Prescription For Health Fsep 6 18 09

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2009 FSEP Conference

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Prescription For Health Fsep 6 18 09

  1. 1. Jenna M. Bacolor, MPH, MSW Lily Guzmán, MPH, MSW Washtenaw County Public Health
  2. 2.  Why Prescription for Health?  Downtown Ypsilanti Farmers’ Market  Clinic process  2008 program results  Plans for 2009
  3. 3. Patients Farmers’ Market Health Clinics
  4. 4.  High food insecurity  Low consumption of fruits and vegetables  New farmers’ market with lots of energy and partnerships  Already programs for low income customers  Clinics giving nutrition advice, but…  Sense that clinics may not be connected to local sources of healthy food
  5. 5. City of Ypsilanti Supermarket Grocery Farmers’ market Specialty grocery Pharmacy Convenience-snack Convenience-alcohol City of Ypsilanti
  6. 6. • Started in 2006 in response to community food assessment results • Management • Programs for low- income customers • Funding from multiple sources • Marketing & community events
  7. 7.  Primary: increased community awareness and use of farmers’ market  Increased awareness of and utilization of Food Stamps/EBT at market  Increased consumption of fruits and vegetables  Long term…decreased chronic disease risk
  8. 8.  Consulted with staff from four clinics: ◦ St. Joseph Mercy Health System - Neighborhood Health Clinic ◦ University of Michigan Health System - Ypsilanti Health Center ◦ The Corner Health Center ◦ Hope Clinic  Doctor-patient relationship as starting point  Grant funding from Ypsilanti Beyer Memorial Health Foundation paid for tokens; clinics also contributed cash match
  9. 9.  Public health provided orientation  Clinics “prescribed” patients PFH packet: ◦ $5 in tokens ◦ program brochure ◦ recipe card ◦ pre-program questionnaire  Posters for waiting rooms
  10. 10. Key Findings
  11. 11.  Token use at market tracked weekly  Pre-program questionnaire completed by all participants  Post-program telephone survey completed by ~30% of participants  Post-program semi-structured interviews conducted with lead staff at each clinic
  12. 12.  344 patients participated ◦ 79% female ◦ 50% African American, 45% white, 5% Latino ◦ Average age: 40 ◦ 71% less than $15,000 yearly income ◦ 49% currently use Food Stamps ◦ 2 fruit and 1.9 vegetable servings consumed on a typical day ◦ 80% had not shopped at farmers’ market before
  13. 13.  41% of tokens prescribed were redeemed, resulting in almost $1,500 additional market sales from PFH tokens  Tokens were redeemed June-October  By clinic, redemption ranged from 30% to 49%
  14. 14. "At the clinic, who recommended this program to you?" 12% 9% 36% Doctor Social Worker Front office 33% Other 10% Program material Asked on post-test: 103 respondents
  15. 15.  75% of participants became repeat farmers’ market shoppers in 2008  50% of participants spent additional money at the market ◦ 95% bought additional produce
  16. 16. "Next year, how likely are you to shop at the farmers' market on a regular basis?" 2% 6% Very likely 51% 41% Somewhat likely Somewhat unlikely Very unlikely Asked on post-test: 103 respondents
  17. 17.  Overall, 70% of participants lived in Home All No tokens Ypsilanti zip codes zip tokens redeemed  Residency varied by code Ypsilanti redeeme 66% 25% d clinic Zips  Where patients lived All other 50% 40% was associated with token use
  18. 18. "Why didn't you use the tokens?" 50 45 Hard to get to market 45 40 Market not at good 35 time/day Poor selection 30 27.5 25 Cost 20 17.5 Not worth effort 15 10 7.5 Hard to carry food 5 5 2.5 2.5 Other 0 Percent Note: Respondents could choose as many answers as they wanted, thus results total more than 100%.
  19. 19. EBT Sales 2006-2009 $3,000 $2,757 $2,500 $2,000 2006 $1,500 2007 $1,000 $870 2008 $355 $462 2009 $500 $0 EBT Sales
  20. 20.  High percentage of patients eligible for food stamps, but only 49% reported receiving them  44% aware of EBT at market  Post-test respondents reported increased consumption of fruits and vegetables, even if they hadn’t redeemed tokens  It appeared that receiving more than one packet increased token redemption  Materials had mixed impact: posters in waiting room were effective; brochures may not have been
  21. 21.  Fit with clinic mission: “one stop shopping,” consider “whole person”  Program complemented medical advice  Very satisfied with program, but wanted to increase redemption
  22. 22.  Patients residence in 48197 or 48198  Receiving multiple packets  Prescribing earlier in the market season and ending in September  Displaying promotional flyers in waiting room
  23. 23.  Expanded to five clinics!  Extra coupon on 3 special days – additional incentive to use tokens – get redemption up  Evaluation  Repeating EBT message  Michigan Department of Community Health is our funder
  24. 24. Our dedicated graduate student interns:  Carissa Williams, UM School of Social Work and & School of Public Health  Leslie Paulson, UM School of Social Work  Sarah Freedman, UM School of Social Work
  25. 25.  Jenna M. Bacolor, MPH, MSW ◦ 734-544-2969 ◦ bacolorj@ewashtenaw.org  Lily Guzmán, MPH, MSW ◦ 734-544-2983 ◦ guzmanL@ewashtenaw.org

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