Will “Produce Prescriptions” Show Healthy Returns?

Will “Produce Prescriptions” Show Healthy Returns?

Federal, private funders bet food-as-pharmacy programs will deliver healthcare cost savings

When low-income patients with high blood pressure fill their “produce prescriptions” at certain New York City pharmacies, they walk away with $30 in vouchers to spend on fresh fruits and vegetables at the city’s farmer’s markets.

The city’s “Pharmacy to Farm Prescriptions Program” has reached more than 1,000 hypertensive SNAP recipients since it launched in 2017, and has grown from 3 to 16 participating pharmacies. It is set to report outcomes data next year.

The program is supported in part by a grant from the U.S. Department of Agriculture (USDA), which is poised to make an even bigger impact on the food-as-pharmacy programs that have been growing in popularity. The 2018 Farm Bill established a national Produce Prescription Program that sets aside millions in grants each year.

With diet-related illnesses like heart disease and obesity costing hundreds of billions of dollars each year in the U.S., other funders are also expecting a healthy return-on-investment (ROI) in these programs, which means more initiatives like New York City’s may find the means to thrive.

Not Just for SNAP Recipients

USDA has been supporting projects to increase healthy food consumption among SNAP recipients since 2014, under the Gus Schumacher Nutrition Incentive Program (GusNIP, formerly the Food Insecurity Nutrition Initiative). The bill now guarantees GusNIP can administer $25 million in produce prescription grants—not just for SNAP-based programs—for the fiscal year beginning in 2018, jumping to $45 million for the 2019 fiscal year and rising to its cap of $56 million in 2023. The first grants will be awarded in October.

The Local Food Hub in Charlottesville, Virginia, currently receives funding from local businesses and philanthropies, but has applied for a federal grant. Its Fresh Farmacy program provides low-income patients who have chronic disease with produce from local farmers. Participants pick up their “shares” every other week during the growing season.

“We have seen first-hand the impact of incorporating healthy food to manage weight, maintain healthy blood glucose levels, and reduce the risk of diabetes complications,” said Patricia Polgar-Bailey, a nurse practitioner at the Charlottesville Free Clinic, which participates in Fresh Farmacy.

Non-Profit and Private Sectors Pitch In

Federal dollars aren’t the only way to keep food-as-pharmacy programs afloat. Wholesome Wave, a non-profit that was co-founded by Gus Schumacher, has been supporting produce prescription projects since 2010.

Wholesome Wave gets money from philanthropies and corporate partners – including Target, Chobani, and Humana, to name a few – to foster such programs.

“There are non-profits and private-sector supporters trying to prove the model in the interest of getting insurers and the healthcare industry to really step up,” said Julie Peters, director of programs at Wholesome Wave.

An example of the organization’s support: it’s putting money into a produce prescriptions pilot for diabetes at Community Health and Wellness Partners (CHWP) in Logan County, Ohio, which is also supported by state and federal dollars.

Healthy Food = Healthier Lives

Once a month, participants attend nutrition classes taught by staff dietitians, and subsequently receive vouchers for up to $120, depending on family size, to purchase produce at local grocery stores or farmer’s markets.

Among those who have completed three months of classes, HbA1c has already declined 0.6 percentage points on average, said Jason Martinez, a clinical pharmacist at CHWP who has analyzed preliminary data from the program.

Will these improvements translate to reduced healthcare costs? That has been the case at Geisinger Health System’s Fresh Food Farmacy initiative. The program focuses on patients with type 2 diabetes who experience food insecurity. In addition to 15 hours of disease and nutrition counseling, participants get enough healthy food for 5 days of the family’s weekly meals.

Over 18 months, participants’ HbA1c levels fell 2.1 points on average, compared with declines of 0.5-1.2 points for those taking two or three medications only. Along with improvements in weight, cholesterol, and hypertension, that has translated to an 80% drop in healthcare spending for 37 of about 200 participants who were insured by Geisinger, according to early data.

“We know the cost of the program, all-in, for the food and the clinical care is around $2,500, so it’s reasonable to assume that there’s an ROI that we would experience with that,” said Allison Hess, vice president of health and wellness at Geisinger. She’s hopeful that ROI will convince insurance companies “to potentially fund this as part of a benefit package.”

Similarly—albeit hypothetically—a recent simulation study of Medicare and Medicaid recipients predicted that providing a 30% subsidy on fruits and vegetables would prevent nearly 2 million cardiovascular events and save almost $40 billion in annual healthcare costs.

This story was originally posted on MedPage Today.

