Q&A with Andrea Feinberg, medical director of health and wellness, Geisinger,
and program champion for the Fresh Food Pharmacy.
AMGA: How did you conceive of the Fresh Food Pharmacy?
Feinberg: Geisinger’s focus on population health and using
our community health needs assessments has led us to an understanding of the
challenges that some of our patients face. Diabetes management begins with a
proper diet and exercise plan— if our patients cannot obtain healthy, safe and
nutritious foods, their diabetes outcomes will be compromised. Geisinger’s
focus on the individual as well as the population has led us to addressing food
insecurity and health care disparities in communities at high risk for diabetes.
Many of our patients are food insecure, and it seems like an insurmountable task
for an individual with diabetes to manage their disease if they are watching
every dollar and are deciding between paying for food, housing, health care or
other essential items. With limited food dollars, our patients are often faced
with difficult decisions leading them to spend on inexpensive, nutrition-poor
foods. With our patients’ increasing need for emergency food services, the Fresh
Food Pharmacy was developed to deliver the gold standard of diabetes care in
conjunction with providing healthy food in a sensitive, caring and respectful
manner. Geisinger’s Medical Home model at the Fresh Food Pharmacy now
serves to meet the medical needs of our patients with diabetes having sugars out
of control and to close the meal gap.
AMGA: How do you screen for food insecurity?
Feinberg: We began in Northumberland County and used our
Electronic Medical Record to identify patients with sugars out of control
typified by HBA1C > 8, and then screened our patients with a two-question
questionnaire for food insecurity. If a patient answered affirmatively, they
were referred to the program.
AMGA: How does the program work?
Feinberg: After identifying the patients by HBA1C and food
insecurity, the patients were referred to the other team members, including an
RN health manager, pharmacist, nutritionist, and a health and wellness coach who
teaches a Diabetes Self-Management class. Then, each week, the patient picks up
fresh groceries along with menus and recipes for the week based on items
consistent with American Diabetes Association guidelines. We provide enough food
for the patient and the entire household for five days a week. The Central
Pennsylvania Food Bank has been a key partner and instrumental in the sourcing
and provision of diabetes-appropriate food including fresh fruits, vegetables,
lean proteins and whole grains.
A key component of this medical home is that the RN health manager,
physician, pharmacist, nutritionist and community health worker all work closely
together to assist our patients with education and support while monitoring the
patient’s condition and their changing medication needs. Free diabetes wellness
classes, dietary consultation, and workshops address healthy eating, and
AMGA: What are the outcomes of this program?
Feinberg: Our outcomes have exceeded our expectations. This
patient population was disengaged and historically had poorly controlled
diabetes. By participating in our classes, the patients realized they weren’t
alone, and the challenges they faced were faced by many others. By providing the
food free of charge, the stress of food insecurity was lifted from the patients
and their household members, which seemingly has had a positive psychosocial
effect. Blood sugar control has been remarkable with an average drop in HBA1C by
2 points or 20%. Patients have also noted drops in weight and cholesterol, and
improvements in their mood.
Based on these initial encouraging results, we are expanding the program to
other challenged communities in Pennsylvania and New Jersey. We believe, by
providing patients with key tools for success including diabetes education and
healthy food, we are designing a new health care model by removing obstacles and
caring for patients the way they need to be cared for.