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.

Expert: Forget Detox for Substance Use Disorder

LAS VEGAS — There’s a lot more to substance abuse disorder than physical dependence, which means that acute detox treatment by itself isn’t an effective therapy, a researcher said here.

The real key, said Debra Gordon RN, DNP, of the University of Washington in Seattle, in a talk here at the annual PAINWeek conference, is establishing a relationship with patients so that behavioral changes can be implemented.

Withholding opioids from patients with substance use disorder will not cure their addiction, she said. Moreover, providing them with opioids will not necessarily worsen their addiction and may help them accept behavioral therapies.

“There is no evidence that detoxing someone in an acute situation or hospital setting is going to impact that disease,” Gordon said in a presentation. “In fact, the evidence seems to be they will be more at risk for using at their discharge and having an overdose, some of that being in the prison system, but you see that in hospitals too.”

Patients with substance use disorder continue to use drugs despite recurrent problems in their social, workplace, or familial spheres that occur because of their use. Many take multiple substances and have underlying mental health disorders, both of which need to be screened for, Gordon said.

These patients have a higher pain threshold and the prevalence of chronic pain is also much higher in patients with drug abuse disorder. As such, using the Numeric Rating Scale (NRS-11) to define their pain will be insufficient, and providers should determine whether the source of pain is acute, chronic, or related to the patient’s addiction.

Clinicians should also anticipate that patients with substance abuse disorder may have had negative experiences with the healthcare system previously, Gordon said, and asking open-ended questions without judgment may mitigate feelings of shame or fear that prompt them to withhold information.

Seemingly obvious physical comforts, like turning off the lights or keeping a room quiet, also go a long way as well, Gordon said. Cognitive behavioral therapy can also help patients change their perception of pain and help with sleep, mood, and anxiety issues co-occurring with substance use disorder.

Still, some patients may not be willing to change, and others may try to use within the hospital. When encountering patients who deny having a problem, or who recognize the disorder but are unwilling to change, providers should focus on helping them transition out of the hospital when the time comes and providing naloxone emergency overdose kits to patients who may return to illicit drug use.

“Failure to engage in treatment is not a failure,” Gordon said. “It’s part of the process and it’s part of the disease.”

But despite the treatment options available for patients with substance abuse, some providers may be unaware they exist, or may be unsure of what they are authorized to provide, Gordon said.

“There are barriers in the healthcare system in terms of the way we’ve traditionally been trained and traditionally work in silos, and to care for this population we have to really have a team approach,” Gordon told MedPage Today. “It’s one thing to say stuff on paper and another to try and find out how it works in the real world.”

This story was originally posted on MedPage Today.

Massachusetts Nurses Association Trying Again for Patient Limit Legislation

Massachusetts Nurses Association Trying Again for Patient Limit Legislation

The Massachusetts Nurses Association (MNA) is trying a second time to establish patient limits in state legislation. This comes six months after losing a ballot question in the November 2018 state election.

As reported by the Boston Business Journal, the current legislation being reviewed now would hire an independent researcher to study issues affecting nurses, such as staffing, violence, injuries, and quality of life. The data collected by the researcher will then be used by state legislators to determine healthcare staffing needs and acute care patient limits.

“If these studies determine there is a best practice limit on the number of patients a nurse should care for at one time, that should inform future policy discussions,” MNA spokesman Joe Markman told the Boston Business Journal.

The original measure from this past election was defeated largely because of lobbying from the Massachusetts Health & Hospital Association (MHA), who spent $25 million to defeat the ballot. This current bill would be revisiting the same legislation, which raises points for state consideration regarding nurse staffing measures.

“The recent ballot measure raised important issues and challenges that our nurses still face today regarding their ability to give patients the quality care they need and deserve,” Massachusetts state Senator Diana DiZoglio, a sponsor of the current legislation, shared with the Boston Business Journal in an email. “While the policy prescription on the ballot was rejected by the majority of voters, we still need to remain vigilant in identifying best practices to ensure the very best patient care is afforded to all.”

MNA has been working to get nurse-to-patient ratios at all Massachusetts hospitals for several years, including a ballot measure in 2014 that was removed, after Governor Deval Patrick passed a law patient limit law. Markman said this study is necessary to convince voters, after the 2018 election.

“The hospital industry spent … million(s) misleading people about those facts and sometimes outright lying,” Markman told the Boston Business Journal. “For example, they continuously said ED wait times would increase with safe patient limits. That is just wrong and not supported by the evidence. Based on how the industry ran its campaign, it’s clear the public will benefit from additional independent studies.”

10 Things Nurses Need to Know about the Measles Outbreak

10 Things Nurses Need to Know about the Measles Outbreak

From New Years’ Day 2019 through April 11th, the United States has reported 555 cases of measles in 20 states—the second largest measles outbreak reported since the disease was eliminated in 2000. Keep reading to learn the 10 things nurses need to know about the measles outbreak:

1. Measles is brought into the U.S. by travelers who’ve been in foreign countries where the disease is prevalent—countries in Europe, Asia, Africa, and the Pacific. It is then spread in U.S. communities via contact with pockets of unvaccinated populations.

2. Measles outbreaks, defined as three or more reported cases, are currently ongoing in Rockland County New York, New York City, New Jersey, Washington state, Michigan, and the counties of Butte County California. In addition, new cases have recently been identified in New York’s Westchester and Sullivan counties.

3. Once a person is exposed to the measles virus, it may take up to two weeks before symptoms begin to show. A person is contagious four days before the tell-tale rash appears and for four days after. Measles is an airborne virus that can be shed by those infected long before the symptoms arise.

