Presentations

Abstract

Introduction: Food Insecurity (FI) is associated with an array of adverse health outcomes in adults and children. In a prior project, we measured FI among 139 patients at our student-run free clinic (SRFC) in Norfolk, VA, and found 76% to have food insecurity. Despite high rates of FI, less than half of patients reported using any kind of food assistance resource, such as food pantries, soup kitchens, or federal aid. Our prior work aimed to provide resource booklets to patients while they waited for their appointments, but this process was not integrated into routine clinic operations and initial feedback indicated that the handouts alone did not provide patients with the support they needed. Given that FI is an important social determinant of health and a prevalent issue among our patient population, our current project aimed to implement a modified strategy that integrates documenting FI in patients' electronic medical records (EMR) and includes patient counseling.

Methods: First, we developed a new volunteer position at the clinic to serve as FI coordinator. The role of the FI coordinator was to facilitate routine measurement of FI and support clinicians in counseling patients on FI during appointments. We integrated a standardized FI screening into our SRFC's EMR to track patient FI status using the validated two-question Hunger Vital Sign questionnaire, which patients filled out when they checked in for their appointment. The FI coordinator documented patients who screened positive for FI in their EMR and notified the clinician teams, consisting of two medical students and one attending physician, of such patients. To support clinicians in counseling their patients on FI, we created a binder of resources featuring where to find local food resources and budget-friendly healthy eating tips, as well as a conversation guide. After each appointment, the FI coordinator would check with clinicians to determine whether they had a conversation about FI with their patients. If clinicians did not address it, the coordinator would counsel to the patient instead. Finally, clinicians and the coordinator documented the conversations and any resources provided in the patient's EMR.

Results: From May through August 2024, we attended the once weekly clinic nights offered at our SRFC. We found that collecting FI information from patients when they checked in for their appointment to be a feasible and effective method of gathering this information without interrupting clinic flow. In terms of documenting patient FI status and the discussion of resources provided in the EMR, we found this approach to be feasible, but it often fell to the responsibility of the FI coordinator rather than the clinicians or other volunteers. Similarly, discussions with patients who screened positive for FI were often relegated to the FI coordinator instead of being done by the clinicians directly. Informal feedback from clinicians indicated that there was often not enough time in clinic appointments to discuss FI.

Conclusion: Our project indicates that measuring and addressing FI in our SRFC was feasible, yet heavily relied on the FI coordinator. As a result, we will train and recruit a team of volunteers specifically assigned to managing FI in our clinic.