Answering the Call: The Role of Nurses in Addressing Suicide Prevention and Mental Health

Answering the Call: The Role of Nurses in Addressing Suicide Prevention and Mental Health

The importance of mental health in achieving overall wellness cannot be overstated. Mental health is defined as a state of physical, emotional, social, and psychological well-being in which the individual is productive, able to adapt to changes or adversity, able to maintain fulfilling relationships with others, and contributes positively to society. In the past 20 years, this nation has seen a steady and alarming increase in the number of people who cannot meet that description. The lack of access to treatment, along with a general need for education and decreased stigma around mental health have greatly increased the risk of undiagnosed or delayed treatment of depression and other mental illnesses. Exasperating the problem are low rates of health literacy and a reluctance to seek help due to lack of health insurance. Additional risks of depression include poverty, family history, trauma, poor education, and multiple losses.

The two populations most susceptible to this type of illness are the ones most inherently vulnerable and difficult to diagnose: adolescents and veterans. In these groups particularly, depressed individuals frequently deny the severity of their symptoms and seek bodily medical care, hoping a physical condition has caused their psychic discomfort. While the situation is dire, nurses are here to help. With a unique view into day-to-day patient experiences and clinical research, nursing leaders are in a distinct position to provide high-level direction on solving problems at scale. Our nation’s most vulnerable populations have plenty of challenges, but increased risk of mental illness is one nurses are making strides to alleviate.

Adolescents and Young Adults

In children and adolescents, depression may manifest through irritability, aggression, or poor school performance. As “digital natives” who have never lived in a world without high-tech forms of communication and social media as part of daily life, children and adolescents are more exposed to bullying and peer comparison than ever before. Additionally, this age group has seen increased sleep disturbance and adverse health outcomes related to high levels of screen time, affecting physical, cognitive, and behavioral health outcomes during this vulnerable stage of development. These prolonged periods of sleep disturbances have been associated with poor mental health, suicidal thoughts, and self-injury.

Suicide is an act of violence against self and for every successful suicide there are multiple survivors of attempts. Nurses both in hospital psych wards and in decision-making roles behind the scenes are leading the charge to reduce the rate of suicide and attempted suicide in teenagers and young adults. Jonas Scholar Alumni Kari McDonald, PhD, is a prime example of the power of nurses in making progress on behalf of at-risk youth communities, dedicating her research to LGBTQ adolescent mental health and suicide prevention. Additionally, public awareness campaigns that help the public and teens understand warning signs and train the primary care workforce to screen for suicide ideation, intent, and risk have the potential for significant positive impact.

Our Nation’s Veterans

Another especially vulnerable group is our veterans, who are disproportionally at risk for suicide. In 2017, The Office of Mental Health and Suicide Prevention at U.S. Department of Veterans Affairs reported that in 2014 on average 20 veterans died by suicide each day. Six of the 20 were recent users of VHA services and about 67% of veteran deaths were the result of firearm injuries. Due to the experiences they have been exposed to, veterans have a complex set of medical, social, and psychological needs, and require tailored solutions to their mental illnesses.

Jonas Scholar Alumni Cynthia Knight, a primary care nurse practitioner in the Home Based Primary Care Program at Veterans Affairs (VA), is part of the solution. In alignment with the VA’s plan to integrate mental health services into primary care, Knight explores the needs of the older adult veterans with depressive symptoms and assesses how to bridge gaps in care to improve health outcomes. It is the work of nurses like Knight that will lead to actionable breakthroughs in suicide prevention for this at-risk population.

Nurses are a critical workforce in helping form additional mental health training and infrastructure, which can expand access across the breadth of patient care from hospitals and primary care to communities and school-based health. The American Academy of Nursing recommends funding for research that supports developing and testing new interventions. It also encourages the training of nurses and other health care professionals committed to raising public mental health awareness about the dangers of sleep disturbance. Nurses not only play a critical role in providing timely, effective, and comprehensive services, but they are valuable advocates to those living with depression and mental illness. By utilizing nurses to help address mental health, we can promote prevention and promote mental health for people at all levels of risk.

Ovarian Cancer and PCOS Awareness Month: Your Role as a Nurse

Ovarian Cancer and PCOS Awareness Month: Your Role as a Nurse

As with any disease process, the role of nurses is to be ever vigilant about staying current on the latest advances with regards to ovarian cancer and polycystic ovarian syndrome (PCOS). As September is the awareness month for both of these conditions, it’s a good time to brush up on understanding the nurses’ role as caregivers to women. Here is a brief overview of each condition.

