition is also a challenge. Many of my patients struggle to put food on the table, and healthy food is typically more expensive and harder to come by than cheaper options. Some patients feel lost when it comes to choosing healthy recipes and then actually preparing the food, so they opt for packaged foods instead.  

Fortunately, thanks to my health system -- Providence Health & Services -- and my community, I finally have access to resources that can make a difference.

Screening for Food Insecurity: Ask the Question
According to U.S. Census data for 2015,15.4 percent of Oregonians lived below the federal poverty level, compared to a national average of 13.5 percent. In a 2015 Oregon Food Bank poll, 28 percent of food pantry benefit recipients said they worried about where their next meal would come from(www.oregonfoodbank.org). And sadly, Oregon saw the nation's highest rate of participation in the Supplemental Nutrition Assistance Program (SNAP) in 2013, with 19.8 percent of the state's residents receiving SNAP benefits(www.census.gov).

With these sobering statistics in mind, my clinic began participating in a pilot project called "Screen and Intervene(media.wix.com)" a few years ago. In partnership with Oregon Food Bank and community agencies, we have started asking patients about food insecurity at all well-child visits.

We ask every parent and teen whether their family had run out, or had been afraid they would run out, of food in the past year. If they answer "yes," we offer the family a referral to a "navigator" from a community outreach organization. The navigator, an ally who speaks the patient's language, meets with families for as long as it takes to identify and find solutions to overcome barriers to having enough food. The solutions range from enrolling someone in SNAP to helping them start a home business.

In fact, one of my patients became a success story for the Screen and Intervene program(www.youtube.com). Ms. E is a single mom with two kids. She is a strong woman who doesn't like to ask for help, but her family came to the office often -- and sometimes to the ER -- for various aches and pains, and especially for headaches. The medical assistant asked her the Screen and Intervene questions during a well-child visit, and she finally admitted that she has difficulty feeding her family at the end of each month.

I referred the family to the outreach navigator, who met with Ms. E at home and explained all the benefits she could access and also helped plan meals. Because Ms. E didn't have a car, the navigator helped secure bus fare so she could get to a food pantry. The next time I saw her in clinic, her headaches had vanished. The ER visits stopped. Ms. E felt empowered, and her kids did better in school. I saw a photo of her and her daughter cooking dinner with a smile, and it was clear that food security had made a big difference in their lives.

Teaching Kitchen and "Food Pharmacy": Taking Action
Sometimes, however, patients need more than just access to healthy food. They need help learning how to cook. My health system wanted to help patients do just that, so my hospital -- Providence Milwaukie Hospital -- and community decided to build a healthy teaching kitchen and "food pharmacy" right on the hospital campus(oregon.providence.org).

In 2015, the Providence Milwaukie Foundation raised more than $450,000 and renovated an old medical building adjacent to the hospital, turning it into a 2,090-square-foot, group-sized kitchen. The foundation designed the kitchen with long counters and wheelchair accessibility so all patients can learn in group classes.

All it takes is a "prescription" from a doctor, and any patient can take free cooking classes with the goal of empowering them to cook healthy (and tasty) meals that cost $5 or less per serving in less than 20 minutes. During the course of six two-hour classes, chefs, dietitians and volunteers work directly with patients or their caregivers to practice every step of meal preparation in a fun, welcoming atmosphere. The kitchen uses microwaves, toaster ovens and ranges similar to what might be found in a patient's home.

Every patient receives all the ingredients needed for that week's recipe so they can recreate it at home. If the patient also suffers from food insecurity, they can go to the food pharmacy for two to three days' worth of produce, dry and frozen goods.

In the little more than six months since it opened, the teaching kitchen already has logged almost 800 volunteer hours and graduated seven cohorts of patients. Doctors have referred more than 400 families to the kitchen, and a wait list is growing. Almost half the patients at the teaching kitchen reported food insecurity, so the food pharmacy has already filled more than 220 food prescriptions. I am thrilled when patients come back to my clinic with stories of what they've learned.

Good nutrition is the foundation of health. In a state that struggles with poverty and food insecurity, community outreach programs like Screen and Intervene and the teaching kitchen go a long way toward improving the health of my patients and my community. I am inspired by the creative thinking that is happening in Oregon, and I hope programs like these spread across the country. 

Melissa Hemphill, M.D., is faculty at Providence Oregon Family Medicine Residency and practices in an urban underserved clinic in Portland, Ore. You can follow her on Twitter at @MhemphillMD(twitter.com).

Posted at 03:23PM Nov 14, 2016 by Melissa Hemphill, M.D.

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