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10:33 AM

ACP Hospitalist: Moving beyond medical needs

By Charlotte Huff

Doctors and nurses working for Geisinger, a health system based in Danville, Pa., no longer assume that their patients who are already struggling with uncontrolled diabetes have access to healthy food, or even enough food.

In 2016, Geisinger launched a program in Shamokin, Pa., to ask patients about food insecurity during clinic visits. Those who meet clinical criteria and admit to not having enough food are given a prescription to pick up free produce, whole grains, lean protein, and other healthy foods at a food pantry located on the hospital's campus. They're given enough to feed their households 10 healthy meals a week and, in return, the patients commit to working with a care team and attending 15 hours of group classes about managing their diabetes. The program already has paid off in better blood glucose control and lower health costs.

Hospital leaders and physicians have long known that access to food, housing, and transportation significantly affects patients' ability to stay healthy.

Asking patients about something as basic as their access to food can provide insights into far more than what's sitting in their cupboards, said Darren DeWalt, MD, FACP, chief of the division of general medicine and clinical epidemiology at the University of North Carolina (UNC) at Chapel Hill.

“When someone is food insecure, they're usually living check to check, and trying to decide, ‘Well, do I buy medications for my heart disease or do I get food for my children?’” Dr. DeWalt said. “Food insecurity causes people to make tradeoffs that are not in their individual self-interest or in society's interest.”

When talking to patients about uncomfortable subjects, it's better to ask broader questions that require more than a “yes” or “no” answer, said Jennifer Lowry, MD, who directs the division of clinical pharmacology, toxicology, and therapeutic innovations at Children's Mercy Kansas City in Kansas City, Mo.

Over the course of nearly two decades, Children's Mercy Kansas City has conducted more than 1,000 home assessments through its Healthy Home Program, according to Dr. Lowry. The program, initially launched to help asthma patients, soon expanded to check out the homes of at-risk children who were getting cancer treatment or for some other reason were considered more vulnerable to infection, she said.

Nobody wants to admit that they have cockroaches, Dr. Lowry pointed out. Instead, she suggested asking, “What do you use to get rid of cockroaches?” Or, “What do you do when you see a mouse?” Similarly, the question shouldn't be if the patient's home has mold, but rather if there has been any trouble with roof or ceiling leaks, Dr. Lowry said.

“It's important for hospitalists to understand that when this patient goes home, they don't necessarily have everything that you think they have,” Dr. DeWalt said. “And once you start to think about that, you think, ‘How can they have a good [health] outcome?’” 


Read the full story via ACP Hospitalist

Learn more about the Healthy Home Program at Children's Mercy