PCOS

PCOS is a condition that involves a cluster of symptoms related to the endocrine system, metabolism, and physical appearance. Women with PCOS experience irregular or absent menses, hormonal imbalance, and often infertility. Furthermore, PCOS is linked to diabetes, hypertension, sleep apnea, depression, and endometrial cancer. 

Although most of the symptoms are invisible, the symptoms related to appearance can be incredibly distressing. This includes hirsutism, (or excess body and facial hair), acne, abdominal fat, skin discoloration, and male-patterned baldness. 

PCOS affects up to 10% of women with childbearing age of all races and ethnicities. It is more common in women with obesity and those who have family members with PCOS.  

Ovarian Cancer

Ovarian cancer is often asymptomatic until it has progressed significantly. Furthermore, symptoms of ovarian cancer are often the same as symptoms of noncancerous conditions, such as bloating, fullness, pain during sex, constipation, and urinary urgency and frequency. For these reasons, it is often diagnosed at a later, potentially more fatal stage of the disease. 

The five-year survival rate for ovarian cancer varies significantly by stage and tumor type, ranging from 47% to 93% for all stages combined.

Risk factors for ovarian cancer according to the National Cancer Institute are a family history of ovarian cancer, breast cancer, certain types of colorectal cancer, and certain changes in the BRCA1, BRCA2 genes, hormone replacement therapy, endometriosis, and obesity. Protective factors include oral contraceptives, tubal ligation, having given birth, history of salpingectomy, and breastfeeding.  

The Nurse’s Role

The nurse’s role for both PCOS and ovarian cancer are the same: stay informed, educate patients, be alert for risk factors, encourage screening, and treat them with compassionate care.  

By understanding a patient’s family history and lifestyle, the nurse can encourage patients to take action that supports their health and potentially protects them from the long-term consequences of an undiagnosed or untreated disease.

All nurses, particularly those who work in oncology and women’s health, can take it upon themselves every September to revisit their understanding of both PCOS and ovarian cancer. Although studies have been inconclusive in looking at correlations between PCOS and ovarian cancer, it is worth mentioning that either can have a profound effect on the quality of life and morbidity for women.

Suicide Awareness and Prevention Among Nurses: A Q&A with Risk Specialist Georgia Reiner

Suicide Awareness and Prevention Among Nurses: A Q&A with Risk Specialist Georgia Reiner

In recognition of Suicide Awareness Month, Georgia Reiner, a risk specialist for Nurses Service Organization (NSO), shares her expertise on the subject of nurses and suicide prevention with DailyNurse.

Q: What do you consider the most striking statistics on suicide in the nursing profession?

A: The phenomenon of nurse suicide has been largely overlooked by researchers in the US. The most prominent research in this area by Davidson and colleagues — just published this year — found that suicide incidence was significantly higher among nurses than the general population. The researchers found suicide rates of 11.97 per 100,000 person-years among female nurses and 39.8 per 100,000 among male nurses, compared to 7.58 and 28.2 per 100,000 person-years among general population women and men, respectively.

Q: Why might nurses be particularly at-risk? Are they more prone to depression than the general population?

A: More research needs to be done to determine why nurses have greater odds of dying by suicide than the general population. However, existing research has suggested that there are some collective risk factors for nurses, including undertreatment of depression and other mental health issues, knowledge of and access to lethal doses of medications, and a combination of personal and work-related stressors. The high-pressure, emotionally draining environment that nurses work in, compassion fatigue, burnout, and job dissatisfaction can each contribute to these risk factors.

Q: Is the phenomenon gaining attention in the healthcare field—and if it is, what measures are being taken to reduce the danger?

A: Yes, and work is being done by organizations like the American Nurses Association, the American Organization of Nurse Executives, the National Academy of Medicine, and the National Suicide Prevention Lifeline to try to raise awareness of the issue and promote protective factors. While systemic and organizational-level solutions in healthcare are critical to addressing burnout, depression, and suicide among nurses and other healthcare professionals, progress in implementing evidence-based solutions has frankly been slow or nonexistent. Therefore, it is also important for nurses to take individual action.

Q: How can nurses bring this problem to the attention of their own institutions?

A: Supporting nurse well-being requires sustained attention and action at the organizational level. This first requires buy-in and investment from leadership and managers. Nurses should work with their managers and organizational leadership to promote a healthier, more positive work environment that cares for nurses as whole people. This includes educating nurse managers and staff nurses about suicide prevention, how to offer support to someone who may be struggling, where to get help, and alleviating the stigma around suicide and depression.