4. There is no available antiviral therapy to cure measles—only supportive therapy for the symptoms, among which are those similar to the common cold: fever, cough, runny nose, sore throat, followed by conjunctivitis and body rash. Measles can sometimes lead to more serious and life-threatening complications such as pneumonia and encephalitis.

5. New York City Mayor Bill de Blasio has declared a health emergency in the neighborhood of Williamsburg, Brooklyn and is mandating unvaccinated residents to become vaccinated. Those not complying could receive violations and fines of $1,000.

Actions Taken

6. Mayor de Blasio has sent a team of “disease detectives” into the Hasidic Community in the Williamsburg neighborhood of Brooklyn, where nearly half of the U.S. cases reported are identified.

7. Coincidentally, the New York State Nurses Association just reached an agreement with the NYC Hospital Alliance to hire more nurses to fill vacancies and add new positions.

8. Detroit is urging those Michiganders vaccinated prior to 1989 to receive a booster vaccination.

How Nurses Play a Role

9. The role of nurses in these outbreaks is education and the promotion of vaccination.

10. It is critical that frontline health care professionals are vaccinated themselves in order to prevent the further spread of the virus, particularly when treating those patients infected by the disease.

UNLV to Develop Continuing Education Nursing Programs Through State Grant

UNLV to Develop Continuing Education Nursing Programs Through State Grant

The Nevada Governor’s Office of Economic Development (GOED) has rewarded the University of Nevada Las Vegas School of Nursing with a $900,000 grant. UNLV will put the grant toward expanding new advanced training opportunities and continuing education for nurses.

UNLV received the grant to develop nursing certificates designed to meet specific needs around the state, such as teaching, specialty care, and clinical research.

“We are excited to be able to expand the skills and competencies of Nevada nurses as clinical research nurses, genetics counselors, and clinical preceptors,” Angela Amar, professor and dean of the UNLV School of Nursing, shared with the UNLV News Center. “This funding allows us the opportunity to advance the health of Nevada citizens by increasing the capabilities of our nurses.”

The grant support, which originated from the GOED’s Workforce Innovations for a New Nevada program, is a continuation of UNLV’s plans in recent years to work on solving the state’s continually evolving medical needs. The UNLV School of Nursing has seen an admission increase of 50 percent since fall 2017 for BSN candidates. The school also has one of the top-ranked online master’s degree programs, and is also home to the Clinical Simulation Center of Las Vegas (CSCLV). The CSCLV, a technologically advanced educational facility, provides nursing and medical students opportunities to practice their skills through various simulations.

“At the UNLV School of Nursing, we educate nurses to provide the highest quality care for the citizens of Nevada,” Amar said. “The developing Las Vegas medical district and UNLV medical school make it important that nursing grows also. The increase in enrollment furthers our ability to meet the health care needs of our diverse population. With a critical need for highly trained nurses across our region and state, expanding our BSN class sizes will increase the number of graduates who can meet this demand.”

The planned certificate programs, which include Certified Nursing Assistant Instructors, Clinical Research Administrators, and Health Information Technology and Data Analytics, were developed in partnership with several health care organizations across the state, such as University Medical Center of Southern Nevada, and Comprehensive Cancer Centers of Nevada. These partners will help with job placement for all certification program participants.

The Valley Health System, University Medical Center of Southern Nevada, Comprehensive Cancer Centers of Nevada, and the Kenny Guinn Center for Policy Priorities. Health care employer partners, along with projected industry growth, will ensure successful placement of participants following their completion of the various programs, to ensure these nurses provide the best possible care to Nevada patients.

For more information about UNLV’s School of Nursing, click here.

North Carolina Nurses Lobby State Legislature for Healthcare Policies

North Carolina Nurses Lobby State Legislature for Healthcare Policies

Earlier this week, over 1,000 North Carolina nurses and nursing students met with state lawmakers to lobby on behalf of their patients. These discussions were part of the North Carolina Nurses Association’s 2019 Nurses Day at the Legislature. School nurses and the SAVE Act (a bill that would provide advanced practice registered nurses with more practice authority) were among the issues discussed.

Before meeting with legislators, the nurses and students gathered for an advocacy-themed continuing education program to hear Dr. Ernest Grant, president of the American Nurses Association, deliver the keynote address, which included notes about why the SAVE Act is crucial for North Carolina nurses and patients.

“In some cases, a nurse may have to wait on a physician signature or something like that in order to provide the healthcare for a patient- something they can easily sign for themselves and be on to the next patient, if you will,” Grant shared with the crowd.

As ABC11’s Andrea Blanford reported, North Carolina’s rural areas are currently experiencing a shortage of both nurses and physicians, which is why these issues are particularly crucial right now to all healthcare providers across the state. Luckily, the nurses and students already had the ears of a few legislators, like Rep. Gale Adcock. Rep. Adcock has been a family nurse practitioner for 32 years and is one of three nurses in the General Assembly.

 In fact, Adcock introduced one of the pieces of healthcare legislature that the nurses rallied for. The bill would ensure every school in North Carolina will have at least one nurse, as schools currently are experiencing their own nursing shortages.

“There are many districts where nurses have three and four schools they have to cover and that’s untenable,” Adcock said.

Besides advocating for nurses and patients across the state, the North Carolina Nurses Association (NCNA) provides resources to advance nursing practice and education. The NCNA hosts the Nurses Day at the Legislature every other year.  

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