Q: What sorts of self-care practices can nurses follow to reduce the risk of depression and suicide?

A: Nurses need to support each other and take time to have open dialogues with their colleagues about issues affecting them personally and professionally. Increasing connectedness, or a sense of belonging, has shown to be a protective factor against suicide. Nurses also need to work on an individual level to build resilience to cope with stressors in their professional and personal lives. Practicing mindfulness, eating well, exercising, getting enough sleep, limiting time spent on social media, and taking regular time off from work are all important. Speaking to someone, whether by going to a therapist or by attending a support group, can also help nurses feel better and improve their mental health and resiliency.

Q: Are nurses more or less likely to enter therapeutic treatment than people outside their field?

A: Nurses face many of the same barriers to mental health care as other people: the stigma associated with mental illness and asking for help, how difficult it can be to get the energy to reach out for help when you’re depressed, and then the time and cost associated with accessing mental health treatment. These barriers can be extremely difficult for some individuals to overcome by themselves, which is why it is so important for nurses to look out for one another.

Q: Are there resources specifically to help nurses who might be suffering from suicidal ideation or actively considering suicide?

A: It is important for nurses to learn about how they can look for signs of someone who may be struggling with suicidal ideation. Starting the conversation, providing immediate support, and helping someone who has suicidal thoughts to connect with ongoing support can help save lives.

If you or anyone you know are considering self-harm or suicide, feeling anxious, depressed, upset, or just need to talk to someone, it is important to know that there are people who want to help. The National Suicide Prevention Lifeline is available 24/7 at: 1-800-273-8255, as well as the Crisis Text Line, available by texting “START” to 741741 at any time, for any kind of crisis.

Also of interest: A Nurse I Know Tried to Commit Suicide

At NSO, Georgia Reiner is responsible for educating healthcare professionals on professional liability issues and risk management strategies by creating informative risk management content, including self-assessment tools, newsletters, webinars, and claim reports.

Practice What You Preach: The Value of Healthy Nurses

Practice What You Preach: The Value of Healthy Nurses

One can easily surmise that Nurse Ratched was not drinking kale smoothies, jogging daily, and taking long, hot baths. The facets of compassionate nursing care that Ratched famously lacked, such as kindness and generosity, seldom come from a nurse experiencing a sense of deficit within themselves. A lackluster approach to one’s work is generally the prerequisite for what is now a bonafide medical diagnosis: burnout.  

The old adage goes something like this: you can’t give what you don’t have. This is no less true for nurses than for anyone else. The work of an effective nurse requires the maintenance of a certain level of physical fitness, sound sleep practices, sensible nutrition, and the fortification of a positive and resilient attitude. This is because the nursing model demands not just the carrying out of physical tasks, but a wholehearted relationship with the patient as a human, rather than a set of symptoms. Nurses can best enter into this dynamic with their own health and well-being needs already met. 

More than Full-Time

Although many nurses work a full-time 40-hour workweek, additional overtime and per diem work is common. Because nursing skills are in high demand, it is easy for a nurse to take on more than a full-time workload. In addition, many nurses continue their schooling after being licensed as registered nurses, to advance their career as either nurse practitioners, in leadership roles, or as nurse educators. With these demands, in addition to personal and familial responsibilities, one can see why some nurses let their own health lose priority.

A Picture of the Healthy Nurse

A well-rounded routine of well-being includes the obvious undertakings of healthy eating, regular exercise, and adequate sleep, in addition to the oft-forgotten needs of fun, leisure, social support, and hobbies. Many studies show the importance of these seemingly superfluous features of one’s lifestyle as incredibly important to health and well-being. A rich lifestyle filled with healthy activities and robust relationships may be more valuable than the income overtime generates for many nurses, and for their patients.

Self-care for Caregivers

For the nurse who scoffs at the idea of self-care, consider this — self-care is not an alternative to patient care, but an essential feature of it. Nurses who score higher on happiness index scores are more motivated in their work and demonstrate the enhanced quality of their nursing practice. Furthermore, a well-rested nurse is a more patient nurse, and a fit nurse is a more energetic, capable nurse. Lifestyle balance that allows for creativity, friendship, recreation, and sound physical health help nurses cope with the gravity and sometimes tragedy encountered in their work.  

Each nurse is free to determine for themselves what work/life balance, fulfillment, and well-being mean to them. For some, financial responsibilities may necessitate extra work; however, there is no nursing job worth sacrificing one’s health for.

Recognizing Postpartum Depression in New Moms

Recognizing Postpartum Depression in New Moms

According to the CDC, about one in nine women experience postpartum depression. Oftentimes, nurses may be able to recognize this in their patients and assist them in getting help. First, though, you have to know what you’re looking for.

Susan Altman, DNP, CNM, FACNM, a clinical assistant professor and midwifery program director at the NYU Rory Meyers College of Nursing, has been a midwife for more than 20 years. She took some time to answer our questions on recognizing postpartum depression in new moms.

What are the main symptoms of postpartum depression in new moms? How can nurses learn to recognize what are the signs of PPD as opposed to something else?

Many women who give birth experience changes in mood due to significant changes in hormone levels after the birth. These changes do not cause depression in all women. The most common of perinatal mood changes in the postpartum period is postpartum blues or “baby blues,” which manifests itself with such symptoms as sadness, crying, and mood swings. Most often these signs begin 5-7 days after the birth, lasting just several weeks.

PPD, a major depressive disorder, can also begin in the days following birth, and may be mistaken for baby blues at first. But the symptoms are more commonly noticed several weeks or months after the birth, and their duration is usually much longer. Symptoms are more severe in PPD than they are in postpartum blues. Those diagnosed with PPD often have symptoms with severe features such as feeling sad and hopeless, crying for no apparent reason, being worried or overly anxious, oversleeping, having difficulty concentrating or remembering things, losing interest in activities that were once enjoyed, being angry, withdrawing from family and friends, not feeling emotionally attaching to baby, and thinking about harming themselves.

Nurses and midwives are experts in assessment and should carefully investigate and look more closely at the postpartum person who is frequently crying, having trouble sleeping, reports low energy or appetite changes or loss of enjoyment of activities that were once enjoyed.

It is important to be mindful that increased anxiety is often associated with perinatal depression, so assess for signs of this as well. A thorough, comprehensive review of the person’s prenatal history in order to flag certain risk factors for PPD is important to help clinicians distinguish between diagnoses. Risk factors include prior history of any depression or mental illness, stressful life events during pregnancy, and little or no social support, just to name a few.

Most importantly, providers must listen to what the person is saying about what they are feeling or experiencing. Most patients know that something is not right. They know themselves the best.

If a nurse recognizes some of the signs in a new mom, what should s/he do? Approach the mom? What should s/he say? Please explain.

Nurses and midwives who suspect postpartum mood disorders in anyone they take care of must intervene.  PPD should not be ignored.

In approaching a mom, nurses and midwives need to let the person know what symptoms they are observing and why they are concerned. The person must be educated that postpartum depression is common and that they are not alone. Explaining that PPD is simply a complication of birth can be helpful. Always acknowledge that the person has done nothing wrong. Include that although PPD may be difficult to deal with, it is possible that with the right individual treatment and emotional support, management of symptoms and recovery is very likely.

Suppose the mom denies it. What should the nurse do then?

From my experience, when someone is approached, they rarely deny it. They often already know that something is not right in how they are feeling, and they are often relieved that someone has reached out to them to help. Again, telling them that they are not alone and that there is care that they can get which can make them feel better is helpful.

If the person really does deny it and does not see the need for help, this is where family members and friends should be recruited to help. Family and friends may actually have already recognized the symptoms of PPD in this person and are often very willing to get involved. They can help reinforce what the nurse has explained and encourage the person to meet with a mental health care provider. They can also offer ongoing emotional support, assist with transportation to appointments, and care for the baby or help with household chores—freeing up the person to go for care. Again, underscore that the person is not alone in this recovery process. 

What if the nurse recognizes the symptoms after the mom has left the hospital—like in a home health visit? What should s/he do?

Because, in most cases, PPD does not manifest itself until weeks or months after birth, it is quite common that the nurse who works at the bedside immediately postpartum will not be the one to recognize the signs and symptoms of postpartum depression.

Our standard system of postpartum care for birthing individuals is generally only a postpartum visit at six weeks after birth with little or no communication until that visit. Many suffer with signs of PPD during this six-week window, not knowing that what they are feeling is not normal and may require professional help. More often than not, recognition of signs and symptoms of PPD can come from nurses other than those working in the postpartum unit. For instance, nurses making home visits, taking office phone calls, or perhaps taking care of the baby in the pediatrician’s office are sometimes the ones who bring the symptoms to the postpartum person’s attention.  

Any nurse who recognizes PPD has the responsibility to educate and then provide resources and referral to providers skilled in caring for those with symptoms noted. In this way, nurses can be instrumental in helping women get the care they need in a timelier manner.


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